WCN19 Journal Posters Part 2 Revised V1

Home , Engel classification, Joint locking (medicine), Melbourne Summer Cycle, Neuroradiology, Triparesis

JNS-0000116542; No. of Pages 131 ARTICLE IN PRESS

Journal of the Neurological Sciences (2019) xxx–xxx

Contents lists available at ScienceDirect

Journal of the Neurological Sciences

journal homepage: www.elsevier.com/locate/jns

WCN19 Journal Posters Part 2 revised_V1

WCN19-2260 WCN19-2269

Poster shift 01 - Channelopathies /neuroethics /neurooncology / Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Part I /stroke /training in neurology - Part I and traumatic brain injury injury

Numb chin syndrome- The first finding in metastatic malignancy Results of surgical treatment in patients with moyamoya disease considering CT-perfusion imaging study N. Mustafayev, A. Bayrakoglu, F. Ilgen Uslu, M. Kolukısa Bezmialem University, Neurology, Istanbul, Turkey O. Harmatinaa, V. Morozb, I. Skorokhodab, I. Tyshb, N. Shahinb,R. Hanemb, U. Maliarb a Numb chin syndrome (NCS) is a sensory neuropathy of the SI «Romodanov Institute of Neurosurgery of NAMS of Ukraine», mental nerve, which is accompanied by hypoesthesia and paresthe- Neuroradiology Department, Kyiv, Ukraine b sia of the jaw and lower lip. Although being well known in neurology SI «Romodanov Institute of Neurosurgery of NAMS of Ukraine», practice, most of the physicians who have not experienced this Emergency Department of Vascular Neurosurgery, Kyiv, Ukraine phenomenon are unaware of this phenomenon since it is rare and can be confused with somatic complaints. This case report aims to Aim point out that NCS may be the first sign and symptom of metastatic To improve the results of surgical treatment of patients with cancers in patients who are not diagnosed. moyamoya disease based on the MSCT-perfusion (CTP) results.

Case Material and methods We report a 52-year-old man who presented to our outpatient The retrospective analysis of surgical treatment was performed clinic with numbness on his right jaw for 1 month. He had a history patients with moyamoya disease (n = 5; m/w, 3/2; age range = 16– of renal transplantation and used immunosuppressive therapy. He 55 yrs) underwent brain CTP examination. Clinical manifestations was diagnosed as metastatic lung cancer when he was investigating were due to repeated acute ischemic stroke as a result of cerebral the etiology and died within a month. arteries occlusions (n = 4). In one case, clinical manifestations were due to hemorrhagic stroke. According to moyamoya disease classifi- Discussion cation by Suzuki, the stage 6 (n=3), the stage 3 (n = 1), the stage 4 (n Patients presenting with numb chin syndrome are diagnosed late = 1) were recorded. The ischemia lesion was imagined in the left because of being rare. 75% of the patients presenting with this middle cerebral artery (MCA) region (n = 3), the both MCAs regions complaint are due to malignant metastasis and maybe the first sign (n = 1); the hemorrhagic stroke was in the left temporal/basal of malignancy in a significant rate of them, as presented here. Many ganglion region (n = 1). CTP on basal ganglion levels was performed. malignant and metastatic neoplasms may cause this neuropathy. In Doppler ultrasonography, cerebral computed tomography angiogra- most cases, life expectancy is short and is considered as a sign of phy, cerebral digital subtraction angiography to identify the potential poor prognosis. donor artery for extracranial-intracranial microanastomosis (EICMA) in preoperative planning was carried out. In our study, it was the Conclusion superficial temporal artery (STA) with parietal (n = 3), frontal (n = Numb chin syndrome is a lesser known symptom of mental nerve 2) branches. The indications for surgical treatment were based on the neuropathy. In case dental and jaw-related pathologies cannot be anamnesis, neurological status, absence of regiones of extensive brain detected, it should be kept in mind that this may be the first sign of lessions by CT, the cerebral hypoperfusion regions by CTP. All patients malignancy and all detailed investigations should be planned for this underwent surgical treatment by EICMA(STA-MCA) overlays. purpose. Results doi:10.1016/j.jns.2019.10.758 Positive dynamics as an improved cognitive function, partial regressions of focal neurological events in all patients were observed.

0022-510X/$ – see front matter ARTICLE IN PRESS

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Conclusion WCN19-2277 CTP could be used to cerebral hypoperfusion localize and to objectively evaluate the changes in cerebral hemodynamics before and after revascularization in moyamoya disease. Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - doi:10.1016/j.jns.2019.10.759 Part I /stroke /training in neurology - Part I and traumatic brain injury

Antidiabetic agents differentially affect the extent of neurologic WCN19-2272 deﬁcit after stroke

Poster shift 01 - Channelopathies /neuroethics /neurooncology / M.A.L. Qawasmeha, A. Alhusbanb, F. Alfwaressc, K. El-Salema,Z. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Alalwania Part I /stroke /training in neurology - Part I and traumatic brain aJordan University of Science and Technology, Neuroscience Depart- injury ment, Faculty of Medicine, Irbid, Jordan bJOrdan UNiversity of Science and Technology, Clinical Pharmacy, Faculty of Pharmacy, Irbid, Jordan Application of extracranial-intracranial bypass for surgical treat- cJordan University of Science and Technology, Rehabilitation Sciences ment of complex cerebral arterial aneurysms Department, Faculty of Applied Medical Sciences, Irbid, Jordan

O. Harmatinaa, V. Morozb, I. Skorokhodab, I. Tyshb, N. Shahinb,R. Introduction Hanemb, U. Maliarb a Diabetes and acute hyperglycemia at the time of presentation has SI «Romodanov Institute of Neurosurgery of NAMS of Ukraine», been shown to increase stroke severity and worsen outcome both Neuroradiology Department, Kyiv, Ukraine b preclinical and clinical studies. Recently, the use of metformin has SI «Romodanov Institute of Neurosurgery of NAMS of Ukraine», been shown to reduce the severity of stroke in patients with type 2 Emergency Department of Vascular Neurosurgery, Kyiv, Ukraine diabetes. It’s still unknown whether other oral hypoglycemic agents would confer similar benefit. Aim To improve the results of surgical treatment of complex cerebral Objectives arterial aneurysms (CCAAs) using of modern methods and surgical To assess the effect of pretreatment with oral hypoglycemic correction. agents, insulin and their combination on stroke severity at presentation. Materials and methods The analysis of surgical treatment using microsurgical revascular- Patients and methods ization in 11 patients with CCAAs was performed. AAs localization was Patients admitted to the King Abdullah University Hospital anterior cerebral artery - anterior communicating artery (ACA-ACoA) (KAUH)-Jordan with ischemic stroke between January 2015 and (9.1%), internal carotid artery (ICA) (63.6%), middle cerebral artery December 2016 were evaluated and their comorbid diseases, (MCA) (27.3%). AAs were giant, fourth of them with severe thrombosis treatment on admission and their neurologic severity was assessed (36.4%). Hemorrhagic complications (36.4%), aneurysm mass effect using the National Institute of Health Stroke Scale (NIHSS) were exacerbation pseudotumorosis disease (54.5%), MCA occlusion in AA documented. Stroke severity was compared for non-diabetic МСА dissection (9%) were identified. Features of revascularization patients and diabetic patients treated with different antidiabetic techniques were included the imposition of intracranial-intracranial agents. microanastomosis (IICMA) between A4 of ACAs with AA detachment in AA ACA-ACoA; an overlay of high-flow microanastomosis between Results the external carotid artery and MCA(M2) with AA detachment (n = Data from 324 patients with acute stroke was documented. The 6); the overlay of the extracranial-intracranial microanastomosis median age of participants was 69 years. Diabetes was documented (EICMA) between the surface temporal artery and MCA (STA-MCA) in about 50% of the patients. Multinomial regression analysis with the AA detachment by balloon-catheter (n = 1); an EICMA (STA- identified diabetes treatment status as an independent predictor of MCA) upon MCA occlusion in AA dissection (n = 1); superimposition neurological severity of stroke (p = 0.032). Patients treated with oral of multiple IICMA between MCА(M3) and high-flow EICMA (АСА- hypoglycemic agents had a significantly lower NIHSS as compared to MCА(М2)) with АА MCА deconstruction in pseudotumorrhagic nondiabetic patients and insulin treated patients (p b 0.02). The complications; a microanastomosis between common CA and MCA positive effect of oral hypoglycemic agents was blunted by insulin (M2) with dissecting AА MCA(M1) detachment. co-treatment. Insulin did not alter the severity of stroke as compared Results was ranked by a modified Rankin scale. Satisfactory to non-diabetics. results of surgical treatment of CCAAs were recorded (81.8%); profound disability due to development of microanastomosis Conclusion thrombosis with hemispheric cerebral ischemia (n = 1); fatal Oral hypoglycemic agents may reduce the severity of outcome (n = 1). neurologic deficit of ischemic stroke and may have neuroprotective effect. Conclusions Indications for the use of revascularization techniques in the complex cerebral AA are the high risks of endovascular treatment and the inability of standard AA clipping. doi:10.1016/j.jns.2019.10.760 doi:10.1016/j.jns.2019.10.761 ARTICLE IN PRESS

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WCN19-2278 WCN19-2280

The utility of serum Thrombospondin-1 levels as a prognostic An audit on the use of antiplatelets in patients with ischemic marker in ischemic stroke stroke

M. Al Qawasmeha, A. Alhusbanb, F. Alfwaressc, L. Alhusbanb,D. M. Al Qawasmeha, A. Alhusbanb, F. Alfwaressc, L. Alhusbanb,S. Obiedata, K. El-Salema Mohaidata, K. El-Salema aJordan University of Science and Technology, Neuroscience/Faculty of aJordan University of Science and Technology, Neuroscince Department/ Medicine, Irbid, Jordan Faculty of Medicine, Irbid, Jordan bJOrdan University of Science and Technology, Clinical Pharmacy/ bJordan University of Science and Technology, Clinical Pharmacy/Faculty Faculty of Pharmacy, Irbid, Jordan of Pharmacy, Irbid, Jordan cJordan University of Science and Technology, Rehabilitation Sciences/ cJordan University of Science and Technology, Rehabilitation Sciences/ Faculty of Applied Medical Sciences, Irbid, Jordan Faculty of Applied Medical Sciences, Irbid, Jordan

Introduction Background Despite improvements in stroke management, it remains the Embolic events has been considered as one of the major causes of leading cause of disability worldwide. It has been suggested that stroke. It has been demonstrated that the use of antiplatelets after enhancing brain angiogenesis after stroke will improve stroke stroke reduces the risk of stroke recurrence. Data regarding the outcome. Promoting post stroke angiogenesis requires the upregu- prevalence and preferences toward antiplatelets use in the Arab lation of angiogenic factors with a simultaneous reduction of anti- region is lacking. angiogenic factors. Thrombospondin-1 is the main anti-angiogenic protein in the living cells. Counterintuitively, it has been shown that Aim animals with Thrombospondin-1 knockdown will have better stroke To evaluate the usage and selection of antiplatelets after stroke in outcome. Data about the clinical significance of Thrombspondin-1 a Jordanian teaching hospital. levels at the time of admission is still lacking. Methods Objective Patients admitted to the King Abdullah University Hospital To assess the association between serum Thrombospondin-1 (KAUH)-Jordan with ischemic stroke between January 2015 and levels measured at the time of admission and baseline neurologic December 2016 were evaluated and their comorbid diseases, severity after stroke. treatment on admission and their neurologic severity was assessed using the National Institute of Health Stroke Scale (NIHSS) were Patients and Methods documented. Blood samples were collected from patients admitted to the King Abdullah University Hospital (KAUH) with ischemic stroke at the Results time of admission and serum Thrombopsondin-1 levels were The median age of participants was 69 years old (59–75). Males measured using ELISA. Patients neurologic severity was evaluated constituted more than half of the participants (58 %). the majority of using the National Institute of Health Stroke Scale (NIHSS). participants had hypertension (81.1%) and dyslipidemia (91.6%). About half of the participants had diabetes (49.5%) whereas 35 Results (12.7%) of the participants had atrial fibrillation. The majority of Samples from 50 patients admitted between January 2016 and patients were prescribed antiplatelet therapy (86%). Aspirin alone December 2016 were collected. The median age of participants was was prescribed for 110 patients (58.8%). A combination of aspirin 68 years and the median NIHSS was 3. Multinomial regression and clopidogrel was prescribed in 48 patients (18%). Anticoagulants identified serum Thrombospondin-1 as an independent predictor of were prescribed for 35 patients (12.8%). About 14 patients (5.1%) stroke outcome (p = 0.003). Baseline serum Thrombsopondin-1 was received the combination of an antiplatelet and anticoagulants negatively associated with NIHSS at the time of admission (spearman therapy. rho correlation coefficient = 0.272, p = 0.032). Conclusion Conclusion Antiplatelets are highly prescribed to stroke patients in an Serum Thrombospondin-1 at the time of admission may be a appropriate way. This practice needs to be maintained. useful marker of stroke severity that predicts more severe neurologic severity. doi:10.1016/j.jns.2019.10.762 doi:10.1016/j.jns.2019.10.763 ARTICLE IN PRESS

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WCN19-2281 WCN19-2283

The effect of patients premorbid characteristics on the severity Pre-stroke angiotensin II manipulation has a differential effect on and recovery of speech and language after stroke: A pilot study the initial severity and long-term outcome

F. Alfwaressa, A. Alhusbanb, M. Al Qawasmehc, L. Alhusbanb, M. Al- A. Alhusbana, M. Al Qawasmehb, F. Alfwaressc, M. Megdadib,L. qudahc, K. El-Salemc Alhusbana, K. El-Salemb aJOrdan UNiversity of Science and Technology, Rehabilitation Sciences/ aJOrdan UNiversity of Science and Technology, Clinical Pharmacy/ Faculty of Applied Medical Sciences, Irbid, Jordan Faculty of Pharmacy, Irbid, Jordan bJOrdan UNiversity of Science and Technology, Clinical Pharmacy/ bJordan University of Science and Technology, Neuroscience/Faculty of Faculty of Pharmacy, Irbid, Jordan Medicine, Irbid, Jordan cJOrdan UNiversity of Science and Technology, Neuroscience/Faculty of cJordan University of Science and Technology, Rehabilitation Sciences/ Medicine, Irbid, Jordan Faculty of Applied Medical Sciences, Irbid, Jordan

Background and Aims Introduction Speech recovery is one of the commonly overlooked parame- Despite improvements in stroke management, it remains the ters that have a significant impact on patient’s quality of life, leading cause of disability worldwide. Angiotensin II manipulation which ultimately affects recovery and functioning after stroke. has been evaluated as a potential prorecovery intervention. Available Unfortunately, there is a lack of data on the effectiveness of data is from studies assessing the effect of angiotensin II altering available pharmacologic interventions on speech recovery after drugs in the post stroke setting. Data regarding the effect of pre- stroke. The aim of this pilot study is to assess the effect of patients stroke treatment with either angiotensin converting enzyme inhib- premorbid characteristics on speech and language recovery after itor (ACEI) or angiotensin receptor type 1 blockers (ARBs) on stroke stroke. outcome is limited. It has been suggested that enhancing brain angiogenesis after stroke will improve stroke outcome. Method Stroke patients referring to the speech rehabilitation clinic at King Objective Abdullah University Hospital (KAUH) were recruited into the study To assess the effect of pre-stroke treatment with ACEI and ARBs after getting their informed consent. Patient's baseline language and on stroke outcome. speech in addition to their current medications were documented. Patients and Methods: Patients admitted to the King Abdullah Patients received speech and language rehabilitation and their University Hospital (KAUH)-Jordan with ischemic stroke between recovery were evaluated. January 2015 and December 2016 were evaluated and their comorbid diseases, treatment on admission and their neurologic Results severity was assessed using the National Institute of Health Stroke Forty patients were included in this pilot study. The median Scale (NIHSS) were documented. Stroke severity was compared for age of the participants was 62 years (33–73). Rehabilitation pretreatment with ACEI and ARBs. improved language recovery by about one-fold (p b 0.001). Treat- ment with ARBs enhanced the beneficial effect of language Results rehabilitation (38 vs.48; p b 0.01). None of the comorbid condi- Data from 324 patients with acute stroke was documented. The tions or other commonly used drugs altered the beneficial effect of median age of participants was 69 years. Hypertension was docu- rehabilitation on language recovery. Furthermore, smoking signif- mented in about 81.1% of the patients. Multinomial regression icantly increased the extent of speech and language abnormalities analysis identified pre-treatment with ACEI or ARBs as an indepen- (p b 0.05) dent predictor of neurological severity of stroke (p = 0.003 and p = 0.031, respectively). Patients treated with ACEI had a higher baseline Conclusion (8.6 vs. 6.9, p = 0.04). in contrast, patients pre-treated with ARBs Treatment with ARBs enhanced the prorecovery effect of had a lower NIHSS (6.03 vs. 7.76; p = 0.028) language rehabilitation. Comorbid conditions did not alter the response to language rehabilitation therapy. Conclusion Patients treated with ARBs had a smaller stroke severity whereas pre-treatment with ACEI resulted in larger stroke severity. doi:10.1016/j.jns.2019.10.764 doi:10.1016/j.jns.2019.10.765 ARTICLE IN PRESS

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WCN19-2291 system gives stroke suspected patients an in-time emergency care system.

Poster shift 01 - Channelopathies /neuroethics /neurooncology / doi:10.1016/j.jns.2019.10.766 pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain injury WCN19-0013 Prehospital time saving: Web based smart pre-notification system of acute stroke Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and M.U. Jang outcomes / neuroepidemiology and environmental and other Hallym University, College of Medicine, Department of Neurology, Hwasung, Republic of Korea Multifocal encephalitis and recurrent shingles in HIV patient; A case presentation and review of literature Objective Patients suspected acute stroke are critical in time delay of W. Ibrahim, A. Karam-allah Mohamed endovascular or intravenous thrombolytic therapy. Prehospital Kasralainy Hospital, Faculty of, Medicine, Cairo University, Neurology, fi noti cation from emergency medical services (EMS) may shorten Cairo, Egypt the door to recanalization time. The ‘Brain Saver’, web-based prehospital notification system could reduce the time interval from Background symptom onset to recanalization. Neurological manifestations can occur in up to 17% of cases of HIV infection. 50–90% of individuals infected with HIV develop fever and Methods non-specific symptoms within a few weeks of acquiring the infection. Between March 2017 and February 2019 stroke team consisted of stroke specialized doctors, nurses and radiologists of Review of literature multi departments received direct alarms via smart phone Viral encephalitis is an infectious process associated with a application from paramedics of EMS about transport information complicated diagnostic workup, limited treatment options, and of patients with suspected stroke. We compared baseline significant morbidity and mortality. characteristics and prehospital/ in-hospital delay time in stroke patients treated with intravenous thrombolysis or endovascular Case presentation treatment for 12 months with and without EMS use Brain Saver Protocol. • F.A 51y old male patient, presented to Kasaralainy hospital, with Lt sided hemiparesis and an attack of Generalized seizure. Result • History of recurrent painful rash in thoracic region[Figure 1-1].. 167 patients (69 patients with protocol and 98 patients without examination revealed multiple oral ulcers. protocol) were enrolled in this program. The patients who used Brain • MRI Brain [Figure 1-2]. Saver had shorter median onset-to-arrival times (63 minutes versus • EEG: focal temporal and frontal epileptogenic activity 142 minutes, P b .001) and in in-hospital delay time (35 minutes • Patient was diagnosed as Encephalitis and started Acyclovir versus 52 minutes, P b .001). Prehospital notification by Brain Saver treatment and Antiepileptic drugs with no improvement was associated with shorter median door-to-imaging time (5 • Laboratory investigations revealed HIV Ab –N positive minutes versus 12 minutes, P b .001), door-to-needle time (20 • patient was started HAART minutes versus 31 minutes, P b.05), door to puncture time (55 minutes versus 137 minutes, P b .001) DISCUSSION & CONCLUSION Individuals with neurological manifestations of primary HIV Conclusions infection should initiate HAART as these manifestations are associ- We found that prehospital notification was associated with ated with accelerated progression of HIV. faster door-to-imaging time, door-to-needle time and door-to- puncture time in patients presenting within 6 h of symptom onset. doi:10.1016/j.jns.2019.10.767 Close collaboration between stroke team in hospitals and the EMS ARTICLE IN PRESS

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videos, used social media to share the music, and performed live at the MS Walk in Fontana, CA and at the 42nd ACOFPCA meeting in Disneyland, CA.

Results The single “Someone Else” was released in Oct 2017, and was a semiﬁnalist for the 2018 ATM Awards.The album “Walk Again” was released in Jan 31 2018 on 37 platforms via Kobalt Music, and publicized in the Korea Daily. To date, all songs have been heard in over 40 countries worldwide with over 20,000 Youtube views, and used to raise funds for the Alzheimer’s Association, etc.

Conclusions Music can be a powerful tool in not only raising patient awareness but also therapeutic, providing solace to patients worldwide. Further research is in need to see how music therapy can improve measurable outcomes.

doi:10.1016/j.jns.2019.10.768

WCN19-^0021

Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and outcomes / neuroepidemiology and environmental and other

Differential diagnosis of isolated visual disturbances^, management of prion diseases and the heidenhain variant of Creutzfeldt- WCN19-0015 Jakob disease

ı ı ş Poster shift 02 - Autoimmune disorders - Part I /CNS infections - N. Kale, D. Çelik, S. Yaz c Akka , S. Mumcu Timer, S. Erdogan, I. Serifoglu Part I / dementia - Part I /epilepsy - Part I / health economics and Bagcilar Training and Research Hospital, Neurology, Istanbul, Turkey outcomes / neuroepidemiology and environmental and other ^

Creutzfeldt-Jakob disease(CJD) belongs to spongiform encepha- Musicalization of neurological disorders: Songs of love and hope lopathies or prion diseases, a group of neurodegenerative disorders to heal our patients characterized by tissue deposition of prion protein. Despite their relative rarity, prion diseases show a wide spectrum of clinical and W. Baek pathological phenotypes including a wide range of neurological signs. Parkside Medical Group, Neurology, Upland, USA Heidenhain variant is characterized by isolated visual symptoms including poor vision, disturbed perception of colors, optical distor- Objective tions as well as hallucinations. Visual symptoms may persist in A. To describe the illness and its impact through lyrics. isolation for weeks without cognitive decline or motor signs may B. To musicalize the condition while combining medicine, music, cause diagnostic difficulty and delay. In addition to ocular diseases, ethics, and religion. differential diagnosis may include occipital stroke and other neurode- C. To motivate patients to overcome their illness. generative conditions causing a posterior cortical atrophy (PCA) syndrome, including Alzheimer's disease, dementia with Lewy bodies, Background and corticobasal degeneration. Diagnosis is based on the clinical Patient education not only includes explaining the disease itself course, CSF biomarker analysis, brain DWI- or FLAIR-MRI, and EEG but also how it affects the individual. Due to time constraints in findings. In this case series we would like to present 3 CJD (2 females, everyday practice there has been less opportunity for physicians to ages 50–70 years) with one Heidenhain variant of CJD. The clinical share their invaluable experiences. A scientific article may not be presentations and neuroimaging were all compatible with CJD. Despite able to convey the emotional, social and ethical challenges the its rarity, the Heidenhain variant of CJD remains of clinical relevance. A patient must face. significant number of patients are initially referred to the ophthalmologist, and misdiagnoses are not uncommon, especially in the early Design/Methods clinical stages as well as in the clinical neurological setting. Careful The presenter has written 10 songs on neurological disorders, exam and clinical suspicion is warranted for diagnosis. including Alzheimer’s disease, Parkinson’s disease, ALS, stroke, multiple sclerosis/spinal cord injury, myasthenia gravis, etc. He doi:10.1016/j.jns.2019.10.769 released a music album worldwide, created a website with music ARTICLE IN PRESS

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WCN19-0029 of whom 2 (40%) were poorly complaint with anticonvulsant drug therapy. So only 3 patients (13%) had no other apparent cause but the war to account for their increased ﬁts. The emergence of new Poster shift 02 - Autoimmune disorders - Part I /CNS infections - fear, stress, panic, or depression and phobias was documented in Part I / dementia - Part I /epilepsy - Part I / health economics and 39%. These were more likely with lack of drug compliance (78%), and outcomes / neuroepidemiology and environmental and other the presence of comorbidity(17%).

Case report: Oral antibiotics as conservative management of Conclusions multiple pyogenic brain abscesses from a rare hematogenous We concluded that when drug availability and compliance were spread ensured stable patients with epilepsy were unlikely to suffer increased frequency during stressful war events; however a signif- J.K.N. Paberab, M. Kalbia icant percentage (39%) reported the emergence of new fear, stress, aZamboanga City Medical Center, Internal Medicine, Zamboanga, panic, or depression and phobias. These were more likely with lack Philippines of drug compliance. bJose R. Reyes Memorial Medical Center, Neurology, Manila, Philippines Keywords: Epilepsy, War related disorders, Psychological effect, This is a rare case of hematogenous spread of brain abscess in a Benghazi, Libya young immunocompetent adult, who presented with an acute onset of symptoms of one-week duration of headache and sudden onset of seizure. With the patient's refusal for neurosurgical intervention and doi:10.1016/j.jns.2019.10.771 staying in the hospital, the choice for conservative management with aggressive oral antibiotics and close monitoring proved to be a viable alternative treatment. WCN19-0045 doi:10.1016/j.jns.2019.10.770

Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and WCN19-0041 outcomes / neuroepidemiology and environmental and other

Anti-N-methyl-D-aspartate receptor encephalitis mimics neuro- Poster shift 02 - Autoimmune disorders - Part I /CNS infections - leptic malignant syndrome: A case report and challenges Part I / dementia - Part I /epilepsy - Part I / health economics and outcomes / neuroepidemiology and environmental and other H.Y. Wanga, B.W. Zhangb, X.L. Lic, X.X. Zhanga, Z.R. Yana,Y.Xua aJining No. 1 People’s Hospital, Department of Neurology, Jining, China War related disorders: A prospective study of 23 patients with bFirst Affiliate Hospital of Dalian Medical University, Department of epilepsy from Benghazi Libya Neurology and Psychiatry, Dalian, China cJining No. 1 People’s Hospital, Department of Intensive Care Unit, Jining, H.A. El-Zawawi China Benghazi Medical Center, Neurological Medicine, Benghazi, Libya Background Background Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is War related disorders such as posttraumatic stress and psycho- a severe autoimmune disease characterized by complicated psychi- somatic disease have been recognised over recent years; however atric and neurological symptoms and a difficult diagnosis. This the exact spectrum of these disorders, is unknown. disorder is commonly misdiagnosed, and diagnosis is often delayed. The clinical signs can mimic other psychiatric abnormalities, such as Objectives neuroleptic malignant syndrome (NMS) that is usually caused by To study the effect of war on the Benghazi Libyan population with antipsychotic exposure. This fact raises the question of whether the epilepsy. symptoms common to NMS are due to anti-NMDA receptor encephalitis or established NMS. Methods A prospective study by questionnaire and EEG of 23 patients who Cases presentation have epilepsy attending the neurological clinics at Benghazi Medical We describe a rare case of a 29-year-old male without psychiatric Center and the University Specialist Clinic Benghazi. Their psycho- history who initially presented with a fever, altered consciousness, logical status was documented, as well as the physical status, drug behavioral changes, rigidity, and elevated creatine kinase. He was availability and compliance. initially diagnosed with NMS. NMS-like symptoms did not improve Data were analysed, and graphs created using Microsoft Word with active treatments and disappeared for a long period after EXCEL. discontinuing antipsychotics. The patient gradually developed a complicated disease progression, including speech impairment, Results mutism, and movement disorders, and symptom progression led to The war did not appear to change the epilepsy frequency in the the final diagnosis of anti-NMDA receptor encephalitis. The related majority of patients. 18 (78%) reported no change, only five (22%) pathophysiological mechanisms, clinical features, and treatment of patients had a significant increase in seizure activity and frequency, this disease are reviewed. ARTICLE IN PRESS

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Conclusion as a signiﬁcant alarm to suspect anti-NMDA receptor encephalitis and We highlight that the natural progress of anti-NMDA receptor lead neurologists or psychiatrists to investigate such a diagnosis. encephalitis can mimic the symptoms of NMS and NMS-like features could be due to anti-NMDA receptor encephalitis upon antipsychotic doi:10.1016/j.jns.2019.10.772 exposure, and not true NMS. Clinically, the suspicion of NMS may serve ARTICLE IN PRESS

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WCN19-1772 approach to current strategies for smokers who would otherwise continue to smoke. The Tobacco Heating System (THS) 2.2 is a novel tobacco product that heats tobacco instead of burning it, never Poster shift 02 - Autoimmune disorders - Part I /CNS infections - allowing the temperature to exceed 350°C, thereby preventing the Part I / dementia - Part I /epilepsy - Part I / health economics and combustion process from taking place and producing substantially outcomes / neuroepidemiology and environmental and other lower levels of toxicants compared with CS.

Clinical and neurophysiological(cognitive potential-P300) assess- Methods ment of cognition in type 2 diabetes mellitus Philip Morris International’s (PMI) assessment program aims to demonstrate that switching to THS has the potential to reduce the S. Medarametla risk of smoking-related diseases versus continued smoking. Vydehi institute of Medical sciences, Neurology, Bangalore, India Results People with type 2 diabetes have a 1·5-times increased risk of The results of the THS assessment program demonstrated positive dementia, are more prone to subtle cognitive impairments, and have cardiovascular effects in both in vitro, in vivo, as well as in clinical accelerated cognitive decline compared with people without diabetes. assessments. Although the effects of diabetes on the peripheral nervous system are Since the start of THS commercialization in November 2014 and fi well established, its effects on higher mental functions are often cumulatively up to the end of 2018, eleven cases of MI and ve cases overlooked, due to lack of clear signs and unavailability of standard of ischemic stroke were reported by users. In most of these cases, no assessment techniques. There is no consensus as to the specific information was provided about the smoking history or the time of fi domains of cognition that may be affected by T2DM, hence early switching to THS, which makes it dif cult to assess the causal recognition with either clinical or neurophysiological assessment may relationship from a medical point of view. help in controlling the progression of the decline in cognition. We did this hospital based, cross-sectional study in a tertiary care centre in Conclusions urban India to clinically study the pattern of cognitive impairment in The evidence available to date indicates that switching to THS has relation to the duration of diabetes and to analyze the sensitivity of the potential to reduce the risk of smoking-related diseases, such as cognitive potential P300 for detection of cognitive impairment in CVD. T2DM. The clinical characteristics, cognitive functions of 50 diabetes As a next step, PMI will complement its THS assessment program patients was assessed using the Montreal cognitive assessment scale with cardiovascular outcome studies intended to further support the fi and Mini mental scale examination. Patients with other obvious causes clinical bene ts of switching to THS as compared with continuous of dementia were excluded from the study. All the patients underwent smoking. neurophysiological assessment of cognition through P300, by using the oddball paradigm in which the subject is attentive and consciously doi:10.1016/j.jns.2019.10.774 distinguishes a target acoustic stimuli from a group of other nontarget acoustic stimuli. We studied the prevalence of subclinical cognitive impairment in these subjects either clinically or neurophysiologically. We found that patients with longer duration of diabetes had much prolonged P300 latencies. WCN19-0102 doi:10.1016/j.jns.2019.10.773 Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and outcomes / neuroepidemiology and environmental and other

WCN19-0101 Stroke burden in Egypt: Data from ﬁve epidemiological studies

a b c d Poster shift 02 - Autoimmune disorders - Part I /CNS infections - F. Abd-Allah , E. Khedr , M. Oraby , R. Reda a Part I / dementia - Part I /epilepsy - Part I / health economics and Cairo University, Neurology, Cairo, Egypt bAssuit University, Neurology, Assuit, Egypt outcomes / neuroepidemiology and environmental and other cBeni-Suef University, Neurology, Beni-Suef, Egypt dAinshams University, Neurology, Cairo, Egypt Assessing the impact of switching to the tobacco heating system on cardiovascular events: Translating basic science into clinical Purpose benefit Accurate data on the epidemiology of stroke in Egypt is scarce. The aim of this review is to address this issue based on available C. Pater, N. Blanc, A. van der Plas, C. Haziza, A. Elamin, S. Pouly, G. de community-based studies and compare the resulting findings to la Bourdonnaye, C.T. Tran, F. Luedicke those of other regional and international studies. Philip Morris International, Science & Innovation, Neuchatel, Switzerland Method A systematic literature search was conducted to identify popula- Background tion-based epidemiological studies of stroke in Egyptians. Original Cigarette smoke (CS) is causally linked to the development of articles published in English between 1990 and 2016 were included. cardiovascular disease (CVD). Tobacco harm reduction, by substitut- Five studies from five different governorates in southern Egypt fulfilled ing cigarettes with less harmful products, is a complementary the study criteria (Qena, Sohag, Assiut, New Valley and Red Sea). ARTICLE IN PRESS

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Results studies on risk factors that predispose to recurrence are lacking The mean and median crude prevalence rates (CPRs) across the and there are no randomized placebo-controlled trials on its ﬁve studies, which were conducted in southern Egypt were 721.6/ treatment. 100,000 and 655/100,000, respectively. The mean and median crude incidence rates (CIRs) were 187/100,000 and 180.5/100,000, respec- doi:10.1016/j.jns.2019.10.776 tively. The average CPR weighted by sample population size was 613/100,000 and the average CIR weighted by sample population size was 202/100,000. WCN19-0136 Conclusion The incidence and prevalence of stroke in Egypt are high. More population-based studies are urgently needed in northern Egypt and Poster shift 02 - Autoimmune disorders - Part I /CNS infections - in Cairo – the capital of Egypt. Part I / dementia - Part I /epilepsy - Part I / health economics and outcomes / neuroepidemiology and environmental and other Keywords: Stroke, Epidemiology, Egypt, Incidence, Prevalence Voltage-gated potassium channel complex autoimmune encephalitis presenting as memory loss: A case report doi:10.1016/j.jns.2019.10.775 F. Ocampo, E. Saniel, M.S. Martinez St. Luke's Medical Center- Philippines, Section of Adult Neurology, Institute for Neurosciences, Quezon City, Philippines

WCN19-0127 Background and aims Voltage gated potassium channel (VGKC) autoimmune encepha- Poster shift 02 - Autoimmune disorders - Part I /CNS infections - litis is caused by antibodies against cell surface proteins that are part Part I / dementia - Part I /epilepsy - Part I / health economics and of the voltage-gated potassium complex in neurons. We hereby outcomes / neuroepidemiology and environmental and other present a case of a 46-year-old female who manifested with subacute onset of memory loss, behavioral changes, hyponatremia, and focal motor seizures. She was diagnosed with anti-VGKC encephalitis Recurrent Miller Fisher syndrome (LGI1 variant), treated with pulse steroid therapy with marked improvement of symptoms. M.D.F. Tamayo, E. Saniel The Medical City, Neurology, Pasig, Philippines Methods Case report Introduction Miller Fisher syndrome is an acute, self-limiting neurological Results disorder presenting with thetriad of opthalmoplegia, ataxia and On initial admission, patient underwent plain cranial MRI which fl are exia. It has a worldwide incidence of 0.09% per 100,000 population. showed hyperintense signals on the right amygdala and hippocam- The incidence of recurrent Miller Fisher Syndrome is unknown. pus. Electroencephalography revealed epileptiform discharges on the right temporal lobe with focal slowing over the same region. She was Case managed as a case of focal motor seizure secondary to right mesial A 69 year old female presents with 3 episodes of ataxia, temporal sclerosis and was given levetiracetam. Interim, there was opthalmoplegia and hypo to areflexia in 2005, 2015 and 2018. This was persistence of memory loss until one day, she experienced focal associated with dizziness, diplopia, blurring of vision, ptosis, mild motor motor seizures. Repeat cranial MRI showed increased signal inten- weakness, sensory loss, dysphonia and urinary retention. Electro- sities on bilateral medial temporal lobes. Electroencephalography diagnostics were consistent with Miller Fisher syndrome. Patient was showed focal slowing on the right frontotemporal and left frontal given plasmapheresis and had complete remission after 3 to 4 months. regions while serum tests revealed euovolemic hyponatremia. Patient underwent lumbar puncture and cerebrospinal fluid analysis Discussion revealed high titers for antibodies against voltage-gated potassium Recurrent cases of Miller Fisher syndrome in 2 retrospective studies channel complex. Patient underwent pulse steroid therapy with document 4 out of 28 recurrent cases over a period of 15 years and 4 out tapering doses of oral steroids. The patient showed marked of 34 over a period of 12 years. All of these cases had only 1 recurrent improvement of symptoms without recurrence of motor seizures. episode with a mean age of onset at 22 years old. Antecedent cause is most commonly an upper respiratory tract infection and autonomic and Conclusion bulbar symptoms are seen in recurrent attacks. Anti-GQ1B antibodies This case highlights VGKC autoimmune encephalitis as an are present in 85–90% of cases of Miller Fisher syndrome. Immuno important diagnostic consideration in patients presenting with modulatory treatments like plasmapheresis and Intravenous Immuno- subacute onset of memory loss, behavioral changes, hyponatremia, globulin G have shortens the course of the disease. and focal seizures. Prompt initiation of immunotherapy results to improvement with excellent prognosis. Conclusion Our case of recurrent Miller Fisher syndrome has typical and doi:10.1016/j.jns.2019.10.777 atypical features. Studies on prevalence and incidence as well as ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 11

WCN19-0141 Conclusion Pontine Myelinolysis is a demyelinating disease of the Pons and Extra Pontine sites. MRI remains the gold standard investigation. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Early recognition of risk factors and clinical features reﬂects decrease Part I / Dementia - Part I /Epilepsy - Part I / Health economics and in mortality rates. outcomes/ Neuroepidemiology and environmental and other MRI Flair Image showing increased signal in Pons. Case of Pontine Myelinolysis doi:10.1016/j.jns.2019.10.778 A. Khana, K. Javaidb, A. Abrasa, S. Babarc aManor Hospital, Care Of Eldelry, Walsall, United Kingdom bNew Cross Hospital, Stroke, Wolverhampton, United Kingdom cNew Cross Hospital, Care of Elderly, Wolverhmapton, United Kingdom WCN19-0153

Background and aims Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Pontine Myelinolysis or Osmotic Demyelination is a rare neuro- Part I / Dementia - Part I /Epilepsy - Part I / Health economics and logical disorder represented by demyelination of the Pons. It is classified in to Central Pontine Myelinolysis and Extra Pontine outcomes/ Neuroepidemiology and environmental and other Myelinolysis. We report such a case diagnosed as Central Pontine Myelinolysis. Anti-N-Methyl-D-Aspartate encephalitis possibly triggered by Japanese encephalitis in an immunized adolescent Method Case Report R.D. Cansanay, M. Ortiz, L. Lee Philippine Children's Medical Center, Child Neuroscience Division, Results Quezon City, Philippines 57 year old lady with background of significant alcohol intake presenting to medical admission unit with a history of coffee ground Japanese encephalitis (JE) is a vaccine preventable, arthropod- vomiting and productive cough. She was initially managed for her borne illness known to be an important cause of viral encephalitis in gastrointestinal symptoms and chest infection. However, she dete- children, especially in Asia. Here, we present a case of an adolescent riorated and had to be managed on ITU requiring Intubation and male who was immunized with a single dose of Japanese encephalitis Inotropic support. After 3 days she was extubated but her GCS vaccine who later on developed a biphasic pattern of encephalopathy 3 remained low at 10/15 (E4 M5 V1). On examination she was aphasic, months after. He initially presented with fever, headache, behavioral reduced Tone in all limbs, Power was 1/5 right side, 1/5 left side, all changes which improved after antibiotic treatment however a month Reflexes brisk, bilateral up going Plantars. After discussion and into the recovery, a new set of neuropsychiatric symptoms emerged. review by Stroke team MRI head was arranged, which showed He was positive for Japanese encephalitis IgM capture ELISA and anti- Central Pontine Myelinolysis. N-methyl-D-aspartate receptor antibodies. To the best of our knowl- She was further managed on Stroke ward requiring MDT edge, this is the first reported case of anti-NMDA receptor encephalitis approach from Dietitian, Physiotherapist and Occupational Therapist. probably triggered by Japanese B encephalitis in the Philippines. The Her power improved to 4+/5 right side and 4/5 left side. She was emergence of worsening neuropsychiatric illness a month after discharged to rehabilitation centre where she received further substantial recovery from a febrile encephalopathy may be a clue. This therapy. paper may further support the possibility of linking the JE virus as a trigger for CNS autoimmune diseases particularly anti-NMDA receptor encephalitis.

doi:10.1016/j.jns.2019.10.779

WCN19-0166

Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / Dementia - Part I /Epilepsy - Part I / Health economics and outcomes/ Neuroepidemiology and environmental and other

Multiple sclerosis associated with systemic sclerosis (Sclero- derma): Case report

A. Almutairia, M. Al-Jumahb aNational Neuroscience Institute- King Fahad Medical City, Department of Neurology, Riyadh, Saudi Arabia bKAIMRC- King Saud Ben Abdul-Aziz University for Health Sciences, NGHA and MS center- Prince Mohammed Ben Abdul-Aziz Hospital- MOH, Department of Neurology, Riyadh, Saudi Arabia ARTICLE IN PRESS

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Introduction diagnosis. There were no complications documented during or after Multiple sclerosis is one of the most common chronic inﬂamma- the procedure. tory demyelinating disease of the central nervous system (CNS), affecting more than 2 million people worldwide. Multiple sclerosis Conclusion (MS) has been increasingly reported to be associated with other Albeit being an uncommon condition, successful treatment of autoimmune diseases not affecting the central nervous system SDAVF is deﬁnitely possible provided the diagnosis is made early, allowing timely intervention. It is therefore crucial for clinicians to be Objective aware of this condition with good understanding of the clinical To report a case of Multiple sclerosis in coincidence with systemic presentation and imaging5. sclerosis.

Clinical presentation doi:10.1016/j.jns.2019.10.781 A 25-year-old female recently diagnosed with systemic sclerosis on methotrexate treatment. She started to complain of diplopia, eye pain and blurring vision. Full evaluation was performed, leading to the diagnosis of multiple sclerosis (MS). WCN19-0178

Conclusion Detailed history and systemic examination followed by laboratory Poster shift 02 - Autoimmune disorders - Part I /CNS infections - and radiological investigation whenever there is a suspicion of MS Part I / Dementia - Part I /Epilepsy - Part I / Health economics and especially with other connective tissue disease. outcomes/ Neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.780 Ginkgolide K induces myelin regeneration by immunoregulation

Q. Miaoa, R.X. Suia, J. Wangb, Q. Wanga, W.J. Jianga, L.J. Songa, J.W. Yuc, L. Caod, J.Z. Yuac, L. Fengc, J.J. Huange, W. Xiaod, B.G. Xiaof, C.G. Maabc WCN19-0170 aShanxi University of Chinese Medicine, The Key Research Laboratory of Benefiting Qi for Acting Blood Circulation Method to Treat Multiple Sclerosis of State Administration of Traditional Chinese Medicine- and Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Scientific and Technological Innovation Team of Integrated Chinese and Part I / Dementia - Part I /Epilepsy - Part I / Health economics and Western M, Jingzhong, China outcomes/ Neuroepidemiology and environmental and other bShanxi Medical University, Dept. of Neurology, Taiyuan, China cShanxi Datong University, Institute of Brain Science, Shanxi Key Spinal dural arteriovenous fistula : A case series Laboratory of Inflammatory Neurodegenerative Diseases, Datong, China dJiangsu Kanion Pharmaceutical Co.- Ltd, State Key Laboratory of New- D. Krishnan, A.M. Ong, H.S. Ng, N. Rose, F.L. Hiew, S. Viswanathan tech for Chinese Medicine Pharmaceutical Process, Lianyungang, China aPlace of work, Neurology, Kuala Lumpur, Malaysia; eGeneral Hospital of Datong Coalmine Group, Dept. of Neurosurgery, bPlace of work, Radiology, Kuala Lumpur, Malaysia Datong, China fFudan University, Institute of Neurology, Huashan Hospital, Institutes of Introduction Brain Science and State Key Laboratory of Medical Neurobiology, Spinal dural arteriovenous fistula (SDAVF) is a rare diagnosis that Shanghai, China requires a high index of clinical suspicion1. Classically described as slowly progressive, a typical patient presents in the 6th decade of life Background with chronic myelopathic and/or radiculopathic symptoms2. SDAVF Ginkgolide K (GK), a novel compound isolated from Ginkgo can be suspected based on pathognomonic findings on imaging such biloba, has shown the neuroprotective capacity as cord edema and perimedullary dilated vessels on MRI/MRA of the spine3.Definite diagnosis requires spinal angiography4. Endovascular Objective or surgical modes of treatment show variable success rates. We In this study, the therapeutic potential and its possible mecha- present the diverse clinical spectrum and course of SDAVF based on a nisms of GK for myelin protection were explored through cuprizone series of cases encountered at our centre. (CPZ)-induced demyelination model and MOG-induced encepha- thogenic cells Case presentation We present 4 cases of SDAVF treated at our centre in the past Methods three years. The mean duration taken to reach a diagnosis was 14 The mice of CPZ-induced demyelination were treated with GK months with the longest being 2 years in a 27 year old gentleman. (20mg/kg/day) for two weeks. Then mice were sacrificed and splenic Presentation varied with some exhibiting acute deterioration mononuclear cells (MNCs) and brains were obtained. Immune mimicking other spinal cord pathology such as inflammatory changes and myelin regeneration were observed by flow cytometry, disorders. All patients eventually underwent endovascular treatment ELISA, Western blot and etc. MOG-specific encephalopathic cells with successful embolization of SDAVF and remarkably, none of were treated with GK. Cell viability was detected by MTT in vitro. them exhibited further neurological deterioration after embolization. ELISA and flow cytometry were performed to observe the levels of However, the patients’ functional outcome was not satisfactory and pro-/anti-inflammation cytokines and the change of immune cell this was attributed to the cord atrophy that had already occurred at subsets respectively ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 13

Results WCN19-0193 GK reduced behavioral abnormality and effectively protected myelin from damage. CPZ feeding triggered atrophy of the spleen and production of MOG-specific antibody, and this was strongly Poster shift 02 - Autoimmune disorders - Part I /CNS infections - inhibited by GK treatment. GK prevented the infiltration of T, B cells Part I/Dementia - Part I /Epilepsy - Part I/Health economics and and macrophages, inhibited IL-1β, IL-6 and TNF-α production in the outcomes/ Neuroepidemiology and environmental and other brain, suppressed the inflammation response of MOG-specific encephalopathic cells. Administration of GK also promoted the A study of seizures in rural adolescents from Trichy Tamilnadu proliferation and differentiation of oligodendroglia precursor cells Southern India (OPCs) M.A. Aleem Conclusions The Tamilnadu Dr.M G R Medical University Chennai, Dhanalakshami GK showed a potential therapeutic role in CPZ-mediated demy- Srinivasan Medical College Perambalur, ABC Hospital Trichy Neurology, elination. In addition to its inhibition of myelin-specific autoantibody Trichy, India production and immune-regulation, GK may protect a supportive microenvironment for CNS remyelination. (NNSF of China 81473577, Objectives/background Shanxi Scholarship Council of China 2014-7, the 2011 Cultivation Seizures in adolescents are not uncommon There are many Project of SUTCM 2011PY-1. Ma and Xiao are corresponding LifeStyle Changes in this age group and which can Precipitate authors). Seizures in certain circumstances. The study of seizures in these age group is very much helpful for their future and their lifestyle doi:10.1016/j.jns.2019.10.782 modifications.

Method This prospective study was done in adolescents with seizure for WCN19-0179 one year in 2018 at ABC hospital Trichy and KM crescent hospital Thuvarankurichi to find out the various precipitating factors for the onset of seizures along with routine investigations for seizures Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / Dementia - Part I /Epilepsy - Part I / Health economics and Results outcomes/ Neuroepidemiology and environmental and other In 2018 about 1254 cases of seizures in the age group of 15 to 60 years were analyzed. Among then 344( 36.44%) were in the It is never a good syndrome adolescent age group. Out of them 201(58.43%) were male and 143 (42.15%) were female. In this, about 19% of Patients had focal Y.N. Mew seizures with evidence of focal seizures in 8 patients in EEG and United Christian Hospital, Neurology Division, Department of Medicine normal imaging finding. Analysis of Precipitating factors showed and Geriatrics, Hong Kong, Hong Kong Special Administrative Region sleep deprivation in 41% of male and 33% of female. Alcohol played a role in 12% of male and 1% of female. Menstruation related seizures A 65 year old gentleman, with a past history of resected were in 3% of girls/History of fibril seizures were noted in 26% of thymoma, was admitted for one week history of fever, headache female and 24% male and two episodes of generalized tonic clonic seizure. MRI showed a cerebral abscess. Emergency craniotomy was performed, and biopsy Conclusion confirmed herpes encephalitis. He was treated with a prolong course In Adolescent with seizures sleep deprivation due to excessive of acyclovir. He was noted to have a buttock wound with HSV 2 PCR cell phone usage, in night, prolonged computer and net surfacing in detected. On reviewing his past medical records over the past 5 night, prolonged studies in night and worries are the common years, he had recurrent vesicular rash at various parts of body causes, Significant number of patient also had fibril seizures. managed as herpes zoster, he had history of recurrent gastroenteritis with positive campylobacter and norovirus detection in stool, he had doi:10.1016/j.jns.2019.10.784 recurrent chest infection with haemophilus influenzae. Underlying immunodeficiency was suspected, and he was subsequently confirmed to have Good's Syndrome, i.e. thymoma with immunodeficiency. However, despite adequate acyclovir treatment for brain WCN19-0194 abscess, active search of common and opportunistic pathogens, as well as up-to-date immunization and regular intravenous immunoglobulin, he developed bilateral necrotising retinitis by HSV 2 after Poster shift 02 - Autoimmune disorders - Part I /CNS infections - discharge, and that had resulted in blindness of both eyes. Part I / Dementia - Part I /Epilepsy - Part I / Health economics and Good's Syndrome is a rare condition associated with poor outcomes/ Neuroepidemiology and environmental and other prognosis. Neurologists should have high awareness of this condition, as we manage myasthenia gravis patients day in and day out, A study of seizures in rural adolescents from Trichy Tamilnadu and some of them may have thymoma. A good understanding into Southern India this disease entity can help prevent our patients from devastating infections. M.A. Aleem The Tamilnadu Dr.M G R Medical University Chennai, Dhanalakshami doi:10.1016/j.jns.2019.10.783 Srinivasan Medical College Perambalur, ABC Hospital Trichy Neurology, Trichy, India ARTICLE IN PRESS

14 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Objectives / background (42.15%) were female. In this, about 19% of Patients had focal Seizures in adolescents are not uncommon There are many seizures with evidence of focal seizures in 8 patients in EEG and LifeStyle Changes in this age group and which can Precipitate normal imaging finding. Analysis of Precipitating factors showed Seizures in certain circumstances. The study of seizures in these sleep deprivation in 41% of male and 33% of female. Alcohol played a age group is very much helpful for their future and their lifestyle role in 12% of male and 1% of female. Menstruation related seizures modifications. were in 3% of girls/History of fibril seizures were noted in 26% of female and 24% male. Method This prospective study was done in adolescents with seizure for Conclusion one year in 2018 at ABC hospital Trichy and KM crescent hospital In Adolescent with seizures sleep deprivation due to excessive Thuvarankurichi to find out the various precipitating factors for the cell phone usage, in night, prolonged computer and net surfacing in onset of seizures along with routine investigations for seizures night, prolonged studies in night and worries are the common causes, Significant number of patient also had fibril seizures. Results In 2018 about 1254 cases of seizures in the age group of 15 to 60 doi:10.1016/j.jns.2019.10.786 years were analyzed. Among then 344( 36.44%) were in the adolescent age group. Out of them 201(58.43%) were male and 143 (42.15%) were female. In this, about 19% of Patients had focal seizures with evidence of focal seizures in 8 patients in EEG and normal imaging finding. WCN19-0198 Analysis of Precipitating factors showed sleep deprivation in 41% of male and 33% of female. Alcohol played a role in 12% of male and 1% of female. Menstruation related seizures were in 3% of girls/History of Poster shift 02 - Autoimmune disorders - Part I /CNS infections - fibril seizures were noted in 26% of female and 24% male Part I / Dementia - Part I /Epilepsy - Part I / Health economics and outcomes/ Neuroepidemiology and environmental and other Conclusion In Adolescent with seizures sleep deprivation due to excessive A study of seizures in rural adolescents from Trichy Tamilnadu cell phone usage, in night, prolonged computer and net surfacing in Southern India night, prolonged studies in night and worries are the common fi fi causes, Signi cant number of patient also had bril seizures. M.A. Aleem The Tamilnadu Dr.M G R Medical University Chennai, Dhanalakshami doi:10.1016/j.jns.2019.10.785 Srinivasan Medical College Perambalur, ABC Hospital Trichy Neurology, Trichy, India

Objectives / background WCN19-0195 Seizures in adolescents are not uncommon There are many LifeStyle Changes in this age group and which can Precipitate Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Seizures in certain circumstances. The study of seizures in these age group is very much helpful for their future and their lifestyle Part I / Dementia - Part I /Epilepsy - Part I / Health economics and modifications. outcomes/ Neuroepidemiology and environmental and other Method A study of seizures in rural adolescents from Trichy Tamilnadu This prospective study was done in adolescents with seizure for Southern India one year in 2018 at ABC hospital Trichy and KM crescent hospital Thuvarankurichi to find out the various precipitating factors M.A. Aleem for the onset of seizures along with routine investigations for The Tamilnadu Dr.M G R Medical University Chennai, Dhanalakshami seizures Srinivasan Medical College Perambalur, ABC Hospital Trichy Neurology, Trichy, India Results In 2018 about 1254 cases of seizures in the age group of 15 to 60 Objectives / background years were analyzed. Among then 344( 36.44%) were in the Seizures in adolescents are not uncommon There are many adolescent age group. Out of them 201(58.43%) were male and 143 LifeStyle Changes in this age group and which can Precipitate (42.15%) were female. In this, about 19% of Patients had focal Seizures in certain circumstances. The study of seizures in these seizures with evidence of focal seizures in 8 patients in EEG and age group is very much helpful for their future and their lifestyle normal imaging finding. Analysis of Precipitating factors showed modifications. sleep deprivation in 41% of male and 33% of female. Alcohol played a role in 12% of male and 1% of female. Menstruation related seizures Method were in 3% of girls/History of fibril seizures were noted in 26% of This prospective study was done in adolescents with seizure for female and 24% male one year in 2018 at ABC hospital Trichy and KM crescent hospital Thuvarankurichi to find out the various precipitating factors for the Conclusion onset of seizures along with routine investigations for seizures. In Adolescent with seizures sleep deprivation due to excessive cell phone usage, in night, prolonged computer and net surfacing in Results night, prolonged studies in night and worries are the common In 2018 about 1254 cases of seizures in the age group of 15 to 60 causes, Significant number of patient also had fibril seizures. years were analyzed. Among then 344( 36.44%) were in the adolescent age group. Out of them 201(58.43%) were male and 143 doi:10.1016/j.jns.2019.10.787 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 15

WCN19-0223 cTechnoSuruga Laboratory Co.- Ltd, R&D Department, Shizuoka, Japan dTohoku University, Graduate School of Agricultural Science, Laboratory of Food and Biomolecular Science, Department of Bioscience and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Biotechnology for Future Bioindustries, Sendai, Japan Part I/Dementia - Part I/Epilepsy - Part I/Health economics and eNational Center for Geriatrics and Gerontology, Medical Genome outcomes/Neuroepidemiology and environmental and other Center, Obu, Japan

Disseminated haematogenous tuberculosis mimicking a transient Background ischaemic attack Recent studies have revealed an association between dysregula- tion of the gut microbiomeand dementia. However, such association S. De Alwisa, B. Senanayakea, H. Fernandob with mild cognitive impairment (MCI), a very early stage of cognitive aInstitute of Neurology, National Hospital of Sri Lanka, Colombo, Sri decline, has not yet been clarified. Lanka bNational Hospital of Sri Lanka, Ministry of Health, Colombo, Sri Lanka Methods We cross-sectionally analysed associations between the gut A transient ischaemic attack (TIA) is an episode of neurologic microbiome and MCI. Information on patient demographics, risk dysfunction caused by focal brain, spinal cord or retinal ischemia factors, activities of daily living, cognitive function, and brain without acute infarction. Atherosclerotic arterial disease, cardiogenic imaging were collected. The gut microbiome was assessed by embolism and small arterial disease secondary to hypertension are terminal restriction fragment length polymorphism analysis, one of responsible for the great majority of TIAs. the most well-established and reliable 16S ribosomal RNA-based We report a 54-year-old patient with a history of right face, arm methods. We performed multivariable logistic regression models to & leg paresis for a period of 3 hours with spontaneous recovery. identify the items independently associated with MCI. We also used His past medical history revealed a debilitating back pain for the graphical modelling to illustrate mutual associations with MCI and past 6 months, poorly responsive to analgesics resulting in him being these items. bed bound. During his ward stay intermittent spikes of low-grade fever was recorded. Results On routine post stroke/TIA work up, his 2D echocardiogram We analysed 82 eligible patients (female: 52.4%, mean age: 73.9 revealed a moderate pericardial effusion with early right atrial years, mean MMSE score 27), with 61 patients exhibiting MCI. collapse. Following pericardiocentesis, a Contrast Enhanced CT chest Patients with MCI had a higher prevalence of Bacteroides (55.7% vs. was obtained to ascertain the cause for the effusion and revealed 19.1%, P = .009). Further, patients with more Bacteroides were more multiple miliary nodules throughout the lung fields. likely to have higher prevalence of white matter hyperintensity An MRI study of the brain with contrast showed multiple high (34.4% vs. 4.8%, P = .009) and a high voxel-based specific regional signal intensity lesions bilaterally in the deep white matter analysis system for Alzheimer's Disease (VSRAD) score (median compatible with miliary lesions and Spinal imaging showed active score, 0.96 vs. 0.52, P = .01), indicating cortical and hippocampal Tuberculosis spondylitis in the D11/12 region. atrophy. Multivariable logistic regression analysis revealed that A presumptive diagnosis of disseminated haematogenous TB greater prevalence of Bacteroides was independently associated with (miliary TB) was made based on the aforesaid findings on imaging. the presence of MCI (odds ratio 5.36, 95% confidence interval, 1.30– This was supported by a strongly positive mantoux test. The patient 28.7, P = .019). Graphical modelling also showed a close association was started on anti-tuberculous chemoprophylaxis to which his between Bacteroides and MCI. condition responded both clinically and radiologically. This case highlights how even a transient ischemic attack in an Conclusions otherwise healthy patient can have several etiologies including TB in Increased prevalence of Bacteroidesis independently associated an endemic region. with the presence of MCI in patients without dementia. doi:10.1016/j.jns.2019.10.788 doi:10.1016/j.jns.2019.10.789

WCN19-0224 WCN19-0225

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I/Dementia - Part I/Epilepsy - Part I/Health economics and Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/Neuroepidemiology and environmental and other outcomes/neuroepidemiology and environmental and other

The relationship between the gut microbiome and mild cognitive Anti-NMDA receptor encephalitis; a psychiatric manifestation of impairment in patients without dementia: A cross-sectional study autoimmune process conducted in Japan M. Gaharu, N. Afany, A. Rahmatya N. Sajia, K. Murotanib, T. Hisadac, T. Tsudukid, T. Sugimotoa,A. Raden Said Sukanto Hospital, Neurology, Dki Jakarta, Indonesia Kimuraa, S. Niidae, K. Tobaa, T. Sakuraia aNational Center for Geriatrics and Gerontology, Center for Comprehen- Background sive Care and Research on Memory Disorders, Obu, Japan Anti-N-methyl-d-Aspartate (anti-NMDA) receptor encephalitis is bKurume University, Graduate School of Medicine, Biostatistics Center, an encephalitis that cause by autoimmune process and rarely found Kurume, Japan in Indonesia. The symptoms may be different from other causes of ARTICLE IN PRESS

16 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx encephalitis. With predominant psychiatric symptoms such as WCN19-0236 personality changes, seizure, and movement disorders. The diagnosis of encephalitis is frequently delayed as it misdiagnosed as psychiatric problem. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Methods outcomes/neuroepidemiology and environmental and other We reported a young woman who studied in boarding school with anti-NMDA receptor encephalitis. She got behaviour changes Visual-verbal paired associate memory in mild cognitive impair- worsened in 4 months. Her family assumed that she was bullied by ment: A neuropsychological and brain volumetric study her school friends. S. Nandaa, R. Menonb, S. Kumaric, N. Mohanb, C. Kesavadasc Results aAyushman Hospital and Health Services, Neurology, New Delhi, India A 13-year-old female presented with complaining of fever and bSree Chitra Thirunal Institute of Medical Sciences and Technology, behavior changes. After several days in wards she got lips smacking, Neurology, Trivandrum, India spasticity, seizure, and followed by decreased consciousness. She was cSree Chitra Thirunal Institute of Medical Sciences and Technology, IS consult to neurologist and we found her mental status was delirium, and IR, Trivandrum, India spastic without paresis, and positive in Babinski sign. Brain CT-scan reported as early abscess in right periventricular. CSF analysis result Purpose relatively normal. Electroencephalography (EEG) showed diffuse 1. To assess visual and verbal paired associative learning; famous slow wave. We checked serum anti-NMDA receptor and the result faces recognition ability among subjects with stable amnestic was positive. She was treated with intravenous immunoglobulin mild cognitive impairment (MCI) relative to early stage dementia ﬁ (IVIG) and methyl prednisolone as rst line therapy. After completed due to Alzheimerʼs Disease (AD) and cognitively normal controls theraphy she was discharged home and drastically improved. (NC) 2. To correlate these differences with volumetric differences on MRI. Conclusions Anti-NMDA receptor encephalitis sometimes misdiagnosed as Methods psychiatric problem. Detection of antibodies anti NMDA receptors in Hospital-based cross sectional observational study was conducted ﬁ serum or CSF are important for de nitive diagnose. Right diagnose on 61 participants. Subjects underwent neuropsychological evalua- will lead to responsive treatment and good prognosis. tion, including validated newly-designed tests for novel face name paired association learning-recall; verbal paired associate learning doi:10.1016/j.jns.2019.10.790 and famous faces recognition. MRI volumetry was done on a subset of patients. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 17

Results annualized relapse rate (ARR) pre- Rituximab was 16.9 compared There were significant differences in free recall scores for face- to 2.4 in an international study while the mean ARR post-Rituximab name paired associate learning in MCI (N = 22) compared to NC (N was 1.6 compared to 0.1 (p-value of 0.001).There was 1 patient who = 20) (p b 0.001) and to AD (N = 19) (p b 0.001). Performance in was initially seropositive then later converted to seronegative at the Verbal paired associate learning (WMS-paired associate scores) was last follow-up. No adverse effects were reported. significantly lower in MCI when compared to NC (p = 0.040) and higher compared to AD (p = 0.002) as were scores in famous Conclusion personalities test between MCI and NC (p = 0.007), MCI and AD (p Rituximab was effective in reducing relapse rates among Filipino = 0.032). The free recall component of face-name pair associative NMOSD patients with no reported adverse effects. fi learning signi cantly correlated with left cuneus (p=0.005; doi:10.1016/j.jns.2019.10.792 r=0.833) and right cuneus (p = 0.003; r = 0.861) volume in AD with no significant correlation among MCI and NC cohorts. The verbal paired associate learning scores had a positive correlation with right cuneus volume (p = 0.002; r = 0.871) in AD cohort only. WCN19-0249 Conclusions Novel and semantically-familiar face-name associative recall; Poster shift 02 - Autoimmune disorders - Part I/CNS infections - fi verbal paired associate learning are signi cantly impaired in MCI Part I/dementia - Part I/epilepsy - Part I/health economics and and these potentially pre-date the MRI-volumetric changes in MCI. outcomes/neuroepidemiology and environmental and other Our findings indicate the utility of associative learning-recall measures in MCI to delineate subjects at risk of longitudinal Modulation and role of brain neurotransmitters in pilocarpine- progression. induced seizures in the rat doi:10.1016/j.jns.2019.10.791 N. Kumar, R. Khanna Vivekananda Global University, Department of Basic and Applied Biology, Jaipur, India WCN19-0239 Background Epilepsy, a group of serious disorders of the central nervous Poster shift 02 - Autoimmune disorders - Part I/CNS infections - system characterized by a predisposition to recurrent unprovoked Part I/dementia - Part I/epilepsy - Part I/health economics and seizures due to abnormal excessive synchronous neural activity. outcomes/neuroepidemiology and environmental and other Animal models of pilocarpine-induced seizures have been employed to demonstrate that ongoing epileptic activity in the brain can affect Effectiveness of rituximab in reducing relapse among Filipino both excitatory and inhibitory synapses and thus neuronal plasticity. neuromyelitis optica patients Neurotransmitters play a vital role in the functioning of brain. Our study aimed to investigate the changes in brain neurotransmitters in Wistar rat models of pilocarpine-induced seizures. G. Mandigma, L. Damian St. Luke's Medical Center, Institute for Neurosciences, Metro Manila, Methods Philippines Total 75 animals of pilocarpine-induced seizures models for epilepsy were studied. Behavioral, electroencephalographic and Background morphological changes induced by systemic administration of Neuromyelitis optica (NMO) is an autoimmune disease with a pilocarpine hydrochloride were studied in 3–90-day-old rats. relapsing progressive course, which result to disability. Recent Pilocarpine, 100, 200 and 380 mg/kg, presented a characteristic array evidence points to repeated treatment with Rituximab as effective of behavioral patterns in developing rats. Determination of brain in reducing relapse rates. Currently, there is no local data regarding norepinephrine, Gamma-aminobutyric acid (GABA), dopamine and the effectiveness of Rituximab in adult Filipino patients. serotonin was carried out using high performance liquid chroma- tography (HPLC) system, Agilent technologies 1100 series. Methods A retrospective cohort study of Filipino patients diagnosed with Results NMOSD and treated with at least 1 Rituximab infusion and a The mean values of brain norepinephrine, dopamine and minimum of 6 months follow-up from August 2013 until September serotonin levels in pilocarpine-induced seizures rat brain were 2018 in a private tertiary hospital was done through records review. significantly increased compared to control group, which conse- Patients who were lost to follow-up for 2 years were excluded. The quently, may reduce seizure susceptibility and epilepsy comorbidi- primary outcome was the effectiveness of rituximab, defined based ties. There was a significant decrease in Gamma-aminobutyric acid on the comparison of Annualized Relapse Rate (ARR) before and (GABA) values in treatment group compared to control. after Rituximab infusion. Seroconversion of anti-aquaporin 4 antibody and the safety profile of Rituximab were secondary outcomes. Conclusion Neurotransmitters play a vital role in brain functioning and also Results have important function in epilepsy status. Among 23 qualified patients, 21 (91.3%) were female. The mean age of the participants was 46.1 years old.The number of patients doi:10.1016/j.jns.2019.10.793 relapse-free during rituximab treatment was 69.5%. The mean ARTICLE IN PRESS

18 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0250 bSchool of Information Systems, University of New South Wales- UNSW, Technology and Management, Sydney, Australia cAlbert Einstein College of Medicine, Neurology, New York, USA Poster shift 02 - Autoimmune disorders - Part I/CNS infections - dUniversité de Paris- AP-HP, Pharmacology, Montrouge, France Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other As the global population ages, there has been an explosive (and continuing) growth in the incidence of Alzheimer’s disease (AD). Is Acute hearing loss and tinnitus as relapse symptoms of multiple research (as seen through publications) keeping up with the medical sclerosis and socio-economic challenges posed by AD? Towards this end, our paper charts the growth of the AD literature by analyzing in five-yearly A. Jori Birkas periods from 1983-2017 articles retrieved from the SCI-Expanded National Institute of Clinical Neurosciences Hungary, Neurology, database of the Web of Science. During the past 35 years, articles on AD Budapest, Hungary have increased 46-fold (1,095 papers in 1983–1987 to 50,532 in 2013– 2017), accelerating especially during the last 20 years. Simultaneously, Introduction the number of journals containing AD-papers increased 14-fold (227 Acute hearing loss is the most frequent auditory problem in journals in 1983–1987 to 3,257 in 2013–2017). In 2013–2017, the ten multiple sclerosis (MS). While acute hearing loss is a relatively rare most productive journals concentrated 19% of the AD literature (7% in relapse symptom; approximately diagnosed in only 1% of MS three AD-focused journals: The Journal of Alzheimer’s Disease, patients, the incidence rate as initial symptom could exceed the 10%. Alzheimer’s & Dementia and Current Alzheimer Research), while nearly As relapse symptom, the major features of acute hearing loss are two-thirds of the journals published five or fewer AD papers. The the unilateral appearance, the involvement of central auditory number of countries with publications on AD has grown from 27 in pathway and the pathological evoked potentials. 1983–1987 to 152 in 2013–2017. The USA was by far the most prolific country; however, its share decreased from 43% in 1983–1987 to 33% Materials and methods in 2013–2017. Several EU countries (Germany, UK, Italy and France), 39-year old female patient was admitted to our neurology English-speaking countries (Canada and Australia), and Japan follow department with acute left sided tinnitus and hearing loss. She has behind the USA in productivity; however, by the end of the 1990s, been suffering from relapsing-remitting MS since 4 years. several Asian countries (China, South Korea and India) have emerged Audiometry showed intact hearing threshold on the right side, as important contributors of AD research. This study reveals an while on the left, until 500 Hz mild-and moderate level, above 500 increasing concern worldwide in the various challenges of AD. Hz mixed type hypacusis has been observed. doi:10.1016/j.jns.2019.10.795 Results Audiometry pointed out deficit loss of hearing on the left, electrophysiological examination revealed ponto-bulbar, ponto-mes- encephalic deficiency on the left side and brain imaging illustrated WCN19-0259 the involvement of central auditory pathway in the background of the relapse symptom. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Following therapy, the subjective improvement of the complaints corresponded well to the results of control examinations. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Conclusion Acute hearing loss is a rare, frequently reversible relapse Skin-adhesive extracranial photobiomodulation improved mem- symptom of MS and could be followed with objective diagnostic ory and depression in mild cognitive impairment: A randomized, approaches until the phase of complete reconvalescence. controlled, single-blind pilot study The importance of audiological, otoneurological and BAEP examinations might be underestimated in MS. More frequent N.G. Kima, W. Jeonga, C. Heob, K.J. Parka, J.R. Leea, M.H. Ryuc, J. Kimd,K. application of these methods is a promising future direction for the Pake, Y.H. Kimf, Y.I. Shing better understanding and treating of MS. aColor Seven Co.- Ltd, Medical Research Center, Seoul, Republic of Korea bInstitute for Basic Science, Center for Integrated Nanostructure Physics, doi:10.1016/j.jns.2019.10.794 Suwon, Republic of Korea cChonbuk National University, Division of Biomedical Engineering, Jeonju, Republic of Korea dSamsung Advanced Institute for Health Science and Technology- WCN19-0251 Sungkyunkwan University, Department of Health Sciences and Technol- ogy, Suwon, Republic of Korea ePusan National University Hospital, Department of Nuclear Medicine, Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Pusan, Republic of Korea Part I/dementia - Part I/epilepsy - Part I/health economics and fSamsung Medical Center-Sungkyunkwan University School of Medicine, outcomes/neuroepidemiology and environmental and other Department of Physical and Rehabilitation Medicine-Center for Preven- tion and Rehabilitation- Heart Vascular Stroke Institute, Seoul, Republic Evolution of the scientific and medical literature on Alzheimer's of Korea disease from 1983 to 2017: A bibliometric analysis gSchool of Medicine- Pusan National University- Pusan National University Yangsan Hospital, Department of Rehabilitation Medicine- C. Roberta, C. Wilsonb, R. Liptonc, C.D. Arretod Research Institute for Convergence of Biomedical Science and Technol- aGliaxone- Université de Paris, Pharmacology, Paris, France ogy, Yangsan, Republic of Korea ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 19

Background Lack of successful treatments for mild cognitive impairment (MCI) and dementia underlines the need for new effective and safe treatments.

Objective We developed a new intervention modality to improve cognitive decline in MCI patients by applying a skin-adhesive extracranial photobiomodulation.

Patients and methods/material and methods 22 MCI patients and 24 healthy volunteers were allocated into four groups according to stimulation sites. All participants received treatments for 4-week (once per day) and were administered neuropsychological assessments before and after treatments. Light (610 nm, 3 mW/cm2) was applied to the skin over carotid artery (CA) or/and vertebral artery (VA) on the neck through two small skin-adhesive LED units for 30 min. Ten healthy volunteers underwent SPECT scans to measure regional cerebral blood flow (rCBF) at baseline and under irradiation. Methods We conducted educational program for the families, consisting of Results the lectures about the definitions, subgroups, symptoms and courses After 4-week treatment, MCI patients showed improvement of of dementia. We moreover explained the differences between the memory and depression compared with those in placebo group: CA unimprovable core features of dementia and the improvable in memory (P = 0.01); VA in a general cognition (P = 0.03); CA + behavioral and psychological symptoms of dementia. We finished VA in memory (P = 0.01), all three groups in a depression (P = our lecture with teaching them how to response to each symptom of 0.01). Healthy volunteers improved memory in VA and CA groups (P dementia patients. We administered the Zarit Burden Interview (ZBI) b 0.05). Adverse effects after 4-week treatment were rarely reported. to the families before and one month after the program. rCBF increased in multiple brain regions compared to baseline images (P b 0.005) including the prefrontal, frontal, temporal, and Results occipital areas under irradiation. Twenty six families joined our educational program. The diagnosis of the patients were 21 dementias of Alzheimer type, 2 dementias Conclusion with Lewy body, 1 argyrophilic grain dementia, 1 frontotemporal Results suggest that long-term skin-adhesive extracranial photo- lobar degeneration and 2 other dementias. They were 10 males and biomodulation can be a safe and effective treatment modality for MCI 16 females, and 79.4 ± 6.7 years. The mean score of total ZBI was to improve cognitive dysfunction and mood, presumably by 30.0 before, and 30.5 one month after the program. The mean total enhancing CBF. scores of ZBI increased, but the role strain scores slightly decreased (Graph). doi:10.1016/j.jns.2019.10.796 Conclusion Educational program could not decrease all part of familie's burden, but may decrease role part of them. WCN19-0266 doi:10.1016/j.jns.2019.10.797

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other WCN19-0267

The educational intervention on the families having dementia Poster shift 02 - Autoimmune disorders - Part I/CNS infections - patients Part I/dementia - Part I/epilepsy - Part I/health economics and T. Oki, M. Otake, M. Ito, A. Kato, M. Hatoya outcomes/neuroepidemiology and environmental and other Trinity Neurology Clinic, Clinic, Sakura, Chiba, Japan An autopsy case of elderly-onset inﬂuenza-associated encepha- Background lopathy (IAE) Sometimes dementia patients worsen their symptoms and the burden of their families increase. It depends mostly on the familie's Y. Tanakaa, H. Takanoa, N. Nakajimab, H. Kobayashic lacking of knowledge about dementia and their inadequate care. aTachikawa General Hospital, Department of Neurology, Nagaoka city, Niigata, Japan Objective bNational Institute of Infectious Diseases, Department of Pathology, In order to the families can give adequate care to their dementia Shunjuku-ku, Tokyo, Japan patients and decrease the familie's burden, we planned an educa- cTachikawa General Hospital, Department of Pathology, Nagaoka city, tional program on the families. Niigata, Japan ARTICLE IN PRESS

20 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

A 75-year-old man presenting disturbance of consciousness and WCN19-0275 slight fever was admitted to our hospital. Two days before admission, he presented with dizziness and after then his consciousness gradually became worse. His past history included hypertension Poster shift 02 - Autoimmune disorders - Part I/CNS infections - and lower back pain. On admission, the state of his consciousness Part I/dementia - Part I/epilepsy - Part I/health economics and was GCS7 (E2V1M4). But in 3 hours, he fell into deep coma of GCS 5. outcomes/neuroepidemiology and environmental and other Laboratory examination only showed a slight increase in C-reactive protein (1.40mg/dL). Cerebrospinal fluid was colorless with cell Efficacy and tolerability of lacosamide as addition therapy in count of 1/μL, glucose of 73 mg/dL and protein of 106 mg/dL. pediatric population with refractory epilepsy Magnetic resonance imaging showed bilateral high intensity signals in the dorsal brain stem, the thalami and the cerebral cortices on J.I. Castro Macias, J. Vázquez-Briceño, R.E. Melo-Ventura, M.O. Diaz- FLAIR. The influenza test was positive for type B. We diagnosed acute Campos necrotizing encephalopathy (ANE) of influenza-associated encepha- Hospital Regional de Alta Especialidad del Bajio, Neuroscience Depart- lopathy (IAE). We treated him with peramivir and high-dose ment, Leon, Guanajuato, Mexico intravenous pulse methylprednisolone therapies. But he developed respiratory failure, and we intubated and placed him on a ventilator. Objective We added high-dose intravenous immunoglobulin therapy. Never- To assess the long-term efficacy and tolerability of lacosamide theless, his condition deteriorated, and he had status epilepticus (LCM) as adjunctive treatment through a retrospective study in frequently. He died on the 11th hospital day. Post-mortem exami- children and adolescents with refractory epilepsy. nation revealed massive brain edema and widespread necrosis in the fl fi bilateral thalami, and in ammatory cell in ltration was not observed Methods fi in brain parenchyma. Glial brillary acidic protein- immunostaining All patients consecutively treated with LCM as add-on for fi revealed clasmatodendrosis. These ndings were consistent with the refractory focal and generalized epilepsy and followed who received previous IAE reports. There have been only a few autopsy cases with follow up in our institution between January 2016 and December elderly-onset IAE. This is a very rare autopsy case of elderly-onset 2017 were included in the study. Responder rate, relapse-free fl ANE-IAE with in uenza B infection. survival, and tolerability were assessed by reporting adverse events. doi:10.1016/j.jns.2019.10.798 Results We included 37 individuals (21 female), their mean age was 10 years ([SD +/- 4.09]), median 9, who received add-on LCM treatment for refractory focal and generalized epilepsy. Twenty six WCN19-0274 (70%) responded favorably. Twenty one of the 26 responders were seizure-free at twelve months of follow-up. A logistic regression analysis was carried out finding that the number of antiepileptic Poster shift 02 - Autoimmune disorders - Part I/CNS infections - dugs had an impact on response rate; other factors that were Part I/dementia - Part I/epilepsy - Part I/health economics and significantly different between responders and nonresponders in this outcomes/neuroepidemiology and environmental and other study included older age at the time of lancosamide initiation and the duration of epilepsy. Kaplan-Meier survival estimates for Prolonged status epilepticus as a first symptom of a negative probability to remain responders at twelve months of follow up, antibody autoimmune disease – A case report showed that age of onset and duration of epilepsy has a negative impact on seizure freedom. The most common adverse events were A. Feitosaa, C. Assunçãob, T. Yoshidaa, J.R. Sabbaga, T. Araujoa,E. neuropsychiatric symptoms (8 %) and nausea (3 %). Londonc aVita Batel Hospital, Neurology, Curitiba, Brazil Conclusions bAngelina Caron Hospital, Neurology, Curitiba, Brazil Current evidence shows lacosamide as a good option in pediatric cVita Batel Hospital, Head of Departament of Neurology, Curitiba, Brazil patients with refractory epilepsy as add-on therapy given its efficacy on seizure control and safety profile. Neuropsychiatric symptoms Status epilepticus can be a symptom of activity in some were the main cause of treatment abandonment and not response autoimmune diseases, such as Lupus or Autoimmune Encephalitis, failure. this presentation usually occurs in patients with previous diseases. Hence, it was very unusual to have a healthy young woman, with no doi:10.1016/j.jns.2019.10.800 history of any previous disease, admitted with a refractory status epilepticus that lasted approximately 22 days. It was the first symptom and tests came without any positive antibody on blood or cerebrospinal fluid (CSF). Status epilepticus is a frightening and WCN19-0276 difficult situation for any physician. In order to be appropriately treated, it needs to have its underlying cause identified. The aim of this article is to report a case of a 24 years old, female, without any Poster shift 02 - Autoimmune disorders - Part I/CNS infections - known disease who develops a status epilepticus as the first Part I/dementia - Part I/epilepsy - Part I/health economics and symptom of a possible autoimmune disease negative antibody in outcomes/neuroepidemiology and environmental and other CSF, with a fortunate good outcome. Detection of vertebrobasilar insufficiency by using color-coded doi:10.1016/j.jns.2019.10.799 Doppler sonography in patients with isolated vertigo ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 21 ARTICLE IN PRESS

22 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

A.M. Nyeina, A.A. Sannb, N.N. Ayec, P.P. Layb Neurosarcoidosis, Behcet’s disease, SLE,Idiopathic hypertrophic aNorth Okkalapa General and Teaching Hospital, Department of pachymeningitis or IgG4 related hypertrophic pachymeningitis. Neurology, Yangon, Myanmar, Burma bUniversity of Medicine 2, Department of Neurology, Yangon, Myanmar, Keywords: Hypertrophic pachymeningitis, Focal seizure, SLE, Hy- Burma pertrophic pachymeningitis cUniversity of Medicine 2, Department of Radiology, Yangon, Myanmar, Burma doi:10.1016/j.jns.2019.10.802 Background and objectives Data regarding the use of color-coded Doppler sonography (CCDS) with transcranial insonation in screening of isolated vertigo of vascular origin is limited. The primary objective of this study was WCN19-0287 to detect vertebrobasilar insufficiency (VBI) by using color-coded Doppler sonography in patients with isolated vertigo. Methods: This Poster shift 02 - Autoimmune disorders - Part I/CNS infections - study was a hospital-based cross-sectional comparative study conducted on 91 patients with isolated vertigo. All patients who Part I/dementia - Part I/epilepsy - Part I/health economics and fulfilled selection criteria were chosen using systemic sampling outcomes/neuroepidemiology and environmental and other method. CCDS with transcranial insonation as well as CTA (Com- puted tomographic angiography) was performed when their symp- Treatment satisfaction with botulinum toxin in different neuro- toms resolve or within one week of attending the hospital. Results:In logical disorders: A clinic-based study this study of 91 participants, 29.7% were found to have VBI. Mean age of patients with confirmed VBI was 65.74 ± 12.23 years while that of D. Youssrya, J. al hashelb, I. Ibrahimb, S. Ahmedb patients without VBI was 55.02±9.97 years. Correlation between aCairo University, Neurology, Cairo, Egypt CCDS and CTA was good in terms of detection of stenosis depending bIbn Sina Hospital, Neurology, Kuwait, Kuwait on the site of stenosis (kappa = 0.698, p b 0.0001) and strong in fi terms of detection of vertebrobasilar insuf ciency (kappa = 0.831, p Introduction b 0.0001). Compared to CTA, CCDS was found to have sensitivity of Botulinum toxin BTX is safe and effective treatment in a variety of fi 77.7%, speci city of 100%, positive predictive value (PPV) of 100% neurologic conditions. Many factors affect successful outcome such and negative predictive value (NPV) of 91.4%. Conclusion: The as injector experience, patients' feedback and satisfaction. prevalence of isolated vertigo of vascular origin is significant and it is worth evaluating. CCDS with transcranial insonation has a strong Objective fi overall agreement with CTA as well as high speci city and positive To characterize overall patients /caregivers satisfaction with BTX predictive value compared to CTA in detecting vertebrobasilar treatment for symptom control. insufficiency. Methods doi:10.1016/j.jns.2019.10.801 A cross-sectional survey included all patients who received at least two BTX sessions in our injection clinic. We asked them to rate overall treatment satisfaction at the peak of treatment effect on a 1 to 10 scale. WCN19-0283 Results A total of 548 patients were included; Headache disorders 240 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - (43.7%) patients; chronic migraine 213 (38.9%) and other headache Part I/dementia - Part I/epilepsy - Part I/health economics and disorders 27 (4.9%), Hemifacial spasm and related disorders 92 outcomes/neuroepidemiology and environmental and other (16.8%); hemifacial spasm (HFS)73 (13.3%), blepharospasm 14 (2.6%) and eyelid opening apraxia 5 (0.9%), primary focal hyperhidro- Hypertrophic pachymeningitis an unusual manifestation of sis (HH)74 (13.5%); axillary 46 (8.4%), palmar 18 (3.3%) and planter 10 systemic lupus erythematosus: A case report (1.8%), Focal dystonia 49 (8.9%); oromandibular dystonia 16 (2.9%), cervical dystonia 15 (2.7%), other focal dystonia 13 (2.4%) and writer’s J. Patel cramp 5 (0.9%), Spasticity 47 (8.65%); adult 29 (5.3%) and children Sumandeep Vidyapeeth, Neurology, Vadodara, India cerebral palsy (CP) 18 (3.3%), sialorrhoea 24 (4.4%), neuropathic pain syndromes 12 (2.2%); trigeminal neuralgia 5 (0.9%) and 7 (1.3%) other Hypertrophic pachymeningitis is a rare inflammatory disease of neuropathic pain syndromes and musculoskletal pain 10 (1.8%). the dura matter characterised by localized or diffuse thickening of Overall satisfaction; for axillary HH (9.2±0.9), palmar HH (8.9 the dura mater with fibrosis. Hypertrophic pachymeningitis is often ±1.0), blepharospasm (8.6±0.9), other neuropathic pain syndromes secondary to infections, carcinomatosis or inflammatory diseases. It (8.6±1.3), planter HH (8.3±1.3), trigeminal neuralgia (8.2±1.6), HFS may also be idiopathic. We report a case of pachymeningitis which (7.9±1.4), eyelid opening apraxia (7.6±1.1), chronic migraine (7.2 was A 45-year-old female presented with left-extremity focal ±2.0), CP (7.1±1.6), musculoskeletal pain (6.8±1.7), oromandibular seizure. MRI revealed diffuse pachymeningeal thickening showing dystonia (6.8±2.8), other headache disorders (6.5±2.1), sialorrhoea intense post contrast enhancement involving falx cerebri and along (6.5± 2.9), spasticity (6.4±1.8), other focal dystonia (6.1±1.6), bilateral fronto-parietal convexities. These findings suggest either cervical dystonia (5.6±2.4), and writer’s cramp (4.4±2.7) ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 23

Conclusions Methods The highest satisfaction observed with primary focal HH, and the In this cross-sectional study, we enrolled 62 PD, 27 AD and 52 least with focal dystonia disorders. These surveys indicate that controls from Phramongkutklao Neurology clinic. Odor identification patients’ satisfaction with BTX is overall good. kit with 8 familiar-to-Thai odors was used to evaluate odor scores. To assess disease severity, Thai Mental State Examination, Functional doi:10.1016/j.jns.2019.10.803 Assessment Staging Test, The Lawton Instrumental Activities of Daily Living Scale, Thai Neuropsychiatric Inventory Questionnaire were applied in AD patients. While PD patients were evaluated using modified Hoehh & Yahr staging and Unified Parkinson’s Disease WCN19-0288 Rating Scale part I and II. Kruskal-Wallis test as a rank-based nonparametric test was performed to determine difference of odor scores between groups. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Results outcomes/neuroepidemiology and environmental and other A total 141 volunteers were included in the analysis. PD and AD patients had significantly lower scores compared with controls. The Agenesis of the corpus callosum: A rare association with Ehlers- analysis also revealed significantly lower scores in PD compared with Danlos syndrome controls between 51-60 years of age. There was no correlation between the scores and disease severity in both disease groups. M. Afrakhteh, F. Haji-akhoundi, M. Almasi-dooghaee, Z. Mirzaasgari Iran university of medical science, Firouzgar hospital-neurology ward, Conclusions fi Tehran, Iran Phramongkutklao odor identi cation kit is applicable as a supplementary tool to diagnose patients with PD and AD. Ehlers-Danlos syndrome (EDS) is a rare congenital disorder of doi:10.1016/j.jns.2019.10.805 connective tissues which involves skin and musculoscleletalsystem. There are also some reports for involvement of central and peripheral nervous system. We want to present a very rare co- association of EDS, spondylolisthesis and Agenesis of the corpus callosum in an Iranian lady. WCN19-0313

Keywords: Ehlers-Danlos syndrome, Spondylolisthesis, Agenesis of Poster shift 02 - Autoimmune disorders - Part I/CNS infections - the corpus callosum Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.804 Psychosocial problem of people with epilepsy in Ulaanbaatar of Mongolia

WCN19-0311 B. Dagvadorja, T. Avirmedb aThe Central Hospital of the Khuvsgul Province, Neurology, Khuvsgul, Mongolia Poster shift 02 - Autoimmune disorders - Part I/CNS infections - bMongolian National University of Medical Sciences, Neurology, Ulaan- Part I/dementia - Part I/epilepsy - Part I/health economics and baatar, Mongolia outcomes/neuroepidemiology and environmental and other Background Odor identiﬁcation kit as a diagnostic tool for patients with Epilepsy is a common neurological disease, which need to health Parkinson's and Alzheimer's disease care and public health service topicality that is a very important for people with epilepsy (PWE). K. Paurika, P. Sithinamsuwan, N. Namphol, L. Cheewakriengkrai Phramongkutklao Hospital, Neurology division Department of Medicine, Purpose Bkk, Thailand To investigate psychosocial problem of the people with epilepsy.

Introduction Method Olfactory dysfunction has been described in preclinical stages of 77 patients were included in our study. In order to identify certain neurodegenerative diseases. The association has been psychosocial problems we used the Beck Depression Inventory (BDI), described in Alzheimer’s disease (AD) and Parkinson’s disease (PD). the Beck Anxiety Inventory (BAI) and a ten-item measure of felt However, there are no standard methods in Thailand to study the stigma for this cross-sectional study. olfactory dysfunction among these groups of patients. Result Objectives There were 46.8% female, 44.2% were married, 75.3% unemploy- Primary: to verify Phramongkutklao odor identiﬁcation kit as an ment. The frequencies of anxiety symptoms in PWE were 31.2% very accurate tool to identify patients with early and established AD and anxiety, 32.5% anxiety and 36.4% not anxiety, the rates of depressive PD. Secondary : to ﬁnd correlations between degree of olfactory symptoms in PWE were 18.2% very depressed, 19.5% depressed and dysfunction with patient characteristics and severity of the two 62.3% not depressed, respectively. All of the 62.3% PWE felt stigma. diseases. Considering the age, psychological problem, some of the variables of ARTICLE IN PRESS

24 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx the participants, the age of the people with epilepsy was associated WCN19-0332 with depression and the stigma scores, negatively. (r= -0.2 p=0.05; r = -0.2 p=0.05). There are relationships between stigma and anxiety, depression, social-interaction of the attitude scores in PWE. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - – (r= 0.5 p= 0.01; r= 0.5 p= 0.01; r=0.4 p= 0.01). Whereas that the Part I/dementia - Part I /epilepsy Part I/health economics and correlation statistic did not indicate a relationship between the outcomes/neuroepidemiology and environmental and other duration of the epilepsy and anxiety, depression, stigma and social- interaction’s scores Awake epilepsy surgery

Conclusion A. Diwan This reveals that it has positive relationship with social-interac- DR VP Medical College- Nashik, Pediatrics, Nashik, India tion and attitude. Frequency of epileptic seizures induces the anxiety and depression of the people with epilepsy and thus worsens their Epilepsy surgery performed as curative or palliative to control stigmatization. epilepsy by resecting the epileptogenic region while preserving function. In some patients the epileptogenic foci can be involving or Key words: Epilepsy, Anxiety, Depression very next to eloquent cortex. In those patients, Epilepsy surgery becomes challenging and awake surgery is implemented. We present our experience of 2 cases, who underwent doi:10.1016/j.jns.2019.10.806 lesionectomy for epilepsy with awake craniotomy. Both cases had FCD (focal cortical dysplsia in left frontal cortex, near motor strip and Broca’s speech area. Presurgical work up and functional MRI were performed. Intraoperatively under awake conditions, patients were asked to WCN19-0316 move Rt hand or speak continuously. Electrocorticograms (ECoGs) were recorded in both cases before and after the excision of lesion Poster shift 02 - Autoimmune disorders - Part I/CNS infections - (FCD). EcoG information did not change surgical strategy. Postoper- ﬁ Part I/dementia - Part I/epilepsy - Part I/health economics and atively, both patients did not have any neurode cit. 1st patient 18 mths after surgery, is still seizure free. 2nd patient is just 6mths post outcomes/neuroepidemiology and environmental and other surgery and without any seizures. Thus, for patients with epileptogenic foci in and around Pachymeningitis as a presenting manifestation of Wegener`s functionally eloquent areas, awake surgery allows safe and maximal granulomatosis resection of the epileptic foci; intraoperative ECoG evaluation did not changed much of our surgical strategy. Awake craniotomy for D. Hota epilepsy leads to improved seizure control and functional outcomes. West Bengal University of Health Science, Department of Neurology, Burdwan, India doi:10.1016/j.jns.2019.10.808

An 18yr old married female presented with 3 month history of intermittent headache mostly on right side of hemicranium associated with on & off fever along with nausea and vomiting. The pain in WCN19-0342 right side of head is radiating into right inner canthus of eye along with right side of neck. Non diabetic but past history of multiple episodes of epistaxis in the childhood period along with chest Poster shift 02 - Autoimmune disorders - Part I/CNS infections - infections which resulted in multiple local doctor consultation with Part I/dementia - Part I/epilepsy - Part I /health economics and permanent cure. She has normal menstrual cycle. On examination outcomes/neuroepidemiology and environmental and other she has mild pallor. On Cranial nerve examination there is restriction of lateral rectus on right gaze but rest of movement is normal with Comparison of zonisamide with non-levodopa, anti-Parkinson’s pupil normally reacting to light. motor & sensory system normal. disease drugs in the incidence of Parkinson’s disease-relevant There is mild neck stiffness with kernig`s negative. CSF study shows symptoms no pleocystosis with normal protein and sugar showing noninfective nature. As there is history of multiple episode of epistaxis M. Nomotoa, H. Iwakia, M. Tagawab, K. Iwasakic along with that she herself again developed 2-3 episodes of epistaxis aEhime University Graduate School of Medicine, Department of during hospitalisation with normal PT-INR. CT Scan of PNS showed Neurology and Clinical Pharmacology, Ehime, Japan hyperintensity of maxillary sinus margin with HRCT of Thorax bSumitomo Dainippon Pharma Co. Ltd., Medical Affairs, Tokyo, Japan showed granulomatous interstitial lung diseases. So we suspected cMilliman Inc., Japan Healthcare Practice and Data Analytics, Tokyo, Wegener`s granulomatosis (GPA) and sent ANCA proﬁle which came Japan out to be C-ANCA positive. On MRI of Brain & Orbit it showed patchy meningitis at and along the lateral wall of right cavernous sinus Backgrond and objective extending into right temporal bone. Finally we concluded that Patients with Parkinson’s disease (PD) experience various constrast enhancement along cavernous sinus is non-infective with symptoms, both from the disease progression itself and the inﬂammatory lesion most probably due to Granulomatosis with medication. Few large-scale studies have investigated the associa- polyangitis tions between zonisamide and these symptoms. This study com- doi:10.1016/j.jns.2019.10.807 pared zonisamide and other anti-PD drugs by analyzing their associations with the incidence of PD-relevant symptoms. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 25

Methods WCN19-0345 This was a cohort study based on claims data from Diagnosis Procedure Combination hospitals between April 2008 and December 2014 in Japan. Patients were included in the cohort if they were Poster shift 02 - Autoimmune disorders - Part I/CNS infections - diagnosed with PD, aged 40 years or older, and were prescribed anti- Part I /dementia - Part I/epilepsy - Part I/health economics and PD drugs from the same single class without switching to/ outcomes/neuroepidemiology and environmental and other combination use with other drug classes except for levodopa. The outcomes of this study were the incidence of 15 PD-relevant Seizures in adults with tuberculous meningitis during long-term symptoms from the following categories; mental and psychiatric follow-up: Characteristics, outcomes and risk factors symptoms, autonomic nervous system symptoms, motor-related symptoms, and gastric symptoms. The associations between the K. Lia, W. Lanb incidence of these symptoms and the prescriptions of 8 different aThe First Affiliated Hospital- Chongqing Medical University, Neurology classes of anti-PD drugs were explored by the survival analysis. Department, Chongqing, China bChongqing Medical University, Neurology Department, Chongqing, China Results fi In the nal cohort, 9,157 patients with PD (46.3% male) were Background fi included. The zonisamide use was signi cantly associated with a Seizure is a common complication of tuberculous meningitis lower risk of dementia, insomnia, and gastric ulcers than 3 of 7 other (TBM), but few studies have focused on this condition. This study fi classes of non-levodopa drugs at the signi cance level of 0.05. aimed to determine the characteristics and risk factors of adult seizure patients with TBM during long-term follow-up. Conclusion Our analyses indicate there may be a potential clinical impact of Methods zonisamide on some of the PD-relevant symptoms. Patients with TBM who were seen between June 2012 and January 2018 were retrospectively reviewed and were categorized into two doi:10.1016/j.jns.2019.10.809 groups based on the presence or absence of seizures. The seizure ARTICLE IN PRESS

26 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx characteristics, outcomes and potential risk factors were assessed, A. Bhasina, P. Srivastavaa, S. Kumaranb, K. Pawanb, S. Mewarb with a median follow-up of 44.8 months (12.1–72.7 months). aAll India Institute of Medical Sciences, Department of Neurology, Delhi, India Results bAll India Institute of Medical Sciences, Department of NMR, Delhi, India A total of 223 patients (124 male and 99 female) with TBM were enrolled, including 20.6% (46/223) with seizures. Poor outcomes, Background including death and disability, occurred in 56.5% (26/46) of the Stem cell technology and transplantation has helped scientists to patients with seizures compared to 28.2% (50/177) of the patients study its potential role in neural repair and regeneration. This study without seizures (p b 0.001). According to the frequency of the evaluates the functional potential of bone marrow derived mononu- seizures, the patients with seizures were divided into the single clear stem cells (BM-MNC) in chronic ischemic stroke through fMRI seizure (n = 14/46, 30.4%), repetitive seizures (n = 25/46, 54.3%), and & H-NMR spectroscopy. status epilepticus (n = 7/46, 15.2%) groups. We found that non-single seizures (repetitive seizures and status epilepticus) were associated Methods with mortality (P = 0.002, P = 0.022), while single seizure was not Twenty (n = 20) chronic stroke with 3 months to 1.5 years of associated with morality (P = 0.834). In a multivariate analysis, the index event were recruited with MRC grade of hand muscles at least risk factors associated with non-single seizures were cortical involve- 2; Brunnstrom stage: 2–5. These patients were randomized to study ment (p = 0.017) and epileptiform discharges (p ˂ 0.001). group receiving autologous BM-MNC (mean 60–70 million) in one group and other receiving saline infusion/placebo. All patients were Conclusion administered with neuromotor rehabilitation regime for 2 months. Non-single seizures (repetitive seizures and status epilepticus) Clinical assessment (FM, mBI, MRC, Ashworth) were done at were associated with poor outcomes, and cortical involvement and baseline, 2 & 6 months. Block design with alternate baseline and epileptiform discharges are independent risk factors for non-single activation task was used with a total of 90 whole brain EPI seizures. measurements (TR = 4520 ms, TE = 44 ms). doi:10.1016/j.jns.2019.10.810 Results Interim results revealed no serious adverse events. No statistical signiﬁcant clinical improvement in functional scales between both groups (FM: 95% CI; 7.2 to 3.35, p = .85; mBI: 95% CI; 11.3 to 5.5, p WCN19-0347 = .81). In one group, LI of BA 4 increased from −0.13 to 0.56 (p = .001) and LI BA 6 increased from −0.05 to 0.75 (p = .0001). We observed elevated peaks of glutamate, glutamine (2.32 ppm) and Poster shift 02 - Autoimmune disorders - Part I /CNS infections - acetone (1.9 ppm) in one group and glucose (4.0 ppm)/ lactate peaks Part I/dementia - Part I /epilepsy - Part I /health economics and were observed in the other (p N .05) (Fig. 1). outcomes/neuroepidemiology and environmental and other Conclusion Bone marrow derived mononuclear stem cells in chronic stroke: Intravenous infusion of bone marrow derived mononuclear stem Functional imaging & spectroscopic analysis cell is safe and tolerable in stroke. Stem cells and physiotherapy ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 27 might aid in functional recovery as demonstrated by fMRI & serum WCN19-0372 spectroscopic analysis.^ doi:10.1016/j.jns.2019.10.811 Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I /dementia - Part I /epilepsy - Part I /health economics and outcomes /neuroepidemiology and environmental and other

WCN19-0368 Effectiveness of intravenous valproate for treatment of status epilepticus in adults

Poster shift 02 - Autoimmune disorders - Part I /CNS infections - D. Racic, D. Obradovic, V. Dragovic, A. Dominovic, V. Djajic Part I /dementia - Part I /epilepsy - Part I /health economics and University Clinical Center of Republic of Srpska, Neurology, Banja Luka, outcomes/neuroepidemiology and environmental and other Bosnia and Herzegovina

One year outcome in bacterial meningitis - A hospital based Objective retrospective (non concurrent) cohort study Status epilepticus (SE) is one of the major neurological emergiences. Rapid and appropriate treatment is extremely impor- J.J.K. Thadam tant because of high mortality rate. We report a prospective llh Hospital, Neurology, Abu Dhabi, United Arab Emirates registration of the effect of intravenous (IV) valproate (VPA) in our patients. Background There are not many studies on Long term outcome of patients Patients and methods with bacterial meningitis in the Indian setting. Data were obtained from 55 adult patients (31 male, 24 female) with the median age of 53 years. All had previously been Objectives unsuccessfully treated with diazepam. For 51, the main SE seizure To assess the one year outcome of patients with Bacterial type was generalized tonic-clonic, for one complex-partial, for two Meningitis and To ﬁnd out the risk factors for poor outcome. simple-partial, while one had nonconvulsive SE. The treatment protocol recommended 20 mg/kg of VPA loading dose over 30 min, Materials and methods followed by continuous infusion of the same dose for the next 24 h, Hospital based Retrospective cohort study including all cases of than per oral administration. If seizures persisted after the loading Bacterial meningitis aged N13 years admitted to the Neurology dose, general anesthesia was administrated. Department, at Trivandrum Medical College from January 2010 to December 2013. Results Data was collected from case records and their follow up at one No serious side effects were observed. In 82% of the patients (45 year was done using the mRS score. of 55) SE stopped and anesthesia was not required. The response rate End Points to assess outcome: mRS and Long-term speciﬁc sequel to VPA treatment in patients with history of epilepsy was 75% (28 of Statistical analysis: Proportions and chi square test 27) and 88% (15 of 17) in patients without history of epilepsy.

Results Conclusion Out of the 248 cases, 156 met the Inclusion and Exclusion criteria. According to the findings of our study, VPA seems to be a safe and The one year mortality was 26.9% (40 patients out of 156), of which effective treatment for SE patients. the in hospital mortality was 12.8% (20 patients out of 156).Out of the survivors who were discharged (136 patients) 20 patients doi:10.1016/j.jns.2019.10.813 (14.7%) died and 6 patients(5.2%) had significant morbidity. Death was within an average of 23 days of discharge. The patients were divided into 2 groups based on the outcome as per the mRS.46 patients (29.4%) had poor outcome and 110 patients (70.5%) had WCN19-0380 good outcome. The risk factors for poor outcome were altered sensorium, seizures, low GCS, thrombocytopenia, Hyponatremia, sepsis, culture positivity and older age group. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I /dementia - Part I /epilepsy - Part I /health economics and Conclusion outcomes/neuroepidemiology and environmental and other Patients continued to die even after discharge, after completion of standard treatment with a out of hospital mortality of 13.6% and Influence of seasonality and environmental factors within affec- morbidity of 5.2% at one year follow up. tive disorders doi:10.1016/j.jns.2019.10.812 K. Tajima-Pozoa, E.R. Silvinab, C. Adriana, A.H. Raquela, Z.E. Dianaa,M. R. Franciscoa ARTICLE IN PRESS

28 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx aHospital Fundacion Alcorcon, Psychiatry, Madrid, Spain and myoclonus alone in 27 patients. We were able to classify 273 bHospital Fundacion Alcorcon, Neurology, Madrid, Spain patients (72.6%) to one of the IGE syndromes. 112 patients were JME (56.3% were females). 75 patients classified as IGE with GTCS alone Introduction (GTCSA) (58.6% female). CAE classified in 48 patients (45.8 female). Affective disorders are influenced by a wide variety of environ- 18 patients JAE (83.3% female). First EEG was abnormal in 91.8% of mental factors. The aim of this study is to determine the influence the patients. EEG of all patients studied showed evidence of those environmental factors on the amount of psychiatric emergen- generalized epileptiform activity such as generalized spike and wave cies and hospitalization. (GSW) or polyspikes. Atypical abnormalities were present in 40.2% patients which include GSW and fragments of GSW with shifting Methods asymmetries, focal spikes and slowing. 44% of total 219 female A descriptive and retrospective epidemiological study has been patients showed photosensitivity (P b 0.0001). Generalized photo- conducted for all psychiatric hospitalisations occurring in the paroxysmal response was the only abnormalities in 4 patients. Psychiatric Unit at “Hospital Universitario Fundación de Alcorcón” Absence attacks followed by myoclonic jerks were the most common (HUFA) in 2016 (a total of 389 patients). clinical event noted during routine EEG of IGE patients.

Results Conclusion The total number of psychiatric incomes was 39% lower on holiday IGE shows a clear female preponderance in our cohort. GTCS was than in working days (P = 0.000). Concerning to seasonality, the the most common seizure type and JME is the most common IGE number of psychiatric incomes was 16% higher in autumn (p = 0.353), syndrome identified. Initial EEG is abnormal in most patients; 14% higher in spring (P = 0.390) and 5% higher in summer (P = 0.734) however, some patients may show atypical abnormalities. than in winter. Significant differences were also found regarding doi:10.1016/j.jns.2019.10.815 atmospheric pressure, so that the number of psychiatric incomes is 2% lower for each 1 hPa increased (P = 0.011). Finally, in relation to lunar phase, double hospitalisations occurred a few days before full moon (P = 0.097) and also a few days before new moon (P = 0.089). WCN19-0386 Conclusions The influence of seasonality and environmental factors on Poster shift 02 - Autoimmune disorders - Part I /CNS infections - affective disorders is clear, although it should be studied individually Part I /dementia - Part I /epilepsy - Part I /health economics and for each population. outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.814 Unverricht-Lundborg disease

K. Khalid Dubai Health Authority, Neurology, Dubai, United Arab Emirates WCN19-0385 We are reporting 22-year-old male who had seizures and ataxia Poster shift 02 - Autoimmune disorders - Part I /CNS infections - started at 11 years. Patient had two types of seizures, including Part I /dementia - Part I /epilepsy - Part I /health economics and generalized convulsive, controlled by Valporic-acid. Myoclonic outcomes/neuroepidemiology and environmental and other seizures, which progressed from once every 3 weeks to daily seizures and became intractable despite four anti-epileptic medications. Trials of increasing anti-epileptics to optimal doses to control Seizure types and electroencephalographic changes among at- the myoclonic seizure were associated with side effects; however, by tendees at tertiary care neurology unit in Oman with idiopathic starting Perampanel we achieved myoclonic seizure control. His generalized epilepsy (IGE) cognitive function was normal. Brain computed tomography was normal, and electroencephalography showed frequent generalized A. Al-Asmia, R. Poothrikovilb, A. Al-Futaisic, R. Nandhagopala,A. spike-and-wave discharges as well as photosensitivity. A Cystatin-B Gujjara gene analysis exhibited the presence of two expanded alleles in the aSultan Qaboos University, Medicine, Al-Khod, Oman repetitive region of the CSTB gene, the absence of amplified smaller bSultan Qaboos University Hospital, Clinical Physiology, Al-Khod, Oman alleles (b30 dodecamer repeats) by PCR and the ladder profile cSultan Qaboos University, Child Health, Al-Khod, Oman suggests that this patient carries two expanded alleles. This result is compatible with the clinical diagnosis of Unverricht-Lundborg Aim disease (ULD); however, absence of PCR amplification due to the To classify cases of IGE based on the EEG abnormalities and presence of a polymorphism or mutation in the binding area of the seizure types. primers cannot be excluded. Therefore, testing the parents was recommended to determine if both are healthy carriers of a Methods dodecamer expansion in the promoter region of the CSTB gene, thus Patients with EEG abnormalities suggestive of IGE were selected genetic analysis was recommended, but they declined. It is well for a consecutive 4 yrs period. Clinical information was obtained known that in ULD clinical symptoms have a big degree of variety, ’ from patients record. and genetic analysis is golden diagnostic tool. Genetic testing was of a high yield in this patient because myoclonus and ataxia were much Results milder than those commonly seen in patients with ULD. A total of 376 patients were identified with EEG abnormalities suggestive of IGE. GTCS was the most common type of seizure (64%). doi:10.1016/j.jns.2019.10.816 GTCS alone was noted in 137 patients, absence alone in 62 patients ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 29

WCN19-0396 hypermetabolism was found to be a feature of acute phase, whereas hypometabolic areas were seen in sub acute and chronic phases of the disease. On follow-up, the post-treatment FDG PET CT scans Poster shift 02 - Autoimmune disorders - Part I /CNS infections - obtained in some of these patients showed reversal to normal Part I /dementia - PART I /epilepsy - Part I /health economics and metabolism in the corresponding areas. outcomes/neuroepidemiology and environmental and other Conclusion A rare variant of Guillain-Barre syndrome after a chikungunya FDG PET CT may have an important role both in the identiﬁcation viral fever of AE itself and in the detection of the unknown malignancy that might have caused it. S.H. Shaikh, S. Khan Aga Khan University Hospital, Neurology, Karachi, Pakistan doi:10.1016/j.jns.2019.10.818

Chikungunya (CHIK) viral fever is a self-limiting illness that presents with severe debilitating arthralgia, myalgia, fever and rash. Neurological complications are rare. We present a case of a 36-year- WCN19-0407 old woman who presented with acute onset progressive difﬁculty swallowing and left arm weakness. She was diagnosed with CHIK Poster shift 02 - Autoimmune disorders - Part I /CNS infections - viral fever 4weeks prior to admission. After investigations, she was Part I /dementia - Part I /epilepsy - Part I /health economics and diagnosed with a pharyngeal–cervical–brachial variant of Guillain- Barré syndrome. In hospital, she required ventilator support. Her outcomes/neuroepidemiology and environmental and other condition improved after ﬁve sessions of intravenous immunoglobulin with almost complete resolution within 6months of symptom Scintigraphic spectrum of fronto temporal lobar degeneration on onset. With frequent CHIK outbreaks, the neurological complications FDG PET CT are increasingly seen in the emergency department. The knowledge of these associations will result in early diagnosis and treatment. R. Vermaa, R. Ranjanb aSir Ganga Ram Hospital, Nuclear Medicine, New Delhi, India doi:10.1016/j.jns.2019.10.817 bSir Ganga Ram Hospital, Neurology, New Delhi, India

Material and methods A retrospective analysis of 40 patients of clinically suspected WCN19-0402 frontotemporal lobar degeneration, presenting with variable degrees of altered behavior, language, executive control and motor symptoms, was done. All the subjects underwent F-18 FDG PET CT scan of Poster shift 02 - Autoimmune disorders - Part I /CNS infections - the brain and the studies were analyzed both qualitatively (visually) Part I /dementia - Part I /epilepsy - Part I /health economics and and semi quantitatively. Few of the subjects also underwent outcomes/neuroepidemiology and environmental and other dopamine transporter imaging with Tc 99 m TRODAT 1 on a separate day. The subjects were clinically divided into Behavioral variant Spectrum of autoimmune limbic encephalitis on FDG PET/CT fronto temporal dementia (FTD), Non fluent/agrammatic variant primary progressive aphasia (PPA), Semantic variant PPA, Logopenic R. Vermaa, R. Ranjanb PPA and FTD with motor symptoms. The FDG uptake patterns were aSir Ganga Ram Hospital, Nuclear Medicine, New Delhi, India; recorded and areas of cortical hypometabolism in the cerebral cortex bSir GangaRam Hospital, Neurology, New Delhi, India that were two standard deviations from the mean were considered as abnormal. Objectives and methods To evaluate the role of FDG PET CT in the management of patients Results with suspected autoimmune encephalitis (AE). A retrospective Behavioral variant subjects, showed diffuse hypometabolism in analysis of 27 patients of clinically suspected cases of AE, who the medial frontal, Orbital frontal, anterior cingulate and fronto- fl underwent FDG PET CT, was done. The patterns of FDG uptake in insular cortices. The subjects with non uent/agrammatic variant different antibody subtypes were recorded and comparison with PPA showed predominant left posterior fronto-insular normalized data was attempted. Post treatment follow-up scans hypometabolism. The subjects with Semantic variant PPA revealed were also acquired and analyzed. predominant anterior temporal hypometabolism, the Logopenic PPA subjects showed hypometabolism around the angular gyrus and the Results subjects with motor symptoms showed hypometabolism in the Focal areas of hypermetabolism involving medial temporal sensorimotor cortices. regions, basal ganglia and thalami with relative global hypometabolism, both on visual inspection and on semiquantitative Conclusion analysis. Serologically, 17 patients had antibodies against Voltage FDG PET scan may act as a non invasive diagnostic modality in gated potassium channel (VGKC) complex /LGI1 receptors, 2 had differentiating the myriad clinical and pathologic presentation of antibodies against CRMP-5 (Anti-CV-2) and 1 had had antibodies fronto temporal lobar degeneration and may help in documenting against PCA-1/Anti-Yo receptor. We could not isolate the antibody in and characterizing the various overlap syndromes thereby helping in 7 seven patients. Suspicious mitotic lesions were identified in 10 prognosticating the disease process. patients on the whole body scan, which later were biopsied and doi:10.1016/j.jns.2019.10.819 characterized. No scan evidence of mitotic pathology was identified in 17 patients, thus were labeled as non para neoplastic. Focal ARTICLE IN PRESS

30 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0416 Y. Takeshitaa, S. Fujikawaa, H. Nishiharab, T. Maedaa, F. Shimizua,Y. Sanoa, M. Kogaa, T. Kandaa aYamaguchi University Graduate School of Medicine, Department of Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Neurology and Clinical Neuroscience, Ube, Yamaguchi, Japan Part I /dementia - Part I /epilepsy - Part I /health economics and bUniversity of Bern, Theodor Kocher Institute, Bern, Switzerland outcomes/neuroepidemiology and environmental and other Background Neuropsychological impairment in vascular dementia The breakdown of the blood-brain barrier (BBB) is a key step in the pathogenesis of multiple sclerosis (MS). We previously D. Lumia, S. Grabovab, A. Qukac, P. Djamandic, J. Krujaa identiﬁed the auto-antigen responsible for the BBB impairment in aFaculty of Medicine- University of Medicine- Tirana, Neurology, Tirana, secondary progressive MS using 2D electrophoresis of hole cell- Albania preparation of brain microvascular endothelial cells (HBMECs). bUHC Mother Teresa, Neurology/Neurophysiology, Tirana, Albania However, this method required much work to select the targeted cUHC Mother Teresa, Neurology, Tirana, Albania cell-surface antigens from huge number of protein-spots in all cell fractions. Aim The purpose was to discover the neuropsychological impairment Objective ﬁ in Vascular dementia (VaD), using some neuropsychological tests: Our aim is to construct the new method to ef ciently investigate MMSE, Hachinski Ischemia Score and Mini-Cog, and to compare for the targeted antigens from the membrane-protein fraction of these results with other previous studies. HBMECs in relapsing-remitting MS (RRMS).

Methods Method We prospectively examined 100 stroke patients hospitalized in the Sera from the patient of RRMS (N=1) which can downregulate Neurology Service, at UHC “Mother Teresa”, Tirana. After performing the BBB function of HBMECs was selected. The membrane of HBMECs neuropsychological tests (MMSE, Hachinski Ischemia Score and Mini- were biotinylated and its plasma membrane fraction was isolated Cog), we divided them in two groups, according with the scorings of by ultracentrifugation. The extracted membrane-protein were each patient and evaluation of their signs and imaging data. We have immunoprecipitated with IgG from the RRMS or normal been careful in considering each patient background, education, age and subjects (N=4). After separating eluted proteins by SDS-PAGE, fi other factors that could gave us bias in the test scoring. speci c bands in the RRMS were determined by mass spectrometry. Results We found 28 patients (28%) with low scores in the neuropsycho- Results fi logical tests. Respectively MMSE average scoring was 17 points We identi ed the 21 membrane-proteins as targeted auto- (SD=2.62) in 7 cases. 19 (moderate) and 2 severe cognitive antigens in the RRMS. One of them was known to be relevant to impairment cases are recorded. The average Hachinski Ischemia Score BBB function. In 10 RRMS patients, three patients had the auto- was 9.03 points (SD=2.16) while in the Mini-Cog test the average antibody against this molecule. scoring was 1.9 points (SD=1.1). We compared these results with the scorings from the control group that had a much higher result. Conclusions In the study group we see male predominance (63.4%) and an We succeeded in construction of the method that allows us to fi average age 70.3 years old. ef ciently investigate targeted antigens from plasma membrane The tests of temporo spatial orientation together with the fraction of HBMEC, using the biotinylation of HBMECs and the fi constructive practice and abilities shown the most common impair- isolation of membrane fraction by ultracentrifugation. This identi ed ment, while abrupt onset, stepwise deterioration, previous stroke antigen could be an immunological target molecule, contributing to history, previous arterial hypertension history, evidence associated the BBB breakdown in RRMS. with atherosclerosis and neurological signs and symptoms were quite frequent. doi:10.1016/j.jns.2019.10.821

Conclusions According to our data the most frequent deﬁciencies of VaD are temporospatial orientation and the constructive practice and WCN19-0443 abilities. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - doi:10.1016/j.jns.2019.10.820 Part I /dementia - Part I /epilepsy - Part I /health economics and outcomes/neuroepidemiology and environmental and other

– WCN19-0438 From Antarctica to Alzheimers Exercise helps to prevent cognitive decline

Poster shift 02 - Autoimmune disorders - Part I /CNS infections - S. Schneider, P. Wollseiffen Part I /dementia - Part I /epilepsy - Part I /health economics and German Sport University Cologne, Center for Health and Integrative outcomes/neuroepidemiology and environmental and other Physiology in Space, Cologne, Germany

Identiﬁcation of targeted membrane antigens of human brain Introduction microvascular endothelial cells in relapsing-remitting multiple Regular physical exercise has been proven to counteract physio- sclerosis logical deconditioning caused by a sedentary lifestyle. More recently, ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 31 human and animal studies have demonstrated that regular physical Results activity also targets brain function by increasing cognition and mood. A signiﬁcant decrease in cortical activity was detected in all 4 In two studies, presented here, we aimed to show the long-term lobes after exercise but not after art classes ( p b 0.05). No changes in effect of exercise on mental health. cognitive performance were observed after exercise and art classes.

Methods Conclusion Study 1: Eight male volunteers were isolated and conﬁned Data presented here show a clear effect of exercise on brain during the winter period at the Antarctic Concordia Station. Every cortical activity, similar to the theory of a transient hypofrontality six weeks electroencephalographic measurements were recorded that has been introduced by Arne Dietrich. Nevertheless, there is no under rest, cognitive tests and a mood questionnaire were direct effect on cognitive performance. Hence, the neurophysiolog- executed. ical effect of exercise should be further evaluated regarding different Study 2: 75 previously sedentary patients with a clinical diagnosis kinds of cognitive performance: creativity, knowledge acquisition as of mild cognitive impairment (MCI) were randomized to one of three well as the outlasting effects of exercise on academic achievement. groups, either provided with high intensity exercise, moderate exercise or no exercise for 12 month. An inﬂuence of exercise on doi:10.1016/j.jns.2019.10.823 the progression of MCI was determined by a neuropsychological test battery (CogState).

Results WCN19-0449 Study 1: Whereas brain activity showed a decline throughout the isolation period for both groups, regular active people were able to remain their mood state and cognitive performance. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Study 2: Participants who showed an increase in physical fitness Part I /dementia - Part I /epilepsy - Part I /health economics and over the 12 month intervention period, also showed a significant outcomes/neuroepidemiology and environmental and other increase in cognitive performance and life-quality. Neurological manifestations of dengue infection: A systematic Discussion review In both studies, we could show that a regular exercise program was able to improve mood, cognitive performance and life-quality. A V. Neriab, A.C. Ribeirob, B. Firminob, L. Reis Salesb, W. Ferreira Juniorb transfer of results from space life science into everyday life, allows aUniversidade Federal do Estado do Rio de Janeiro, Neurology, Rio de emphasizing the importance of regular physical activity for brain Janeiro, Brazil health and stressing its relevance for a healthy life-style. bFaculdade de Medicina de Campos, Neurology, Campos dos Goytacazes, Brazil doi:10.1016/j.jns.2019.10.822 Objectives To provide a summary estimate of the neurological manifestations as a complication of Dengue, including studies on direct WCN19-0444 invasion of the central nervous system and secondary effect of Dengue virus (DENV) in Nervous System. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Methods Part I /dementia - Part I /epilepsy - Part I /health economics and Systematic review of studies published in databases SciELO, outcomes/neuroepidemiology and environmental and other PubMed, MEDLINE, Lilacs, Embase, CINAHL and ProQuest Disserta- tions and Theses from inception to January 2018. The effects of exercise on brain cortical activity and academic achievement in school Results 300 articles found, 47 selected according to inclusion criteria. P. Wollseiffen, S. Schneider Neurological manifestations reported in publications from 13 German Sport University Cologne, Center for Health and Integrative countries, the majority coming from Asia (74.4%), followed by Latin Physiology in Space, Cologne, Germany America (17%), Europe (4.2%) and Oceania (4.2%) (Figure 1). Neurological manifestations described: 19 (40.4%) encephalic, 14 Objective (29.7%) peripheral, 8 (17%) demyelinating and 6 (12,7%) spinal cord. The aim of this study was to compare the influence of a class of Brain manifestations: encephalitis (6/19, 31,5%), besides reports of aerobic exercise and an art class on brain cortical activity and seizure, cerebellar syndrome, cerebral ischemia, meningitis, cerebral possible effects on cognitive performance. hemorrhage and subdural effusion. The most frequent peripheral manifestation was Guillain-Barré syndrome-GBS (8/14, 57,1%), Subject and methods followed by hypokalemic tetraparesis, neuralgic amyotrophy and Electroencephalography was used to record the electrocortical peripheral facial paralysis. Among the demyelinating manifestations, activity of 16 schoolchildren (8–10 years old) before and after an the most common was acute disseminated encephalomyelitis (7/8, aerobic exercise class and an art class. Performance in a standardized 87,5%), followed by optic neuromyelitis (1/8, 12,5%). The most test of educational attainment (VERA-3) was assessed following both common spinal cord involvement was acute transverse myelitis (5/6, classes. 83,3%), followed by compressive myelopathy (Table 1). ARTICLE IN PRESS

32 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Conclusion encephalitis, and secondary lesions, such as GBS, as the most Prevalence of neurological lesions in this Arboviruse, especially common forms of nervous system involvement. No deaths were in countries of the Southern hemisphere, and evidence of DENV reported. neurotropism makes neurological lesions important complications in Dengue, which explains the high morbidity in these countries. doi:10.1016/j.jns.2019.10.824 We observed direct manifestations of the virus, such as ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 33

WCN19-0454 \WCN19-0456

Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I /dementia - Part I /epilepsy - Part I /health economics and Part I /dementia - Part I /epilepsy - Part I /health economics and outcomes/neuroepidemiology and environmental and other outcomes/neuroepidemiology and environmental and other

Clinical profile and outcome of patients with myasthenia gravis, SESN3 and seizures following brain injury post-thymectomy versus non-thymectomy. A 10-year retrospective study in a tertiary care hospital Q. Zhoua, Z. Leia, C. Dongb, Z. Xua aIndiana University School of Medicine, Anatomy & Cell Biology, T. Alharbia, N. Alzahranib, S. Bashirc, A. Amperd, A. Almutairie Indianapolis, USA; aKing Fahad Specialist Hospital- Dammam, Neurology Department- bIndiana University School of Medicine, Biochemistry, Indianapolis, USA Neuroscience Center, Dammam, Saudi Arabia b King Fahad Specialist Hospital-Dammam, Neurology Department. Seizures are the most common neurological sequelaee following Neuroscience Center, Dammam, Saudi Arabia brain injury. The mechanisms of seizure/epilepsy in these acute c King Fahad Specialist Hospital-Dammam, Neurology Department- neurological disorders remain unclear. Recent studies indicated that Neuroscience Center, Dammam, Saudi Arabia epilepsy could be mediated by Sestrin3 (Sesn3). The present study d King Fahad Specialist Hospital-Dammam, Neurology Department- attempted to reveal the contribution of Sesn3 to seizure generation Neuroscience Center, Dammam, Saudi Arabia in ischemia in diabetic condition and TBI. e King Fahad Specialist Hospital, Thoracic Surgery Department, Transient global ischemia was produced in adult rats and mice. Dammam, Saudi Arabia Diabetes was induced by i.p. injection of 50 mg/kg streptozotocin (STZ). TBI was induced in mice using the control cortical impact Objectives method. The seizure activity was defined by the Racine scale III-V. To study the clinical profile and outcome of post-thymectomy The Sesn3 levles were analyzed by Western blotting and immuno- versus non-thymectomy in patients diagnosed with Myasthenia histochemistry. The neuronal excitability was evaluated using Gravis followed at King Fahad Specialist Hospital-Dammam, Saudi electrophysiological approaches. Arabia. The seizure rate significantly increased after 15 min ischemia in diabetic animals. Sesn3 expression in hippocampus significantly Methods elevated in diabetic animals with seizures. The potassium A retrospective, observational study was conducted in a tertiary channel expression in hippocampal neurons were decreased and care hospital in Dammam, Saudi Arabia. Data from 75 patients’ files neuronal excitability increased. The seizure rate was significantly diagnosed with myasthenia gravis across ten years, between January decreased from 60% of wild type to 15% of Sesn3 KO mice after 2008 to December 2018, were analyzed by Statistical Package for ischemia. Social Sciences (SPSS). The seizure rate significantly increased in Sesn3 KO mice after TBI. The spike threshold, the amplitude of after hyperpolarization Results and rheobase in granule cells significantly increased in KO mice after All patients were above the age of 16 years. Fifty-five patients are TBI. The frequency of mEPSCs in granule cells increased after TBI as female (74%), and 20 patients are male (26%). At diagnosis, the compared with the naive animals but returned to control levels in majority of the patients had a generalized type (66.6%), and ocular/ Sesn3 KO mice. oculobulbar accounts for 33.4%. Using the Myasthenia Gravis There results suggest that Sesn3 might have difference effects on Foundation of America (MGFA) classification, 44 % of patients fell seizure generation after cerebral ischemia with diabetes or traumatic under Class 3. Acetylcholine receptor (AchR) antibody was positive brain injury. in 50 patients (66.7%), and antiMUSK antibody was positive in 14 patients (18.7%). The most common thymic histopathology was doi:10.1016/j.jns.2019.10.826 normal (57.3%) followed by follicular hyperplasia (18.7%) and thymoma (13.3%). Thymoma was only found in patients with AchR antibody positive. Thymectomy was done for 39 patients (52%). Patients who underwent thymectomy achieved stable and pharma- WCN19-0458 cological remission more than non-thymectomy patients ( p-value b0.000). No significant difference in the clinical outcome was found between patients taking Azathioprine versus Mycophenolate. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I /health economics and Conclusion outcomes/neuroepidemiology and environmental and other Thymectomy appears to provide a high rate of stable remission as compared to non-thymectomy. Moreover, Mycophenolate seems to Neurological manifestations of dengue fever be as effective as Azathioprine in the long term therapy of Myasthenia Gravis. N. Prabhat, A. Rebello, H. Kathuria, S. Ray, K. Chakravarty, V. Lal Post Graduate Institute of Medical Education and Research- PGIMER- doi:10.1016/j.jns.2019.10.825 Chandigarh, Neurology, Chandigarh, India ARTICLE IN PRESS

34 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Introduction H. Someshwara, K. Agrawalb, N. Suryab Dengue fever is a highly endemic mosquito-borne viral infection aKJ Somaiya College of Physiotherapy, Neurophysiotherapist, Mumbai, with a wide range of neurological manifestations including enceph- India alitis, neuromuscular and neuro-ophthalmic involvement. bBombay Hospital and Research Center, Neurology, Mumbai, India

Aim Purpose To explore the pleiotropic effects of dengue virus infection on the To evaluate the information that school children have on epilepsy nervous system. and to compare the difference in attitudes and perception among these students post an informative session on epilepsy. Neuropathogenesis Effect of the dengue virus on nervous system is pleiotropic. Direct Methods central nervous system invasion by dengue virus is implicated in A Pre- questionnaire with 13 questions regarding knowledge, encephalitis whereas immune mediated release of cytokines may attitudes and perception about epilepsy was completed by the school involve peripheral nerve constituents (myelin/axon), muscle fibres children in Mumbai after giving assent for the study. 45 minutes leading to myositis, and damage omnipause cells in the brainstem interactive awareness lecture about epilepsy was taken by medical causing ocular flutter. professionals working in the field of Epilepsy. Following which a Post- questionnaire with same 13 questions was completed by the Observations school children. Five patients of serologically confirmed Dengue fever (NS1 Antigen and Immunoglobulin M antibody positive) were included, Results who presented with the following uncommon neurological 43 students in the age group 14–16 years of both genders took manifestations. part in this pilot study. 61% students had insufficient perceived knowledge of information about epilepsy which changed to 39% post Conclusion intervention. 73% students had a poor attitude towards epilepsy and Recently emerging evidence of neurotropism and neurovirulence 51% students had a prejudice towards people with epilepsy which by dengue virus emphasizes the need for neurologists to look for changed to 51% and 63% respectively. these associations while dealing with dengue infection. It also emphasizes the need for specific immunomodulation in addition to Conclusion supportive measures for causing neurological recovery. This Study suggests that there is inverse relationship between knowledge and stigma on epilepsy. Nevertheless, the best results did doi:10.1016/j.jns.2019.10.827 not reflect an ideal situation, revealing an urgent need for an improved level of overall health education programs. This can be achieved by implementing educational policies, training programs and the universal inclusion of epilepsy awareness in the national WCN19-0919 educational program.

Keywords: Stigma, Epilepsy, School children, Questionnaire, Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Awareness Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

doi:10.1016/j.jns.2019.10.828 Effect of a brief awareness lecture on knowledge, attitude and perception of epilepsy amongst school children of Mumbai, Maharashtra ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 35

WCN19-0918 Conclusion In PTLE and comorbid psychiatric disorders who underwent anterior temporal lobectomy with amygdalohippocampectomy Engel Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Class I outcome was associated with the signiﬁcant reduction of Part I/dementia - Part I/epilepsy - Part I/health economics and epilepsy-speciﬁc IDD. outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.829 Psychiatric comorbidity and temporal lobe epilepsy surgery outcome

G. Kustova, F. Riderb, I. Trifonovc, I. Kaymovskiyde, A. Yakovlevbf,A. WCN19-0916 Lebedevadg, A. Avedisovaah, A. Guekhtgi aMoscow Research and Clinical Center for Neuropsychiatry, Department Poster shift 02 - Autoimmune disorders - Part I/CNS infections - of New Methods of Therapy of Mental Disorders, Moscow, Russia bMoscow Research and Clinical Center for Neuropsychiatry, Department Part I/dementia - Part I/epilepsy - Part I/health economics and of Epidemiology- Prophylaxis and Healthcare, Moscow, Russia outcomes/neuroepidemiology and environmental and other cEvdokimov Moscow State University of Medical Dentisitry, Neurosur- gery Department, Moscow, Russia Retinal changes in cerebral malaria among sudanese patient in dMoscow Research and Clinical Center for Neuropsychiatry, Department Khartoum State, Sudan of Nonepilptic Paroxysmal Conditions, Moscow, Russia eBuyanov City Clinical Hospital, Department of Paroxysmal Distur- A. Hussein, M.M. Aldar, K. Zeinelabdeen, Y.F.O. Altayeb, R. Tofaha bances, Moscow, Russia AlHusseini, K. Mohamed Ahmed Hussien, A. Mohamed Hassan, L.A. fInstitute of Higher Nervous Activity and Neurophysiology, Russian Seralkhatim, M. Abbashar, M.A. Alwalied, A. Altyeb, H. Abbashar, A. Academy of Sciences, Laboratory of Functional Biochemistry of the Sidig, T.F. Mahdi, M.A. Ibrahim, O. Eladill, M.H.B. Balla Nervous System, Moscow, Russia Daoud Research Group, Neurology, Khartoum, Sudan gPirogov Russian National Research Medical University, Department of Neurology- Neurosurgery and Medical Genetics, Moscow, Russia Introduction h Serbsky Federal Medical Research Center for Psychiatry and Narcology, It is thought that Malaria parasites live in red blood cells and Department of Therapy of Mental and Behavioral Disorders, Moscow, make them stick to the inside of small blood vessels, particularly this Russia causes the unique whitening of eye blood vessels. The light-sensitive i Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia tissue in the eye is also affected because the parasites disrupt the supply of oxygen and nutrients These changes, known as malarial Pharmacoresistance in PWE is frequently associated with psychi- retinopathy, include white, opaque patches, whitening of the atric comorbidity. The effectiveness of epilepsy surgery is well infected blood vessels, bleeding into the retina and swelling of the established, established; however, the impact of surgery on depres- optic nerve. sion and anxiety remains controversial. Objectives Objective Our study aims to demonstrates malarial retinopathy in patients To study possible association between psychiatric comorbidity in presented with neurological manifestations of malaria. patients with temporal lobe epilepsy (PTLE) and epilepsy surgery outcome. Methodology A cross-sectional Hospital based study included all patients with Material and methods malaria seen during the period between 1-1-2019 and 25-4-2019. PTLE who underwent anterior temporal lobectomy with amygdalohippocampectomy were examinined before surgery and 6 Result months after. The diagnosis of psychiatric disorder was verified by a Almost 40 patients with neurological manifestations of malaria structured diagnostic interview for DSM-IV (SCID-I). Epilepsy- were included in the study (29 having cerebral malaria, 3 with post specific interictal dysphoric disorder (IDD) was also assessed. Seizure malarial cerebellar ataxia, 2 with post malarial syndrome and outcome was determined according to Engel’s classification. abnormal movement, one with peripheral neuropathy, one with proximal myopathy, one had cerebral infaction, one had cerebral Group characteristics haemorrhage, one had sagital sinus thrombosis and one had six 18 PTLE aged 35 ± 9.16 years with the age of the onset of nerve palsy). Out of 29 patients with cerebral malaria 14 were epilepsy 13.67 ± 10.75 years, duration 21.39 ± 12.24 years and children and 15 were adult. Malarial retinopathy changes were frequency 11.72 ± 7.23 seizures per month were examined. 11 of detected only among those with cerebral malaria (7 children and 3 them suffered from major depression, 6 had anxiety and 2 - Adult). obsessive-compulsive disorders. IDD was detected in 16 patients. 10 patients were treated with psychopharmacotherapy. Conclusion The eye can provide a very reliable way of diagnosing cerebral Results malaria. By looking at the changes to the retina Our research 10 PTLE achieved Engel Class I with significant (P b 0.05) demonstrates that the detection of malarial retinopathy is a much reduction of IDD in 7 of them. In 8 PTLE with Engel II and III needed diagnostic tool in cerebral malaria, and can identify those outcomes no appreciable changes in IDD were observed. Only 4 from children at most risk of death. 18 PTLE with different surgery outcomes had no signs of any psychiatric disorder 6 months after. All of them were treated with doi:10.1016/j.jns.2019.10.830 psychopharmacotherapy before and after the surgery. ARTICLE IN PRESS

36 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0461 WCN19-0471

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Poster shift 02 - Autoimmune disorders - Part I/CNS infections - part I/dementia - part I/epilepsy - Part I/health economics and Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other outcomes/neuroepidemiology and environmental and other

Clinical features of patients with epilepsy and cerebral palsy Molecular docking studies and cognitive impairment attenuating effect of phenolic compound rich fraction of trianthema portu- G. Kutlu, Y. Unal lacastrum in scopolamine induced Alzheimer’s disease like Mugla University, School of Medicine, Neurology, Mugla, Turkey condition

Cerebral palsy is known as a risk factor for epilepsy. The aim of P. Yadav the this study was to evaluate demographic and clinical properties of SHUATS, Pharmaceutical Sciences, Prayagraj, India patients with epilepsy and cerebral palsy. Forty-one patients with cerebral palsy who were followed in the outpatient clinic of Mugla Dementia is considered as the frequent cause of neurodegener- Sitki Kocman University Epilepsy Unit were reviewed. The mean age ative mental disorder such as Alzheimer’s disease (AD) amongst was 26.9 ± 11.3 years old (Age range: 8–55 years old). Twenty five elderly people. Various phenolic phytoconstituents exists in of them were male (61%) and remaining 16 patients were female Trianthema portulastrum (TP) leaves have been reported as active (39%). Seizure onset age ranged from 0 to 49 years old (mean 6.2 ± against various neurological disorders. The current investigation was 9.5). 27 of them (65,9%) had focal seizures while generalized seizures undertaken to evaluate the antiamnesic potential of butanol fraction were observed in eight patients (19,5%). The remaining six patients of TP hydroethanolic extract (BFTP) by utilizing rodent models of had unclassified seizure. The awareness of 7 patients (17.1%) was elevated plus maze (EPM) and Hebbs William Maze (HWM) along maintained during the seizure; 34 (82.9%) patients were unrespon- with in vitro and in vivo antioxidant as well as acetylcholinesterase sive during seizures. The frequency of seizures ranged from 0 to 9125 (AChE) inhibition studies. Molecular docking studies were also per year (mean 357.9 ± 459.9). After treatment, 20 patients (48.8%) performed for evaluation of molecular interaction of existed phenolic were seizure-free. Seizure frequency decreased in four patients compounds in BFTP. In vitro antioxidant study revealed concentra- (9.8%) and increased in one patient (2.4%) after treatment. Seizure tion dependant strong ability of BFTP to inhibit free radicals. In vitro frequency was not changed in 10 patients (24.4%) with treatment. AChE inhibition study showed competitive type of inhibition Eleven patients (26.8%) received monotherapy and polytherapy was kinetics. BFTP significantly reversed (p b 0.005 versus scopolamine) given to 29 (70.7%) patients. Nineteen patients (46.3%) were the damaging effect of scopolamine by reducing TL (Transfer classified as intractable epilepsy. Intractable epilepsy is more Latency) and TRC (Time taken to recognize the reward chamber) in common in cerebral palsy. Most patients had focal onset seizures. the EPM and HWM, respectively. BFTP also contributed towards increased (p b 0.005 versus scopolamine) enzymatic antioxidant as doi:10.1016/j.jns.2019.10.831 well as hippocampal acetylcholine (ACh) levels. Histological studies also supported the results as BFTP pretreated mice significantly reversed the scopolamine induced histological changes in hippocampal region. Docking studies confirmed chlorogenic acid has the WCN19-0465 most significant binding affinity towards AChE. This research finding concludes that BFTP could be a beneficial agent for management of cognition and behavioral disorders associated with AD. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and doi:10.1016/j.jns.2019.10.833 outcomes/neuroepidemiology and environmental and other

Chronic autoimmune encephalitis: An unrecognized entity WCN19-0482 K.V. Mahesh Department of Neurology, Neurology, Chandigarh, India Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Autoimmune encephalitis can present with subacute onset Neuro outcomes/neuroepidemiology and environmental and other behavioural symptoms, seizures and cognitive decline. Usually they are often misdiagnosed as psychiatric conditions before the red flag signs develop, we present a series of 3 patients who had a chronic Novel initiative for policy paper on national neurology registry history ranging from 9 months upto 9 years, were earlier misdi- a b agnosed as neurodegenerative or psychiatric illness, of them one had S. Pramod , B. Patidar a antibody proven Autoimmune encephalitis while other 2 were Indian Forum for Healthcare, Med, Indore, India b diagnosed on characteristic PET brain findings of hypermetabolism SFHCP, Med, Indore, India in the temporal lobes or basal ganglia, all were treated with immunosuppresive therapy with significant improvement in symp- Background and aims toms. Our series highlights that chronicity of symptoms and indolent Neurology-case-Registry provides allied-health-Professionals/re- course can mimic a neurodegenarative or a psychiatric illness hence searchers detailed information on incidence/trend/survival-statistics neurophysicians should be aware of such rare presentations national level neurology registries are population-based and seek to Especially when the course is atypical for the same. describe incidence, rates and trends of neurology issues within set populations. Provides info on staging, treatment, allied clinical-data doi:10.1016/j.jns.2019.10.832 required to monitor clinical care/outcomes. Such comprehensive- database on neurology not-available. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 37

Objective Nationality, Stroke subtype, and Panel of blood tests were evaluated. Our NGO developed primary plan in consultation with four Based on the Integrated Ischemic Stroke Guidelines of AAH; 22 blood divisional-hospitals & Health-ministry. We aim to establish platform tests used for screening of uncommon causes. Based on their results, for multi-clinician, multi-centric collation of neurology datasets with they were classified as significant (≧10%) moderately significant stroke as pilot disease entity. We plan to integrate this concept at (b10%) and insignificant (0%). major neurology institutes with expertise from WCN/WHO. Results Methods 66 patients met inclusion criteria. 7 patients had TIA and 59 IS. 51 This is policy-paper-initiative aimed at establishing methodology, males and 15 females, composed of 65% Asian, 18% Emirati, and 17% statistical-analysis & supportive-control-center for multicollaborator Arab. Of the 22 tests; 6 showed to be significant, including; TFT, ESR, neurology disorders data collection, aiming to establish national- factor V Leiden, activated protein C resistance, lupus anticoagulant neurology-data repository. and urine microalbumin level. 9 were moderately significant, including; homocysteine, syphilis Results screen, antithrombin III assay, Protein S Free Ag, ANA, C3 comple- Initiated from four sites, modern technology of data-collection, ment, C4 complement, Cardiolipin IgG and Beta-2-microglobulin. 6 storage/analysis & distribution is optimized towards implementation tests showed no abnormality, including; Vitamin D level, Cardiolipin of sustained comprehensive and multi-collaborator data-registry. IgM, ANCA-Panel, Anti-Ds DNA, fibrinogen level, protein C and Need for minimum datasets, customization of technology to suit Brucella titer. needs, data capture, storage, retrieval. These can-be leveraged to inform future direction of initiatives: expanding scope of database, Conclusion optimizing variables for data analysis and addressing data privacy, We recommend that tests which showed no abnormality could be security and ownership concerns. We have developed our model removed from our panel and tests which showed moderately database but need participation of private-neurology-care-institutes & significant abnormality can be done if clinically indicated. Further naturopathy-clinics. Total such participants projected by 2020 are 46. prospective studies based on these results can yield in updating the current guidelines. Conclusions *Institutional Review Board approval is obtained. Our 3-year-experience with this initiative shows- data can be collated centrally in secure/private manner. Multicentre, multi- doi:10.1016/j.jns.2019.10.835 clinician collaboration possible with Collaborative-efforts with WCN/WHO. Major concern is haphazard data/protocol maintenance by private entities. Most difficult data outsourcing was about survival statistics. NATIONAL-NEUROLOGY-Registry is distant dream in WCN19-0486 resource-poor-nations. But we have taken step in forward direction on this burning issue. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - doi:10.1016/j.jns.2019.10.834 Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

Clinical pattern of neurological disorders in patients presenting WCN19-0483 to out-patient neurology clinics of a private tertiary care University Hospital in Islamabad, Pakistan

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - R. Siddiquia, A. Ahmadb, M. Siddiquib Part I/dementia - Part I/epilepsy - Part I/health economics and aShifa International Hospital Ltd, Neurology, Islamabad, Pakistan outcomes/neuroepidemiology and environmental and other bShifa International Hospital, Shifa Tameer-e-Millat University, Neurol- ogy, Islamabad, Pakistan How useful current workup panel of young stroke? - Audit data from UAE Introduction There is an increasing burden of neurological disorders in a a b O. Azzam , R. Alkatheeri , R. Renganathan Pakistan and Worldwide, where they prove to be an important and a College of Medicine and Health Sciences, Al Ain, United Arab Emirates growing cause of disability, morbidity and mortality. bAl Ain Hospital, Consultant Neurologist, Al Ain, United Arab Emirates Objective Background To determine the frequency and pattern of neurological disorders Current stroke workup for young patients in Al Ain hospital in neurology outpatient clinics in a tertiary care hospital of (AAH) consist of cardiac, radiologic evaluation, and multiple blood Islamabad. tests. Our objective was to assess the efﬁciency of the blood panel tests. Methodology The neurology outpatient database registry was established in Methodology July 2014, after approval from our Institutional Review Board. Data Retrospective data from AAH Stroke registry was reviewed for the was recorded on a pre-designed format and then entered in SPSS v23 year 2018. We included patient of 50 years old and younger who had for further analysis. Duplicate entries and forms with incomplete ischemic stroke (IS) and transient ischemic attack (TIA). Gender, data were excluded. ARTICLE IN PRESS

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Results Conclusion A total of 10,047 patients were included from July 2014 to Isolated oculomotor palsy secondary to herpes zoster although November 2018. 51.7% were male. Mean age was 44.19 (±20.14) rare should be considered in a patient with headache, ptosis and years. 16.72% were diagnosed with Headache disorders [Migraine dilated pupil with history of herpes zoster. Treatment with antivirals (62.86%), Cluster (2.20%), tension type (29.58%) and other (5.36%)], and corticosteroids usually results in good prognosis. followed by stroke (16.41%) [Ischaemic (88.42%)] and Haemorrhagic (11.59%)]. Epilepsy was diagnosed in 11.86% patients, psychiatric doi:10.1016/j.jns.2019.10.837 disorders in 8.97% and Movement disorders in 7.59%. A subgroup analysis of four age groups was carried out. Epilepsies, Migraines and Cerebral Palsy were most common in Group 1 (0–18 years). Headache, Epilepsies and Anxiety Neurosis in Group 2 (19–45 years); Stroke, WCN19-0493 Headache and Parkinson’s in Group 3 (46–65 years); Stroke, Parkinson’s and Alzheimer’s in Group 4 (66–100 years). Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Conclusion Part I/dementia - Part I/epilepsy - Part I/health economics and Our data shows that headache, stroke and epilepsy are the most outcomes/neuroepidemiology and environmental and other common neurological diagnoses in outpatient clinic. From organic psychosis to mixed dementia doi:10.1016/j.jns.2019.10.836 S. Trifu University of Medicine and Pharmacy "Carol Davila", Neurosciences, Bucharest, Romania WCN19-0491 Introduction Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Alcoholism pathology involves complications of delirium tremens, grand mal epileptic seizures, and cerebral trauma in acute Part I/dementia - Part I/epilepsy - Part I/health economics and ethanolic intoxications. When these issues are complicated, the outcomes/neuroepidemiology and environmental and other patient develops cognitive impairment with progression to dementia. Rare case of headache, ptosis and dilated pupil- isolated oculomotor palsy secondary to zoster meningitis Objectives To present the evolution of a 47-year-old patient with cranio- a b S.W. Khan , R. Radhakrishnan cerebral trauma with intense intracerebral bleeding contusions as a Al Ain Hospital, Internal Medicine, Al Ain, United Arab Emirates well as subarachnoid hemorrhage, boarded for crossing an organic b Al Ain Hospital, Neurology, Al Ain, United Arab Emirates psychosis.

Introduction Methods Isolated oculomotor palsy secondary to herpes zoster is rare. We Dynamic CT of the brain, neuroprotective treatment, GCS follow- will discuss a case presenting with headache, ptosis and dilated up (10 points at admission, 14 points at discharge), adaptive pupil. (See Figs. 1 and 2.) disability scale, antipsychotic, anti-dementia treatment, cognitive training for real-time insertion and memory recall. Case description A 43 years old Indonesian female, presented to Emergency Results department with headache of 2 days, double vision and drooping of Reduced intraparenchymal hematoma dimensions, gaining sub- left eye. She had crusted rash in ophthalmic distribution of the acute, right temporal aspect from 40/33 mm to 27/24 mm, left trigeminal nerve, partial left oculomotor nerve palsy with tonic dilated occipital left 45.2/23.7 to 22/14 mm and right occipital hematoma left pupil with partial left ptosis and restricted upgaze. CT brain, CT disappears. Subacute subdural hematoma, temporal parietal occipital angiogram of head, MRI brain were unremarkable. Cerebrospinal fluid left, with thickness up to 8.5 mm. 28.2/18.4 mm hypodense area, showed 100% lymphocytes with raised protein; Herpes simplex and with sequalae aspect, right parietal at the vertex level. Minimal right Varicella zoster DNAP-PCR were negative. parietal subarachnoid hemorrhage. Ventricular system moved to the She was treated with IV acyclovir for 14 days, Gabapentin, right of the median line, up to 5 mm, asymmetric, through moderate followed by 14 days of Valacyclovir and tapering dose of steroids. collation of the left lateral ventricle. She had minimal headaches and recovering ophthalmoplegia at 2 weeks follow-up. Conclusions Fig. 1. Crusted lesion in the left ophthalmic branch of Mixed dementia (posttraumatic and alcoholic), with disorienta- trigeminal nerve with left oculomotor palsy tion, aphasia, attention deficit, hypomnesia, blackouts and memory Fig. 2. Dilated tonic pupil of the left eye gaps, confabulations, ideo-verbally incoherence, fragmentary delu- sional idea, illusions, auditory hallucinations, visual confusion. Discussion Medication: Olanzapine, Memantine, Donepezil, Pramiracetam, Car- In presentations with headache, ptosis and dilated pupil, first rule out bamazepine for the prevention of epileptic seizures, the patient aneurysmal compression of third cranial nerve. Our patient had history of agitating with SSRIs. herpes zoster affecting the ophthalmic division of the trigeminal nerve and presented with isolated oculomotor palsy. Differential diagnosis doi:10.1016/j.jns.2019.10.838 includes zoster meningitis and should be treated appropriately. ARTICLE IN PRESS

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WCN19-0513 bUniversity of Sydney, Brain and Mind Centre, Sydney, Australia cUniversity of Cambridge, Department of Metabolic Medicine, Cam- bridge, United Kingdom Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Background outcomes/neuroepidemiology and environmental and other Frontotemporal dementia (FTD) is associated with complex changes in eating behaviour and metabolism, which potentially Immunomodulatory therapy in 6427 relapsing-remitting multi- affect disease pathogenesis and survival. It is currently not known if ple sclerosis (RRMS) patients over time under special consider- body composition changes also exist in FTD, the relationship of these ation of switching to oral DMD: A retrospective data analysis changes to eating behaviour, and whether these changes are centrally mediated. A. Bergmann, K.H. Goesswein, S. Braune NeuroTransData GmbH, StudyGroup, Neuburg, Germany Methods In 28 behavioural variant frontotemporal dementia (bvFTD), 16 Background Alzheimer’s disease (AD) and 19 controls, body composition was NeuroTransData, a german neurology network of 66 physicians, measured using dual x-ray absorptiometry. Changes in body has been collecting real world data in a speciﬁc MS database with composition were correlated to grey matter atrophy using voxel- more than 23.000 patients for 10 years. based morphometry on high resolution MRI.

Objectives Results Longitudinal assessment of MS patients on injectable DMD who Behavioural variant frontotemporal dementia was characterised switched to oral DMD and other DMDs. by changes in body composition, with increased total fat mass, visceral adipose area, and android: gynoid ratio compared to control Methods and AD subjects (all p values b .05). Changes in body composition RRMS-patients stable on injectable DMDs (Avonex®, Rebif®, correlated to abnormal eating behaviour and behavioural change (p Betaferon/Extavia® Copaxone®) for 4,3y (median) were analyzed for b .01) and functional decline (p b .01). Changes in body composition 6,1y (median) regarding clinical course and potential switch to oral also correlated to grey matter atrophy involving a distributed and other treatments. network of neural structures including the hippocampus, the amygdala, nucleus accumbens, insula, cingulate and cerebellum, Results known to be to central to autonomic control, and also areas involved 2682 (41.7%) of these 6427 patients were switched to oral DMD. in reward processing including the thalamus, putamen, accumbens The other patients stayed on their DMD for 4,6 years (median). The and caudate. main reasons for switching were insufficient therapeutic effect (34,2%), side effects (18,1%) and patient’s wish (18,2%). After 1.1 Conclusions years (median), 716 (26,7%) of these already switched patients were Changes in body composition extend the clinical phenomenology switched once again to another DMD, 123 (17,2%) switched back to in bvFTD beyond cognition and behaviour, with changes potentially their first DMD. 1735 patients (65%) remained on their first switch mediated by changes in reward and autonomic processing suggest- therapy. Observation period was 3,8 years (median). ing that these deficits may be central in FTD, and providing targets to modify the neurodegenerative process. Conclusions The main reason for switching from injectable to oral DMD was doi:10.1016/j.jns.2019.10.840 the therapeutic effect, followed by patient’s wish and side effects. In those patients who switched a second time, side effects were the main reason for switching. Most patients (65%) who switched from injectible to oral DMDs remained on that therapy during the WCN19-0537 observation period. doi:10.1016/j.jns.2019.10.839 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

WCN19-0525 Epidemiology, healthcare resource use, and mortality in patients with probable dravet syndrome: A population-based study on German health insurance data Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and A. Strzelczyka, S. Schubert-Bastab, A. Simonc, S. Sertc, G. Wyattd, R. outcomes/neuroepidemiology and environmental and other Hollandd, F. Rosenowa aGoethe-University, Epilepsy Center Frankfurt Rhine-Main, Department Neural correlates of body composition in frontotemporal of Neurology, Frankfurt am Main, Germany dementia bGoethe-University, Department of Neuropediatrics, Frankfurt am Main, Germany c R. Ahmeda, R. Landin-Romerob, C. Liangb, J. Keoghc, E. Henningc,D. Vilua Healthcare GmbH, Medical Data Science, Munich, Germany d Emmab, J. Hodgesb, M. Kiernanb, F. Sadafc, O. Piguetb GW Research Ltd, Market Access and Health Economics and Outcomes aRoyal Prince Alfred Hospital, Neurology, Camperdown, Australia Research, Cambridge, United Kingdom ARTICLE IN PRESS

40 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx ARTICLE IN PRESS

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Objective Background This retrospective study examined the epidemiology, costs, High-dose immunosuppressive therapy (HDIT) with autologous hospital admissions and length of stay (LOS), and mortality in cases hematopoietic stem cell transplantation (AHSCT) is a new effective classified as probable Dravet syndrome (DS) in the German method of treatment of aggressive multiple sclerosis. healthcare system. The aim of this study was to assess the long-term effects of nonmyeloablative autologous hematopoetic stem cell patients in Methods multiple sclerosis (MS). This retrospective, insurance data analysis utilised the Vilua Healthcare research database, representing approximately 5% of the Materials, methods German population covered by statutory health insurance. Probable Ninety-nine patients with MS were included in the study. They DS cases were defined by an algorithm using ICD-10 coding and AED have been exposed to HDIT+AHSCT with nonmyeloablative protocol prescriptions. Costs and LOS were stratified by the use of emergency (Cyclophosphamide 200 mg/kg b.w+Rituximab 500 mg/m2). Mean seizure medication. The cost of illness was assessed on all hospital age – 35 years old; male/female – 39/60; median EDSS = 3.5; 43 admissions between 1 January 2007 and 31 December 2016. relapsing/remitting MS, 56 progressive MS. The median of follow-up Mortality was calculated and compared to age- and gender-matched period is 48.9 months. database controls with an equal observation time. Results Results No transplant-related deaths were observed. At 6 months post- Based on 64 patients in 2016 with probable DS, the mean age was transplant neurological improvement or stabilization was observed 33.2 years with a calculated standardised prevalence of 4.7/100,000 in all the patients except one. Cumulative incidence of disease (Table 1). Patients with emergency drug use had a higher rate and progression was 16.7% at follow-up period after treatment. LOS in hospital, as well as treatment costs, than those without. Estimated event-free survival at median follow-up of 48.9 months Inpatient care was the highest treatment cost (Table 2). Over 96 was 80% (83.3% in relapsing/remitting MS versus 75.5% in months, mortality was 13.14-fold higher in probable DS than the progressive MS). 64 patients who did not progress during the first control group (Figure). 3 year post-transplant and were monitored for more than 3 years were included in long-term outcome analysis. At the median long- Conclusion term follow-up of 62 months 47% of patients improved by at least The findings of this retrospective study indicate that patients with 0.5 points on the EDSS scale as compared to baseline and exhibited probable DS incur substantial costs related to hospitalisation, improvement during the entire period of follow-up; 45% of patients medication, outpatient services, and multidisciplinary care. Emer- were stable. No active, new or enlarging lesions on magnetic gency medication can be used as a marker for disease severity resonance imaging were registered in patients without disease resulting in considerably more hospitalisations and higher costs. The progression. higher mortality rate in patients with DS reinforces the need for new patient treatment. Conclusions Сonsequently, demonstrated high efficiency and safety HDIT Funding +AHSCT with nonmyeloablative protocol in patients with MS. GW Research Ltd, Cambridge, UK. Further studies are necessary for better assessment of treatment outcomes. doi:10.1016/j.jns.2019.10.841

doi:10.1016/j.jns.2019.10.842

WCN19-0538 WCN19-0546 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - ^ Part I/dementia - Part I/epilepsy - Part I/health economics and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - outcomes/neuroepidemiology and environmental and other Part I/dementia - Part I/epilepsy - Part I/Health economics and outcomes/neuroepidemiology and environmental and other Long-term outcomes of nonmyeloablative autologous hematopoietic stem cell transplantation in multiple sclerosis Epidemiology, healthcare resource use, and mortality in patients with probable Lennox-Gastaut syndrome: A population-based I. Nikolaeva, D. Fedorenkob, O. Vinogradova, A. Kuznetsovc study on German health insurance data aFederal State Budgetary Institution “National Medical and Surgical Center Named After N.I. Pirogov” of the Ministry of Healthcare of the A. Strzelczyka, S. Schubert-Bastab, A. Simonc, S. Sertc, G. Wyattd, R. Russian Federation., Neurology Department for Patients With Cerebral Hollandd, F. Rosenowa Circulation Disorders, Moscow, Russia aEpilepsy Center Frankfurt Rhine-Main, Department of Neurology, bFederal State Budgetary Institution “National Medical and Surgical Goethe-University, Frankfurt am Main, Germany Center Named After N.I. Pirogov” of the Ministry of Healthcare of the bDepartment of Neuropediatrics, Goethe-University, Frankfurt am Main, Russian Federation., Hematology Departmet, Moscow, Russia Germany cFederal State Budgetary Institution “National Medical and Surgical cMedical Data Science, Vilua Healthcare GmbH, Munich, Germany Center Named After N.I. Pirogov” of the Ministry of Healthcare of the dMarket Access and Health Economics and Outcomes Research, GW Russian Federation, Department of Neurology With a Course of Research Ltd, Cambridge, United Kingdom Neurosurgery, Moscow, Russia ARTICLE IN PRESS

42 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx ARTICLE IN PRESS

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Objective which were divided into 2 equal groups. Patients of the 1st group (8 This retrospective study examined the epidemiology, costs, patients) received repeated standard therapy in combination with 5 hospital admissions and length of stay (LOS), and mortality in cases plasmapheresis sessions, and patients of the 2nd group (7 patients) classified by an algorithm as probable Lennox-Gastaut syndrome received the same therapy without plasmapheresis (taking into (LGS) in the German healthcare system. account that plasmapheresis is effective only in the first 2 weeks of the onset of the disease). The level of motor deficit in both groups Methods was not significantly different: it was 2 points of the upper and 3 This insurance data analysis utilised the Vilua Healthcare research points in the lower extremities. database, containing anonymised data on N3.5 million insured individuals, representing ~5% of the German population covered by Results statutory health insurance. Probable LGS cases were identified by an It should be noted that the above-mentioned patients received algorithm using ICD-10 coding and AED prescriptions. Costs and LOS standard therapy with the use of therapeutic plasma exchange in the were assessed for all hospital admissions between 1 January 2007 and acute period of the disease. After one month in patients of group 1, 31 December 2016; these data were stratified by emergency seizure muscle strength in the upper extremities increased to 3 points, and medication use. Mortality was calculated and compared to age- and in the lower extremities to 4 points, respectively after repeated gender-matched controls over an equal observation time. treatment. In group 2, there was no dynamic improvement in the motor area. Results 545 patients were identified with probable LGS during 2016. Conclusion When further restrictions were applied to confirm the diagnosis (at Therefore, the use of repeated plasmapheresis even after 3–4 least 1 epilepsy diagnosis b6 years of age), this number was reduced months from the onset of the disease in Guillain-Barre syndrome is a to 102 with a calculated standardised prevalence of 6.5/100,000 pathogenically justified method of treatment. (Table 1). Mean age was 7.4 years. Mortality over 10 years was higher in patients versus controls (Figure). The average annual cost doi:10.1016/j.jns.2019.10.844 of care was €22,523/patient year (Table 2). Patients with emergency medication use had a higher rate of hospitalisation and LOS than those without (Table 2). WCN19-0568 Conclusion ^ Patients with probable LGS have a high mortality rate (3.99%), compared to controls (0.01%), and incur substantial hospitalisation, Poster shift 02 - Autoimmune disorders - Part I/CNS infections - medication, outpatient services, and multidisciplinary care costs. Part I/dementia - Part I/epilepsy - Part I/Health economics and Patients with emergency medication use incur Ndouble the costs outcomes/neuroepidemiology and environmental and other than those without. Sex differences among epileptic patients: A comparison of Funding epilepsy and its impacts on demographic features, clinical GW Research Ltd., Cambridge, UK. characteristics, and management patterns in a tertiary care hospital doi:10.1016/j.jns.2019.10.843 N. Kishka, H. Mourada, S. Ibrahimb, R. Shamloula, A. Al-Azazic,N. Shalabya aNeurology, Kasr Al-Ainy Hospital and school of medicine, Cairo WCN19-^0565 University, Cairo, Egypt bDepartment of Community Medicine, Cairo University, Cairo, Egypt c, Neurology, Cairo University, Cairo, Egypt Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/Health economics and Background outcomes/neuroepidemiology and environmental and other Epilepsy is one of the commonest neurological conditions. We aimed to identify sex differences in the demographic, clinical fi High ef ciency of repeated courses of therapeutic plasmapheresis features and treatment strategies in epileptic patients. with transferred guillain-barre syndrome, pathogenically based treatment method Objectives To analyse and compare the differences in the impact of epilepsy N. Panjiyeva, S. Dadajonov, R. Sodiqov, R. Ismoilov, D. Boykhonova, A. on the socio-demographic characteristics of male and female patients Sobirov, A. Turakhanov, M. Mavlanov along with gender differences in various types of epilepsies and 1st Clinic, Neurology, Tashkent Madical Academy, Tashkent, Uzbekistan treatment strategies.

Objective Materials and methods To evaluate the effectiveness of re-plasmapheresis in patients A record based study for 1000 individuals attending the epilepsy undergoing Guillain-Barre syndrome, who had a gross residual motor out-patient clinic. The medical records were reviewed through a deficit during the first 3–4 months from the onset of the disease. predesigned questionnaire to obtain all relevant data. Statistical analysis: Data was summarized using range, mean, standard Materials and methods deviation, and median interquartile range for quantitative variable 15 patients were examined for 3 years who had Guillain-Barre or frequency and percentage for qualitative ones. Comparison syndrome for 3–4 months with a pronounced residual deficiency, between groups was done using Chi-square test. ARTICLE IN PRESS

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Results activity, and enhanced glucagon-like peptide-1 concentration in Females were more illiterate and unemployed compared to vascular dementia in experimental model mice. males, but higher number of males were unmarried. Tonic clonic seizures were more frequent in males. Speciﬁc epileptic syndromes Conclusion as juvenile myoclonic epilepsy (JME), idiopathic generalized tonic ^This study suggests that genistein has potent neuroprotective clonic (IGTC) epilepsy, and temporal lobe epilepsy (TLE) were more activity against chronic cerebral hypoperfusion and may be consid- frequent in females (p = .01, p = .02, p = .02) while juvenile ered as a potential treatment for cognitive deﬁcits and neuronal absence epilepsy (JAE) was more common in males (p = .02) More injury in the hippocampal CA1 area. males had an underlying secondary etiology (p = .001). The commonest drug used was valproate (51.2%) which was more doi:10.1016/j.jns.2019.10.846 utilized by males while more females were prescribed CBZ and levetiracetam.

Conclusions WCN19-0591 Signiﬁcant differences between both sexes were observed in certain social impacts in addition to seizure syndromes, etiology and drug utilization. Poster shift 02 - Autoimmune disorders - Part I/cns infections - Part I/dementia - Part I/epilepsy - Part I/health economics and doi:10.1016/j.jns.2019.10.845 outcomes/neuroepidemiology and environmental and other

Clinico-radiologic profile of a dorsal variant of posterior cortical atrophy in a 55-year old female WCN19-0573 J. Yu, J. Dominguez, M.S. Martinez, F.M. Cruz, R. Pilotin St. Luke's Medical Center, Institute for Neurosciences, Quezon City, Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Philippines Part I/dementia - Part I/epilepsy - Part I/Health economics and outcomes/neuroepidemiology and environmental and other Posterior Cortical Atrophy is a group of neurodegenerative disorders characterized by early, prominent and progressive impair- Neuroprotective effect of genistein on cognitive impairment in ment of visuospatial and visuoperceptual functions in the context of vascular dementia experimental mice model relatively preserved memory and insight in the early phases. Initial visual symptoms are vague and peculiar, compelling them to seek R. Kumar, V. Paracha ophthalmologic consult. Patients present with simultagnosia and Sardar Bhagwan Singh PG Institute of Bio-medical Science & Research, spatial disorientation, which are often missed by routine ophthal- Uttarakhand Technical University, Dehradun, India mologic and neurologic exams. This causes delay in diagnosis and early recognition of symptoms, as well as thorough examinations of Objectives higher cortical function are required to diagnose this disorder. As the The present study aims to determine the neuroprotective efficacy disease progresses, Posterior Cortical Atrophy ultimately leads to a of genistein on vascular dementia in experimental model mice and more diffuse pattern of cognitive dysfunction. The underlying explore the underlying mechanisms. pathology is believed to be Alzheimer's Disease and a greater level of amyloid plaques is correlated with earlier clinical symptoms of Materials and methods Posterior Cortical Atrophy. The clinical features of reported cases are To induce vascular dementia, chronic bilateral common carotid heterogenous, leading to a classification of different variants and artery occlusion was performed on female mice brain by occluding underlying pathologies. We report the serial clinical, cognitive and both common carotid arteries for 30 min followed by 24 h reperfu- imaging data of a variant of Posterior Cortical Atrophy primarily sion to induce neuronal injury. After surgery, the mice were treated affecting the dorsal stream. daily by oral administration of genistein (5.0, and 10.0 mg/kg, i.p., o. d.) for one months. The cognition function of treated mice, were doi:10.1016/j.jns.2019.10.847 evaluated by Morris Water Maze (MWM) test, neurological functions measured as short-term memory and motor performance. In addition, cerebral infarct size, oxidative damage, mitochondrial activity in terms of neuronal apoptosis and cellular viability, Nissl and TUNEL staining were chosen to assess neuronal damage within WCN19-0600 the hippocampal CA1 area. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Results Part I / dementia - Part I /epilepsy - Part I / health economics and In present study, there was an increase in cognitive impairment outcomes / neuroepidemiology and environmental and other and neuronal damages within CA1 hippocampal subregion caused by chronic cerebral hypoperfusion. Genistein administration significantly counteracted cognitive impairment and re-established motor Alcohol and epilepsy seizures correlation performance in vascular dementia in mice. Genistein was able to a b c prevent cognitive deficits, and reversed CCH-induced hippocampal E. Shemsi , K. Shemsi , F. Domi a neuronal loss and apoptosis. Genistein treatment significantly Regional Hospital Durres, Neurology, Durres, Albania b reduced neuronal apoptosis and increased cellular viability, almost Faculty of Medicine, University Of Medicine Tirana, Tirana, Albania c completely suppressed the circulating dipeptidyl peptidase-4 Regional Hospital Durres, Emergency, Durres, Albania ARTICLE IN PRESS

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Alcohol abuse and its consequences related seizures are Well old were studied using solid-phase enzyme immunoassay (ELISA). The known in experimental and clinical data. The best Recognized control group consisted of 36 healthy persons of comparable sex and seizures are “alcohol withdrawal seizures” Specific epileptogenesis age. Average values of Aß1–40, Aß1–42 in blood samples of PWE did may underlie seizure unrelated to withdrawal and in this contects not differ from the control group and were within 0–10 pg/ml for Aß1– involves several mechanisms including alterations of excitation/ 40, 30–40 pg/ml – for Aß1–42. At the same time, the ph-Tau values in inhibition systems and a kindling like effect. Patients presenting with PWE were almost three times higher than the norm (0–10 pg/ml) and seizures unrelated to any cause other than alcohol are classified in amounted to 28.64 pg/ml. It can be assumed that the presence of several successive stages of “alcoholic epilepsy”, as solitary and hyperphosphorylated Tau protein may be associated with the chronic seizure. Epidemiological data have shown that 4 to 7% subsequent formation of neurofibrillary plexuses (“tangles”) in the alcoholics have seizures. There are several possible contexts in which brain. The determination of the concentration of phosphorylated Tau- seizures can occur in chronic alcoholics, hypoglycemia, hyp- protein, amyloid Aβ40, Аβ42 in the cerebrospinal fluid, blood plasma onatremia, hepatic en-cephalopathy, thiamine deficient, head trauma can be allows to recognize the neurodegenerative process in the early cerebral atrophy^,etc. stages of the disease before the development of severe cognitive impairment, reaching the stage of dementia in PWE. Methodology We have data for 40 patients recovered with diagnoses of doi:10.1016/j.jns.2019.10.849 epileptic seizure in emergency division in Regional Hospital Durres Albania in years 2014–2017. Mean age of patients 42.4 years old. 38 are male and 2 are female. The types of seizures observed Generalized tonic clonic 57%, status epileptic 13%, simple partial WCN19-0608 fi seizures5%, simple complex seizures 4^%, 21% un classi cation seizures. Two causes (female) had the first time of alcohol abuse. The mean times of alcohol abuse for the males were 16.5 years. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and Conclusion outcomes / neuroepidemiology and environmental and other In our opinion the classifications of time abuse and the type of seizures can help for drug choice anti epileptic treatment but The particularities of motherhood for women suffering from alcoholic epilepsy we think is an epileptic syndrome whose epilepsy particularity resides in the fact that it is potentially reversible and the herapy can be stopped in cases of free seizures for long time. T. Kopystsevaa, V. Titovaa, L. Lipatovab, T. Dakukinac, T. Alexeevab aSt. Petersburg State Pediatric Medical University of the Ministry of doi:10.1016/j.jns.2019.10.848 Healthcare of the Russian Federation, Psychiatry, St. Petersburg, Russia bAlmazov National Medical Research Centre- Saint-Petersburg- Russia, Neurology and Psychiatry, St. Petersburg, Russia cThe State Institution «Republican Research and Practice Center for WCN19-0606 Mental Health»- Minsk- Belarus, Psychiatry, Minsk, Belarus

fi Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Women with epilepsy (WWE) face a number of dif culties, in particular, the presence of family, personal and maternal problems. Part I / dementia - Part I /epilepsy - Part I / health economics and Epilepsy affects the further relationship between the child and the outcomes / neuroepidemiology and environmental and other mother. However, psychological aspects of motherhood WWE – insufficiently studied topic, despite the large number of available data Biomarkers of dementia in epilepsy. in the literature on the study of personality characteristics of patients with epilepsy. 24 WWE are between the ages of 25–35, and have one or a b c c T. Dakukina , A. Astashonok , L. Lipatova , T. Alexeeva more children aged 0–10 years, were studied using a battery of a The State Institution «Republican Research and Practice Center for psychological tests: “Parental Attitude Research Instrument (PARI)” by Mental Health»- Minsk- Belarus, Psychiatry, Minsk, Belarus E.S. Shefer, R.K. Bell (1958), projective technique “Unfinished Sugges- b The Republican Research and Practical Center for Epidemiology and tions” by Joseph M. Sachs (1950) and other. As a result of using the Microbiology- Minsk- Belarus, Epidemiology and Microbiology, Minsk, Manna-Whitney's U-Criteria criterion was obtained: style of upbring- Belarus ing has a directive character and that women are fixated on their own c Almazov National Medical Research Centre- Saint-Petersburg- Russia, children. The patients feel tired from the role of mother, however they Neurology and Psychiatry, St. Petersburg, Russia strive to devote much time to inner familial interaction, as well as to control and suppress everything that is happening with the child; Patients with dementia present epilepsy more frequently than the according to the used methods the level of empathy is reduced; general population. Seizures are more common in patients with according to the results of projective techniques, the mothers can be Alzheimer's disease (AD), dementia with Lewy bodies (LBD), characterized as irritable, emotional, anxious, over-protective, self- frontotemporal dementia (FTD) and progressive supranuclear palsy indulgent, emotionally distant, hypochondriacs, dependent, religious. (PSP) than in other dementias. Brains of patients with AD, LBD, FTD Therefore, the nature of upbringing among such patients has an and PSP show hyperphosphorylated tau aggregates, amyloid-β authoritarian and directive style. Such mothers have a low sense of plaques and neuropil threads. Increasing evidence suggests the empathy. Mothers with this diagnosis can be described as irritable, existence of overlapping mechanisms related to the generation of emotional, anxious, over-protective, self-indulgent, emotionally dis- network hyperexcitability and cognitive decline (Sánchez M.P. et al., tant, hypochondriacs, uncritical, dependent, religious, and vain. 2018). Levels of β-amyloids Aß1–40, Aß1–42, phosphorylated Tau protein (ph-Tau) in blood samples of 33 patients with doi:10.1016/j.jns.2019.10.850 pharmacoresistant epilepsy (PWE) both sex, the ages of 20–70 years ARTICLE IN PRESS

46 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0610 E. Korsakovaa, N. Sivakovab, L. Lipatovac, O. Nikonovab,A. Godlevskayab, T. Dakukinad, T. Alexeevac aNational Medical Research Centre of Psychiatry and Neurology named Poster shift 02 - Autoimmune disorders - Part I /CNS infections - after V.M. Bekhterev, Neurophysiology, St. Petersburg, Russia Part I / dementia - Part I /epilepsy - Part I / health economics and bNational Medical Research Centre of Psychiatry and Neurology named outcomes / neuroepidemiology and environmental and other after V.M. Bekhterev, Epilepsy, St. Petersburg, Russia cAlmazov National Medical Research Centre- Saint-Petersburg- Russia, The relation of coping behavior strategy with emotional charac- Neurology and Psychiatry, St. Petersburg, Russia teristics of patients with epilepsy dThe State Institution «Republican Research and Practice Center for Mental Health»- Minsk- Belarus, Psychiatry, Minsk, Belarus O. Yakuninaa, L. Lipatovab, N. Sivakovaa, O. Nikonovaa, A. God- levskayaa, T. Dakukinac, T. Alexeevab The purpose of this study was to determine the effectiveness of aNational Medical Research Centre of Psychiatry and Neurology named EEG monitoring in the diagnosis of epilepsy. after V.M. Bekhterev, Epilepsy, St. Petersburg, Russia We studied 94 PE. All patients had an EEG with using functional bAlmazov National Medical Research Centre- Saint-Petersburg- Russia, loads (eye opening, photostimulation, hyperventilation), 31 people Neurology and Psychiatry, St. Petersburg, Russia (14 men and 17 women, mean age 27 years) were conducted to EEG- cThe State Institution «Republican Research and Practice Center for monitoring with night sleep deprivation, a few days after EEG. We Mental Health»- Minsk- Belarus, Psychiatry, Minsk, Belarus used the 21-channel electroencephalograph “Telepath” for the EEG. The electrodes were located on the surface of the head of the The aim of the study is to investigate strategies of stress-coping International System “10–20”. behavior in patients with epilepsy (PE). The study of these phenomena The PA on EEG was detected only in 58.51% of patients, in 41.49% is relevant, since the disease itself and the associated difficulties of of PE - was absent. The EEG-monitoring allowed additional PA social and labor adaptation are a source of emotional stress for detection in 25.51% PE, in 54.83% of patients, paroxysms significantly patients. Knowledge of ways to cope with stress allows for more increased during sleep and in areas of awakenings. The PA has targeted psychotherapeutic work with this category of patients. become more frequent, increased its amplitude and duration, it has We examined 80 PE with various clinical forms of the disease. The become significantly more likely to include epileptiform patterns as psychological method of “Сoping strategies” (R.S. Lazarus, 1984) was spikes, sharp waves, complexes “spike-wave”, “multiple spike-wave”, used to study coping strategies. Research findings were compared “sharp-slow wave”. The EEG-monitoring in 45.16% of PE allowed to with some psychological characteristics of patients. specify the shape of the PA, the localization of epileptic focus, the level of involvement of the brain stem. In general, we can talk about Results increasing the efficiency of diagnosing epilepsy by 70.67% using the Intracorrelation relations of coping strategies with emotional EEG monitoring with night sleep deprivation.The EEG-monitoring is characteristics of patients were found. In case of heightened mood, an effective method for the diagnosis of epilepsy. The advantage of patients more frequently choose an optimistic strategy in the this method is a significant increase in the quantity and quality of structure of emotional coping (p = .05). With a reduced mood clinically relevant information that makes it possible to significantly non-adaptive forms of coping strategies are revealed, strategies for improve the accuracy, reliability and informativity of electroenceph- suppressing emotions, self-blame and aggression are more common. alographic diagnosis of epilepsy. In the presence of asthenic manifestations, decreased mood background and communication skills, patients tend to choose the doi:10.1016/j.jns.2019.10.852 escape-avoidance strategy (p ≤ .01). When patients' adaptive capacity is reduced, it is probably a kind of protective reaction from excessive strain. With a sufficient level of activity and good mood the «planning for problem solving» strategy prevails (p ≤ .01). WCN19-0613

Conclusion Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Thus, the application of the “Сoping strategies” method comple- ments and expands psychological examination in epilepsy, provides Part I / dementia - Part I /epilepsy - Part I / health economics and a quantitative and qualitative assessment of such psychological outcomes / neuroepidemiology and environmental and other formations as stress-coping behavior strategies. Knowing of stress- coping ways allows for more targeted psychotherapeutic treatment The structure of epileptic seizures in women of reproductive age of this category of patients. D. Victoria, M. Gavriliuc doi:10.1016/j.jns.2019.10.851 Republican Hospital of Neurology and Neurosurgery, Department of Neurology, Chisinau, Republic of Moldova

Background WCN19-0612 Semiology of epileptic seizures is one of the most important things in its diagnosis and treatment. According to extensive data from previous studies, women are more commonly encountered Poster shift 02 - Autoimmune disorders - Part I /CNS infections - with focal epileptic seizures. What type of epileptic seizure Part I / dementia - Part I /epilepsy - Part I / health economics and occur more often in women and which brain structures are more outcomes / neuroepidemiology and environmental and other likely to generate a seizure is a controversial subject. We proposed to analyze the spectrum of seizures in women of The efﬁciency of EEG-monitoring in a diagnosis of epilepsy reproductive age. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 47

Methods consciousness. Descriptive analysis was used to study the factors In this study, 148 women aged 15–45 were included. The involved in the patient ﬁndings. importance of an accurate description of simptoms was considered. Paraclinical examination was performed by electroencephalography ^Findings/prognosis (EEG) simple, EEG sleep deprivation, long-time computerized EEG on Only 1 of the 4 patients with subclinical seizures had periodic the Nicoletone cEEG system using the”10–20 system”method. lateralizing epileptogenic discharges. Only one of the patients with Cerebral Computerized tomography was performed on Tomato Spiral the subclinical seizures was known to have seizure. Last 2 patients Somatom Emotion 16 Slices tomograph (“Siemens”). Cerebral were post cardiac arrest & one had brain metastasis. 2 of the patients Magnetic Resonance (MRI) imaging was applied using IR Mag- with the subclinical seizure died few days later because of the netom-Open (“Siemens”) and T1, T2, T1C, FLAIR recording tech- seizure or drug side effects. niques. Data was processed using Excel methods. ^Conclusion Results Patient with decrease level of consciousness after clinical seizure Initially, 99 patients were diagnosed with focal epileptic seizures. increase suspicion of subclinical seizure, therefore, early diagnosis of According to repeated EEG monitoring, for 48 h, 15 of patients were the subclinical seizure allows early management and most likely without a certain focal origin, although it has clinical focal seizures. better outcome. However, there was an over utilization of EEG found These subjects were transferred to the unknown seizures group for in through the study. further investigation. Subsequently, patients with generalized seizures initially constituted 49, of whom 7 had a diagnosis difﬁcult to Keywords: cEEG, NCSE differentiate between the absence and the focal seizure with the disturbance of consciousness, thus falling into the group with unknown seizures. As a result, we obtained 84 patients-focal doi:10.1016/j.jns.2019.10.854 seizures, 42-generalized seizures, 22-unknown.

Conclusion Focal seizures were prevalent in women with epilepsy monitored WCN19-0627 in the study. The fact that suggests in depth examination by cerebral neuroimaging to determine etiology and optimal treatment. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - doi:10.1016/j.jns.2019.10.853 Part I / dementia - Part I /epilepsy - Part I / health economics and outcomes / neuroepidemiology and environmental and other

Role of dementia support groups in countries like India WCN19-0617 B. Rajendran Kauvery Hospital, Chennai, India Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and Dementia isn't a specific disease. Instead, dementia describes a outcomes / neuroepidemiology and environmental and other group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning. Alzheimer's EEG efficiency of detecting sub-clinical seizures in critical ill disease accounts for 60 to 80% of cases. Vascular dementia, which patients: Retrospective study occurs after a stroke or small vessel disease, is the second most common dementia type. But there are many other conditions that R. Alharbia, A. Baarmahb can cause symptoms of dementia, including some that are reversible, aKing Faisal University, Biomedical Science, Hofuf, Saudi Arabia such as thyroid problems and vitamin deficiencies. b King Fahad Specialist Hospital, Department of Neuroscience, Dammam, Medical treatment is useful to reduce some of the symptoms^, Saudi Arabia mainly in the early stages of dementia but there is no complete cure. Support is vital for people with dementia. The help of families, friends and carers can make a positive difference to managing the condition. Întroduction Continuous electroencephalography (cEEG) monitoring in the Caring for patients with dementia is huge responsibility especially critical care setting demonstrates a linear increase in seizure in countries like India where we do not have many residential or incidence with declining mental status. Delayed diagnosis and nursing homes. The family has to take up care and it is a huge burden treatment of non-convulsive status epilepticus (NCSE) may lead to financially and physically leading to a lot familial disharmony. increased mortality. No clinical or paraclinical parameter can reliably We wanted to see if this integrated care for dementia which distinguish elderly patients with delirium with or without patterns includes creating awareness about dementia, evaluation, treatment compatible with NCSE in the absence of cEEG monitoring. EEG may of dementia and establishing support care for the patients who are in be over-utilized in our hospital ICUs & usually ordered for most of the later stages of dementia helps with better management. India is a the patient with altered mental status. We aimed to evaluate the country where many disease have a stigma attached and we were efficiency of EEG to detect subclinical seizures in patients with not sure if we could bring people together to talk freely about the altered level of consciousness. problems they face. The caretakers'support group has become very popular and helped beat so much taboo and alleviate fear. ^Methods Single-center retrospective study comprised 24 patients who were hospitalized in King Fahad Specialist Hospital in Dammam doi:10.1016/j.jns.2019.10.855 between January2017-December2018 due to change of their level of ARTICLE IN PRESS

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WCN19-0632 2016 to March 2019. Patients seropositive for anti VGKC complex antibodies were included in the study. Relevant clinical information was collected from patients, their relatives and physicians. Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and Results outcomes / neuroepidemiology and environmental and other Â total of 755 patients were tested for autoimmune encephalitis associated autoantibodies; 14 (1.9%) patients were seropositive for Low albumin and pretreatment severity score can predict the anti VGKC complex antibodies. Eight patients, 7 males and 1 female functional outcome of Guillain–Barré syndrome with an age range of 14 to 64 years (median age 32.5 years) were included in the study. Five patients were positive for both anti LGI1 A. Dyah Kusumawati, I.S.K. Harahap, Y. Yudiyanta and anti CASPR-2 antibodies and 3 only for anti CASPR-2 antibodies. Gadjah Mada University, Neurology, Yogyakarta, Indonesia Clinical features included anger (7 patients), sleep disorder (6 patients), cognitive decline (5 patients), history of fall (3 patients), Guillain–Barré syndrome (GBS) is an acute immune-mediated seizures (3 patients), hallucinations (3 patients), impulsive behav- demyelinating polyradiculoneuropathy. The disease is characterized iour (3 patients), depression (2 patients), hypotension, hyp- by a progressive flaccid paralysis with areflexia and various motor, onatremia, dysphoria, paranoia and altered consciousness (1 sensory and autonomic symptoms. There are only limited data assess patient). Those who were treated shortly after symptom onset with association between serum albumin levels and outcome of GBS in immunosuppressive therapy including steroids, IVIg and plasma patients treated with plasmapharesis. Serum albumin concentration exchange completely recovered in contrast to those in whom was determined before and after treatment with plasmapheresis and diagnosis and treatment were delayed. related to clinical outcome. We reviewed the medical records of 30 GBS patients who underwent plasmapheresis as the first-line Conclusion therapy. The severity of disease was evaluated by GBS disability Early diagnosis followed by prompt initiation of immunomodu- scores. Functional outcome was defined as good (GBS disability score latory therapy including steroids, IVIg and plasmapheresis is crucial 0 to 2) or poor (GBS disability score 3 to 6) at admission and for effective management of these disorders as it leads to complete discharge. The cohort included 9 women and 21 men with a mean recovery and prevents residual brain damage. age of 51.4 ± 19.22 years. In univariate logistic regression analysis, doi:10.1016/j.jns.2019.10.857 potential factors associated with poor outcome include an older age (p = .012), using mechanical ventilation (p = .013), a low albumin (p = .025), a low serum sodium level (P = .497) and a high disability score on admission (P b .001). In multivariate analysis, a low albumin was associated with a poorer outcome (OR, 8,2; 95% CI, WCN19-0650 1.046 to 64,6; P 0.045). In conclusion, patients with GBS may develop hypoalbuminemia after treatment with plasmapheresis, which is Poster shift 02 - autoimmune disorders - Part I /CNS infections - related to a more severe clinical course and a poorer outcome. Part I / dementia - Part I /epilepsy - Part I / health economics and doi:10.1016/j.jns.2019.10.856 outcomes / neuroepidemiology and environmental and other

Cerebral cryptococcosis in an immunocompetent patient: a case report WCN19-0647 J. Jesiscaa, D.S. Roryb, Y.B. Hartantoc adr. H. Ishak Umarella Hospital, Family Medicine, Central Maluku, Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Indonesia Part I / dementia - Part I /epilepsy - Part I / health economics and bdr. Abdul Aziz Hospital, Family Medicine, Singkawang, Indonesia outcomes / neuroepidemiology and environmental and other cBethesda Hospital, Neurology, Yogyakarta, IndonesiaKeywords: Cere- bral Cryptococcosis, Immunocompetent, Amphotericin B, Fluconazole Anti VGKC complex antibody associated disorders: A retrospective audit Introduction Cryptococcal infections of the central nervous system are very S. Sheikha, F. Qayyuma, A. Ahmadb, T. Ahmeda, M. Amjadb rare in immunocompetent patients. Rapid diagnosis and appropriate aShifa International Hospital, Immunology, Islamabad, Pakistan treatment is crucial to the prognosis. bShifa International Hospital, Neurology, Islamabad, Pakistan Case presentation Introduction A 29-year-old male with sudden onset headeache and right eye ’ Anti voltage gated potassium channel (VGKC) complex antibody lacrimation. Brudzinski s sign positive and papilledema. Laboratory ﬁ disorders mainly include Limbic encephalitis and neuromyotonia, ndings were positive to Cryptococcosis, while HIV test was negative. caused by antibodies directed against VGKC associated proteins i.e., Patient was treated with Fluconazole 1200 mg IV daily for 10 weeks Leucine rich glioma1 (LGI1) and Contactin associated protein-2 and shows no improvement. Medication was changed into (CASPR-2), present on neuronal membranes. Amphotericin B 48 mg IV, once a day. Then, patient experienced Acute Kidney Injury. Therapy was changed to oral ﬂuconazole 1200 mg/day. Methods Patient was seen presenting poor general condition. However, despite A retrospective audit was undertaken for patients referred for optimal clinical treatment, his condition evolved to death. Low CD4 μ autoimmune encephalitis associated autoantibody testing, from January count, 76 cells/ L, was found before the patient die. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 49 ARTICLE IN PRESS

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Discussion WCN19-0655 Monotherapy is not an effective treatment, but we gave ﬂuconazole back as monotherapy after patient experienced acute kidney injury caused by Amphotericin B. Because of CD4 T Poster shift 02 - Autoimmune disorders - Part I /CNS infections - lymphocyte depletion (in October 2018 and January 2019, his CD4 Part I / dementia - Part I /epilepsy - Part I / health economics and counts were 740 and 76 cells/ μL), our patient met the existing outcomes / neuroepidemiology and environmental and other criteria for Idiopathic CD4 T-lymphocytopenia with CNS cryptoccocosis because there is no serological evidence of HIV Changing face of stroke care in the middle east north africa infection and the absence of receiving T-Cell Depleting Induction region therapy. It has been suggested that cryptococcal antigens may inhibit 1 induction of a protective T-cell-mediated immune response. M. Khan, S. Al Rukn Rashid Hospital, Neurology, Dubai, United Arab Emirates Conclusion Patients with CNS cryptococcosis can cause Idiopathic CD4 T- The Middle East North Africa (MENA) consists of nineteen ﬂ lymphocytopenia and uconazole as monotherapy failed in the countries with an estimated population of over 400 million. In the treatment of CNS cryptococcosis. absence of good quality data on stroke incidence and prevalence from the region, the exact burden of this devastating disease is hard doi:10.1016/j.jns.2019.10.858 to determine. However, as these countries undergo epidemiological transition, the burden of non-communicable diseases is on the rise ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 51 and a recent review of the available literature, suggests an increase Conclusion in the stroke incidence and mortality in the region. This humble work tries to affirm that eradication of H.pylori Unfortunately, stroke care is still in its infancy and despite infection may have a benefit impact on the clinical outcome of alteplase being approved more than two decades ago, only a few Parkinson disease. Furthermore, additional study with larger popu- centers provide this intervention. To the best of our knowledge, lation and suitable statistical tools are required to precisely estimate there were less than ten centers that were thrombolysing patients the impact of the infection on the prognosis of Parkinson’s disease. with acute ischemic stroke in the whole region before 2012, and the rate of thrombolysis was less than 1%. doi:10.1016/j.jns.2019.10.860 In the past five years, through efforts of a group of like-minded neurologists from the region, there has been a significant improvement in the level of stroke services in the region. Under the umbrella of Middle East North Africa Stroke Organization (MENASO) with its WCN19-0660 headquarters in Dubai, the number of stroke centers has grown exponentially in the region. We describe the growth of stroke services in various countries and the role of the organization in Poster shift 02 - Autoimmune disorders - Part I /CNS infections - achieving strategic objectives aligned to improve overall stroke care PART I / dementia - Part I /epilepsy - Part I / health economics and in the region. outcomes / neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.859 Cerebral venous thrombosis associated with recurrent cryptococcal meningitis in an HIV infected patient

A. Mohameda, S. Alia, J. Kanyib, A. Gardnerac WCN19-0656 aMoi University, Department of Medicine, Eldoret, Kenya bMoi Teaching and Referral Hospital, Department of Medicine, Eldoret, Kenya Poster shift 02 - Autoimmune disorders - Part I /CNS infections - cIndiana University, Department of Medicine, Indiana, USA Part I / dementia - Part I /epilepsy - Part I / health economics and outcomes / neuroepidemiology and environmental and other Cerebral venous thrombosis (CVT) in HIV related cryptococcal meningitis is uncommon. We report a case of a forty-year-old HIV Parkinson's disease and helicobacter pylori: About 20 patients infected woman on second line protease inhibitor based antiretroviral therapy; tenofovir, lamivudine and atazanavir/ritonavir and flucona- M. Bensaadi, N. Slimani, Z. Amamra, Y. Koubci, H. Bouzenada zole prophylaxis with poor adherence who presented to the HIV Army central hospital HCA, Algiers faculty of medicine, ALGIERS, Algeria outpatient clinic with history of treatment for multiple relapses of cryptococcal meningitis. She presented with complaints of recurrent Background headache, vomiting and blurring of vision and a painful right eye. One Helicobacter pylori is endemic in Algeria. The association year earlier, she had been treated three times for cryptococcal between HP infection and Parkinson disease has been evaluated meningitis diagnosed by positive CSF cryptococcal antigen (CRAG) by multiples studies in the world, although this is the first and CSF India ink stain. On all treatment episodes, she had completed observational study realized in north africa including 20 patients induction therapy with amphotericin B and fluconazole, had negative with Parkinson disease infected by HP, an evaluation of UPDRS repeat fungal cultures and fluconazole after induction therapy and was Score have been realized after eradication of HP by sequential on fluconazole for consolidation and maintenance phases. On tritherapy. presentation, she had cranial nerve palsy with otherwise normal central nervous system (CNS) examination. Her CD4 count was 9 /μL Objective and HIV viral load 234,387 copies/ml. Magnetic Resonance (MR) brain The study aimed to investigate the effect of HP eradication on the imaging with MR-venogram done showed mild filling defects in distal motor symptoms of Parkinson’s disease. saggital and left transverse sinuses. A diagnosis of CVT was made. Repeat CSF CRAG was positive but repeat cultures were negative. She Methods was initiated on treatment for CNS cryptococcosis with amphotericin B The cohort study evaluated 20 patients with Parkinson’s disease and fluconazole and started on anticoagulation. She completed 6 infected by HP ( confirmed by histology ) who received eradication months therapy with warfarin with marked improvement. This case treatment of HP (sequential tritherapy : PPI and amoxicillin for 5-7 contributes to the literature on CNS cryptococcosis and CVT and days followed by PPI, clarithromycin, and metronidazole for 5-7 highlights the difficulties of managing a patient with poor adherence days (each twice daily) and evaluated by UPDRS score Section III especially in CNS cyptococcosis that requires prolonged treatment. after it. doi:10.1016/j.jns.2019.10.861 ARTICLE IN PRESS

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WCN19-0673 A. Bhat, A. Biswas, A. Mukherjee, G. Das Bangur Institute of Neurosciences IPGMER & SSKM Hospital, Neurology, Kolkata, India Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and Introduction outcomes / neuroepidemiology and environmental and other Vascular Dementia (VaD) is the second leading cause of dementia worldwide,superseded only by Alzhiemer’s disease. Its myriad of Correlation between hyponatremia with clinical feature, labora- clinico-pathological and cognitive profile which depends on the tory-radiology finding and outcome in tuberculosis meningitis anatomical location of vessel and the cortico-subcortical circuitry involved along with its preventable and treatable nature make it a B. Munir, W. Mardi Santoso, S.B. Rianawati, R. Rakhmatiar, H. Al distinct entity in itself. Rasyid aUniversity of Brawijaya-Saiful Anwar Hospital, Neurology, Malang, Materials and methods Indonesia 76 patients of diagnosed probable Vascular Dementia were bMedical faculty Brawijaya University, Public health, Malang, Indonesia recruited at Bangur Institue of Neurosciences Kolkata with respect to their clinico-epidemiological, cognitive, and imaging parameters. fi Background The patients were then classi ed as small vessel and large vessel VaD Hyponatremia is common complication in tuberculosis meningitis accordingly.Kolkata cognitive battery and Bengali versions of stan- (TM), but correlation between hyponatremia with clinical feature, dard cognitive assessment batteries were used. laboratory-radiology finding and outcome was’t well documented especially in developing country Results Among 76 patients of VaD, small vessel VaD was identified in 48 Objective (62.5%) cases and large vessel VaD in 28(37.5%). Hypertention was To know correlation between Hypornatremia with clinical the most prevalent risk factor in all the patients, smoking in 22 feature, laboratory-radiology and outcome in tuberculosis meningitis (27.5%) cases and diabetes mellitus in 14(17.5%) cases.Other risk factors associated were hyperlipidemia in 10(12.5%), cardiac disease Method in 8(10%) cases and atherosclerotic carotid disease in 3(3.8%) cases. Cohort study, all patients tuberculosis meningitis were hospital- The predominant domains impaired in small vessel VaD were b ized at Saiful Anwar general hospital Malang Indonesia for 24 months executive in 33(68.80%;) cases (p 0.001), attention in 37(77%;) b (January 2017-December 2018), consecutive sampling with inclusion cases (p 0.001) and calculation in 28(58.3%) cases while in large criteria : age N 15 yo, perform lumbal functi and head CT scan or MRI, vessel VaD, the predominant domains involved were memory in 10 Exclusion criteria is re-hospitalized patient. (33.3%) cases, visuospatial in 9(30%), language in 8 (26.6%) cases b b Diagnosed of TM based on Lancet criteria; definitive, probable (p 0.05) and praxis in 7(23.3%) cases(p 0.05). and possible. Severe disease based on British Medical Council (BMC). And parameter outcome are modified Rankin Scale (mRS) and death Conclusion fi when patient discharge from hospital. This study was approved by The above ndings suggest that the diverse anatomical lesions fi ethical clearance commite Saiful Anwar Hospital and risk factors lead the heterogenous clinico-cognitive pro le in patients of VaD which if diagnosed at the earliest will help in treating Result and even prevention of this disease entity. Fivety-two sample, mean 34 yo (15-78), man 61%, serology HIV positif 11%. 74 % had hyponatremia including with 34% severe doi:10.1016/j.jns.2019.10.863 hyponatremia (b120mEq/L). Pasien with severe hyponatremia more often had concomitant with clinical outcome, higher leucocyte, neutrophils and glucose LCS (pb0,05). Hyponatremia wasn’t correlate with low Glassglow coma scale (GCS), radiological feature, WCN19-0687 serology HIV positive and rate of mortality Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Conclude Part I / dementia - Part I /epilepsy - Part I / health economics and Hyponatremia is common complication in TM and had correlated with poor outcome, higher leucocyte-glucose LCS outcomes / neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.862 Assessment of the response to antiepileptic drugs in epileptic patients WITH structural lesion(S) on neuroimaging

M. Zaki, L. El Sherif, R. Shamloul WCN19-0673 Neurology- Kasr Al-Ainy Hospital and school of medicine, Cairo University. Egypt, Neurology, Cairo, Egypt Poster shift 02 - Autoimmune disorders - Part I /CNS infections - Part I / dementia - Part I /epilepsy - Part I / health economics and Background outcomes / neuroepidemiology and environmental and other Focal epilepsy is the most common form of epilepsy in adults. Advances in brain imaging allowed better identiﬁcation of different Vascular cognitive impairment from a comparative perspective– structural lesions underlying focal epilepsy. However, the response A critical analysis of large vessel versus small vessel dementia to antiepileptic drugs in lesional epilepsy is heterogeneous and ﬁ from a tertiary care center in Eastern, India dif cult to anticipate. ARTICLE IN PRESS

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Objectives Results To evaluate the response to antiepileptics in patients with One hundred and one patients participated. 71 patients (70%) lesional epilepsy and to identify the predictors for poor seizure believed that CAM would be helpful in treating seizures; the most control. commonly reported CAM therapies were prayers, exercise, and herbs. Sixteen patients (16%) had actually used CAM to treat their Subjects and methods seizures, but only one patient perceived that CAM was more effective This study included 165 patients with lesional epilepsy, the than AEDs to bring her seizures under control. 31 neurologists clinical diagnosis of epilepsy and seizure classification were based on participated in the study. Seventeen neurologists (55%) believed that the revised criteria of the International League Against Epilepsy CAM would be helpful in treating epileptic seizures. The most (ILAE). Patients were subjected to full clinical assessment, MRI brain commonly reported CAM therapies were meditation, yoga, and imaging epilepsy protocol and EEG monitoring. All subjects were exercise. followed in the epilepsy clinic for at least six-month, epilepsy was defined as “well controlled” if the patient reported less than one Conclusion seizure per month. CAM is considered and used by many PWE to treat seizures, despite the lack of enough scientific evidence. Cultural issues Results probably play an important role in having faith in CAM. Physicians 75.8 % of patients with lesional epilepsy showed poor response to involved in the care of PWE should provide appropriate information antiepileptic medications. Cerebromalatic lesions related to brain regarding the safety and efficacy of various CAM treatments. trauma were the most frequently encountered (21.8%). Mal- formations of cortical development were significantly associated doi:10.1016/j.jns.2019.10.865 with poor seizure control (p=0.040). Logistic regression analysis revealed that younger age at seizure onset and abnormal EEG findings were 0.965 times and 2.5 times more associated with poor seizure control respectively. WCN19-0709

Conclusion This study revealed that high percent of epilepsy patients with Poster shift 02 - Autoimmune disorders - Part I /CNS infections - MRI brain lesions suffer from poor seizure control. Patients with Part I / dementia - Part I /epilepsy - Part I / health economics and early onset epilepsy, malformations of cortical development and outcomes / neuroepidemiology and environmental and other abnormal EEG ﬁndings should be closely monitored and evaluated for uncontrolled seizures Elucidation of sodium potassium atpase activity of epileptic rat brain synaptosome by neurotransmitters doi:10.1016/j.jns.2019.10.864 S. Sinha University of Allahabad, Centre of Biotechnology, Allahabad, India

WCN19-0695 Epilepsy behavioral and physiological disorder. Epilepsy is the fourth most common neurological disorder and affects people of all Poster shift 02 - Autoimmune disorders - Part I /CNS infections - ages which is characterized by unpredictable seizures and can cause other health problems.Epilepsy is a spectrum condition with a wide Part I / dementia - Part I /epilepsy - Part I / health economics and range of seizure types and control varying from person-to-person. outcomes / neuroepidemiology and environmental and other We have studied the effect of Norepinepherine,Serotonin (5HT) individually, in combination and in presence of receptor antagonists Complementary and alternative medicine in epilepsy: What Prazosin and Propranolol in different permutations and combina- patients and physicians perceive tions. It was found that Norepinepherine increases Na+/K+ ATPase activity. It was also validated that NE induced increase is blocked by A. Asadi-Pooya, M. Homayoun, S. Sharifi prazosin which is a α-1 adrenoceptor blocker antagonist but Shiraz University of Medical Sciences, Neurology, Shiraz, Iran propranolol which is a β adrenoceptor blocker antagonist cannot block it. There is a marginal but significant increase in Na+/K+ Purpose ATPase activity. Propranolol seems to block 5HT mediated increase in The purpose of the current study was to investigate the extent to Na+/K+ ATPase activity. When both NE and 5HT are given in which people with epilepsy (PWE) use complementary and alterna- combination an increase in ATPase activity has been found which is tive medicine (CAM) to treat their illness and to assess their equal to the sum of the two given separately. Both Prazosin and perceptions. We also investigated the perceptions of their physicians. Propranolol could decrease the basal values of the enzyme which could be due to some mechanism involving endogenous NE and 5HT Methods present in the sample or by other mechanism leading to nonspecific In this cross-sectional study, all patients with epilepsy, who had binding and decrease of ATPase activity. The results seem to assume the illness for at least one year, were recruited at the outpatient significance in response to epileptic rats. Many disorders like epilepsy clinic at Shiraz University of Medical Sciences, from January epilepsy could be addressed by studying the significance of NE and 2019 until March 2019. A questionnaire was designed for this survey. 5HT with blockers. We also designed a similar questionnaire to investigate perceptions of the physicians in the same region with approval by the Shiraz doi:10.1016/j.jns.2019.10.866 University of Medical Sciences Review Board. ARTICLE IN PRESS

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WCN19-0710 G. Bonillaa, J. Castrejonb, I. Bonilla Mejiac aNeurology, Cuenca, Ecuador bIMSS, Neurology, Ciudad de Mexico, Mexico Poster shift 02 - Autoimmune disorders - Part I /CNS infections - cInstitute of Public Health Cuenca Ecuador, Ministry of Public Health Part I / dementia - Part I /epilepsy - Part I / health economics and Cuenca Ecuador, Cuenca, Ecuador outcomes / neuroepidemiology and environmental and other Cysticercosis is a common disease in Latin America, with no Lobar disconnective versus resective surgery in epilepsy: Surgical predilection for age or sex and affects any social class. Parasitic outcome and safety condition of the CNS, due to poor hygiene conditions and fecalism. Cryptococcosis, a serious fungal infection deﬁned as the main cause H. Kamalboor, M. Alkhateeb, F. Alotaibi, I. Althubaiti, S. Baz, T. of chronic meningoencephalitis. The course of the disease can be Abalkhail acute, subacute and chronic, and may present a subclinical form with King Faisal Specialist Hospital & Research Center, Neurosciences, an evolution of years; with periods of remission and exacerbation Riyadh, Saudi Arabia and normalization of the CSF.

Background Objective Epilepsy surgery is an alternative & potentially more beneficial -Know the neurological complications of infectious and parasitic treatment intervention for some patients with drug-resistant pathologies in our hospital. epilepsy. While earlier studies have demonstrated the benefitof -Manage the treatment to avoid the appearance of complications respective surgeries, in terms of seizure control, there is a recent of the disease. interest in disconnective surgeries, especially lobar disconnection, with an attempt to avoid or minimize the morbidity that was Patients and methods associated with respective surgeries. -Review of the literature and neurological manifestations of patients affected by Cryptococcosis and cerebral Neurocysticercosis. Aim & objectives -Neurological clinical recognition of 1 male patient in the The aim of our study is to analyze the surgical outcome and safety Neurology room of the Santa Inés Hospital in Cuenca. of disconnective surgery in drug-resistant focal epilepsy arising from either the anterior or posterior head region over a period of ten Results years, & compare the results to patients undergoing respective A 67-year-old man, without risk factors, debuted with intense surgery alone without disconnective surgery. Our objectives are to vascular headache, diagnosed with cerebral neurocysticercosis. collect information on the two groups & compare them for Neurological examination: normal. MRI of the skull: cystic images postoperative seizure control & perioperative risks. in right lateral ventricle compatible with cysticercosis. HIV negative laboratory. LCR: positive Chinese ink for cryptococcus, Elisa for NCC Methods positive. Our study follows a quasi-experimental study design in a single- The patient was managed with amphotericin B x 2 weeks and fl center, King Faisal Specialist Hospital & Research Center, in Riyadh. uconazole x 6 weeks, Albendazol for 14 days. Following the approval of our institute’s Institutional Review Board, the medical records from the last ten years were reviewed to identify Conclusions eligible patients for the study. Cripotococcosis severe CNS infection, Neurocysticercosis rare presentation in our environment, it is unusual the presence of both Results in non-immunocompromised patients, it is important to make an We identified a total of 117 patients who underwent disconnective early diagnosis in order to avoid serious neurological complications. surgery &/or resective surgery for focal drug resistant epilepsy. Final results of the study will be shared following abstract approval. doi:10.1016/j.jns.2019.10.868

Signiﬁcance & conclusion There are no available published studies that compare lobar disconnective surgery to resective surgery as a treatment for focal WCN19-0718 drug-resistant epilepsy. We hope that our study would provide insight on the beneﬁts of lobar disconnective surgery among all age groups. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - doi:10.1016/j.jns.2019.10.867 Part I /dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

Fulminant guillain barre syndrome associated with bartonella WCN19-0714 hensle infection in a sudanese patient - Rare and fatal case

O. Seidia, A. Ahmedb, M.S. Yaddic, A.M. El Hassand Poster shift 02 - Autoimmune disorders - Part I/CNS infections - aDr Sulaiman Al Habib Medical Group, Al Takhassussi Hospital, Part I /dementia - Part I/epilepsy - Part I/health economics and Neurology IM, Riyadh, Saudi Arabia outcomes/neuroepidemiology and environmental and other bFaculty of Medicine, Soba University Hospital, University of khartoum, Neurosciences, Khartoum, Sudan Cerebral neurocisticercosis and crytococcosis in a non-immuno- cSoba University Hopsital, Neursciences, Khartoum, Sudan comprommended patient. An unusual association. Literature dInstitute of Endemic diseases, University of Khartoum, Immunology, review and case report. Ecuador Khartoum, Sudan ARTICLE IN PRESS

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21 years Sudanese male presented with three weeks history of for CHIKV, Epstein-Barr virus (EBV) and Herpes simplex virus (HSV), fever, lethargy and myalgia. A week before his admission to hospital the latter as probable cross-reactions. CSF analysis seven days after developed rapidly progressive weakness from the feet upwards. 2 the onset of symptoms revealed lymphocytic pleocytosis, increased days later had swallowing difficulty, then develop respiratory failure proteinorraquia, positive IgM sorology for CHIKV and polymerase and was intubated and ventilated. Hours before intubation he was chain reactions (PCR) negatives for Zika virus, EBV, and HSV, and noted to have palatal weakness and flaccid limbs with power zero positive for CHIKV. Magnetic resonance imaging of the brain with and total areflexia with tachycardia (110 bpm)and tachypnoea (24/ contrast was normal, and the electroencephalogram demonstrated min). Multiple tense skin bullae were noted on his feet and legs with diffuse slowing. The patient evolved with decreased level of few inguinal lymph nodes. He has no contact with animals, recent consciousness and need for orotracheal intubation. She was treated travel orr a diarrhoel illness. His basic blood tests were normal. so with human intravenous immunoglobulin for five days, with no was CPK. evidence of clinical improvement, and evolved to death days later. He received antibiotic (ceftriaxone and doxycline) as well as five This is the first Brazilian case report of death secondary to days of intravenous immunoglobulins (2 gm/Kg in 5 doses). meningoencephalitis by CHIKV, and with concomitant demonstra- Nerve conduction studies showed non excitable nerves in all tion of positive serology and PCR for CHIKV in CSF. limbs. EMG showed no spontaneous activity. He develop significant autonomic instability with swinging pulse and blood pressure.The doi:10.1016/j.jns.2019.10.870 cardiology team was consulted and while preparing to insert a temporary pace maker he developed ventricular fibrillation and all measures of resuscitation failed. Later the titre for Bartonella hensle in his serum came back as strongly positive. WCN19-0721 Infection with Bartonnela hensle is very rare in Sudan. Few cases were encountered by neurosurgeon colleagues. There are documented case of GBS and myelitis in association with this infection. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - we couldn't identify the possible source of infection and more Part I/dementia - Part I/epilepsy - Part I/health economics and research is needed to explore this previously unreported infection outcomes/neuroepidemiology and environmental and other from this part of the world. Ultrasonographic evaluation of ADNEXA gave useful clue for the doi:10.1016/j.jns.2019.10.869 diagnosis of anti-NMDA receptor encephalitis in young woman

E. Oh, J. Shin Chungnam National University Hospital, Neurology, Daejeon, Republic WCN19-0720 of Korea

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - A 30-year-old woman came to emergency room with comatose mental status and involuntary movement. She developed fever and Part I/dementia - Part I/epilepsy - Part I/health economics and decreased consciousness. The abdominal-pelvic CT was normal. The outcomes/neuroepidemiology and environmental and other brain MRI showed high signal intensity on left cerebellar hemisphere. CSF study showed lymphocytic pleocytosis (31 WBCs, Chikungunya virus meningoencephalitis: A case report mononuclear WBC 60%) therefore, intravenous(IV) acyclovir and cefotaxime was administered at that time. But her level of a b a c C.B. Braune , K.L. Pires , C.C.B. Pupe , A.C.A.D.F. Ferreira , V.R. consciousness was decreased more and more, she intubated and a a d d Guedes , T.D. Pinheiro , P.H.D.S. Xavier , G.F.D.Q. Varella , M.V.V. transferred to our hospital for further evaluation. Choreic or d a Silveira , O. Nascimento semirhythmic movement on both forearms and hands and facial a Fluminense Federal University UFF, Neurology, Niterói, Brazil dyskinesia was showed frequently. Intermittent violent aspects like b Federal University of the State of Rio de Janeiro UNIRIO, Internal as screaming and shouting were showed and lower lip perforate medicine, Rio de Janeiro, Brazil with severe bruxism. Also she showed autonomic failure. c State Servers Hospital of Rio de Janeiro, Neurology, Rio de Janeiro, Hyperintensity signals of left cerebellum were observed in follow- Brazil up brain MRI. CSF profiles showed lymphocytic pleocytosis (32 d São Lucas Hospital, Internal medicine, Rio de Janeiro, Brazil WBCs, mononuclear WBC 90%) and viral, bacterial, fungal markers were all negative. Serum thyroid hormone levels and thyroid A 81-year-old female presented with acute fever, intense body antibodies were normal range. Routine electroencephalogram aches, and a punctual episode of mental confusion. She received an (EEG) showed that continuous medium voltage delta slowings, initial diagnosis of pneumonia with prescription of antibiotics. In the without spikes and sharp waves in all leads. On hospital day 2, the subsequent days, there was worsening of polyarthralgia, as well as hyperechoic mass (about 2 cm) was detected on right adnexa with an evolution to irritability and behavioral changes (patient was transvaginal ultrasonography. It looks like a mature cystic teratoma found disoriented, with difficulty recognizing relatives and clapping which did not find in abdominal pelvic CT. We sent blood and CSF hands without purpose). The patient had cutaneous rash of the trunk samples to Seoul National University Hospital laboratory for and proximal limbs, diffuse arthritis, psychomotor agitation, and detection of antibody of NMDA-R, with considered patient’s history. fluctuation of the level of consciousness. Considering the clinical After operation of teratoma, the symptoms of patient was improved, picture described, and the epidemiological history of neighbors with and NMDA-R Ab was also confirmed later. Chikungunya virus (CHIKV) infection, the patient was admitted to an intensive care unit with suspicion of CHIKV meningoencephalitis. doi:10.1016/j.jns.2019.10.871 Complementary tests demonstrated positive IgM serum serologies ARTICLE IN PRESS

56 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0732 Objectives To present a case with recurrent PRES associated with microbleeds and to discuss various contributing risk factors. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Case report outcomes/neuroepidemiology and environmental and other We are presenting 18 years old female who known to have longstanding SLE, associated with lupus nephritis, CKD on regular Recurrent and hemorrhagic posterior reversible encephalopathy hemodialysis (HD), HTN, severe osteoporosis, and growth hormone syndrome: Does it a really benign and reversible clinical condition? deﬁciency. She was on combined immunosuppression treatment including Rituximab and she was admitted after second dose of its A. Hassan, N. Soliman, H. Elhasin, M. Szolics administration with clinical and radiological sign of PRES (Fig. 1, D, E, Tawam hopsital, Neurology, Al Ain, United Arab Emirates F) which completely resolved after several weeks. Two years later she had been hospitalized again with recurrent PRES associated with Background micro-hemorrhages in both cerebellar hemispheres, occipital, parie- PRES deﬁned as a variable combination of acute clinico-radiolog- tal and posterior frontal regions (Fig. 2, A, B, C, D, E, F). Neuroimaging ical symptoms secondary to several etiological factors. The overall follow up after two months (Fig. 2, I, M, N, P) showed residual incidence of hemorrhage in PRES had been reported in 15.2%, hemosiderin intra-parenchymal deposition, with complete resolu- recurrence of PRES 6% and death up to 15% of patients. Data about tion of vasogenic edema. risk factors for recurrent PRES still limited. ARTICLE IN PRESS

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Conclusion In Donbass getting 55% of military injuries is related to Patients with SLE who are on combined immunosuppressive extremities injuries. treatment, longstanding chronic renal failure on regular HD and It was surveyed 83 soldiers who had surgery on the extremities uncontrolled hypertension seems have a higher risk of recurrent injuries; research was conducted 3–4 years later after sustained PRES which may be complicated by microbleeds and/or intracerebral injuries. Overwhelming majority of defenders have mine-explosive hemorrhage. Clinical prognosis in such cases also still good if PRES injuries (MEI) - 49 people, 34 people have gun-shot injuries (GSI). recognized and managed in time. During research the following methods were used: Montreal Cognitive Assessment (МоСА), Hospital Anxiety and Depression doi:10.1016/j.jns.2019.10.872 Scale (HADS), and the Fatigue Severity Scale (FSS). Mild cognitive impairments were diagnosed in 25.2% of patients suffering from the mine-explosive injuries (MEI), in 18.4% of patients suffering from the gun-shot injuries (GSI). Moderate cognitive WCN19-0736 impairments were detected in 21.1% of defenders suffering from mine-explosive injuries (MEI) and in 15.4% of defenders suffering from gun-shot injuries (GSI). These patients have violated working Poster shift 02 - Autoimmune disorders - Part I/CNS infections - memory, disorders of attention and delayed recall. Moderate Part I/dementia - Part I/epilepsy - Part I/health economics and depressive disorders were diagnosed in the 23 patients suffering outcomes/neuroepidemiology and environmental and other from the mine-explosive injuries (MEI),12 patients suffering from the gun-shot injuries (GSI). Severe somatogenic depression were The distinctions of higher nervous activity disorders during the diagnosed in 7 patients suffering from the mine-explosive injuries long-term period of military injury of the Donbass defenders (MEI) and 2 patients suffering from gun-shot injuries (GSI). The Montreal Cognitive Assessment (МоСА) scale for persons suffering O. Yuryk from mild depressive disorders had following results: 23.21 ± 1.34 МоСА Institute of Traumatology and Orthopedics of the National Academy of points; Montreal Cognitive Assessment ( ) scale for persons Medical Sciences of Ukraine, Laboratory of Pains Problems, Kyiv, Ukraine suffering from the severe depressive disorders - 23.01 ± 1.15 points. ARTICLE IN PRESS

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Asthenic disorders were detected in 36.2% of the examined WCN19-0744 individuals. In the long-term rehabilitation period, patients who have military injuries as the bone injuries and joints damages often require Poster shift 02 - Autoimmune disorders - Part I/CNS infections - corrections of the cognitive and psychoemotional disorders. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.873 The association between napping and dementia – A nationwide population-based study

WCN19-0738 C.J. Lua, C.C. Liub, Y. Suna aEn Chu Kong Hospital, Neurology, New Taipei City, Taiwan, ROC. bNational Cheng Kung University, Public Health, Tainan City, Taiwan, ROC Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Backgrounds outcomes/neuroepidemiology and environmental and other Napping in the afternoon is a common daily habit in the elderly in Taiwan. Though mid-day naps may offer a variety of benefits like Comparison of arm-wrist ratio and body mass index in subjects memory consolidation and a boost in emotional stability, long with carpal tunnel syndrome napping time has also been related to adverse health outcome. We aimed to study the association between napping and dementia in a M. Menon Krishnaa, M.J. Abdul Jalalb nationally-representative sample of Taiwan older adults. aDepartment of Neurology,, VPS Lakeshore Hospital, Kochi, Kerala, India bDepartment of Internal Medicine and Rheumatology, VPS Lakeshore Methods Hospital, Kochi, Kerala, India In this nationwide cross-sectional survey, participants were selected by computerized random sampling in Taiwan. A total of Introduction 10,432 residents aged 65 years and more were assessed by a door- Carpal tunnel Syndrome (CTS) is currently the most common to-door in-person interview. Demographic data and lifestyle includ- entrapment neuropathy found in the general population. The ing self-reported napping habits and night time sleep quality were syndrome is common, with an estimated population life time compared between normal subjects and participants with dementia. cumulative incidence rate of 8% and it can be associated with We used multivariate logistic regression to compare 929 diagnosed fi substantial disability. CTS is a clinically de ned constellation of dementia and 7035 normal participants.^ symptoms caused by a median neuropathy at the wrist. Here, we present a prospective study of 164 subjects with symptoms Results attributable to carpal tunnel syndrome. After adjustment for potential confounders including age, sex, education level, body mass index, comorbidities and lifestyle factors Aims and objectives like smoking, drinking, exercise, social activity and night sleep Our aim was to study the distribution of body mass index [BMI] quality, afternoon nappers have a higher risk of dementia with and the distribution of Arm-Wrist Ratio in subjects with symptoms adjusted odds ratio 1.33 (95%CI 1.02–1.72). Among them, 684 attributable to carpal tunnel syndrome. We also explored the dementia cases and 684 controls matched by age, sex and education relationship between BMI and Arm-Wrist Ratio in these subjects. levels, whose habitual napping duration obtained, were further assessed. As compared to those with no napping, the odds ratio of Materials and methods dementia was 2.15 (95%CI 1.49–3.11) in those with napping time in The data collection was with the help of a study proforma which 61–120 min adjusted for all aforementioned confounders. included demographic questionnaire, symptom analysis, clinical assessment and electrophysiological evaluation. We did a demo- Conclusion fi Daytime napping habit with duration more than 1 h is associated graphic pro le screening and symptom analysis.^ with risk of dementia. Prospective research with objective napping Results time measurement is needed.^ Idiopathic CTS represented approximately half of our study subjects. 59.8% of the study subjects were obese and 19.5% were doi:10.1016/j.jns.2019.10.875 overweight. 54.9% of our study population had an arm-wrist ratio of 1.75–2.00 which could explain compression of carpal tunnel attributing to idiopathic CTS. Among the 98 obese study subjects, 73.3% had an an arm-wrist ratio of 1.75–2.00, which was statistically WCN19-0753 significant (p b .05) and hence explains the compression of carpal tunnel attributing to idiopathic CTS. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Conclusion Part I/dementia - Part I/epilepsy - Part I/health economics and Obesity and arm: wrist ratio disproportions were found as the outcomes/neuroepidemiology and environmental and other risk factors attributing to idiopathic carpal tunnel syndrome. A randomized double-blind sham-controlled clinical trial on the doi:10.1016/j.jns.2019.10.874 effectiveness of RTMS on lower extremity spasticity in patients with hereditary spastic paraplegia ARTICLE IN PRESS

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P. Barahim Bastani, S. Abdi objective sensory-motor disability in AAs in comparison with CAs Tehran University of Medical Sciences, Neurology Department Shariati patients. Hospital, Tehran, Iran One hundred and two MS patients, 52 AA (38.56 ± 11.05 yrs), 50 CA (38.92 ± 10.43 yrs), 38 AA healthy controls (HC) (36.13 ± 12.31 yrs), and 26 CA HC (31.69 ± 10.82 yrs) were prospectively enrolled Introduction as part of an ongoing longitudinal study. The clinical evaluation Hereditary Spastic Paraplegia (HSP) consists of a group of included: 9-hole peg test (9-HPT), grooved pegboard test (GPT), conditions involving a wide array of genes, all characterized by finger tapping test (FTT), 25-ft walk test (25-FWT), 2-minutes walk slowly progressive weakness in lower limbs resulting in gait test (2-MWT), segmental strength (upper and lower limbs), grip abnormalities.^ strength, vibration and balance. Each patients' group was compared with its own race-matched HC group accounting for the effect of age, Methods and materials gender and socioeconomic status. 8 patients, categorized by Fink's criteria as definite or probable AA and CA patients did differ for yearly income (p = .008) but HSP, entered the study. They were randomly assigned to 5 sessions of not for age, gender, disease duration. 9-HPT (p = .001), GPT (p = active 5 Hz-rTMS (n = 4) or control sham rTMS (n = 4). All patients .015), FTT (p = .034), grip strength (p = .033), 2-MWT (p = .010), were evaluated prior to the intervention, upon completion of the balance (p = .001) and foot vibration sensitivity (p = .046) scores rTMS and 1 month after that. We used modified Ashworth Scale were significantly different between AA patients and AA HC. (MAS), 10 Meter Walking Test (10MWT), Fugl Meyer Assessment Significant differences in 9-HPT (p = .011), GPT (p b .001), 25-FWT fl b (FMA) methods^, the H Re ex and H/M ratio and SF-36 quality of life (p = .049) and 2-MWT (p .001) scores were found between CA questionnaire for evaluation. The primary end point was decrease in patients and CA HC.^ knee spasticity based on modified Ashworth Scale (MAS). We AA and CA patients showed similar deficits in walking and performed both mixed model analysis and independent sample t^-test manual dexterity but AA patients had additional motor, balance and fi comparing the variables in active and sham group at the given times.^ sensory de cits. Thus suggesting that, even accounting for sociodemographic status, AA patients with MS show more severe Results disability than CAs patients. Active rTMS resulted in a significant reduction of MAS in the knees compared to the sham both upon completion of the doi:10.1016/j.jns.2019.10.877 intervention (1.75 vs. 2.68 - P b .01) and one month after the rTMS (2.31 vs. 3 - P = .02). Comparison of other variables didn't yield any significant difference. WCN19-0776 Conclusion Based on this study rTMS is effective in reducing lower limb spasticity of the patients with HSP. Finding a significant difference Poster shift 02 - Autoimmune disorders - Part I/CNS infections - despite the small population of patients we evaluated, deems light on Part I/dementia - Part I/epilepsy - Part I/health economics and the important role that rTMS can have in the treatment of HSP patients. outcomes/neuroepidemiology and environmental and other

Women and epilepsy

a b b b doi:10.1016/j.jns.2019.10.876 A. Hussein , R.A.S. Mohamed , M.H. Elsheikh , R.M. Hassan ,R. Sirelkhtemb, E. Ibrahimb, R.A.A. Salihb, M.A. Alwalidb, R. Tofaha AlHusseinib, H. Abbasharb, M. Abbashar Abbasharb, K. Mohamed Ahmed Hussienb, S. Amirab, M. Fadlallab, Z.I.H. Dabaryb, M.M.A.M. Aldarb, Y. Abdellahb WCN19-0765 aUniversity of Khartoum, Neurology, Khartoum, Sudan bDaoud Research Group, Neurology, Khartoum, Sudan Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Introduction outcomes/neuroepidemiology and environmental and other Epilepsy is one of the most common neurological diseases. Both males and females can be affected, however in females there is a Sensory-motor disability in African-American and Caucasian signiﬁcant relationship to menstrual cycle and pregnancy due to patients with multiple sclerosis: A prospective longitudinal study hormones effect.^ a a a a a M. Inglese , M. Petracca , N. Graziano , M. El Mendili , A. Droby ,N. Objectives a a b a c a Saba , A. Falcone , C. Riley , S. Paduri , J. Howard , S. Klineova To study the clinical pattern of epilepsy among females,and the a ^ Icahn School of Medicine at Mount Sinai, Neurology, New York, USA cosmetic side effects of epilepsy, the stigma and the relation to b ^ Coulmbia University, Neurology, New York, USA menstrual cycle, and pregnancy, effect on delivery, congenital, and cNew York University, Neurology, New York, USA fetal abnormalities.^

Retrospective studies have reported a more severe disease course Method in AAs than in Caucasians (CAs) MS patients. This has been attributed This is a prospectivecross sectional non-intervention clinical to differences in socio-demographic status that may lead to delayed based study that was carried out in DAOUD charity clinic, from diagnosis and treatment. Our prospective study aimed at assessing Febrewary-2019 to April 2019. 31 women above 18 years old were ARTICLE IN PRESS

60 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx included and, full detailed history and examination were conducted repeated S. RPR showed reduced titre values and repeat CSF was by a neurologist. normal.

Result Conclusion. ^Eleven patients with syphilitic LETM have been The study included 31 women whom their ages range between reported ^in literature, all with positive HIV. Syphilitic meningo- (18) years old to (65) years old. It reviled that 83.8^% patients had myelitis in absence of HIV is rare. Exclusion of syphilis is important generalized epilepsy, 12.9% had focal epilepsy15 women out of 31 prior to considering neuromyeltis optica in LETM cases. were well controlled, and 13 were not well controlled (n = 28). Cosmetic effects were recognized to be 64.6% due to the drugs and doi:10.1016/j.jns.2019.10.879 32.2% were due to post-epileptic trauma. 26.6^% showed a catamenial seizure, 13.3% and 6.4% of the patients had primary and secondary infertility respectively. As a obstetrical complications 6.5% had miscarriage, 3.22% preterm delivery, and 3.22% neonatal death. Also WCN19-0779 64.6% of patients were stigmatized.^

Conclusion Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Cosmetic effects of antiepileptic drugs are more frequent in Part I/dementia - Part I/epilepsy - Part I/health economics and women. Also the drugs have effect on the reproductive health of the outcomes/neuroepidemiology and environmental and other female, like obstetrical complications, fatal abnormalities, and infertility. A case report: Successful treatment of inﬂuenza B associated acute necrotizing encephalopathy in an adult using combination Keywords: Sudanese women, Epilepsy of high dose oseltamivir-ivig-pulse metylprednisolone doi:10.1016/j.jns.2019.10.878 E. Erdil, E. Vural, P. Kahraman Koytak, E.N. Tuncer Marmara University School of Medicine, Neurology, Istanbul, Turkey

WCN19-0778 Summary Influenza associated acute necrotizing encephalopaty is a disease rarely seen in an adult and is rather frequently poor prognosis presented Poster shift 02 - Autoimmune disorders - Part I/CNS infections - as disturbance in consciousness followed by 1–3days of upper Part I/dementia - Part I/epilepsy - Part I/health economics and respiratory tract infection symptoms. Although existence of findings outcomes/neuroepidemiology and environmental and other for necrosis of bilateral thalami in radiological imaging and history of recent influenza are indicators of diagnosis the absence of definite Neurosyphilis presenting as longitudinal extensive transverse diagnostic criteria and indistinguishable clinical presentation, makes myelitis [LETM] influenza associated acute necrotizing encephalopaty diagnosis hard. Definite treatment has not been achieved yet and various treatment D. Desaia, D. Vithalania, I. Bhanab, B. Vaishnava, S. Desaib methods have been declared in relation with case reports. In this paper, fl aPramukhswami Medical College, Medicine, Anand, India asuccessfultreatmentofinuenza B associated acute necrotizing bShree Krishna Hospital and Pramuhswami Medical College, Neurology, encephalopathy with high oseltamivir - IVIG - high dose Anand, India methyprednisolone is presented in a case of an adult female of age 40 ^ who didn’ t have any medical history and referred with encephalopathy. Introduction doi:10.1016/j.jns.2019.10.880 Neurosyphillis can affect spinal cord with meningomyelitis, meningovascular disease or tabes dorsalis. Rarely it can present as Long segment extensive transverse myelitis [LETM].

WCN19-0780 Case report^.A47^years old male presented with acute onset progressive weakness with gait disturbance, parasthesia over bilateral hands, legs with bladder bowel dysfunction for 15 ^days. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - He did not have fever, trunk weakness, dysphagia, dysarthria, vision Part I/dementia - Part I/epilepsy - Part I/health economics and impairment. outcomes/neuroepidemiology and environmental and other Cognitive functions and cranial nerves were normal. He had hypertonia in all 4 limbs with a power grade 4/5, with exaggerated deep tendon reflexes, extensor plantars and absent abdominal reflexes. Fasudil in combination BMSCS attenuates Alzheimer's disease- He had sensory ataxia with positive Rhomberg's sign and Lhermitt sign. related changes through the regulation of the peripheral immune MRI spine showed altered signal intensity areas from medulla to system mid body of T7 vertebra, with lesion extending over 3 or more ab a a a c c a vertebral segments typically involving centre of the cord over more J.Z. Yu , Y.Q. Yan , Q.F. Gu , H.Q. Wang , Z. Chai , Q. Wang , L. Feng , d e f g b c than 2/3 of spinal cord area suggestive of LETM raising a suspicion of J.J. Hang , H.T. Zhang , Z.Q. Yuan , B.G. Xiao , Y.Q. Jiang , C.G. Ma a neuromyelitis optica {NMO}. Hemogram, renal function and electro- The NO.1 Affiliated hospital of Shanxi Datong University, Institute of Brain Science- Shanxi Key Laboratory of Inflammatory Neurodegener- lytes were ^normal and HIV was negative. CSF analysis showed lymphocytic pleocytosis and elevated proteins with normal glucose. ative Diseases, Datong, China bChinese Academy of Sciences, State Key Laboratory of Molecular His S. RPR and CSF VDRL were positive.^He was treated with intra- Developmental Biology, Institute of Genetics and Developmental Biology, venous methylprednisolone and Ceftriaxone for 2^weeks followed by oral prednisolone. On follow up, his symptoms improved and Beijing, China ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 61 cShanxi University of Chinese Medicine, The Key Research Laboratory of WCN19-0783 Benefiting Qi for Acting Blood Circulation Method to Treat Multiple Sclerosis of State Administration of Traditional Chinese Medicine, Scientific and Technological Innovation Team of Integrated Chinese Poster shift 02 - Autoimmune disorders - Part I/CNS infections - and Western M, Jingzhong, China Part I/dementia - Part I/epilepsy - Part I/health economics and dGeneral Hospital of Datong Coalmine Group, Neurosurgery, Datong, outcomes/neuroepidemiology and environmental and other China eWest Virginia University Health Sciences Center, Departments of Lymphocytic autoimmune hypophysitis in a female outside the Behavioral Medicine and Psychiatry & Physiology, Pharmacology & perinatal period, diagnosed non-invasively and treated Neuroscience, The Blanchette Rockefeller Neurosciences Institute, Mor- successfully gantown, USA f Academy of Military Medical Sciences, Military Cognition and Brain Y. Abdelmajid, Y. Kamal, A. Rashid Science Center, Beijing, China Rashid Hospital-Dubai Health Authority, Neurology, Dubai, United Arab g Fudan University, Institute of Neurology, Huashan Hospital, Institutes Emirates of Brain Science and State Key Laboratory of Medical Neurobiology, Shanghai, China Lymphocytic autoimmune hypophysitis (LAH) was first described in 1962, by Goudie and Pinkerton, in Glasgow. It is a neuroendocrine Background disorder characterised by autoimmune inflammation of the pituitary Mechanism of Alzheimer's disease (AD) is still not clear, majority gland, resulting in various degrees of its dysfunction. In this disorder, the of research focused on the central nervous system (CNS) changes, pituitary gland is infiltrated by lymphocytes, which leads to its while few studies emphasize on peripheral immune system enlargement and subsequently destruction and impaired function. modulation. Typically, the early destruction of ACTH-producing cells is characteristic. LAH is classically observed in young women during pregnancy or Objective postpartum period. We herein report a rare case of lymphocytic Our study aimed to investigate the regulation of the peripheral autoimmune hypophysitis in a 33 years old non-pregnant female, immune system after treatment in an AD model of APPswe/ outside the perinatal period. She presented with an acute left-sided PSEN1dE9 transgenic (APP/PS1 Tg) mice. visual loss and a 4-months history of amenorrhea. Her neurological examination revealed the absence of light perception in the left eye. She Methods underwent several investigations including laboratory tests with a APP/PS1 Tg mice were treated with the ROCK-II inhibitor hormonal profile, brain MRI, visual evoked potential (VEP), in addition Fasudil (25 mg/kg/day) and bone marrow stromal cells (BMSCs, to multiple ophthalmological studies. Her biochemical studies revealed 6 1*10 BMSCs/time/mouse) for two months. Morris water maze only a low serum cortisol. Her brain MRI findings were suggestive of (MWM) test was used to evaluate learning and memory. The autoimmune hypophysitis and her VEP revealed a normal P100 latency. mononuclear cells (MNCs) of spleens were analyzed using flow She received dexamethasone followed by hydrocortisone, and that cytometry for CD4+ T-cells, macrophages. Immunohistochemical consequently lead to a remarkable improvement in both the patient's staining was used to examine the expression of ROCK-II in the vision, as well as her follow up MRI brain imaging. We wish to highlight spleens. that LAH can present in females outside the perinatal period. Definitive diagnosis of LAH can be achieved only histologically, however, the Results diagnosis can be made non-invasively if the clinical, radiological, and The MWM test showed improved spatial learning ability in APP/ laboratory investigations are suggestive of it.^ PS1 Tg mice treated with Fasudil and BMSCs combination. Combination therapy intervention significantly promoted the pro- doi:10.1016/j.jns.2019.10.882 liferation of CD4+/CD25+ and CD4+/IL-10+ lymphocytes, induced the release of cytokine factors, and regulated the balance of the immune system to work functionally. It also shifted M1 (MHC-II, CD86) to M2 (IL-10, CD206) phenotype of macrophages of CD11b WCN19-0784 and significantly enhanced the anti-inflammatory and phagocytic abilities of macrophages. Immunohistochemical staining showed significantly decreased expression of ROCK-II in mice treated with Poster shift 02 - Autoimmune disorders - Part I/CNS infections - combination. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Conclusions Fasudil in combination of BMSCs improved cognition of APP/PS1 Determines the efficacy of antiepileptic drugs based on EEG Tg mice through the regulation of the peripheral immune system pattern for optimization of therapy in epileptic children (NNSF of China 81471412, 81473577, Shanxi Science and Technology Key R&D Program 2016ZD0505, Shanxi Provincial Platform Base I. Khachidzea, M. Gugushvilib Special Project 201805D111009, 201805D131005, *corresponding aI.Beritashvili Center of Experimental Biomedicine, Department of authors). ^ Behavior and Cognitive Functions, Caucasus University, Tbilisi, Georgia 0160, Georgia doi:10.1016/j.jns.2019.10.881 bI.Beritashvili Center of Experimental Biomedicine, Department of Behavior and Cognitive Functions and Human Psychophysiology, Tbilisi, Georgia ARTICLE IN PRESS

62 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Background encephalitis is also very rare and the incidence is unclear. In The study aimed to reveal EEG baseline patter for optimization of Indonesia this case is rarely found due to the unavailability of NMDA anti-epileptic treatment in individual epileptic patients. Such type of anti-receptor examinations in health care centers resulting in late investigation is very important, because characteristics of baseline EEG diagnosis or even undiagnosed. abnormalities may sometimes signal clinical signs of aggravation. Up to now alterations of EEG-pattern are mostly studied with respect to Case report qualitative aspects of epileptic activity whereas the data on quantita- 31-year-old woman with complaints of changes in moody tive characteristics of baseline activity of interictal EEG are less. behavior, hallucinations, memory disorders, experienced neurological deterioration in the form of decreased consciousness and seizures Methods (status epilepticus). There is no typical neurological deﬁcit. Normal 35 patients aged 9-13 with different type of epilepsy were head MRI examination. EEG examination is obtained “extreme delta investigated. EEGs were recorded three times: prior to Valproic Acid- brush”. Anti NMDAR examination on CSF has positive results. monotherapy, at three and forth and eight months under therapy. Gynecological obstetric examination is obtained by a cystic mass Baseline EEG was studied for quantitative mejerment of EEG such as with a solid part of the right ovary. The results of anatomical absolute values of the power (AVP) spectra and EEG topography/ pathology examination on post-salpingooforectomy tissue showed Brain Mapping. mature cystic teratoma. Follow-up management with anticonvulsant and immunotherapy (steroids, intravenous immunoglobulins, Results plasmaparesis, immunosuppressants) results in good clinical impro- Valproic Acid- reduce Delta frequency, but did not effect on vement.^ monomorphic theta-waves of temporal region. The described AVP dynamics was analogous in both hemispheres. Study of basic Conclusion characteristics of EEG during the Valproic Acid- reveal that the Consider a paraneoplastic autoimmune encephalitis (anti NMDA presence of theta-waves may suggest a possible recurrence of receptor encephalitis) as the cause of a neuropsychiatric disorder seizures after drug withdrawal. accompanied by seizures being the main focus in this case. A typical EEG picture can help diagnose. Early diagnosis and adequate Conclusion management will give a good outcome. The efﬁcacy Valproic Acid has shown by reduction of delta- frequency waves. Spectral analysis and Brain mapping reveal the Keywords: Paraneoplastic, Seizures, Anti NMDA receptor, predicting value of baseline EEG. The presence of monomorphic Encephalitis theta-waves with parietal zone can anticipate recurrence of seizures if Valproic Acid will be reduced or withdrawn. Such a special feature of this AED suggests that its anti-epileptic effect is achieved via doi:10.1016/j.jns.2019.10.884 epileptogenesis, neurophysiological and molecular mechanisms which partly differ from the action mechanisms of other AEDs. doi:10.1016/j.jns.2019.10.883 WCN19-0789

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and WCN19-0787 outcomes/neuroepidemiology and environmental and other

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - AIDS and epilepsy Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other A. Husseinab, K. Mohamed Ahmed Hussiena, M. Malk Aldara,M. Abbashara, H. Abbashara, A. Sidiga Seizures due to paraneoplastic anti-n-methyl-d-aspartate aDaoud Research Group, Neurology, Khartoum, Sudan reseptor encephalitis associated ovarian teratoma bUniversity of Khartoum, Neurology, Khartoum, Sudan E-mail address: [email protected] (A. Hussein) S. Handayania, A. Okparastaa, A. Junaidia, O. Tambuna, R. Sanifb,A. Faridac Background aUniversitas Sriwijaya, Neurology, Palembang, Indonesia Sudan shares extensive borders with seven countries several of bUniversitas sriwijaya, Obstretic Gynaecologic, Palembang, Indonesia which have high (HIV/AIDS) prevalence. HIV is a virus belong to the cUniversitas Sriwijaya, Anatomical Pathology, Palembang, Indonesia family retroviridea and its infection causes profound immune suppression. AIDS is a late symptom of the infection and is associated with an unintended weight loss. Background Seizures can be a manifestation of paraneoplastic syndrome Objectives which are the consequence of an immune reaction to neuronal This study investigates the presence of epilepsy among Sudanese elements driven by an underlying malignancy affecting organs and AIDS patients. tissues. This immune reaction can cause autoimun encephalitis. One of the antibody commonly that be found in paraneoplastic Methods encephalitis is antibody against neurotransmitter N-Metil D-Aspartat This is a descriptive cross sectional hospital based study which (anti- receptor NMDA). The anti-receptor NMDA paraneoplastic was carried out at Khartoum state hospitals during the period March ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 63

2007 to November 2017 and 700 AIDS patients were included in this Conlusions study. The experience prescription of TCM syndrome differentiation has no signiﬁcant effect on the prognosis of acute ischemic stroke, Results but reduces the incidence of respiratory infection during Out of the 700 Sudanese AIDS patients almost 5.71% had epilepsy hospitalization. and 50% of them had generalized convulsions. Encephalitis was found to be the commonest cause of epilepsy followed by meningitis, Keywords: Acute ischemic stroke, TCM syndrome differentiation brain abscess, CNS lymphoma and toxoplasmosis. The EEGs showed treatment, Randomized, Double-Blind, Placebo-controlled trial abnormal discharge in 28 patients (70%).

Conclusion AIDS is a great mimicker. It can present in almost any doi:10.1016/j.jns.2019.10.886 neurological manifestation. Epilepsy is not an uncommon neurological manifestation associated with AIDS. doi:10.1016/j.jns.2019.10.885 WCN19-0793

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and WCN19-0790 outcomes/neuroepidemiology and environmental and other11Institutional Review Board approval is obtained. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and ‘Fast'- negative presentation of stroke patients in Alain Hospital - outcomes/neuroepidemiology and environmental and other UAE, 2017–2018

A randomized, double-blind, placebo-controlled clinical study of R. Alkatheeria, O. Azzama, R. Renganathanb traditional Chinese medicine syndrome differentiation in the aCollege of Medicine and Health Sciences-UAEU, Al Ain, United Arab treatment of acute ischemic stroke Emirates bAl Ain Hospital, Al Ain, United Arab Emirates W. Wua,X.Lia,W.Lib, Y. Liub, Y. Zhanga,H.Lua,X.Lia, J. Zhoua,Y. Wanga, X. Zhena,J.Maa Background aYueyang Hospital of Integrated Traditional Chinese and Western Recognizing early symptoms of stroke is vital for proper diagnosis Medicine, Shanghai University of Traditional Chinese Medicine, Depart- and management. Traditionally, ‘FAST’ (Facial drooping, Arm weak- ment of Neurology, Shanghai, China ness, Speech difficulty and Time to call emergency)presentation has bShanghai Municipal Hospital of Traditional Chinese Medicine, Depart- been used to achieve this. But what if the initial presentation of a ment of Neurology, Shanghai, China stroke patient was ‘FAST’-negative? Here we assessed the extent of ‘FAST'-negative presentations in Al Ain Hospital (AAH). Objectives The aim was to objectively evaluate the clinical efficacy of an Methodology experience prescription of Traditional Chinese Medicine(TCM) AAH Stroke registry of 2017 and 2018 were reviewed. We syndrome differentiation for stroke. selected patients with initial presentation of ‘FAST'-negative who had ischemic stroke (IS), transient ischemic attack (TIA) and Methods hemorrhagic stroke (HS). Gender, nationality, stroke subtype, and 102 patients with acute ischemic stroke were recruited. They presenting symptoms were evaluated. Then we classified the results were randomly assigned to the control group (n = 50) and the test based on the most common symptom at presentation. Symptoms group (n = 52). The control group was treated with western were categorized into the 10 most common presentations. medicine and placebo. The test group was treated with western medicine and an experience prescription of TCM syndrome differen- Results tiation (antelope horn, sputum, Cynanchum otophyllum and tur- Total number of patients was 107; which included 80 males and meric) with addition according to the tongue coating. The two 27 females. Composed of 37% Asian, 29% Emirati and 34% Arab. 77 groups were treated for 14 days and followed up for 3 months. had IS, 22 had HS and 8 had TIA. Following analysis of the onset NIHSS, BI, mRS ≤ 2, complications, mortality, recurrence rate, safety symptom; 10 presentations were frequently repeated (Figure 1). indicators and economic indicators were oberserved. Although some of the symptoms may overlap; only the 1st reported presentation was considered. They included, respectively; dizziness, Results headache, confusion/altered mental status, loss of consciousness There was no statistical difference in NIHSS, BI, mRS ≤ 2, mortality (LOC), seizure, visual disturbance, lethargic/fatigue and disorienta- and recurrence rate between the two groups on the fourteenth day tion/memory disturbance. and at 3-month follow-up (P N .05). The incidence of respiratory infection during the 14-day hospital stay in the test group was Conclusion significantly lower than that in the control group (P = .015). After The obtained results reflect that there are different symptoms 14 days, PT, KPTT (P = .022) and INR (P = .013) in the test group reported by patients as the initial presentation of stroke other than were significantly higher than those in the control group in the ‘FAST’. The 2 most common symptoms are dizziness /vertigo and normal range. The test group has a tendency to reduce the average headache. This should alert physicians to consider stroke in atypical daily hospitalization expenses (P = .053).^ presentations and increase their suspicion in high risk population. ARTICLE IN PRESS

64 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

doi:10.1016/j.jns.2019.10.887 had skin atrophy, one patient use to take phenobarbitone had skin eruption, one patient on carbamazipine had skin change while ﬁve patients on phenytoin had skin manifestations.

WCN19-0794 Conclusion Skin changes can occur in epileptic patients as part of drugs toxicity, or as part of clinical manifestations of certain diseases that Poster shift 02 - Autoimmune disorders - Part I/CNS infections - can cause secondary epilepsy eg. Neuroﬁbroma. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.888

Dermatological manifestations of epilepsy among adult Sudanese epileptic patients WCN19-0798 A. Husseinab, A. Sidiga, F. Yassien Omera, H. Abbashara, K.A. Husseina, a a M. Abbashar , M.M.A. Malk Aldar Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part aDaoud Research Group, Neurology, Khartoum, Sudan I/dementia - Part I/epilepsy - Part I/health economics and outcomes/ bUniversity of Khartoum, Neurology, Khartoum, Sudan neuroepidemiology and environmental and other1 1 Introduction Patient and Institutional Review Board approval obtained. Epilepsy is a clinical syndrome characterized by increase electrical excitability of cortical neurons with or without loss of consciousness. Diagnosis of anti-NMDAR encephalitis requires high index of Objective: To study the pattern of dermatological changes associated suspicion: Lessons from a case with epilepsy among adult Sudanese epileptic patients. R. Alkatheeria, O. Azzama, A. Sabbahb, K. Edreesc, R. Renganathand Methods aCollege of Medicine and Health Sciences-UAEU, Al Ain, United Arab This non interventional descriptive study, 360 adult Sudanese Emirates epileptic patients were included in the study which was conducted bAl Ain Hospital, Al Ain, United Arab Emirates at El shaab Teaching Hospital during the period from Feb 2014 to cAl Ain Hospital, Al Ain, United Arab Emirates Aug 2018. Full detailed history and proper clinical examination were dAl Ain Hospital, Al Ain, United Arab Emirates performed by the authors. Dermatological changes were assessed by dermatologist. List of investigations were done including EEG, Brain Background MRI and serial of drugs serum level. Anti-NMDAR encephalitis is one of the most frequent neuropsychiatric disorders which can occur with or without associated cancer. Results Out of 360 patients 31 were found to have scars due to repeated Case description attacks of convulsions, one patient was found to have neu- A 21 years old Filipino women presented with fever and seizure, roﬁbromatoma, one had Tuberous-Sclerosis, one had Sturge-Weber she was treated as case of encephalitis with empiric treatment. She syndrome, one had Kaposi sarcoma, one had SLE, one diabetic patient became disoriented and had motor restlessness. LP was inconclusive, ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 65

however showed high protein. EEG was encephalopathic, and MRI Introduction had subtle changes. Her condition deteriorated; she was catatonic, SSPE is a fatal slow virus disease which requires clinic-radiolog- mutism and still feverish. Repeated MRI brain FLAIR showed mesial ical, electrophysiological and biochemical correlation for diagnosis. temporal hyperintensity bilaterally. EEG showed slowing, non- Autoimmune encephalitis is a group of treatable immune epileptiform features. Repeat CSF showed 11 oligoclonal bands. mediated noninfective encephalitic disorders with spectrum of She was started on IV methylprednisolone and IVIG. While on presentation.^ treatment, she had orofacial dyskinesia, drooling of saliva, and They share clinical, radiological, and immunological features with autonomic dysfunction features: tachycardia, hypertension and a spectrum of disorders including SSPE and diagnosis depends on fever. CT abdomen/pelvis were normal. She received 1st course of careful integration of clinical, and laboratory features. plasmapheresis. Her condition kept worsening, she developed central hypoventilation syndrome and was mechanically ventilated. Aims and objectives She had 2nd course of plasmapheresis. MRI pelvis did not reveal any To present details of a case series where significant elevation of ovarian tumor. She had tracheostomy and PEG tube insertion. She measles antibody titres were found in patients who did not have was started on rituximab and cyclophosphamide. Follow-up MRI other evidence of SSPE. showed lesion resolution. Serum came positive for anti-NMDAR Ab and AChR Ganglionic neuronal Ab. Upon discharge, patient was Methods ambulating without support, feeding orally and communicating Retrospective review of cases with anti measles antibody non-verbally. positivity during 5 yr period. (2012–2016). Raised IgG N 1:25 anti- measles antibody titer was considered as positive.^ Discussion This patient showed all 8 groups of symptoms of anti-NMDAR Discussion encephalitis (Table 1). Initial presentation made the diagnosis CSF Anti-measles antibody can become elevated in situations challenging. Improvement was noted with the second line of other than SSPE probably due to damage to blood-brain barrier. It treatment. can be a nonspecific epiphenomena in autoimmune disorders. Intrathecal synthesis may occur postulating an active immunogenic Conclusion role for the measles virus in autoimmune disorders older age group, Organic causes of psychiatric symptoms should be considered. longer duration from onset to peak, significant psychosis, generalized Close monitoring may reveal additional clues to reach diagnosis. seizures in addition to myoclonus, presence of bladder, bowel involvement, nonspecific changes in the EEG, and normal SEP are doi:10.1016/j.jns.2019.10.889 negative predictors of SSPE even when the antibody titers against measles antigen are high in the CSF. This should be taken as an indication to look for the possibility of other autoimmune illnesses before the diagnosis of SSPE is confirmed. WCN19-0807 doi:10.1016/j.jns.2019.10.890

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other WCN19-0809

From fatal diagnosis of SSPE to treatable cause of autoimmune Poster shift 02 - Autoimmune disorders - Part I/CNS infections - encephalitis Part I/dementia - Part I/epilepsy - Part I/health economics and M.S. Mondal, S.R. Chandra, H. Padmanabha outcomes/neuroepidemiology and environmental and other National Institute of Mental Health and Neuroscieneces, Department of Neurology, Bangalore, India Neurological manifestations of mycetoma ARTICLE IN PRESS

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A. Husseinab, A. Alia, N. Motasima, R. Tofaha AlHusseinia, M.M. Fadela, Background K. Mohamed Ahmed Abbashera, M. Abbashara, H. Abbabshara,A. N-Methyl-d-aspartate receptor (NMDAR) antibody encephalitis is Siddiga, M.A. Ibrahima, E. Elbahia, M. Malk Aldara an autoimmune syndrome in which antibody is produced against the aDaoud Research Group, Neurology, Khartoum, Sudan NMDAR. The syndrome is frequently associated with ovarian bUniversity of Khartoum, Neurology, Khartoum, Sudan teratomas. Clinical features include auditory and visual hallucinations, delusions, behavioral change, impaired consciousness, motor Introduction disturbance (ranging from dyskinesia to catatonia), seizures, and Mycetoma is a chronic specific granulomatous progressive and autonomic dysfunction. disfiguring subcutaneous inflammatory disease. It is caused by true Anti-Hu is a paraneoplastic antibody which binds to tumors and fungi (Euomycetoma) or by higher bacteria (Actinomycetoma), in neural cells. Clinical features include sensory neuropathy, cerebellar 2015 Mycetoma was named as one of the neglected tropical diseases ataxia, limbic encephalitis, brainstem encephalitis and is commonly by the WHO. It mainly affects lower limbs, upper limbs, back and associated with small-cell lung carcinomas. rarely head and neck and other sites. It’s mainly transmitted through trauma with infected sharp objects. Case report A 58 year old male presented with history of gradually progres- Objectives sive behavior disturbance, sensory loss in lower limbs, tremulous- To determine the neurological manifestations of mycetoma. ness of all four limbs, weakness which started in proximal limbs, intermittent involuntary posturing of left upper limb and neck for 3 Methodology months, recent onset swallowing difficulty. On examination had A cross-sectional community based study. behavior disturbance, lower motor neuron type of quadriparesis, sensory ataxia, asymmetrical cerebellar signs, left upper limb and Results neck dystonia with ninth and tenth cranial nerve involvement. Almost 160 patients were included in the study, 90% of them were male. Two patients presented with entrapment neuropathy, Investigations one presented with proximal neuropathy, one patient has peripheral Hematological investigations- normal, ANA-negative, serum and neuropathy, one patient has dorsal spine involvement presented urine protein electrophoresis normal. CEMRI brain and cord –normal, with spastic paraplegia with sensory level, one of our patients has PET-CT-normal, nerve conduction studies showed pure sensory cervical cord compression, and one patient has repeated attacks of axonal neuropathy, EMG-fasciculations in deltoid and first dorsal convulsion due to tumor like mass caused by fungal infection interossei. Autoimmune panel-NMDA antibody positive. Par- affecting the right cerebral hemisphere. aneoplastic panel-anti Hu antibody positive. Till date the simultaneous coexistence of autoimmune antibody- Conclusion NMDA and paraneoplastic antibody-anti Hu has been described very Although it is rare clinicians should highly suspect neurological rarely, moreover both behavior disturbance and cerebellar involve- involvement in mycetoma patients. Mycetoma infection( wither ment which is in common presenting features NMDA and anti-Hu bacterial or fungal) can cause peripheral or central nervous system antibodies respectively with some atypical features like cranial nerve damage(At the level of formation of papule and discharging sinuses involvement are present in the patient which further make this case which can lead to entrapment neuropathy, or direct destruction of unique. the bone which can cause nerve damage or cord compression. A rare manifestation due to spread of infection from the skull to the brain doi:10.1016/j.jns.2019.10.892 causing convulsion or hemiplegia. doi:10.1016/j.jns.2019.10.891 WCN19-0811

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - WCN19-0810 Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Changes in the functions of energetic block of brain in children outcomes/neuroepidemiology and environmental and other. and adolescents with idiopathic generalized epilepsy treated by valproic acid Coexistence of autoimmune antibody-NMDA and paraneoplastic antibody anti-Hu in a patient with behavioral, sensory, motor, R. Gamirovaabc, E. Gorobetsd, T. Akhutinae, K. Idrisovaa, R. Esinbf,D. cerebellar and extrapyramidal features – A rare case report Martyanovd aKazan Federal University, Department of Fundamental Basis of Clinical A. Awasthya, A. Jaina, A. Goela, S. Patnayak Narayana, D. Naranga,R. Medicine, Kazan, Russia b Singhb, V. Lala Kazan Federal University, Laboratory of Clinical Linguistics, Kazan, Russia c aPost Graduate Institute of Medical Education and Research, Neurology, Kazan State Medical Academy, Department of Pediatric Neurology, Kazan, Chandigarh, India Russia d bPost Graduate Institute of Medical Education and Research, Neurology, Kazan Federal University, Department of Applied and Experimental Chandigarh, India Linguistics, Kazan, Russia ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 67 eMoscow State Universit, Laboratory of Neuropsychology, Moscow, Russia Objective fKazan State Medical Academy, Department of Neurology, Kazan, Russia The aim of the study was to evaluate the satisfaction with life and job among doctors working in the Silesian Province, Poland. Background The effect of antiepileptic drugs (AEDs) on cognitive functions Material and methods (CF) should be assessed in idiopathic generalized epilepsy (IGE) as it The study group consisted of 401 doctors (mean age 45.1 ± 12.6) influences CF minimally. In 2018 the authors worked out Russian- working in the hospitals and outpatient clinics in Silesia, Poland. The language battery based on Luria's principles of neuropsychological following tests were used: Satisfaction with Life Scale, Physicians' assessment to study CF in children treated by AEDs. Career Satisfaction Questionnaire, Hospital Anxiety and Depression Scale. An Institutional Review Board has waived the requirement for Purpose the formal approval of the study. To evaluate the functions of energetic block of brain (EBB) in children with IGE treated by Valproic acid. Results Based on the analysis of the collected data, job satisfaction of Methods doctors was rather high in various aspects. The relationship with 42 children (5–16 years old) were examined, 17 (with IGE) other doctors and nurses, as well as doctor-patient relationship were formed the study group (SG), 18 (without neurological diseases) – highly evaluated. On the other hand, the economic aspect of the control group (CG), 7 were excluded (cognitive deficit in anamnesis). profession and the lack of possibility to separate job duties from EBB (indices of Rate, Fatigue, Sluggishness, Hyperactivity, Impulsiv- personal life were low rated. The level of physicians' satisfaction with ity) in SG was evaluated before treatment, after 3, 6, 9, 12 months life seems quite low. A lot of doctors had anxiety and/or depression (Valproic acid), during the same periods in CG (without treatment). symptoms which affected the results of tests assessing life and job Risk ratios (RR) and 95% confidence intervals for unfavorable satisfaction. Factors such as: concomitant cardiovascular diseases outcome (UO) were calculated with RevMan 5.3 package. UO and/or diabetes, bed economic status, and having credit obligations between SG and CG was compared (results were considered affected significantly level of satisfaction with life and job. significant when p b .05). Conclusion Results Polish doctors are rather satisfied with their own professional Significant difference was in indices: Rate after 9 (RR = 12.71), development, but they could not separate personal life and develop 12 (RR = 7.94) months of treatment; Fatigue: 9 (RR = 9.53), 12 (RR other areas of life. Their general satisfaction with life is rather low. = 8.47); Sluggishness: 9 (RR = 4.76), 12 (RR = 7.41); Hyperactiv- ity: 3 (RR = 4.76), 6 (RR = 3.88), 9 (RR = 6.88), 12 (RR = 4.94); doi:10.1016/j.jns.2019.10.894 Impulsivity: 9 (RR = 4.76), 12 (RR = 3.88).

Conclusion Valproic acid inﬂuences negatively the functions of EBB in WCN19-0820 children with IGE; reduce of rate, growth of fatigue, sluggishness, impulsivity is registered after 6 months from the start of pharmaco- Poster shift 02 - Autoimmune disorders - Part I/CNS infections - therapy; growth of hyperactivity – after 3 months. The reported study was funded by Russian Foundation for Part I/dementia - Part I/epilepsy - Part I/health economics and Basic Research (RFBR) according to the research project №17-29- outcomes/neuroepidemiology and environmental and other 09096. Epilepsy among elderly Sudanese patients doi:10.1016/j.jns.2019.10.893 A. Hussein, O. Eladil, A. Sidig, K.H. Hajnoor, M.M. Aldar, K. Mohamed Ahmed Abbasher, H. Abbashar, M. Abbasher Daoud Research Group, Neurology, Khartoum, Sudan WCN19-0817

Background Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Seizure disorders become increasingly common after the age of Part I/dementia - Part I/epilepsy - Part I/health economics and 60 years and can have a signiﬁcant impact on the functional status of outcomes/neuroepidemiology and environmental and other the patient.

Life satisfaction and job satisfaction among doctors in the Silesian Objective Province, Poland The aim of this study was to evaluate the clinical presentation and characteristics of elderly Sudanese patients with epilepsy.^ P. Pawlowskia, B. Labuz-Roszaka, E. Niewiadomskab aFaculty of Public Health in Bytom- Medical University of Silesia in Methodology Katowice, Department of Basic Medical Sciences, Bytom, Poland This is a prospective study (from Feb. 2017 to Jun 2018). The bFaculty of Public Health in Bytom- Medical University of Silesia in study population included 240 elderly epileptic patients (age 60 Katowice, Department of Biostatistics, Bytom, Poland years or above).^

Background Results The job satisfaction is one of the most important factors Cerebrovascular accident was found to be the most common determining the life satisfaction. cause of secondary epilepsy (31%).Generalize epilepsy was seen in ARTICLE IN PRESS

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120 (50%) of patients. Abnormal neurological ﬁndings were more K. Hussain, B. Nabil, K. Sonia, A.S. Souda common (49%) among patients with partial epilepsy. Fifty percent of Prince Sultan Military Medical City, Neurology, Riyadh, Saudi Arabia our patients showed abnormal EEG. Abnormal CT brain ﬁndings were common among patients with partial epilepsy.^ Background Pregabalin has been reported to induce myoclonic jerks, exacer- Conclusion bate myoclonic epilepsy and generalized tonic clonic seizures in The pattern of clinical presentation of epilepsy among elderly overdose. Adult onset absence status epilepticus is unusual and is Sudanese epileptic patients is similar to what was mentioned in the rarely medication induced. literature except that the percentage of epilepsy following infections was more among our studied group (6%). Objective We report a non-epileptic patient who presented with absence status epilepticus induced by pregabalin.

Case report doi:10.1016/j.jns.2019.10.895 A 65 years old man with a past medical history of diabetes mellitus, hypertension, and chronic kidney disease on regular hemodialysis presented to the emergency department with 24 hof confusion. He was started on pregabalin 75 mg daily for diabetic WCN19-0822 polyneuropathy a few days prior to presentation. The patient presented confused, unresponsive to verbal com- Poster shift 02 - Autoimmune disorders - Part I/CNS infections - mand, spacing out and had automatism of mouth. No other abnormal movements were observed. An urgent EEG was performed and Part I/dementia - Part I/epilepsy - Part I/health economics and showed continuous 3HZ spike and waves consistent with absence outcomes/neuroepidemiology and environmental and other status. The patient was given lorazepam 2 mg intravenously, after which he improved clinically and his EEG normalized. His brain CT Symptoms of Lewy-body dementia induced by herpes zoster was unremarkable. The patient's pregabalin was discontinued and he encephalitis was placed on a maintenance dose of valproate for one week. He was then discharged home on no antiseizure medication. On follow up, R. Verity, A. Kirk, G. Hunter he had a normal neurologic exam and a normal EEG.^ University of Saskatchewan, Neurology, Saskatoon, Canada Conclusion Varicella-Zoster virus (VZV) reactivation syndromes have been Pregabalin may induce denovo absence status epilepticus. To our shown to have a multitude of neurologic sequelae, including knowledge this is the first report of absence status epilepticus caused vasculopathy and encephalitis. Complications of Herpes Zoster by pregabalin. Encephalitis (HZE) have not been adequately studied, due to the rare and variable presentation of the condition. However, case doi:10.1016/j.jns.2019.10.897 reports have shown outcomes ranging from favorable to fatal. We present the case of a 65-year-old male who presented with Herpes Zoster Meningoencephalitis, who developed symptoms suggestive of Lewy-Body Dementia (LBD) during the acute phase of his illness, WCN19-0824 which continued to progress. While no virus has been conclusively implicated in a neurodegenerative disease process, there is some evidence to suggest neurotropic viruses play a role in neurodegen- Poster shift 02 - Autoimmune disorders - Part I/CNS infections - eration. The temporal relationship between this patient’s acute viral Part I/dementia - Part I/epilepsy - Part I/health economics and infection and the onset of hallucinations, cognitive changes, REM outcomes/neuroepidemiology and environmental and other behavior disorder and parkinsonism point to a possible causative relationship. Whether the HZE unmasked an early LBD or initiated a Ictal lid movements - Blinks and lid saccades degenerative process with similarities to LBD remains unclear. In this report we discuss details of this unique case and review the available N. Pyatkaa, G. Fernandez-BacaVacaa, S. Lhatoob, A. Shaikha literature surrounding the impact of VZV in the central nervous aUniversity Hospitals Cleveland Medical Center, Neurology, Cleveland, system. USA bUniversity of Texas, Neurology, TX, USA doi:10.1016/j.jns.2019.10.896 Two types of lid movements, lid saccades and blinks, have discrete kinematic properties and physiology. These differences are reflected in distinct phenomenology of disorders affecting their WCN19-0823 neural substrate. Proof of this principle was seen in two cases, one with parietal eyefield epileptiform discharges and the other with Poster shift 02 - Autoimmune disorders - Part I/CNS infections - temporal lobe seizures. The lid movements in the patient with epileptiform discharges in the eyefield were rhythmic, yoked, and Part I/dementia - Part I/epilepsy - Part I/health economics and had rapid upward component that instantaneously followed slow outcomes/neuroepidemiology and environmental and other downward drift. These cyclic movements strikingly resembled nystagmus, but unlike typical eye nystagmus, the rapid upward Pregabalin induced absence status epilepticus component was pathological and seemed to involve saccadic mechanism. We suggest terms “ictal lid saccade” or “ictal lid ARTICLE IN PRESS

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nystagmus” to describe such phenomenology. In contrast, the patient doi:10.1016/j.jns.2019.10.898 with temporal lobe seizures had ipsilateral lid movements with rapid downward trajectories resembling reﬂex or spontaneous blinks. The term “ictal blink” is appropriate for this phenomenology. Schematic organization of the underlying neural circuit for lid WCN19-0825 saccade (A) and blink (B). The caricature of trajectory of lid saccade (C) and blink (D). In the caricature of the lid saccade caricature, vertical lid position is schematized in blue color, while corresponding Poster shift 02 - Autoimmune disorders - Part I/CNS infections - lid velocity is schematized in brown color. The bottom row Part I/dementia - Part I/epilepsy - Part I/health economics and schematized EMG activity from levator palpebrae (LP, green color) outcomes/neuroepidemiology and environmental and other and orbicularis oculi (OO, light brown color). In schematic in panel C, D, the x-axis always represents time, and schematized EMG activity Carbamazepine toxicity during combination therapy with leveti- is temporally matched with schematized lid position and lid velocity. racetam in two pediatric patients ARTICLE IN PRESS

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A. Al-Sulami, S. Alyamani WCN19-0837 King Faisal Specialist Hospital & Research Centre, Department of Neuroscience, Riyadh, Saudi Arabia Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Levetiracetam (LEV) is a third-generation anti-epileptic drug Part I/dementia - Part I/epilepsy - Part I/health economics and (AED), which is used as an adjunctive therapy for partial onset outcomes/neuroepidemiology and environmental and other seizures in adults, as well as for children of four years and older. LEV has been reported to cause Carbamazepine (CBZ) toxicity in four adult A case of relapsing polychondritis with vestibular neuritis and patients after combination therapy. There had been no reported cases cerebellar ataxia of Carbamazepine toxicity in combination with LEV in pediatric age group. We reported two pediatric cases of Carbamazepine toxicity in Y. Leea, G.Y. Kima, K.D. Choib, K. Sang Hoa combination with LEV pediatric case who use LEV in combination with aCollege of Medicine- Dong-A University, Department of Neurology, CBZ should be monitored closely for symptoms and signs of Busan, Republic of Korea Carbamazepine toxicity. Children with developmental disabilities bPusan National University Yangsan Hospital, Department of Neurology, seem more vulnerable to these side effects. Yangsan, Republic of Korea

Keywords: LEV – Levetiracetam, Toxicity, Carbamazepine Introduction doi:10.1016/j.jns.2019.10.899 Relapsing polychondritis(RP) is an autoimmune disease characterized by recurrent inﬂammatory episodes of cartilaginous structures. It is challenge to diagnosis RP, because it is established by clinical manifestations and the disease has diverse nature. We report interesting case, who had recurrent vertigo be seen as vestibular WCN19-0835 neuritis, diagnosed with RP.

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Case report Part I/dementia - Part I/epilepsy - Part I/health economics and A 59-year-old male visited the emergency room with dizziness outcomes/neuroepidemiology and environmental and other and ataxia. The symptom was recurrent from 6 months ago, six attacks were occurred. He also had 1-year history of swelling of both ear lobes. He felt repetitive vertigo and gait disturbance spontane- Adverse neuroprotective effect of cytidine-5-diphosphate choline ously recovered after few hours. to the hippocampus of pilocarpine-induced seizure mouse ^ Neurologic exam showed cerebellar ataxia and left spontaneous beating nystagmus. He showed right side deviation in past-pointing W.J. Kim test. He had purplish erythema of both ear lobes, diagnosed as Gangnam Severance Hospital, Yonsei University, College of Medicine, polychondritis. Neurology, Seoul, Republic of Korea The VOG findings were compatible with vestibular neuritis. There were no specific findings on Brain MRI. In laboratory tests, RA was Purpose elevated, anticardiolipin Ab IgG was positive. Episodic ataxia gene Cytidine-5-diphosphate choline (CDP-choline) is a compound was negative. In Seoul Neuropsychological Screening Battery, all normally present in all cells in the body and has neuroprotective domain functions were decreased.^ effect when administered exogenously. With oral CDP-choline After treatment with high dose steroid and intravenous immuno- fi applying within the rst 24 h after onset of stroke, the positive globulin treatment, neurologic deficit and chondritis were recovered. results were proven in clinical data. However, its precise mechanism of action is not fully known. One possible mechanism is that CDP- Discussion choline might be affecting the accumulation of extracellular gluta- Relapsing polychondritis is a multisystemic autoimmune disor- mate caused by ischemia, either inhibiting its release or increasing its der. Neurological symptoms occur in minor cases but cerebellar uptake. We apply this drug to epilepsy model for evaluating the symptoms could be presented. Cerebella ataxia could be seen in RP, protective effect of CDP-choline for acute seizure. but there were no vestibular neuritis cases by RP. In this case, the patient was clinically diagnosed as RP with recurrent chondritis of Methods both auricles and vestibular neuritis with good response to In pilocarpine induced mice, we injected CDP-choline 1 g/kg i.p. immunosuppressive treatment. To confirm recurrent vertigo with We divided the mice only pilocarpine injection group for control and RP, long term observation is needed. CDP-choline injection group by time serial for 24 h, 1 h before, 1 h and 24 h after seizure. doi:10.1016/j.jns.2019.10.901

Results Pre CDP-choline administration were neuroprotective effect in pilocarpine seizure model. CDP-choline administration in acute seizure phase is not neuroprotective for hippocampal neuron WCN19-0840 although its inhibitory effect for glutamate.^ Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Conclusion Part I/dementia - Part I/epilepsy - Part I/health economics and Injection CDP-choline after seizure event does not protect outcomes/neuroepidemiology and environmental and other neuronal damage. doi:10.1016/j.jns.2019.10.900 Neurological manifestations of visceral leishmaniasis ARTICLE IN PRESS

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A. Husseinab, M.M. ALdara, A. Sidiga, F. Yasseina, O.E.A. El-Adila,K. fullfilled inclusion and exclusion criterias assesed by MOCA-Ina and Hagnoura, H. Abbashara, M.A. Abbashera, K. Mohamed Ahmed questionnaire. Data was analyzed with SPSS 20.0 Chi-square, ANOVA Abbashera and correlation for bivariate and double linear regression for aDaoud Research Group, Neurology, Khartoum, Sudan multivariate. bUniversity of Khartoum, Neurology, Khartoum, Sudan Result Background Samples consists 39 subjects. The prevalence of cognitive N Visceral leishmanesis is not uncommon in our country. The impairment in epilepsy patients was 69.2%. Level of education ^9 neurological manifestations found in some patients as it carry a high years was mostly recorded from the samples with MOCA-Ina score risk of morbidity and mortality. that shows cognitive impairment. In multivariate analysis with multiple linear regression tests of 8 variables (age, sex, education Objectives level, age of onset, type of epilepsy syndrome, type of drug, duration The study was aimed to investigate the presence of neurological of seizure, and frequency of seizures), three variables (gender, level manifestations in a group of Sudanese adults patients with visceral of education, duration of seizure) had significant relationship with leishmanesis. cognitive function of epilepsy patients. There was also a positive correlation between gender (0,333), education level (0,542) on Patient and methods cognitive function and a negative correlation (−0,334) between the This is a descriptive prospective cross sectional hospital based duration of seizure and cognitive function.^ study. It was conducted at Omdurman tropical teaching hospital in Khartoum state, it implies 100 beds and 3 units of general medicine Conclusion and specialists in tropical medicine. The prevalence of cognitive impairment was 69.2% in epilepsy Hundred patients with visceral leishmanesis were examined for patients at Mohammad Hoeasin hospital Palembang. Level of neurological manifestations using standardized questionnaire in- education, gender and duration of seizure influence cognitive cluding medical history, clinical examination and investigation function in epilepsy patient. including, EMG and brain MRI.^ Keywords: Epilepsy, Cognitive function Results Male to female ratio was found to be 3:1 and common age group affected was b30 years. Peripheral neuropathy was found to be the doi:10.1016/j.jns.2019.10.903 commonest neurological manifestations followed by epilepsy, cranial nerves involvement and encephalopathy.

Conclusion Patients with visceral liechmaniasis can present with neurological WCN19-0847 manifestations. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - doi:10.1016/j.jns.2019.10.902 Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

Clinical analysis of adult-onset neuronal intranuclear inclusion WCN19-0843 disease

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Y. Harigayaa, M. Ikedab, H. Okaa, S. Aokia, K. Mizushimaa,S. Part I/dementia - Part I/epilepsy - Part I/health economics and Murayamac, Y. Ikedab outcomes/neuroepidemiology and environmental and other aMaebashi Red Cross Hospital, Department of Neurology, Maebashi, Japan b Factors that influence cognitive function in epilepsy patients at Gunma University Graduate School of Medicine, Department of neurology clinic Mohammad Hoesin Hospital Palembang Neurology, Maebashi, Japan cTokyo Metropolitan Institute of Gerontology, Department of Neurology S. Handayania, Y. Haruna, M. Mukhlisaa, E. Baharb and Neuropathology, Itabashi, Japan aUniversitas Sriwijaya, Neurology, Palembang, Indonesia bUniversitas Sriwijaya, Methodology and Statistic, Palembang, Indonesia Objectives Neuronal intranuclear inclusion disease (NIID) is characterized by eosinophilic nuclear inclusions (NI) in the nervous systems and the Background visceral organs. Ante-mortem diagnoses have been made by NI fi Epilepsy is a clinical manifestation of brain disorder due to identi cation in skin biopsy samples based on characteristic various etiologies that needs appopriate treatment. Lack of therapy corticomedullary junction (CMJ) high intensity in brain diffusion- leade to cognitive impairment. This research aims to evaluate weighted imaging (DWI). However, the clinical symptoms of NIID cognitive function profile and analyze factors that influence cognitive are variable. function in epilepsy patient.^ Methods Method We analyzed 14 (10 sporadic, 4 familial) adult-onset NIID This is a cross sectional study of epilepsy patient in Mohammad patients with clinical examination, electrophysiological study, brain fl Hoesin Hospital Palembang between January–May 2018 that MRI, cerebrospinal uid (CSF) biomarker, and skin biopsy. ARTICLE IN PRESS

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Results patients), color vision defects (3 patients), radicular backpain (2 The mean onset-age was 63.8 years. Initial symptoms were patients), bladder hesitancy (1 patient), tingling sensation in back (1 consciousness disturbance, memory impairment, gait disturbance, patient) and nausea (1 patient). Three patients were diagnosed as etc. The mean scores of MMSE, Japanese version of Montreal having optic neuritis, 1 as recurrent optic neuritis and 1 as NMOSD. Cognitive Assessment and Frontal Assessment Battery were 20.7/30, Ône patient had complete recovery with steroids only. Two patients 14.2/30 and 9.2/18, respectively. Neurological examination demon- were given steroids and azathioprine earlier in the disease course strated hypo-areflexia, miosis and urinary dysfunction. All patients which lead to complete recovery. Treatment was delayed in 2 showed abnormal nerve conduction. Thirteen of 14 patients revealed patients; 1 had frequent relapses and the other showed persistent high intensities of CMJ in DWI and leukoencephalopathy with vision loss. ventricular dilatation and brain atrophy in MRI FLAIR images. In one patient with leukoencephalopathy, DWI high intensity was not Conclusion detected. The levels of total Tau in CSF were increased in accordance Anti MOG antibody detection can prove helpful in early diagnosis with the grade of DWI high intensity. Skin biopsies from all patients of a variety of neuro-demyelinating diseases in which timely demonstrated that NI immunostained with anti-ubiquitin and anti- initiation of immunomodulatory therapy may lead to complete p62 antibodies in the sweat gland cells, adipocytes and fibroblasts, symptom resolution and prevention of future relapses. were composed of filamentous structure without limiting membrane by electron microscopy. doi:10.1016/j.jns.2019.10.905

Conclusions In patients with miosis and hyporeﬂexia with leukoencephalopathy, NIID should be considered for differential diag- WCN19-0871 nosis even when DWI high intensity is negative. Total Tau in CSF will be a biomarker for progression of NIID. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - doi:10.1016/j.jns.2019.10.904 Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

Relationship between the postoperative delirium and dementia in WCN19-0859 elderly patients: Alzheimer's disease or vascular dementia

L. Yoona, H.C. Hab, J.M. Nohb, K.H. Hongc Poster shift 02 - Autoimmune disorders - Part I/CNS infections - aDepartment of Neurology, Seoul Chuk Hospital, Neurology, Seoul, Part I/dementia - Part I/epilepsy - Part I/health economics and Republic of Korea outcomes/neuroepidemiology and environmental and other bDepartment of Orthopedic Surgery, Seoul Chuk Hospital, Orthopedic Surgery, Seoul, Republic of Korea Anti MOG antibody associated neurological disorders: a retro- cDepartment of Orthopedic Surgery, Seoul Chuk Hospital, Orthopedic spective audit Surgery, Seoul, Republic of Korea^

a a b a c F. Qayyum , S. Sheikh , A. Ahmad , T. Ahmed , S. Awan Background a Shifa International Hospital, Immunology, Islamabad, Pakistan Surgeries in elderly patients have increased delirium and the b Shifa International Hospital, Neurology, Islamabad, Pakistan etiologies of delirium are multifactorial. We studied the risk for c Shifa International Hospital, Hematology, Islamabad, Pakistan^ postoperative delirium (POD) in elderly dementia patients. This study was conducted to investigate the clinical effects of surgery to Introduction the dementia patients in Alzheimer's disease (AD) or Vascular Anti MOG antibody associated neurological disorders include dementia (VaD). acute disseminated encephalomyelitis (ADEM), ADEM followed by episodes of optic neuritis (ON), recurrent ON and anti-aquaporin 4 Methods ≥ antibody negative neuromyelitis optica spectrum of disorders From March 2018 to April 2019, 95 patients, aged 56^years and (NMOSD). undergoing surgery were retrospectively enrolled. We reviewed 29 patients with previous and newly diagnosed dementia and 66 Methods healthy controls, and the differences in POD between these groups A retrospective audit was done for patients referred for anti MOG were investigated. The patients with dementia were classiﬁed into 2 antibody testing from January 2018 to April 2019. Patients seropos- groups: AD and VaD. VaD is a disease entity with heterogeneous itive for anti MOG antibodies were included. Relevant clinical clinicopathological nature, which included poststroke, subcortical information was taken from patients, their relatives and physicians. VaD, and combined VaD (AD + VaD).^

Results Results We tested 72 patients for anti MOG antibodies; 9 patients (12.5%) Among 95 surgical patients with a mean age of 77.05^years, 41 tested seropositive. Five patients; 4 males and 1 female with an age (43.2%) developed POD. The frequency of POD was higher in range of 16 to 43^years (median age 34.5) were included. All patients dementia patients compared to no dementia groups {82.80% vs had vision loss (4 with unilateral and 1 with bilateral). Other clinical 25.80%; odds ratio (OR) 3.21, [95% conﬁdence interval (CI) 2.06– b ﬁ features included headache (4 patients), painful eye movement (3 4.99]; P ^.001}. There was no signi cant difference in POD between ARTICLE IN PRESS

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AD and VaD. Delirium was not correlated with conditions, such as WCN19-0878 hypertension (HTN), diabetes mellitus (DM)and gender {HTN, 42.90% vs 43.60%: DM, 45.50% vs. 33.30%: female, 27.2% of 63.0 vs male Poster shift 02 - Autoimmune disorders - Part I/CNS infections - 13.8% of 32.0^%}. Part I/dementia - Part I/epilepsy - Part I/health economics and Conclusion outcomes/neuroepidemiology and environmental and other We assumed that dementia play a key role in the risk factors of POD in elderly surgical patients, but found no clinical difference Clinical proﬁle and geographical distribution of cerebral venous between dementia two subtypes. The results of our study may help sinus thrombosis at a tertiary care hospital reduce POD incidence through targeted patients. S.P. Gorthia, V. Prabhua, N. Nilimab doi:10.1016/j.jns.2019.10.906 aKasturba Medical College MAHE, Neurology, Manipal, India bStatistics, Manipal, India

Introduction WCN19-0874 Cerebral Venous Sinus Thrombosis (CVST) is an important cause of stroke in India. Pregnancy and oral contraceptives are identified as common causes of CVST in western world and this study aims to Poster shift 02 - Autoimmune disorders - Part I/CNS infections - identify the etiological factors in this terrain. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Aim To study the clinical profile and geographical distribution of Epidemiological study of Gerstmann-Sträussler-Scheinker disease patients with CVST. with codon 102 mutation in Japan Materials and methods H. Muraia, Y. Nakamurab, T. Matsushitac, T. Kitamotod, Y. Tsuboie,N. A retrospective observational analytical study. Case records of Sanjof, M. Yamadag, H. Mizusawah CVST cases are extracted from medical record section of Kasturba aInternational University of Health and Welfare, Department of hospital. Neurology, Tokyo, Japan Statistical analysis is done using R software (Choropleth maps) bJichi Medical University, Department of Public Health, Shimotsuke, and SPSS (South Asia Bangalore). Japan cKyushu University, Department of Neurology, Fukuoka, Japan Results dTohoku University, Department of Prion Protein Research, Sendai, Japan One hundred forty five case records of CVST are studied. Seventy eFukuoka University, Department of Neurology, Fukuoka, Japan percent are males. Head ache is most common symptom. Polycythe- fTokyo Medical and Dental University, Department of Neurology and mia (23%) Hyperhomocystinemia (19%) and Puerperal CVST (5%) are Neurological Science, Tokyo, Japan important etiological factors. Geographical distribution showed a gKanazawa University, Department of Neurology and Neurobiology of difference in incidence from coastal regions to other plateau areas. A Aging, Kanazawa, Japan larger community based study is required. hNational Center of Neurology and Psychiatry, Department of Neurol- ogy, Kodaira, Japan doi:10.1016/j.jns.2019.10.908

Gerstmann-Sträussler-Scheinker disease (GSS) is a genetic prion disease harboring mutations in PRNP gene. GSS with codon 102 mutation (GSS102) is the most common type, and is more frequent WCN19-0881 in Japan than in Europe. It presents spinocerebellar degeneration-like feature (typical type), but there also exists a rapid progressive type. To evaluate the clinical and epidemiological feature of GSS102 in Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Japan, we collected information on clinical and epidemiological data Part I/dementia - Part I/epilepsy - Part I/health economics and of GSS102 analyzed by the CJD Surveillance Committee, Japan, from outcomes/neuroepidemiology and environmental and other 1999 to 2016. A total of 117 GSS102 patients were collected. Among them, 90 (76.9%) reside or born in Kyushu island which locates in Beta-interferon therapy in relapsing and remitting multiple south-west part of Japan. Within Kyushu Island, there were two large sclerosis - Challenges in an emerging country clustering of patients. Family history was observed in 88.8%. Periodic synchronous wave complexes (PSWC) in EEG were observed only in P.K. Yadava, S. Radhakrishnanb 12.3%, hyperintense cortices in diffusion-weighted MRI (DWI-MRI), aSanaka Institute of Medical Sciences, Neurology, Durgapur, India 37.6%. The duration until the development of akinetic mutism was bAmrita Institute of Medical Sciences, Neurology, Kochi, India signiﬁcantly shorter in patients with hyperintense lesions in DWI- b MRI (p ^.0001). Hyperintensity in DWI-MRI could be a predictor of Multiple sclerosis (MS) is an immune-mediated demyelinating rapid progression in GSS102. disease, with increasing prevalence in India, as seen in the recent studies. Beta-Interferon is the most widely used treatment option. doi:10.1016/j.jns.2019.10.907 There is a paucity of studies on beta-interferon in relapsing remitting multiple sclerosis (RRMS) in India. ARTICLE IN PRESS

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Aims Pontine myelinolysis (CEPM) and 7 had Central pontine myelinolysis To study efficacy, compliance, and side effect profiles of patients (CPM). 23 patients were males and 17 were Females. Mean Age was on beta-interferon, with a diagnosis of RRMS, and also look at other 56.8 yrs. Hyponatremia was seen in 77.5% of study population. The factors, such as, affordability, preference, and availability. most common cause for it was SIADH precipitated by infection mostly Urinary Tract Infection. 5 patients had evidence of Chronic Settings and design Liver Disease and 6 were alcoholic. Clinical presentation was varied A retrospective-prospective design. and included Altered Sensorium in 19 patients, Extrapyramidal state (18), Locked in state (7), Ataxia (7), Dysphagia, Dysarthia and Materials and methods Dystonia in 3 patients each. MRI showed involvement of Thalamus Twenty patients with a diagnosis of RRMS were included in the and internal capsule commonly apart from the involvement of pons study. They were followed up regularly while on beta-interferon. All and basal ganglia. Diffusion Restricting lesions were seen in 9 patients underwent magnetic resonance imaging (MRI) of the brain, patients. MRI was normal in 2 patients. 22 patients were treated with plain and contrast, and the expanded disability status scale (EDSS) steroids. Dopaminergic drugs were used in most of patients with score was assessed at regular intervals. extra pontine myelinolysis. Botulinum Toxin was used in 2 patients with intractable dystonia. On discharge from hospital 15 patients Results were bedridden and 18 patients were ambulant. 2 of our patients The mean age was 36.25 ± 12.24 years, with a female:male ratio had succumbed to their illness. of 2.3:1. The majority were unemployed, and were dependent on their families for treatment. There was significant delay from Conclusion diagnosis to start of interferon therapy, mean duration being 29.95 ODS is a rare demyelination syndrome. Prompt diagnosis and months. Oligoclonal bands were positive in 70% of subjects. management is needed for favourable clinical outcome. Seventeen patients were on interferon beta 1a intramuscular and three patients on interferon beta 1a subcutaneous injections. The doi:10.1016/j.jns.2019.10.910 mean relapse rates per patient before and after starting beta interferon were 1.85 and 0.55 respectively. First dose fever was most common side effect. Headache, myalgia, and psychiatric symptoms were seen. Periventricular and juxtacortical lesions were WCN19-0884 the most common radiological sites.

Conclusions Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Beta-interferon is effective and safe therapy in Indian patients Part I/dementia - Part I/epilepsy - Part I/health economics and with RRMS. outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.909 Cervical spinal cord injury associated with neck ﬂexion in posterior cervical decompression -Veriﬁcation by intraoperative spinal cord monitoring

WCN19-0882 S. Sumiyaab, S. Kawabatabc, S. Ushiob, T. Sasakid, J. Hashimotob,T. Yoshiibd, A. Okawabd aSaku Medical Center, Orthopedics and Spine Surgery, Saku-city, Japan Poster shift 02 - Autoimmune disorders - Part I/CNS infections - bTokyo Medical and Dental University, Department of Orthopedics Part I/dementia - Part I/epilepsy - Part I/health economics and Surgery, Orthopedics and Spine surgery, Tokyo, Japan outcomes/neuroepidemiology and environmental and other cTokyo Medical and Dental University, Advanced Technology in Medicine, Orthopedics, Tokyo, Japan Clinical and radiological proﬁle of osmotic demyelination syn- dTokyo Medical and Dental University, Department of Orthopedics drome in a tertiary care hospital in Southern India Surgery, Orthopedics, Tokyo, Japan

a b P.K. Yadav , A.G. Roy Introduction a Sanaka Institute of Medical Sciences, Neurology, Durgapur, India Some unexplained postoperative paralysis have reported in the b Amrita Institute of Medical Sciences, Neurology, Kochi, India cervical spine surgery.We experienced several cases of intraoperative monitoring (IOM) warnings because of neck ﬂexion in posterior Objectives cervical procedure. We investigated to evaluate preoperative factors ﬂ In this study the clinical and radiological features^, etiological in patients with spinal cord disorder due to exion of the neck factors and clinical outcomes of patients diagnosed with osmotic during posterior cervical spine surgery by changes in waveforms in demyelination syndrome (ODS). IOM.

Methods Materials/methods A total of 40 patients with clinical and radiological findings A retrospective analysis of 179 consecutive patients who under- suggestive of ODS admitted in AIMS, Kochi from Jan 2009-sept 2012 went IOM during posterior cervical spine surgery. When warning were included in the study. The data from these patients were alarms were set off by amplitude changes in the period between skin analysed. incision and exposure of the lamina, the neck position was changed from flexion to neutral, and patients whose electrical potentials were Result recovered by a change in cervical position were placed in the flexion- Out of 40 patients of ODS 17 patients had Extra pontine induced potential reduction group. We analyzed to extract risk factors myelinolysis (EPM),16 patients had Combined extrapontine and for flexion-induced reduction in potentials. ARTICLE IN PRESS

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Results/conclusion (8.8%), 5 (11.4%), (0%), and 1 (33.3%) for the second, third, fourth 156 patients were analyzed in this study. A warning alarm went and fifth serial EEG studies, respectively. off in 7 patients (4.5%) at the time of posterior cervical spine ^For the sleep-deprived EEG group the number of reports showing exposure. However, by changing their neck position from flexion to abnormality detection for the first time was 2 (6.5%). neutral, the electrical potentials recovered in all patients, with no fl postoperative adverse events such as paralysis ( exion-induced Conclusion^ potential reduction group) and the remaining 148 patients were The result of this study suggests a minimal contribution of used as controls. Logistic regression analysis was performed to follow-up and sleep deprivation methods in improving the EEG identify the risk factors affecting the reduction of TCE-MEP. The two abnormality detection. National guidelines and increasing the factors that were significantly associated with the risk of reduction of awareness between physicians referring for EEG assessment might TCE-MEP were the occupying rate of anterior compression compo- increase the utility of these well-established, yet not optimally- nent at the most compressed level and Kyphotic angle in the flexion used EEG methods. position of anterior compression component at the most compressed level. doi:10.1016/j.jns.2019.10.912 doi:10.1016/j.jns.2019.10.911

WCN19-0894 WCN19-0892 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - outcomes/neuroepidemiology and environmental and other Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Hippocampal sclerosis among Sudanese patients with concomitant epilepsy and psychogenic non epileptic seizures The role of serial follow-up and sleep-deprivation methods in improving electroencephalography diagnostic yield in a cohort of A. Husseinab, T.F. Mahdia, M.A. Ibrahima, Z.I.H. Ibrahima, M.A. Omani adults: An audit study Alwalida, K. Mohamed Ahmed Abbashera, R. Tofaha AlHusseinia, M.I. Omera, H. Abbashara, M.M. Aldara, M. Abbashara, A. Sidiga, O.E. Eladila a b c fific b A. Alobaidy , S. Alrawas , M. Al-Kiyumi , I. Al-A , R. Poothrikovil aDaoud Research Group, Neurology, Khartoum, Sudan a Sultan Qaboos University Hospital, Department of Medicine- Neurology bUniversity of Khartoum, Neurology, Khartoum, Sudan Unit, Muscat, Oman bSultan Qaboos University Hospital, Clinical Physiology, Muscat, Oman Introduction cSultan Qaboos University Hospital, Resident of the Oman Medical ^ Epilepsy is one of the most common neurological diseases. It is Specialty Board, Muscat, Oman either primary, when there is no underlying cause or secondary when there is an obvious cause. There is a well known relation Background^ between epilepsy and hippocampal sclerosis. Follow-up and sleep-deprived electroencephalography (EEG) studies are known methods that increase the likelihood of obtaining Objective fi ^ abnormal ndings in EEG recording. To date, there is no available To assess the presence hippocampal sclerosis in Sudanese data on the utility of these two methods in Oman. patients with both epilepsy and psychogenic non epileptic seizure.

Objectives ^ Methodology^ Our aim is to establish the advantage of follow-up and sleep- Thirty three Sudanese patients with epilepsy and concomitant deprived EEG studies in increasing the opportunity to record psychogenic non epileptic seizure where included in this study. Full interictal abnormalities. detailed history of both epilepsy and PNES was obtained, brain MRI and EEG were done. Methods^ The EEG data were collected retrospectively during the period Result^ between June 2006 and June 2010 at a tertiary referral center in Out of 33 patients 16 were males and 17 were females. Nineteen Oman. All the reviewed EEGs were routinely done for patients older patients had generalized tonic colonic (GTC), 1 patient had GTC plus than 13 years referred for the likelihood of epilepsy. Interictal Atypical absent seizure, and 13 patients had focal epilepsy. Twelve fi fi abnormalities were de ned and identi ed during periods of resting, patients had abnormal brain MRI findings in a form of hippocampal hyperventilation and photic stimulation. sclerosis while the rest of the patients had normal brain MRI.

Results ^ Conclusion^ Total of 3010 EEGs were reviewed. Of those, there were 553 Hippocampal sclerosis is a common finding in people with both (18.4%) follow-up and sleep-deprived EEGs, including the initial epilepsy and psychogenic non epileptic seizure. baseline EEG studies. The total number of follow-up EEGs was 274 (49.5%) and the total number of sleep-deprived EEGs was 31(5.6%). doi:10.1016/j.jns.2019.10.913 În the follow-up EEGs group, the total numbers of reports showing EEG abnormality detection for the first time were 19 ARTICLE IN PRESS

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WCN19-0895 S. Dubeya, V. Ramakrishnana, A. Dubeyb, Y. Sailajaa, N. Prabhua, T.N. Dubeyc aMeenakshi Medical College Hospital and Research Institute, Depart- Poster shift 02 - Autoimmune disorders - Part I/CNS infections - ment of Neurology, Kanchipuram, India Part I/dementia - Part I/epilepsy - Part I/health economics and bSAIMS Medical College and PGI, Neurology, Indore, India outcomes/neuroepidemiology and environmental and other cGandhi Medical College, Neurology, Bhopal, India

Epilepsy e-coded easy (EEE) ARTICLE IN PRESS

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Objectives Discussion 1. To get a detailed and accurate documentation of semiology of This model proforma maybe utilized as a standarized and seizures in a simple and clear digital format which is an qualitative tool in neurology clinics for improving documentation, essential prerequisite for the diagnosis, workup and drug of communication and tracking of epilepsy records in a digital format as choice for treatment of epilepsy. compared to the narrative data entry. 2. To design and evaluate a simplified digital model proforma for By this coding, patient can visit easily in any other epilepsy OPDs seizure semiology based on the recent 2017 ILAE classification of irrespective of the geographical and language status of the patient. seizures. ^Conclusion This model proforma may support in uniform coding & decoding Methods of seizures^, for quick diagnosis of seizures without error, for We formulate a scaling method by a model proforma to epidemiological statistics and indexing, in epilepsy research studies standardise the semiology documentation with minimum variation and for data management on epilepsy efficiently. in an easy way. This alpha-numeric data can also be used in maintaining epilepsy Total 200 patients were included between 1st Sep.2018 and 31st registry and to capture, store, maintain, retrieve and analyse the March 2019 and coded by random sampling based on our Digital epilepsy data for national programmes. Semiology Proforma (DSP). In this, the descriptive verbal and text data of semiology is coded doi:10.1016/j.jns.2019.10.914 in the form of alphabetical and numerical index. ^

Examples ^ ARTICLE IN PRESS

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WCN19-0904 WCN19-0914

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other outcomes/neuroepidemiology and environmental and other

Patterns of cardiac ischemic changes among adult Sudanese Epilepsy out-patient nano-monograph (EPONAM) epileptic patients attending Daoud Charity Clinic - Sudan January – May 2019 S. Dubeya, V. Ramakrishnana, A. Dubeyb, Y. Sailajaa, N. Prabhua, T.N. Dubeyc A. Hussein, S. Hamza, E. Mohammed, Y. Abdalla, A. Mohammed aMeenakshi Medical College Hospital and Research Institute, Depart- Mustafa, R. Abdrabo, M.A. Alwalid, R.A. Salih, E. Alwaleed, R.M. ment of Neurology, Kanchipuram, India Hassan, B.E. Tabage, R.A.S. Mohamed, M.H. Elsheih, K. Mohamed bSAIMS Medical College and PGI, Neurology, Indore, India Ahmed Abbasher, A. Mohammed, H. Abbashar, M.M. Aldar, R. Tofaha cGandhi Medical College, Neurology, Bhopal, India AlHusseini, A. Sidig, S. Dafalla Daoud Research Group, Neurology, Khartoum, Sudan Introduction There are about 50 million people living with epilepsy worldwide and more than 10 million persons with epilepsy (PWE) in India. The Introduction^ burden of epilepsy accounts for 1% of the total burden of disease in Epilepsy is one of the commonest neurologic disorder, with N85% the world. of patients with epilepsy living in low and middle-income countries. Despite advances in epilepsy treatment, a large treatment gap Studies have shown that patients with epilepsy have a higher exists in developing countries, which can be attributed to many prevalence of structural cardiac disease than those without epilepsy. factors including poor clinical documentation. Seizure activity may not only induce arrhythmias but may also lead to structural cardiac changes. Objectives To provide an adequate, precise and clear description and Objectives^ documentation of epilepsy data which provides continuum, This study conducted to determine the patterns of cardiac coordinated^, interactive and research oriented epilepsy healthcare ischemic changes among epileptic patients. without any default error.

Methodology Methods A Community base study was conducted at Daoud Charity Clinic, We designed an epilepsy outpatient monograph card based on and case series study design was used. A questionnaire, interviewer– the current ILAE classiﬁcation and management guidelines with our administered, which included 13 items, was employed on a cumulative clinical experience of more than 10 years and applied on convenient sample consisting of 20 patients. Electrocardiography the patients with epilepsy for last 2 months, 1st March 2019 to 30th and echocardiography were used. April 2019.

Results Discussion Twenty patients were included with age between eighteen and Proper documentation is an obligatory integral part and also an fifty years, thirteen of them were female and seven were male. important tool to ensure comprehensive epilepsy management plan. Twelve patients presented with tonic clonic, Four patients presented There are many epilepsy cards available^, which contain only with focal to bilateral and cases of myoclonic, tonic, and focal minimum basic details for emergency purposes^, hence a compre- without impair was observed. Twelve patients are taking sodium hensive epilepsy card is an essential need of the hour. valproate, five patients are taking carbamazepine and three patients Our EpONaM provides complete health status of epilepsy patients are taking combination of sodium valproate and carbamazepine. Two in an easily accessible way that encourages to observe ongoing patients have ST- segment Abnormalities (St-segment depression outcomes, reviews and complaints of the patient. and elevation). All patients have normal echocardiography.^ Conclusion Conclusion This EpONaM card is a^ user friendly, easily portable and There is a strong relationship between cardiac ischemia and transferrable card which facilitates high quality patient care and epilepsy, St-segment abnormalities are the commonest finding. ^ allows easy monitoring, communication^, uninterrupted follow-up with near zero non-compliance through strict drug alert, seizure alert and tele-surveillance patient catching system.

doi:10.1016/j.jns.2019.10.916 doi:10.1016/j.jns.2019.10.915 ARTICLE IN PRESS

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WCN19-0921 Indonesia bSiloam Hospitals Lippo Village, Inpatient Department, Tangerang, Indonesia Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Introduction outcomes/neuroepidemiology and environmental and other Myoclonic astatic epilepsy is a unique epilepsy syndrome constituting approximately 1–2% of childhood-onset epilepsies with Multiple brain cavernoma presenting as myoclonic astatic sei- 94% of the cases occurs within ﬁrst 5 years of life. Seizures were zures in a pediatric patient: Case report reported as myoclonic jerking movement continued by a brief atonia. EEG may be initially normal and may show polyspike and wave V. Puspitasaria, R.J. Ketarena, J. Simcab complexes with progression of the disease. Myoclonic astatic aSiloam Hospitals Lippo Village, Department of Neurology, Tangerang, epilepsy was known to be genetically involved, we would like to ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 81 report a case with similar seizure pattern in a patient with structural region with no sensory impairment with preserved reflexes abnormality. bilaterally. We found bilateral winging of scapula due to injury of: Findings 1) Long thoracic nerve innervating right serratus anterior causing A 3-year-old male patient presented to the emergency depart- weakness on the right side, and ment with progressing disequilibrium and headache since 1 month 2) Left spinal accessory nerve innervating trapezius on the left side. before admission. Headache, frequent staring and jerking followed by brief falling were also seen. This was the first onset seizure. Patient had a complete immunization schedule. History of previous The possible mechanism maybe traumatic compressive nerve illness was denied. Neurological examination showed myoclonic injury by ruling out spinal cord, root^, plexus injury by imaging and jerks followed by atonia, hence no weakness of the extremities. neurophysiological study. Routine laboratory findings was unremarkable and electroencephalogram study showed multifocal epileptiform discharges in both Conclusion frontal region, left parietal and right temporal region. Head MRI with Atypical complex nerve injury usually results either from traction contrast showed multiple cavernoma in both cerebral hemisphere or heavy impact mechanism. and bilateral lateral periventricle with the diameter of 0.6–2.66 cm. Acute bilateral different types of winging of scapula due to Patient was then discharged on valproic acid and had controlled trauma is a rare presentation. Head to foot clinical examination is seizure until now. inevitably essential to reveal hidden, unnoticed problems irrespective of whether the patient is symptomatic or asymptomatic. Conclusion doi:10.1016/j.jns.2019.10.918 Myoclonic astatic seizures is a rare condition with potential genetic cause. This case shows that structural abnormalities might be a cause of similar seizure pattern. Valproic acid is shown to be effective in controlling seizure of this patient. WCN19-0926 doi:10.1016/j.jns.2019.10.917 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other WCN19-0924 Effects of cerebellar transcranial direct current stimulation upon Poster shift 02 - Autoimmune disorders - Part I/CNS infections - kindled seizures depends upon PPARγ modulation Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other M. Pervak, L. Godlevsky Odessa National Medical University, Biophysics- Informatics and Wings of fall Medical Devices, Odessa, Ukraine

S. Dubeya, V. Ramakrishnana, A. Dubeyb, S. Yadallaa, N. Prabhua, T.N. The purpose of the investigation was to estimate the effectiveness Dubeyc of peroxisomal proliferator-activated γ-receptors (PPARγ) modula- aMeenakshi Medical College Hospital and Research Institute, Depart- tion upon the antiseizure effects of transcranial direct current ment of Neurology, Kanchipuram, India stimulation (tDCS). In rats with the kindling syndrome was induced bSAIMS Medical College and PGI, Neurology, Indore, India by i.p. injections of pentylenetetrazol (PTZ; 30.0 mg/kg daily, for three cGandhi Medical College, Neurology, Bhopal, India weeks). For tDCS active electrode was located over cerebellar zone of cranium (10 mm2). The latent period of seizures induced by a test fi Introduction injection of PTZ (30 mg/kg) increased signi cantly (by 22.5% on b μ Nature of injury in trauma patients is multifactorial with average P .05 vs. control) after tDCS (600 A, 10.0 min, cathode on patterned or unpatterned, predictable or unpredictable presenta- the skull surface). Such stimulation prevented the development of tions. Hence basic, routine and customized evaluation of each patient generalized clonic-tonic seizures in 5 out from 11 rats, and decreased b is mandatory. the duration of ictal discharges about two times (P .05). After administration of an antagonist of PPARγ, bisphenol A diglycidyl ether ′ Case report (2,2 -[(1-methylethylidene) bis(4,1-phenyleneoxymethylene)] bis- A 51 years old male presented with giddiness and fall on uneven oxirane, BADGE, 100 mg/kg, i.p.), tDCS did not lead to an increase in hard surfaced ground followed by sudden onset of weakness of both the latency of PTZ-induced seizures. The latter parameter was shorter γ the upper limbs. Weakness was in the form of difficulty to lift both than that in the tDCS group with no injection of the receptor arms above shoulder but intact distal motor activities. He had no antagonist and did not differ from the control. The seizure latency in headache, loss of consciousness, seizures, lower limb weakness, this case was smaller than that in the tDCS group (by 31.6% on average, b b sensory impairment, bladder/bowel incontinence or other neurolog- P .05), and the seizure severity was greater by 52.3% (P .05). tDCS ical abnormalities. performed after pioglitazone (50,0 mg/kg, i.p.) administration caused complete prevention of generalized clonic-tonic fits with the absence b Observations of seizures in 4 out from 11 rats (P .05). Hence, gained data points on γ On examination, there was proximal muscle weakness of both the PPAR role in the realization of antiseizure effects of cerebellar tDCS. upper limbs with weakness of left trapezius and weakness in right doi:10.1016/j.jns.2019.10.919 serratus anterior muscle with local tenderness in the left scapular ARTICLE IN PRESS

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WCN19-0934 Background^ Pseudoseizures or non epileptic seizures (NES) are termed “nonepileptic psychogenic seizures” and account for approx irately Poster shift 02 - Autoimmune disorders - Part I/CNS infections - 20% of all intractable seizure disorders. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Objective^ To study the prevalence of pseudoepilepsy among adult Sudanese A significant difference of memory beliefs, cognitive activity, and epileptic patients. depression in healthy older adults, patients with amnestic mild cognitive impairment, and patients with Alzheimer's disease Material and methods This non interventional descriptive study, it was conducted at El shaab I.U. Songa, K.S. Leea, Y.A. Chungb, S.W. Chunga Teaching Hospital during the period from Feb 2001 to Aug 2008, 720 aCatholic University of Korea, Neurology, Seoul, Republic of Korea adult Sudanese epileptic patients were included in the study, during the bCatholic University of Korea, Radiology, Seoul, Republic of Korea period of the study 40 non epileptic patients were seen in the outpatient clinic with abnormal movement and diagnosed as pseudoepilepsy. Background Amnestic mild cognitive impairment (aMCI) has been found to be Results^ highly likely to progress to dementia of the Alzheimer's type (DAT). 40 (10 M; 30 F) patients with NES, 720 (390 M; 330 F) patients One of the most frequently reported symptoms in aMCI and DAT with epilepsy and 40 (15 M; 25 F) control subjects were recruited. fi patients is memory impairment. The purpose of this study was to Our preliminary results con rm previous researches showing that compare the levels of beliefs about memory efficacy and control, NES typically manifest between 20 and 30 years of age and that cognitive activity, and depression affecting memory in healthy older approximately three-quarters of all patients were women. The adults (OA), patients with aMCI, and patients with DAT. incidence of childhood sexual abuse varies considerably (10%), as does the incidence of cerebral pathology (5%), the sexual coloring of Methods the attack (4%); the frequency of psychogenic seizures combined The subjects were 21 OA (11 males, 10 females), 16 patients with with epilepsy (50%), the number of patients with pseudoepilepsy aMCI (6 males, 10 females), and 18 patients with DAT (10 males, 8 who remain on anticonvulsive medication (50%). All patients with females). All subjects underwent memory efficacy questionnaire, pseudoepilepsy had normal EEG and normal serum prolactin level. memory control questionnaire, cognitive activity questionnaire, depression questionnaire, and Seoul verbal learning test (SVLT). Conclusion^ Pseudoepilepsy is not uncommon among adult Sudanese epileptic Results patients. DAT patients showed significantly lower performance than OA doi:10.1016/j.jns.2019.10.921 and aMCI patients in recognition test, and no difference was found between OA and aMCI patients. In terms of memory efficacy, memory control, and cognitive activity, DAT and aMCI patients showed significantly lower levels than OA. However, there was no difference between aMCI and DAT patients. WCN19-0943

Conclusion Poster shift 02 - Autoimmune disorders - Part I/CNS infections - This study suggests that aMCI patients felt impairment in Part I/dementia - Part I/epilepsy - Part I/health economics and memory beliefs and memory control in the same way as DAT patients. The results of the study suggest that the early application of outcomes/neuroepidemiology and environmental and other cognitive rehabilitation therapy for patients with aMCI can be expected to be effective in preventing or alleviating memory Analysis of language tests for vascular cognitive impairment-no deterioration. dementia doi:10.1016/j.jns.2019.10.920 Y. Wanga,W.Wua, Y. Zhanga,J.Maa, Q. Guob, X. Zhena, M. Shic,M.Lia, X. Lia,Q.Lia aYueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Depart- WCN19-0937 ment of Neurology, Shanghai, China bShanghai Jiaotong University Afﬁliated Sixth People's Hospital, Depart- ment of Gerontology, Shanghai, China Poster shift 02 - Autoimmune disorders - Part I/CNS infections - cYueyang Hospital of Integrated Traditional Chinese and Western Medicine, Part I/dementia - Part I/epilepsy - Part I/health economics and Shanghai University of Traditional Chinese Medicine, Department of outcomes/neuroepidemiology and environmental and other Internal Medicine of Traditional Chinese Medicine, Shanghai, China

Pseudoepilepsy among adult Sudanese epileptic patients Background A. Husseinab, F. Yassiena, A.A. Aliba, A. Siddiga, O. El-adila, E.M. Language is a cardinal function that makes human unique. The Mahmouda, M.A. Ahmeda, H. Abbashara, M.M. Aldara, M. Abbashara, impairment of language function affects the normal operation and K. Mohamed Ahmed Abbashera recovery of other nerve functions. However, it is unclear what aDaoud Research Group, Neurology, Khartoum, Sudan relationships between language function and other cognitive func- bUniversity of Khartoum, Neurology, Khartoum, Sudan tions are. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 83

Methods and Research Centre – Jeddah. Those successfully underwent Wada We compared performance on the NINDS-CSN-VCIHS test battery test were studied. Memory and language were assessed using a between fifty-six people with VCI-ND and fifty control individuals. We standardized testing performed by a neuropsychologist and a used the receiver operating characteristic (ROC) curve to compare tests neurologist. Patient's demographics were identified. normally found in the NINDS-CSN-VCIHS with additional neuropsychological tests commonly used in China with respect to their ability to detect Results individuals with VCI-ND. The tests encompassed cognitive screening A total of 65 patients were studied. The mean age was 30 years, (MMSE), memory (AVLT), executive function/attention (STT, SCWT, (range; 16–52 years), where 27 of them were females (42%). All RME, DOT-A, SDMT), language (ANT, BNT, FFT, ST, VFT) and visuospatial patients had normal neurological examination, including language and function (CFT). And then, we divided VCI-ND patients into two groups memory. The average dose of amobarbital given was 99.6 mg (range; according to language impairment and observed their characteristics. 65.7–120 mg). There was no statistical difference between the dosing given to patients who passed or failed the memory testing (101.4 mg vs Results 94.7 mg, P value = .6). Multivariate regression analysis showed that Individuals with VCI-ND performed significantly worse than amobarbital dose needed to be adjusted to patient's weight only for b b – those in the control group in terms of language (P .05). The those older than 30 years of age, (P value ^.05, 95% CI; 0.1 0.5), as on language test with the largest predictive power with respect to VCI- average^, an increase of the dose by 0.3 mg/kg was required for each year ND (area under the curve) was the BNT language test (0.75). BNT increase in age to successfully execute Wada test. was correlated with DOT-A (r = 0.28), RME (r = 0.48), STT (r = −0.39) and CFT (r = 0.49), P b .05. VCI-ND patients with language Conclusions dysfunction were significantly lower than VCI-ND patients without No factors other than patient's age could be identified to predict language dysfunction in the scores of ANT and ST in language test the response to amobarbital in Wada tests. This may explain part of and STT in executive test (P b .05). the challenges in establishing a universal protocol for amobarbital dosing. Conclusion BNT test was suitable for language function detection in VCI-ND. doi:10.1016/j.jns.2019.10.923 VCI-ND patients with language dysfunction was worse than VCI-ND patients without language dysfunction in executive functions.

Keywords: Vascular cognitive impairment-no dementia, Neuropsy- WCN19-0949 chological battery, Language function

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and doi:10.1016/j.jns.2019.10.922 outcomes/neuroepidemiology and environmental and other

Neurological manifestations among patients with HIV – Active tuberculosis co infection WCN19-0945 A. Husseinab, M.A. Tahaa, A. Sidiga, O.B.M. Osmana, M.M. Alfakia, B.M. a a a a Poster shift 02 - Autoimmune disorders - Part I/CNS infections - O.A.B.M.O. Arbb , M.I. Alfaki , R.A. Alsherif , A.S. Yeddi , M.A. a a a a a Part I/dementia - Part I/epilepsy - Part I/health economics and Abdelrahim , M.A. Alnor , M.A. Kabeer , K. Hajnoor , H. Abbashar , K. Mohamed Ahmed Abbashera, M. Abbashara, O. Eladila, M.M. Aldara outcomes/neuroepidemiology and environmental and other aDaoud Research Group, Neurology, Khartoum, Sudan bUniversity of Khartoum, Neurology, Khartoum, Sudan Determining the dose of amobarbital in Wada test for the presurgical evaluation of patients with temporal lobe epilepsy Introduction^ ab a a a a At least one-third of the 35.3 million people living with HIV S. Bajammal , F. Babtain , K. Alqadi , N. Madani , S. Baeesa ,K. worldwide are infected with latent tuberculosis. Tuberculosis is the Kurdic, Y. Al Saida a most common presenting illness among people living with HIV, King Faisal Specialist Hospital and Reseach Centre, Neurology, Jeddah, including those who are taking antiretroviral treatment. There were Saudi Arabia b an estimated 1.1 million HIV positive new TB cases globally in 2012. King Fahad Hospital, Neurology division, Jeddah, Saudi Arabia Around 75% of these people live in sub-Saharan Africa. c ^ King Faisal Specialist Hospital and Reseach Centre, Radiology, Jeddah, Despite its great burden, neurological manifestations have not Saudi Arabia been described yet in patients with HIV-active tuberculosis, although tuberculosis and HIV have synergistic inﬂuence on immunity system Abstract^ which may contribute to change in prevalence or severity of CNS The standard use of amobarbital in Wada test varied between involvement in patients with HIV-active TB co infection. epilepsy centres, with no uniﬁed dosing or protocols available in epilepsy centres. We aimed to determine the dose of amobarbital in the Objectives presurgical evaluations of patients with temporal lobe epilepsy (TLE). ^ ^To study neurological manifestations in patients with HIV-active tuberculosis.

Methods Methodology^ A retrospective study of patients with TLE conducted between ^A case series study of 58consecutive patients with laboratory January 2004 and December 2018 in King Faisal Specialist Hospital conﬁrmed HIV- active tuberculosis co infection attending tertiary ARTICLE IN PRESS

84 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx hospital for tuberculosis treatment was conducted. Data signiﬁcant number (41.43%) had upper limbs muscle wasting. about neurological symptoms and signs – conducted by a Impaired olfaction was the most common cranial nerve sign seen neurologist- were collected from each patient. Patients' approval in 12.86%. Leprosy reactions were detected in 21.43%; type 2 reaction was obtained.^ in 14.29% while type 1 reaction in 7.14%.^

Results Conclusion^ 24% of 58 patients were found to have neurological manifesta- Numbness and limbs weakness were the most common neuro- “ ” tions in clinical assessment.^ logical symptoms in leprosy patients. Gloves and stokes peripheral sensory neuropathy being the most common sensory disturbance. Conclusion^ Ulnar and median nerves motor affection was the most common The frequency of neurological manifestations among patients motor dysfunctions. with HIV-active TB co infection was found to be higher compared to that of patients with HIV only. doi:10.1016/j.jns.2019.10.925 doi:10.1016/j.jns.2019.10.924

WCN19-0966

WCN19-0958 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - outcomes/neuroepidemiology and environmental and other Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other The effect of epilepsy control on psychogenic non epileptic seizures Frequency of neurological deﬁcits in Sudanese lepromatic patients A. Husseinab, M.A. Ibrahima, T.M. Elfakia, A. Sidiga, H. Abbashara,M. Abbashara, K. Mohamed Ahmed Abbashera, O. Eladila, M.A. Alwalida, A. Hussein, A. Sidig, M.M. Eldar, K. Hag Nour, K. Mohamed Ahmed K. Hajnoora, M.M. Eldara, Y.A. Osmana, K.A. Dafallaha, Y.E. Awada, O.I. Abbasher, O. Eladil, M. Abbashar, H. Abbashar Halawania, S.A. Elhasana, R. Tofaha AlHusseinia, A.A. Sulimana, A.A. Daoud Research Group, Neurology, Khartoum, Sudan Abbasa, Z.I.H. Dabarya, S.A. Fadlallaha, R.A.M. Rawaaa, R.H.A.M. Rayana, H.M. Osmana, S.A. Yahiaa a Introduction Daoud Research Group, Neurology, Khartoum, Sudan ^ b Leprosy has been a major burden on humanity over thousands of University of Khartoum, Neurology, Khartoum, Sudan years.^ Introduction^ Objectives^ Epilepsy is one of the most common neurological disorders. The To study the pattern of neurological manifestations among adult coexistence of epilepsy and PNES places a great challenge for both Sudanese leprosy patients seen in Khartoum Dermatology Hospital in neurologists and psychiatrists to manage and follow up their patients.^ the period from Feb 2018 to Jul 2018. Objective Methodology To assess the effect of epilepsy control onpsychogenic non This is a prospective cross-sectional hospital-based study. Seventy epileptic seizure in Sudanese patients with epilepsy attending Daoud adult Sudanese leprosy patients were studied using simple, direct, charity clinic May to July 2018. standardized questionnaire including history and neurological examination. Methodology^ Thirty three Sudanese patients with epilepsy and concomitant Results^ psychogenic non epileptic seizure where included in this study and Numbness was the most common neurological symptom seen in full detailed history of both epilepsy and PNES was obtained. The 77.14%.Each of visual disturbance, headache and bilateral ulnar study was conducted in Daoud charity clinic during the period from sensory impairment was detected in 7.14%. Half of the patients had May to July 2018. upper limbs sensory nerve dysfunction while 42.86% exhibited sensory nerve dysfunction in the lower limbs. “Gloves and stoking” Result sensory impairment was the most common ﬁnding (30%) while Out of 33 patients 19 were males and 14 were females. Seven bilateral lateral popliteal sensory impairment was seen with the patients had focal epilepsy, 23 had generalized tonic clonic epilepsy same percentage. Bilateral median and unilateral posterior tibial (GTC), 2 had GTC with atypical absent seizure, and one had GTC with sensory impairment were found in 1.43% each. Unilateral radial myoclonus. Six patients experienced an attack of PNES after more cutaneous sensory impairment was seen in 2.86%. Approximately than 1 year of being free of epilepsy, while 9 patients had PNES half (48.57%) of the patients had upper limbs motor dysfunction. attack between 3 months to 1 year of the last attack of epilepsy, and Bilateral ulnar distribution motor affection was seen in 40%. A 18 patients developed both PNES and epilepsy within less than 3 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 85 months. The pattern of presentation of PNES was bizarre movements Patients in Kyrgyzstan tend to adhere to pursuing alternative in 13 patients, abnormal behavior in 9 patients, while 11 patients regimens (traditional medicine). experienced both bizarre movement and abnormal behavior note doi:10.1016/j.jns.2019.10.927 that all those 11 patients had GTC epilepsy.^

Conclusion Experiencing psychogenic non epileptic seizure (PNES) in patients with coexisting PNES and epilepsy is not affected by the WCN19-0984 epilepsy free period. doi:10.1016/j.jns.2019.10.926 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

WCN19-0976 A distinct presentation oF Fahr's Disease in a patient with secondary hypoparathyroidism: A case report

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - J. Simcaa, R.J. Ketarenb Part I/dementia - Part I/epilepsy - Part I/health economics and aSiloam Hospitals Lippo Village, Inpatient Department, Tangerang, outcomes/neuroepidemiology and environmental and other Indonesia bSiloam Hospitals Lippo Village, Department of Neurology, Tangerang, Depression and situational anxiety are risk factors for noncom- Indonesia pliance with medical treatment in adult patients with epilepsy in Kyrgyzstan Introduction Fahr's Disease (FD) is a rare, inherited neurological disorder I. Lutsenko characterized by abnormal calciﬁed deposits in basal ganglia and Kyrgyz State Medical Academy, Neurology, Bishkek, Kyrgyzstan cerebral cortex. The prevalence of FD is unknown, with a higher incidence among males and typically affects individuals in the third Aim and fourth decades of their lives. The disease can manifest as To determine the severity of depression and anxiety in patients movement disorders, cerebellar dysfunction along with psychiatric with different types of epilepsy, not treated with antidepressive changes and cognitive impairment. Although inheritance is the drugs and anxiolytics and to make a correlation with antiepileptic majority of causes, our patient showed that hypoparathyroidism as drugs compliance.^ the etiology.

Method Findings A case-control study was done in Kyrgyzstan, Bishkek City Clinic We hereby report a 57 year-old female patient presented to the 1, in the group of interest patients with long term of all types of outpatient department with progressing headache since 5 months epilepsy were included and in control group we enrolled other ago and difficulty to maintain balance. Patient was diagnosed with neurological patients, free from seizures and epilepsy. We used multiple nodules on both thyroid and underwent total thyroidec- clinical diagnosis of epilepsy, confirmed with EEG findings. Zung tomy 5 years ago and consumes calcium supplement routinely since. depression scale and Spilberger scale for the anxiety diagnostics Wide and broad gait was found on the neurological examination were adapted to Kyrgyz language and applied. with mild cognitive dysfunction. Routine lab examination showed low calcium levels of 6.1 mg/dL. Brain MRI and CT Scan showed Results calcifications on both basal ganglia, thalamus, dentate nucleus, and 65 patients were included in the study: 34 were with epilepsy. Of cerebellum. NSAIDs, levothyroxine, and calcium was given to the the total sample nearly 70.0% of participants had anxiety and 61% in patient as treatment with routine physiotherapy to regain balance. epilepsy group. The most prevalent symptom of anxiety was “the Headaches decreased and calcium levels increased since her expecting of seizures” (67.6%). We found strong correlation between treatment. low educational level and the risk of pills withdrawal: (OR = 2.79, 95% CI = 1.04–3.05), but higher education was the risk for anxiety Conclusion (OR = 3.1, 95% CI = 2.15–4.01). Patients using benzodiazepins were Endocrine deficiency might be a potential etiology of Fahr's prone to withdraw it in long term more due to side effects (45%), Disease in patients with secondary hypoparathyroidism. Fahr's compared to valproate group (11%). 28% patients with epilepsy were Disease mostly shows symptoms of movement disorders, yet our prone to withdraw pills due to moderate depression (OR = 4.35, 95% patient showed very subtle indistinct neurological symptoms. There CI = 2.27–8.31). are currently no specific treatments for Fahr's Disease but treatment objective mainly focuses on symptomatic relief of clinical signs. Conclusion High level of situational anxiety and moderate level of depression doi:10.1016/j.jns.2019.10.928 were associated with lower compliance to antiepileptic regimen. ARTICLE IN PRESS

86 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0985 accessory nerves that innervate the serratus anterior and trapezius muscles, respectively.Across the literature trauma to the nerves account for majority of cases. Less common non traumatic causes Poster shift 02 - Autoimmune disorders - Part I /CNS infections - fl include viral illness, neuro-in ammatory conditions^, toxins^,compres- Part I / dementia - Part I /epilepsy - Part I / health economics and sive lesions and C7 radiculopathy. We present a case where an apical outcomes / neuroepidemiology and environmental and other lung malignancy cause winging of scapula by infiltrating C5-C7 roots of Brachial plexus. The effects of occupational therapy intervention on homeless 54 year old male presented with recent onset painful difficulty in adults living in homecare house rising his right arm. He had no respiratory or constitutional symptoms. On examination, winging of scapula on the right side G. Akyurek, H. Abaoglu, D.F. Colak, G. Bumin with wasted shoulder girdle and fasciculation was noted. Proximal Hacettepe University, Occupational Therapy, Ankara, Turkey muscle power was of 3/5 and preserved distal muscle power with no sensory loss. A patch of bronchial breathing was found in right upper Introduction zone with hard cervical lymphadenopathy. Chest X ray and CECT Community integration is a vital target for people who are chest revealed a large tumor in right upper lobe which was fi homeless. The engagement of meaningful activity and occupation con rmed to be a carcinoma of the lung. EMG revealed large MUP can be supported that the transitioning from homelessness to being and poor activation of right serratus anterior and internal scapulae housed. while nerve conduction studies concluded the lesion to be a compressive lesion involving C5-C7 nerve roots of brachial plexus. fi Objectives Biopsy of the cervical lymph node con rmed metastasis from poorly The aim of this study was to use the model of human occupation differentiated adenocarcinoma of the lung. fi as a framework to examine the factors associated with community ^Compressive lung pathology with in ltration is a rare differential integration and to determine if a life skills improve program (cope when investigating for winging of the scapula. A Chest radiograph with stress, engaging occupation, occupational balance, employment, and a CECT- chest are useful investigations to exclude it. cognition and communication skills, creating target) was support doi:10.1016/j.jns.2019.10.930 and applicable to homeless adults.

Methods 25 volunteer homeless male (controls n = 11) were interviewed with Canada Occupational Performance Measure (COPM) and the WCN19-0994 Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS) version 4.0 to understand self perceived occupational Poster shift 02 - Autoimmune disorders - Part I/CNS infections - circumstances and performance. Twelve male residents participated Part I/dementia - Part I/epilepsy - Part I/health economics and to eight group sessions in four weeks. outcomes/neuroepidemiology and environmental and other Results 12 of the 14 participants completed the program and 8 of them Possible mechanism involved in attenuated cardioprotective found a new job. A significant intergroup difference was observed effects of ischemic post-conditioning in hyperglycaemic rat heart between initial COPM and OCAIRS scores. Those homeless adults in the intervention program showed a more significant improvement G. Singhac, A. Khannabde than the control group (p b .001). Conclusion: Homeless individuals aRayat-Bahra University, 140104 SAS Nagar, Punjab, India as a disadvantages group are one of the important practice areas of bSaraswati College of Pharmacy, Gharuan, SAS Nagar, Punab, India occupational therapy. This research indicates that the effectiveness of cDepartment of Pharmacology, University School of Pharmaceutical life skills programs for homeless individuals. It is needed that Sciences, SAS Nagar, Mohali, India evidence based researches about occupational therapy intervention dI.K. Gujral- Punjab Technical University, Jalandher, Punjab, India in homeless individuals with more cases. ePharmacy, SAS Nagar, India doi:10.1016/j.jns.2019.10.929 The present study aimed to investigate the possible role of JAK-2 in attenuated cardio protective effects of ischemic post-conditioning (IPOC) in Hyperglycaemic rat heart. Experimental hyperglycaemia was induced by Alloxan monohydrate (100 mg/kg, i.p). Isolated WCN19-0992 normal & hyperglycaemic rat heart mounted on Langendorff's apparatus was subjected to 30 min of global ischemia followed by 120 min of reperfusion. Six episodes of ischemia followed by Poster shift 02 - Autoimmune disorders - Part I /CNS infections - reperfusion with Kreb's-Henseleit solution were given each com- Part I / dementia - Part I /epilepsy - Part I / health economics and prising of 10 s to produce IPOC. Ischemia-reperfusion (I/R) induced outcomes / neuroepidemiology and environmental and other oxidative stress by increasing thiobarbituric acid reactive substances (TBARS), superoxide-dismutase (SOD) and decreasing reduced form Winging of scapula due to an unsuspected, sinister etiology of glutathione in normal and hyperglycaemic rat heart. Furthermore, I/R induced myocardial injury which were indexed by increased in S.N. Gunasekera, H. Karunathilaka, B. Senanayake LDH, CK-MB release in coronary effluent, myocardial infract size, and National Hospital Of Sri Lanka, Medicine, Colombo, Sri Lanka decreased in coronary flow rate in normal and hyperglycaemic rat heart. Extent of myocardial injury was measured in terms of infarct Scapular winging is a rare, but disabling deformity which is size by triphenyltetrazolium chloride (TTC) staining. The hyper- commonly caused by lesions of the long thoracic and spinal glycaemic rat heart showed enhanced I/R-induced myocardial injury ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 87 with noted high degree of oxidative stress. Treatment with WCN19-1021 Tyrphostin-AG490 (5 μM), a selective inhibitor of JAK-2 markedly restored the cardioprotective potential of IPOC in hyperglycaemic rat heart. The high degree of oxidative stress produced in hyper- Poster shift 02 - Autoimmune disorders - Part I/CNS infections - glycaemic rat hearts during reperfusion may activate JAK-2, which Part I/dementia - Part I/epilepsy - Part I/health economics and may be implicated in the observed paradoxically abrogated cardi- outcomes/neuroepidemiology and environmental and other oprotective effect of IPOC. It is concluded that the high degree of oxidative stress produced in hyperglycaemic rat heart during The clinical characteristics of posttraumatic epilepsy following reperfusion may activate JAK-2, may be implicated in the observed moderate-to-severe traumatic brain injury in children paradoxically abrogated cardioprotective effect of IPOC. S. Musaev, Y. Musaeva doi:10.1016/j.jns.2019.10.931 Tashkent Medical Academy, Neurology, Taskent, Uzbekistan

Purpose Children with traumatic brain injury (TBI) are at increased risk of WCN19-0999 posttraumatic epilepsy (PTE); the risk increases according to TBI severity. We examined the long-term incidence and risk factors for developing PTE in a cohort of children hospitalised at one medical Poster shift 02 - Autoimmune disorders - Part I/CNS infections - centre with moderate or severe TBI. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Methods Moderate brain injury was classified as Glasgow Coma Score on Clinical profile and therapeutic response to rituximab in an adult Arrival (GCSOA) of 9–13, and severe brain injury as GCSOA ≤8. We Filipino patient with myelin oligodendrocyte glycoprotein (MOG) collected demographics and clinical data from medical records and autoimmunity: A case report interviewed patients and parents at 5–11 years following the TBI event. K. Luspian, L. Damian St. Luke's Medical Center, Section of Neurology, Institute for Neurosci- Results ences, Quezon City, Philippines During a median follow-up period of 7.3 years, 9 (9%) of 95 children with moderate-to-severe TBI developed PTE; 4 developed Introduction intractable epilepsy. The odds for developing PTE was 2.9 in patients Myelin Oligodendrocyte Glycoprotein (MOG) autoimmunity has with severe compared to moderate TBI. CT findings showed fractures recently emerged as an entity distinct from its clinical brother, in 7/9 (78%) of patients with PTE, compared to 40/86 (47%) of those Neuromyelitis optica (NMO) and its associated spectrum disorders without PTE (p =^.09). Of the patients with fractures, all those with (NMOSD). While these present in the same vein of transverse PTE had additional features on CT (such as haemorrhage, contusion myelitis and optic neuritis, they differ in pathogenesis and biomarker and mass effect), compared to 29/40 (73%) of those without PTE. One positivity, with implications on treatment. This is the first known of nine (11%) PTE patients and 10 of 86 (12%) patients without PTE reported case of MOG positivity in the Philippines. had immediate seizures. Two (22%) children with PTE had their first seizure N2 years after the TBI. Case report A 25-year old Filipino female developed blurring of vision on the Conclusion right with spontaneous resolution after three days. Three years later, Among children with moderate or severe TBI, the presence of she presented with numbness of the left arm and trunk, with T1 additional CT findings, other than skull fractures, seem to increase sensory level. Non-contrast cranial MRI showed T2-FLAIR hyperin- the risk of PTE. In our cohort, the occurrence of an early seizure did tense lesion on the left corona radiata. Spine MRI showed T2 not confer an increased risk of PTE. hyperintensity from C3 to C4. Ophthalmologic evaluation confirmed bilateral optic neuritis. Pulse steroid therapy provided resolution of doi:10.1016/j.jns.2019.10.933 symptoms, with resolution of MRI lesions on repeat study after eight months. Symptoms recurred one month after, with triparesis after two months, in spite of oral steroids and Azathioprine. Patient was referred to our institution, and repeat MRI showed enhancing WCN19-1026 intramedullary lesions from C2 to C5 level. She was seronegative for aquaporin-4 assay. Spinal fluid studies revealed normal protein and IgG, with negative oligoclonal bands. Serum antibodies to MOG Poster shift 02 - Autoimmune disorders - Part I/CNS infections - were detected. Therapy with Rituximab was given on the fourth and Part I/dementia - Part I/epilepsy - Part I/health economics and fifth months after disease recurrence, and has been relapse free with outcomes/neuroepidemiology and environmental and other EDSS score of 1. Paradoxical long segment myelitis in miliary pulmonary Conclusion tuberculosis NMOSD patients will benefit from MOG antibody testing where available, as this will have implications on treatment and prognosis. N. Kumar, H.S. Malhotra, R.K. Garg, V.L. Urs King George's Medical University, Neurology, Lucknow, India doi:10.1016/j.jns.2019.10.932 ARTICLE IN PRESS

88 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

disease semiology. Auxillary findings with biology and spinal MRI A 32-year female presented with weakness of both lower limbs were prescribed. Outcome was evaluated by the Lipton and Taesdall with bladder bowel involvement of 1-month duration. She was scale. bedridden for 10 days. She was diagnosed with pulmonary tuberculosis and was on anti-tubercular therapy (ATT) for last 1 and half Results months. Cough and fever subsided but paraparesis with bladder Twenty-two of 1149 patients were included. Fifteen performed bowel involvement occurred on ATT. Her routine blood parameters spinal MRI. Seven infectious etiology: 03 schistosomiasis and 04 were normal. The chest X-ray shows bilateral miliary shadows. MRI tuberculosis. Six non-infectious etiology: 02 myelitis, 01 vascular spine shows long segment myelitis involving cervical and dorsal malformation, 02 metastatic spinal cord disease, 01 meningioma. No spinal cord with dural enhancement. MRI brain shows meningeal etiology found in 09 patients. Thirteen benefited corticosteroid bolus. enhancement with multiple small tuberculomas. CSF shows 80 cells, Specific management for those with etiology. Functional rehabilita- 75% lymphocytes, 3725 mg% protein and 29 mg% sugar (correspond- tion for all. Disabilities outcome didn't worsen for the majority of ing blood sugar 97 mg%). Anti-nuclear antibodies and extractable cases that was managed at the disease starting. Only 02 patients nuclear antigen panel was negative. Aquaporin 4 antibodies report is developed a bedsore and phlebitis of the lower limbs. awaited. Paradoxical worsening and dissemination in whole body is a Conclusion common occurrence in miliary tuberculosis. Simultaneous involve- In poor settings as Madagascar, diagnosis tools and drug options ment may be due to hematogenous spread. On the other hand, for spinal cord diseases are often nonavailable or nonaffordable. paradoxical reaction is not uncommon and warrant addition of Results of this study rise the point of challenge with local facilities steroid and evaluation for drug resistance. Our patient improved and financial features versus skills of Malagasy neurologist well partially with steroid administration and continuation of ATT. trained worldwide. International collaboration with other specialities We recommend screening of whole body for tuberculosis in cases for training, care and research are useful and encouraged for nervous with miliary pulmonary involvement. system disease management in poor settings.

Keywords: Paradoxical reaction, Tuberculosis, Myelitis, Keywords: Disabilities, Madagascar, Schistosomiasis, Spinal cord Tuberculoma diseases, Tuberculosis

doi:10.1016/j.jns.2019.10.934 doi:10.1016/j.jns.2019.10.935

WCN19-1030 WCN19-1036

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other outcomes/neuroepidemiology and environmental and other

Causes and outcome of non-traumatic spinal cord diseases at the Peculiarities of the functional state of the brain upon reading and neurology unit of Befelatanana hospital, Antananarivo, listening to chapters and verses of the holy Quran Madagascar D. Magomaeva, A. Bairamkulova, A. Chotchaeva S. Razafindrasataa, J. Razafimahefaa, L. Rakotoanadahyb, F. Rav- Stavropol State Medical University, General Medicine Faculty, Stavropol, elosaonaa, L. Rajaonarisona, D. Raharimaminjatovosoaa,A. Russia Tehindrazanariveloa a Neurology Unit, Befelatanana University Hospital, Antananarivo, Throughout years of studying the Quran by the method of Madagascar interpretation, the scientists managed to succeed in disclosing its b Physical Medicine and Rehabilitation, Ravoahangy University Hospital, meanings. Hence, huge interest has arisen nowadays towards Antananarivo, Madagascar researching the “wavelength” component of this holy book. This topic had been investigated in the past. However, it has Background never been conducted in a student environment and it is therefore Etiology confirmation of non-traumatic spinal cord diseases are interesting to carry out this study for the first time among students. still a problem in Africa and so their treatment and management of The research work was based on recording alpha-rhythm waves neurological disabilities. In Madagascar, only two cases of myelitis using the electroencephalograph and recording a number of have been published until now. functional tests: Background recording, reading of A. S. Pushkin's poem (I loved Objective you), recitation of the first Chapter (Surah) of the Quran (Al-Fatiha) To describe causes and outcome of spinal cord diseases to rise the and (Al-Kursi verse), and listening to the verses. etiology diagnosis challenge and improvement of our management. Methods of investigation Methods 1. Recording the EEG on a 21-channel computerised A prospective descriptive study was conducted between Novem- electroencephalograph. ber 2017 and March 2019. It included any patient with spinal cord 2. Dermatoglyphic study. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 89

3. Statistic analysis. Results^ All the patients were examined by a qualified psychiatrist. Among Deduction them 8,7% met diagnostic criteria of depressive episode; 33% patients The study which was conducted on subjects reading and listening reported past episode of major depression. In regards to anxiety to the Quran with their eyes closed, has revealed an increase of the disorders, the most common was generalized anxiety disorder bioelectric activity in the alpha range in the occipital lobe of both (10.7%), followed by agoraphobia (8.7%), panic disorder (7.8%). hemispheres. 6,8% of all patients had at the time of the study suicidal thoughts (including 4 people with a high risk of suicidal attempt according to Conclusion MINI). Taking into consideration the nature of generation and the neurophysiological mechanisms of spread of the alpha-wave Conclusions^ oscillations in the human at the state of relative relaxation, it is Significant prevalence of affective disorders among MS patients possible to propose the fact that reciting and listening to the Surahs has been confirmed however further studies should be continued as and verses of the Quran contribute to the optimisation of the presented results may reflect several factors. central nervous system status, as well as the provision of a relaxing impact. doi:10.1016/j.jns.2019.10.937 doi:10.1016/j.jns.2019.10.936

WCN19-1041

WCN19-1037 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - outcomes/neuroepidemiology and environmental and other Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Protective effects of potocatechuic acid (PCA) on seizure-induced neuronal death Affective disorders among patients with multiple sclerosis in Poland A. Mamatkulov, S. Altibay Kyrgyz State Medical Academy, Neurology, Bishkek, Kyrgyzstan M. Blachuta, A.R. Szczegielniaka, M. Zajac-Tarskab,K.Świerzyb,P. c d a d Sowa , M. Adamczyk-Sowa , P. Goczyca , K. Kubicka-Bączyk Purpose a Medical University of Silesia, Department of Psychiatry in Tarnowskie Protocatechuic acid (PCA), a type of phenolic acid, is a major Góry, School of Medicine, Division of Dentistry in Zabrze, Katowice, metabolite of antioxidant polyphenols found in green tea.PCA is Poland reported to increase cell proliferation and inhibited apoptosis of b Multidisciplinary District Hospital, General Psychiatry, Department of neural stem cells. However, the effect of PCA on seizure-induced Psychiatry, Tarnowskie Gory, Poland neuronal death in the hippocampus has not been evaluated. cMedical University of Silesia, Department of Otorhinolaryngology and Oncological Laryngology, School of Medicine, Division of Dentistry in Method Zabrze, Katowice, Poland We tested the potential therapeutic effects of PCA on seizure- d Medical University of Silesia, Department of Neurology School of induced neuronal death in an animal model of pilocarpine-induced Medicine, Division of Dentistry in Zabrze, Katowice, Poland seizure, a common model for epilepsy. Seizure was induced by intraperitoneal (i.p) injection of pilocarpine (25 mg/kg) in adult Background and aims male rats and PCA (30 mg/kg) was injected into the intraperitoneal Multiple sclerosis is a disease which can be manifested by several space for three consecutive days after seizure onset. Neuronal injury types of other than neurological problems. Literature shows that and oxidative stress were evaluated at 3-day post-seizure. To affective and cognitive disorders are the most common comorbidities conﬁrm whether PCA increases neuronal survival and reduced among these patients. Studies show lifetime prevalence of depres- oxidative injury in the hippocampus, we performed Fluoro-Jade-B sion on a level varying between 24% and 50%, which is substantially (FJB) staining to detect neuronal death and 4-hydroxynonenal higher than in the general population and in most other neurological (4HNE) staining to detect oxidative stress after seizure. disorders. There are no comprehensive studies showing prevalence of these disorders in Poland. Results The aim of this study is to asses the prevalence of affective and In the present study we found that PCA treatment reduced anxiety disorders in a sample of Polish MS patients. neuronal death and oxidative stress in the hippocampus, compared to vehicle-treated controls. Methods^ The study took place in 2017–2018 and consisted of 103 MS Conclusion patients treated in the Neurological Outpatient Clinic of the Medical Therefore, the present study demonstrates that PCA has thera- University of Silesia Hospital No.1 in Zabrze, Poland. Data on peutic potential for preventing hippocampal neuronal death after sociodemographics, type and course of the underlying disease, epileptic seizure. comorbidities and used medicines were collected. MINI-international neuropsychiatric interview and psychiatric examination were uti- doi:10.1016/j.jns.2019.10.938 lized to assess the occurrence of mental disorders. ARTICLE IN PRESS

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WCN19-1051 WCN19-1054

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other outcomes/neuroepidemiology and environmental and other

Association between heterochromatin polymorphism 46, XX 9QH The effect of Ramadan related activities (Mid_day nap), early + and multiple sclerosis (MS) with systemic lupus erythematosus night prayers, and late night prayers on seizure frequency during (SLE). Case report Ramadan among fasting epileptic patients

W. Trillo Alvareza, J.J. Molina Acostab, J.A. Medina Suarezc, A.Z. A. Husseinab, N.A.Y. Ahmeda, A.A. Abbasa, M.A.A. Alhassanc, Z.I.H. Escalante Mercadod, C.R. Ibañez Escalantee Dabarya, E.A. Altayeba, K. Mohamed Ahmed Abbasherc, O.I. aUniversidad Catolica De Santa Maria - Equipu Sinapsis, Facultad De Halawanic, Y.E. Awadc, K.A. Dafallahc, A.A. Sulimanc, M.O. Abdallac, Medicina Humana, Arequipa, Peru O. Eladilc, D.N.O. Osmanc, Y.F. Al-Tayebc, R.A.M. Rawaac, R. Tofaha bUniversidad Catolica De Santa Maria -Equipu Sinapsis, Facultad de alHusseinic, A.Y.A. Alaminc, S.A. Fadallahc, A. Siddigc, K. Hajnoorc,H. Medicina Humana, Arequipa, Peru Osmana, S.A. Elhassanc, K. Hajnoora cUniversidad Catolica Santa Maria - Equipu Sinapsis, Facultad de aDaoud Research Group, Neurology, Khartoum, Sudan Medicina Humana, Arequipa, Peru bUniversity of Khartoum, Neurology, Khartoum, Sudan dUniversidad Catolica De Santa Maria Equipu - Sinapsis, Facultad de cDaoud Research Group, Neurology, Khartoum, Sudan Medicina, Arequipa, Peru eUniversidad Catolica De Santa Maria Equipu - Sinapsis, Facultad de Background^ Medicina Humana, Arequipa, Peru Epilepsy is one of the common neurological disorders; many factors can precipitate on attack of convulsion like sleep deprivation, Objective infection, dehydration, sudden cessation of treatment. Report the first case of Heterochromatin polymorphism 46, XX 9qh + and the phenotypic expression of MS with SLE. Objectives^ To study the effect of Ramadan related activities (Midday nap “ ” “ ” Background qaylola ^, Early night prayers Tarawih ^, and late night prayers Heterochromatin polymorphism 46 xx 9qh + has been associated “tahajud”)and seizure frequency during Ramadan among fasting with infertility and CNS malignancy but recently the LOC101930090 gene epileptic patients. (contactin associated protein like 3B) located in the 9q11.2 band and has been associated with neurodegeneration, MS and autoimmunity. Method and material^ This non interventional descriptive study. It was conducted in Methods daoud charity clinic during the period from May to July 2018.Almost An 18 years old Hispanic female patient with past medical history 75Sudanese epileptic patients who were fasting Ramadan were of neonatal hypoxia was brought to clinic complaining of symptoms included in this study. like arthralgia, mild headache, asthenia, adynamia, diminished visual fi acuity, lack of strength in 4 extremities. The motor complains rst Result^ presented on the right side with self-improvement around 8 weeks ^53% of them male and 46% female.75% of our patients with left sided weakness 1 month later, along with tremor, impaired have generalized tonic clonic, 13% have focal with impairment, gait, and mild cognitive impairment. On physical exam, she had 8% have focal to bilateral 2.7% have myclonus, 1.3% have psychomotor delay, characteristic facial features, afferent pupillary more than one type.The study show the number of attack decrease reflex, Hoffman and Babinski reflexes. Blood work showed ANA (1/ with the midday nap and early night prayers. Late night prayers 2500), anti dsDNA positive, elevated TSH. MRI showed hypoxic basal don't affect the frequency of attack. There was no relationship ganglia lesions, and non-contrast enhancing demyelinating subcor- between type of epilepsy and developing convulsion during tical lesions compatible with criteria of dissemination in space. CSF Ramadan. showed 5 type 2 OCB fulfilling dissemination in time 2017 criteria. Karyotype showed 9qh + heterochromatin polymorphism. Conclusion^ ^Sleep deprivation in Eltahajud doesn't affect developing convul- Results sion while midday nap and early night prayers decrease the chance Because of her karyotype findings, her current diagnosis and of developing the attack. probably poor response to common MS treatments she started receiving methylprednisolone and Rituximab and is now symptom free.

Conclusion This is the ﬁrst case report of Heterochromatin polymorphism 46 XX 9qh + and MS presentation with related systemic autoimmunity. doi:10.1016/j.jns.2019.10.940 doi:10.1016/j.jns.2019.10.939 ARTICLE IN PRESS

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WCN19-1056 Background Autoimmune encephalitis due to VGKC antibodies is a rare disease that can mimic the clinical presentation of sCJD. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Methods outcomes/neuroepidemiology and environmental and other A 72 year old Hispanic female, who was brought to clinic for a second opinion after 18 months of disease with diagnosis of Remitting course of drug resistant epilepsy in the context of Alzheimer. The clinical presentation consisted of depression, epilepsy surgery adynamia, asthenia, forgetfulness, echolalia, visual and auditory hallucinations. During examination, she was disoriented, psychotic, S. Malyshev, T. Alekseeva with orofacial tics, hypertonia, tremor and dysmetria. MRI spectros- Almazov National Medical Research Centre, Department of Neurology copy was negative for Alzheimer, EEG only showed slow waves, but and Psychiatry, Saint Petersburg, Russia seven days later showed triphasic waves. EMG was positive for sensitive polyneuropathy. CRP, ESR, IL-6 and CSF IgG were elevated – There is evidence that drug resistant epilepsy (DRE) may be and protein 14 3-3 was positive. A second MRI showed hyper- remittent in some patients. It can be assumed that the presence of intensities in occipital and medial frontal cortex mainly in the right periods of seizure freedom could cause a delay in referral to the hemisphere without basal ganglia compromise, suggestive of – surgical treatment of drug resistant epilepsy (DRE). autoimmune encephalitis in spite of the results of 14 3-3. Issac's and Morvan syndromes were discarted due to lack of sufficient Material and methods clinical features. Patient was unresponsive to Metylprednisolone. At We analyzed histories of 50 adult patients with focal forms of the time VGKC antobodies results came back positive; plasma DRE (28 men and 22 women aged from 19 to 55 years, mean age - exchange had to be discontinued due to hypotension and coagulop- 31.3 years) who underwent pre-surgical evaluation. athy. IVIGs, Rituximab and Tolicizumab were initated with improvement in motor and cognitive functions. Results The average duration of the disease in the sample was 20.6 years. Conclusion In the majority (30/50, 60%) of the patients, during the course of the We report a case of sCJD mimic due to VGKC positive disease, there was failure of trials with 2–5 different antiepileptic autoimmune encephalitis. Having atypical sCJD images in MRI – fl drugs. Only 18% (9/50) of the patients were referred for pre-surgical with positive 14 3-3 protein is a red ag, and other identities examination after failure of 2–3 AEDs. Remitting DRE was observed such as VGKC positive autoimmune encephalitis should be in 15/50 patients (30%), while in all cases such a period occurred considered. only once. Median of remission duration was 1 year (1–5). There doi:10.1016/j.jns.2019.10.942 were no significant differences in the duration of the disease between patients with remitting and persistent types of DRE (median (interquartile range) - 22.8 (12.0–24.0) and 22.5 (11.5– 31.0) years, respectively, p = .412). WCN19-1067 Conclusion Remitting type of DRE was observed in 30% of cases. The Poster shift 02 - Autoimmune disorders - Part I/CNS infections - remitting course of DRE did not lead to late referral to the surgical Part I/dementia - Part I/epilepsy - Part I/health economics and treatment. outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.941 Efficacy and tolerability of lacosamide for epileptic patient: Study from epilepsy clinic in Makkah

a b c ﬁb WCN19-1061 A. Alkhotani , H. Abualela , S. Ghoneamy , Y. AlMatra ,A. Alkhotanid aUmm AlQura University/ King Abdulla Medical City, Medicine/ Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Neurology, Makakh, Saudi Arabia Part I/dementia - Part I/epilepsy - Part I/health economics and bKing Abdulla Medical City, Neurology, Makkah, Saudi Arabia outcomes/neuroepidemiology and environmental and other cKing Abdulla Medical City, Neuroscience, Makkah, Saudi Arabia dUmm AlQura University/ King Abdulla Medical City, Pathology, Sporadic Creutzfeldt-Jakob disease mimic due to voltage gated Makkah, Saudi Arabia potassium channel antibodies (VGKC) autoimmune encephalitis. (case report) Background Lacosamide (LCM) is new antiepileptic drugs with a novel effect W. Trillo Alvarez, J.A. Medina Suarez, J.J. Molina Acosta, C.R. Ibañez on enhance slow inactivation of sodium channel without effect on Escalante, A.Z. Escalante Mercado fast inactivation. A pooled analysis of three randomized, double Universidad Catolica de Santa Maria Equipu - Sinapsis, Facultad de blind, placebo controlled studies showed that LCM was effective in Medicina Humana, Arequipa, Peru reducing seizure frequency across the dose range (200-600 mg/day). The effect was maintained regardless the patient surgical history or Objective concomitant antiepileptic drug (AED) use. ﬁ To report a Sporadic Creutzfeldt-Jakob disease mimic due to The aim of this study is to assess the real time ef cacy and positive voltage gated potassium channels (VGKC) antibodies. tolerability of LCM in treatment of epilepsy. ARTICLE IN PRESS

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Method Conclusion This a retrospective study carried out in king Abdulla medical city There is an urgent need to improve the standard of care for PWE in Makkah. Patient on LCM was included in this study. in Guinea. Several missed opportunities were identified, including low use of AEDs and high use of traditional medicines, particularly in Results children. Targeted programs should be developed to prevent fi A fty four (54) patients on LCM^, age between 15 and 68 years unintentional injury and improve seizure control. were included. Seven patients (^13%) has LCM as a monotherapy. Thirty five patients (63%) had focal onset seizure with secondary doi:10.1016/j.jns.2019.10.944 generalization, the rest had focal onset seizure. In 87% it is used as an add on therapy. At 1 year 32 patients (59%) were seizure free, 12 patients (22%) had 75% reduction of seizure frequency. Nine patients (16.6%) discontinued the drugs, three (5.5%) because of lack of effect, WCN19-1070 four (7.4%) due to side effect and two have poor compliance to treatment. Out of 54 patients five patients (9%) had significant side effect. Dizziness was the most reported side effect. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Conclusion outcomes/neuroepidemiology and environmental and other LCM significantly reduce seizure frequency in patient with focal epilepsy. It is well tolerated with minimal side effect. Epilepsy in Guinea: The experience of a free consultation doi:10.1016/j.jns.2019.10.943 a a a C. Fodé Abass , F. Sakadi , A. Nana Rahamatou Tassiou , B. Amadou Talibéa, N.W. Arcel Stevena, B. Aissatou Kendaa, B. Souleymane Djiguéa, C. Amaraa, F. Mateen Jasmineb aIgnace Deen Teaching Hospital, Neurology, Conakry, Guinea WCN19-1069 bMassachusetts General Hospital, Neurology, Boston, USA

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Purpose to characterize people with epilepsy (PWE) presenting to a free neurology consultation and antiepileptic drug (AED) service in Part I/dementia - Part I/epilepsy - Part I/health economics and the Republic of Guinea. outcomes/neuroepidemiology and environmental and other Methods Epilepsy in Guinea: The experience of a free consultation Guinea is a low-income country in West Africa that recently experienced an Ebola Virus Disease epidemic. Community-dwelling a a a C. Fodé Abass , F. Sakadi , A. Nana Rahamatou Tassiou , B. Amadou PWE were seen at a public referral hospital in Conakry, the capital a a a Talibé , N.W. Arcel Steven , B. Aissatou Kenda , B. Souleymane city. During two visits in 2017, an African-U.S. team performed a a b Djigué , C. Amara , F. Mateen Jasmine structured interviews and electroencephalograms and provided a Ignace Deen Teaching Hospital, Neurology, Conakry, Guinea AEDs. b Massachusetts General Hospital, Neurology, Boston, USA. Results Of 257 participants (143 children, 122 female), 25% had untreated epilepsy and 75% met our criteria for poorly controlled Purpose to characterize people with epilepsy (PWE) presenting to epilepsy. 59% had N100 lifetime seizures and 58% reported a a free neurology consultation and antiepileptic drug (AED) service in history consistent with status epilepticus. 38 school-aged children the Republic of Guinea. were not in school and 26 adults were unemployed. 115 were not currently taking an AED, including 50 participants who had Methods previously taken an AED and stopped. Commonly cited reasons Guinea is a low-income country in West Africa that recently for AED discontinuation were perceived side effects, experienced an Ebola Virus Disease epidemic. Community-dwelling unaffordability, and unavailability of AEDs. Traditional medicine PWE were seen at a public referral hospital in Conakry, the capital city. use was more frequent among children versus adults (92/143 vs. During two visits in 2017, an African-U.S. team performed structured 60/114, p = .048). 57 participants had head injuries, 29 had burns, interviews and electroencephalograms and provided AEDs. and 18 had fractures. In a multivariable regression analysis, N100 Results Of 257 participants (143 children, 122 female), 25% had lifetime seizure count was strongly associated with seizure-related untreated epilepsy and 75% met our criteria for poorly controlled injury (p b .001). Burns were more likely to occur among females epilepsy. 59% had N100 lifetime seizures and 58% reported a history (p = .02). consistent with status epilepticus. 38 school-aged children were not in school and 26 adults were unemployed. 115 were not currently Conclusion taking an AED, including 50 participants who had previously taken There is an urgent need to improve the standard of care for PWE an AED and stopped. Commonly cited reasons for AED discontinu- in Guinea. Several missed opportunities were identiﬁed, including ation were perceived side effects, unaffordability, and unavailability low use of AEDs and high use of traditional medicines, particularly in of AEDs. Traditional medicine use was more frequent among children children. Targeted programs should be developed to prevent versus adults (92/143 vs. 60/114, p = .048). 57 participants had head unintentional injury and improve seizure control. injuries, 29 had burns, and 18 had fractures. In a multivariable regression analysis, N100 lifetime seizure count was strongly doi:10.1016/j.jns.2019.10.945 associated with seizure-related injury (p b .001). Burns were more likely to occur among females (p = .02). ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 93

WCN19-1075 A. Husseinab, Y.E. Awada, M.M. Aldara, Y.A. Osmana, S.A. Elhasana,O. Eladila, K.H. Hajnoora, K. Mohamed Ahmed Abbashera, R. Tofaha AlHusseinia, M.H.B. Ballaha, A. Sidiga, E.A. Alia, M.A. Ibrahima, T.M. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Elfakia Part I/dementia - Part I/epilepsy - Part I/health economics and aDaoud Research Group, Neurology, Khartoum, Sudan outcomes/neuroepidemiology and environmental and other bUniversity of Khartoum, Neurology, Khartoum, Sudan

Valvular lesions and epilepsy Introduction^ Epilepsy is the most common serious brain disorder worldwide, A. Husseinab, A. Siddiga, K.A. Husseina, R. Tofaha alHusseinia, Y.F.O. the impact of it on quality of life can be substantial with far-reaching Altayeba, E.A. Alia, M.M. Aldara, K.H. Hajnoora, O. Eladila, S.A. and life-long consequences despite all this very few studies have Elhassana, Y.A. Osmana, Z.I.H. Dabarya, A.A. Abbasa, A.A. Sulimana,O. been carried out on the QOL in epilepsy. I. Halawania, Y.E. Awada, T.M. Elfakia, M.A. Ibrahima, A. Sidiga, H.M. a a a a Osman , R.H.A.M. Rayan , R.A.M. Rawaa , S.A. Fadlallah Objectives^ aDaoud Research Group, Neurology, Khartoum, Sudan To investigate the quality of life in adult Sudanese patients with bUniversity of Khartoum, Neurology, Khartoum, Sudan epilepsy attending Daoud charity clinic June to July 2018.

Introduction Methodology^ There is strong relationship between epilepsy and valvular Thirty six adult Sudanese patients with epilepsy were re in the lesions. study, a multi item questionnaire graded scale and check list to explore the demographic characteristics were used to assess the Objective impact of epilepsy on QOL. Respondents were adults aged at least 18 To study the relationship between valvular lesions and epilepsy years old with a diagnosis of epilepsy for N3 months the unpaired t- among Sudanese patients. test or one way analysis of variances was used to compare means of QOL scores between groups. Methodology The study was conducted in Daoud charity clinic during the Almost 50 Sudanese patients with valvular lesion were included period from June to July 2018. in the study during the period October 10th 2017 – July 1st 2018. Results^ Result Out of 36 patients 19 were males and 17 were females the mean Out of 50 patients (38%) males while females (62%). The most of age was 34.81. affected age group was 10–20 years represents 34%0.40% of the The most frequent type of epilepsy according to the ILAE fi patients were found to have generalized tonic colonic epilepsy, while classi cation was the generalized tonic clonic 78.4% of patients^, and 60% have focal epilepsy (24% focal without impairment, 36% focal 40.5% of patients hadb1 seizure per month during last with impairment.) 0.34% of the patients were found to have pure MS yearwhile40.5% had N1 seizure per month and 16.2% were free of and 2% with pure MR, 14% of the patients have double valve MS+ seizure during last year There was a significant negative correlation between age and the scaled questions of QOL. MR, 6% have MS+ AF, another 6% have MR + MS + AF,^2% have TR + MR congenital heart disease was found in 12% of the patients (6% were VSD and 6% were ASD), only 4% of the patients underwent Conclusion^ The decrease in overall score of quality of life in adult Sudanese valvotomy. Abnormal EEG was observed in 46% of the patients (^28% focal and 18% generalized). Abnormal brain MRI was detected in 26% patients is multifactorial. of the patients (22% infarction, 2% hemorrhage and 2% small vessel disease).Almost all the patients 100% diagnosed as having valvular doi:10.1016/j.jns.2019.10.947 lesions before being diagnosed with epilepsy. 14% of the patients have atrial fibrillation especially with mitral stenosis.

Conclusion WCN19-1078 There is strong relationship between valvular lesions and epilepsy most propaply due to association with coexist arrhythmias, tight Poster shift 02 - Autoimmune disorders - Part I/CNS infections - valvular lesions^, associated cerebral infarction and rarely it may follow valvutomy or valvular replacement. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.946 Language mapping in non-lesional extratemporal intractable epilepsy with epileptic focus at elquent cortex

WCN19-1077 A. Khojaa, S. Bazb, T. Abalkhailb aKing Faisal Specialist Hospital and Research Center, Neuroscience, Riyadh, Saudi Arabia Poster shift 02 - Autoimmune disorders - Part I/CNS infections - bKing Faisal Specialist Hospital and Research Centre, Neuroscience, Part I/dementia - Part I/epilepsy - Part I/health economics and Riyadh, Saudi Arabia outcomes/neuroepidemiology and environmental and other Patients with focal intractable epilepsy are candidate for surgical The quality of life among adult Sudanese patients with epilepsy intervention. The goal is to achieve seizure freedom without ARTICLE IN PRESS

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morbidities or neurological deficit. Ictal onset zone at eloquent L.J. Yoona, H.C. Hab, J.M. Nohb, K.H. Hongb cortex, makes surgical intervention less favorable1. Language repre- aDepartment of Neurology, Seoul Chuk Hospital, Neurology, Seoul, sentation on the cortex is variable among people, especially in Republic of Korea structural or functional abnormality of the brain. Early onset epilepsy bDepartment of Orthopedic Surgery, Seoul Chuk Hospital, Orthopedic with left hemisphere lesion or ictal onset zone are more likely to Surgery, Seoul, Republic of Korea^ demonstrate atypical language dominance2. From this prospective, intraoperative awake cortical mapping of the language designated to Background delineate the cortex and minimize the post-operative deficit. We Delirium is common in elderly surgical patients and the etiologies report a case of young lady studying Arabic language with good of delirium are multifactorial. Dementia is an important risk factor collage performance, her epileptogenic zone at the language area for delirium. This study was conducted to investigate the clinical without language deficit post-operatively. relevance of surgery to the dementia in Alzheimer's disease (AD) or Focal intractable epilepsy patients deserve full presurgical Vascular dementia (VaD). workup aiming to achieve seizure freedom. To delineate surgical margin, concordance of data is needed. In case of uncertainty, Methods invasive subdural and depth electrodes are inserted for the best ≥ From March 2018 to April 2019, 95 patients, aged 56^years and localization and lateralization. The challenge in dominant hemi- undergoing surgery were retrospectively enrolled. We reviewed 29 sphere epilepsy is to remove the whole epileptogenic tissue with patients with previous diagnosed dementia and 66 healthy controls, 3 minimization of the post-operative deficit . Cortical language and the differences in postoperative delirium (POD) between these mapping served as a gold standard for over 50 years. Here we have groups were examined. The patients with dementia were classified a young lady who diagnosed with frontal lobe epilepsy, referred to into 2 groups: AD and VaD. VaD is a heterogeneous disease, which our tertiary center for pre-surgical evaluation. Her data localized and included poststroke, subcortical VaD, and combined VaD (AD + lateralized to an eloquent cortex of language area. She is a college VaD). This study evaluated risk factors for POD in underlying medical student, studying Arabic language and her neuropsychology assess- conditions and c-reactive protein (CRP) level. ment was normal apart from borderline naming testing. She had been undergone language cortical mapping and her post-operative Results bedside language assessment was intact. Among 95 surgical patients with a mean age of 77.05^years, 41 (43.2%) developed POD. The frequency of POD was higher in dementia patients compared to no dementia groups {82.80% vs doi:10.1016/j.jns.2019.10.948 25.80%; odds ratio (OR) 3.21, [95% confidence interval (CI) 2.06– b fi 4.99]; P ^.001}. There was no signi cant difference in POD between AD and VaD. Delirium was not correlated with conditions, such as hypertension (HTN), diabetes mellitus (DM), gender and CRP value WCN19-1085 {HTN, 42.90% vs 43.60%: DM, 45.50% vs. 33.30%: female, 27.2% of 63.0 vs male 13.8% of 32.0^%}.

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Conclusion Part I/dementia - Part I/epilepsy - Part I/health economics and Dementia play a key role in the predisposing factor of POD in outcomes/neuroepidemiology and environmental and other elderly surgical patients, but found no clinical difference between dementia two subtypes. The results of our study may help reduce Relationship between the postoperative delirium and dementia in POD incidence through vulnerable patients. elderly surgical patients: Alzheimer's disease or vascular dementia doi:10.1016/j.jns.2019.10.949 ARTICLE IN PRESS

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WCN19-1086 WCN19-1092

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - outcomes/neuroepidemiology and environmental and other Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other The many faces of neurosyphilis: Experience in a Colombian Hospital Landau Kleffner syndrome: A case report

J.P. Duran Ayllón, J.A. Gutiérrez Baquero, M.A. Silva Soler, E. Palacios H.L. Moser Filhoa, V.R. Konzenb, M.S. Medeirosa, M.C. Augustinc, D.S.N. Sanchez D.S. Crestania, R.T. Martinsa, R. Frankea Neurology Resident San José Hospital, Neurology, Bogota, Colombia aHospital Nossa Senhora da Conceição, Neurology, Porto Alegre, Brazil bSanta Casa de Misericórdia de Porto Alegre, Neurology, Porto Alegre, Neurosyphilis, a systemic disease secondary to an infection by Brazil Treponema pallidum that affects the central nervous system at any cHospital de Clínicas de Porto Alegre, Neurology, Porto Alegre, Brazil stage of the disease, remains a diagnostic challenge for the neurologist due to its wide variety of clinical presentation, which Background “ ” led to the name of the great mimicker . Despite being in the post- Landau-Kleffner syndrome (LKS) is an acquired aphasia with loss penicillin era, in Colombia it persists being endemic, although its of acquired language ability associated with epileptiform activity exact prevalence regarding neurological manifestations is still and/or clinical seizures. Aphasia usually starts between 3 to 8 years unknown. of age. Auditory agnosia is another common clinical feature and We present a series of 10 cases of patients hospitalized between patients have difficulty in understanding what they are being told 2017 and 2019 at the San José Hospital in Bogotá, Colombia, and respond poorly to visual as well as auditory stimuli. (See Figs. 1 admitted with different neurological manifestations in whom the and 2.) diagnosis of neurosyphilis is confirmed. Of the clinical presentations described in the literature were: 1 patient with asymptomatic Objective neurosyphilis, 2 patients with syphilitic meningitis (1 with vertex Report and review a typical LKS. involvement and 1 with basilar involvement), 5 with fi meningovascular syphilis and nally 2 with a general paresis type. Material and methods fi Of the 10 patients, the 50% course with human immunode ciency A 13-year-old boy was referred to initiate follow-up at a tertiary virus and presented a favorable clinical evolution after the treatment center. He was previously healthy with good neuropsychmotor and with crystalline penicillin for 14 days. We can observe that social development until 8 years of age. From this moment on, he fi neurosi lis is still a health problem in developing countries and became more inattentive and started having poor grades at school. It given its extensive neurological manifestations associated with was difficult for him to understand what other people said. There presentation in immunocompromised and immunocompetent pa- was no family or personal history of epilepsy, birth and development tients, it remains a diagnostic challenge and should be considered as milestones were unremarkable. a differential diagnosis in daily clinical practice. Results doi:10.1016/j.jns.2019.10.950 On examination, there was no vision or hearing deficiencies. Patient had difficulty to understand written and verbal language, ARTICLE IN PRESS

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with poor vocabulary. He was hospitalized for diagnostic investiga- Introduction tion. Blood exams and brain MRI were normal. EEG revealed Neurology is fundamental discipline for anthropological continuous epileptiform activity with predominant left temporal sciences – medicine, psychology upto biophysics/-chemistry. discharges that were already present since waking period but Future needs creation of an integrative neurology considering increased in somnolence and non-REM sleep. Patient was started holistic&multidimensional the human. Psychosomatics is essential on valproic acid, corticotherapy and benzodiazepine with good for neurology. clinical response. During Opening-Ceremony of 18th-World-Congress-Psychoso- matic-Medicine (ICPM-2005-Kobe) were present their majesties Conclusion Emperor and Empress of Japan, Prime&Ministers for Science-Educa- LKS is a rare neurological disorder that should be remembered in tion-others&prominent-scientists. Emperor AKIHITO honoured con- patients with acquired aphasia. Although other common etiologies gress by strategical ideas, “total symptoms of mind&body, seeking must be ruled out, neurologic exam and EEG may reveal important ways of holistic care … it is extremely important for patients … my signs in order to diagnose correctly and initiate treatment. hope contributes … the progress of medical science and people's happiness in the entire world”. doi:10.1016/j.jns.2019.10.951 Conception Model for an integrative neurology related to integral-anthropology based on physiological and pragmatic anthropology from WCN19-1096 Immanuel KANT considers different “human-areas” of human (“Integrationsebenen”), related to psychosomatic (Thure von UEXKÜLL) and somatopsychic theories (Yujiro IKEMI) is necessary. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Conclusion outcomes/neuroepidemiology and environmental and other Foundation of International Academy for Neurology by WFN, EMINS via network of clinics from selected countries, similar to On anthropology and psychosomatics in neurology European-Acad-Neurology/EAN-2015-Berlin, but enlarged scientific- organizatory principles such as common personnel (similar to UNO- fi M. Michailova, E. Neub, P. Birkenbihlb, T. Plattnerb, T. Sennb,C. employees), honorary-permanent & directors ( xed-term), profes- Luetgec, M. Schratzd, G. Webere sors (meritocratic principle), possibility for whole life working could aInst. Umweltmedizin c/o ICSD e.V., Pharmaco-Physiology, Munich, help for creation of integrative neurology supporting UNO-Agenda21 Germany for better health-education-ecology-economy on global level. bInst. Umweltmedizin c/o ICSD/IAS e.V.- POB 340316- 80100 M. Int. DEDICATION for moral-scientific support (2019-1980): Africa: N. Council Sci.Develop./Int.Acad.Sci, Berlin-Bratislava-Innsbruck- Mahfouz*/Egypt, W.Soyinka*/Nigeria, Bishop D.Tutu*/South-Africa, Muenchen-NewDelhi-Paris-Sofia-Vienna, Pharmaco-Physiology, Australia: Sir J.Eccles*, Austria: K.Lorenz*, E.Busek, France: J.Dausset*, Muenchen, Germany J.-M.Lehn*, Germany: M.Eigen*, K.v.Klitzing*, E.Neher*, H.Michel*, B. cTechn. Univ. Muenchen, Inst. Ethics Dir., Muenchen, Germany Vogel, W.Scheel, J.&Th.v.Uexküll, GB: A.Hewish*, B.Josephson*, Sir J. dUniv. Innsbruck, School Educ. Dean, Innsbruck, Austria Kendrew*, Lord A.Todd*, N.Tinbergen*, India-USA: J.Deisenhofer*, D. eUniv. Luxembourg&Vienna, Univ. Luxembourg&Vienna, Vienna, Austria Hubel*, H.G.Khorana*, L.Pauling*, K.Singh, Japan-USA: K.Fukui*, Y. ARTICLE IN PRESS

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Ikemi, S.Tonegawa*, Norway: D.Föllesdal, L.-R.Langslet, Pakistan: A. WCN19-1107 Salam*, Russia: N.Basov*, A.Prokhorov*, A.Sacharow*, Sweden:S. Bergström*, B.Samuelson* (*Nobel Laureate). Poster shift 02 - Autoimmune disorders - Part I/CNS infections - doi:10.1016/j.jns.2019.10.952 Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

Rapidly progressive dementia secondary to meningeal inﬁltration WCN19-1098 by mantle cell lymphoma

J.P. Duran Ayllóna, J.A. Gutiérrez Baqueroa, M.A. Silva Solerb,E. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Palacios Sanchezb Part I/dementia - Part I/epilepsy - Part I/health economics and aSan José Hospital – Bogotá- Colombia, Neurology, Bogota, Colombia outcomes/neuroepidemiology and environmental and other bSan José Hospital – Bogotá- Colombia, Neurology, Bogota, Colombia

Guillain-Barre syndrome associated with Hodgkin’s lymphoma: A Mantle cell lymphoma is part of the Non-Hodgkin lymphomas in case report which its main characteristics have been described at the level of the lymphoid nodes, spleen, blood and spinal cord. The involvement of K. Gowthamana, S. Kandaswamyb the central nervous system is rare and occurs in the late stages of the aKumaran Medical Center, Neurology, Coimbatore, India disease, with a poor short-term prognosis. The most frequent clinical bSRM Medical College Hospital and Research Center, Pathology, presentations of central nervous system involvement are manifesta- Kanchipuram, India tions related to elevated intracranial pressure and meningeal infiltration. Introduction We present a 61-year-old man with a history of mantle cell Guillain-Barre syndrome or acute inflammatory demyelinating lymphoma with initial cervical nodular involvement; at the time polyneuropathy has been described in association with different with a history of 8 months consisting of tremor of low asymmetric malignant lymphomas, particularly with Hodgkin’s lymphoma. amplitude in the upper limbs associated with a clinical progression Guillain-Barre syndrome causes muscle weakness and paresthesias in the last 3 months given by temporo-spatial disorientation and which interferes in treatment and can affects the prognosis of multi-domain cognitive compromise. It is possible to identify in the patients with underlying lymphoma. We report here a case of first instance a lepomeningeal compromise associated parenchymal Guillain-Barre syndrome in a patient with Hodgkin's lymphoma. involvement, which is why it is considered to expand the study in cerebrospinal fluid evidencing lymphocytic pleocytosis not sugges- Case presentation tive of infectious processes with subsequent flow cytometry that A 27-year-old man with a diagnosis of stage IIIA relapsed recognizes blastoid histology, confirming the central nervous refractory Hodgkin’s lymphoma presented with asymmetrical flaccid system's involvement. arefelxic paraparesis, one month after the end of the third course of The involvement of the central nervous system secondary to chemotherapy. He had been treated 3 years previously for Hodgkin's mantle cell lymphoma cells is a rare complication and with poor lymphoma. The clinical course and neurological examination were short-term prognosis, this can be explained by subtle changes in the consistent with Guillain-Barre syndrome. Cerebrospinal fluid studies revealed markedly elevated protein. Nerve conduction studies demonstrated demyelinating motor polyneuropathy with conduction block. Magnetic resonance imaging did not show evidence of metastasis or spinal cord compression. Following intravenous immunoglobulin administration, the neurological symptoms were significantly reduced after one month and subsequently treated with chemotherapy for his lymphoma.

Conclusion This case report highlights the importance of considering GBS in the background of Hodgkin’s lymphoma. Guillain-Barre syndrome can make the treatment of patients with lymphoma more difﬁcult and can interfere with delivering full-dose conventional chemotherapy. However, the patient will require follow-up examinations.

Keywords: Guillain-Barre syndrome, Hodgkin's lymphoma, Intrave- nous immunoglobulin

doi:10.1016/j.jns.2019.10.953 ARTICLE IN PRESS

98 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx neurological symptoms of patients. The fact that it has been reported WCN19-1116 in the late course of the disease makes us think that these patients should be assesed and investigated in a timely manner to obtain an early diagnosis Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and doi:10.1016/j.jns.2019.10.954 outcomes/neuroepidemiology and environmental and other

Comparation between variant of Guillaine-Barre Syndrome with clinical outcome in adult and children patient in a tarsier referral WCN19-1109 hospital Indonesia

B. Munira, S. Nandar Kurniawanb, C. Ari Setiantob, R. Rahmatiarc,N. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Raisab Part I/dementia - Part I/epilepsy - Part I/health economics and aUniversity of Brawijaya-Saiful Anwar Hospital, Neuromunology Divi- outcomes/neuroepidemiology and environmental and other sion, Neurology Department, Malang, Indonesia bUniversity of Brawijaya-Saiful Anwar Hospital, Neurology, Malang, Poor awareness of role of helmet to prevent head injury Indonesia cUniversity of Brawijaya-Saiful Anwar Hospital, Neurology Department, Malang, Indonesia B. Menona, S. Pasupuletib aApollo Speciality Hospitals, Neurology, Nellore, India Background bApollo Speciality Hospitals, Physiotherapy, Nellore, India Clinical outcome of Guillaine-Barre Syndrome (GBS) is varied, and variant of GBS has corelated with outcome but it was't well Introduction commented in Indonesia. Two wheelers are an inexpensive, popular mode of transportation in India. UN World Health Organization global survey of traffic Objective collisions documented a road fatality rate of 16.6/100,000 people in To compare variant of GBS with clinical outcome in adult and 2013 in India. One of the major causes was not using the helmet. We children patient. did a study to see the reason for not using a helmet while driving 2 wheelers. Method Retrospective review medical record patient hospitalized in Saiful Material and methods Anwar Hospital Malang Indonesia for 24 months (Jan2017-Dec 500 patients or their attending caregivers who use two-wheeler 2018). Diagnostic GBS based on clinical feature, electrocardiography were included in the study. The purpose of the study was informed and LCS analysed. GBS disability score documented when patient fi to them. After informed consent they lled in a questionnaire. The admitted and discharge hospital.^ demographic data and other details were calculated in percentage. Result Results Twenty-eight adult patient GBS mean age 46 yo (20–71) male: 500 subjects completed the questionnaire. Male: Female was 3:1. female = 64%: 36%. GBS disability score when admitted 3,9 and when Average age was 25 + 6 years. 71% had been fined for not using discharge hospital 3,4 with mortality rate is 20%. Variant of GBS are helmets. 63% used both the national and state highway along with AMAN 46%, AMSAN 29%, Miller Fisher 18%, and pantonomic 14%. the other roads. The average speed was 61 50 km/hour. 61% reported AMSAN variant, mean age 44 yo (20–77), GBS disability score when having an accident. Reasons given for not wearing the helmet was admitted 3,8 and discharge hospital 4, rate of mortality 25%. AMAN look odd(31%),short journey (33%), dislike(29%), spoils hair/sweat- mean age 44 yo (20–71) GBS disability score 4,75 and discharge 4, rate ing(34%), heavy/uncomfortable(23%), cant protect(3%), forget(4%), of mortality is 25%. Miller fisher mean of age 51 (27–69) GBS disability no place to store after removing(4%), No one else wears it(2%). score when admitted 4,2 dan discharge of hospital 2,8, mortality rate is 20%. Pantomonic mean of age 45 yo GBS disability score 4 and Conclusion discharge of hospital 6, mortality rate is 100%. Our study clearly showed that the 97% felt helmets are protective In children patient AMSAN mean of age 8 yo (2 month-15 yo) and however had several reasons for not wearing one. According of mortality rate is 50%. Ministry of road transport India accidents in the other roads (45.1%) were more than national (29.6%) and state highway (25.3%). Persons Conclude killed in road accidents by two-wheelers were 29.8%. Of this, 73.8% AMSAN is the common variant GBS in adult, but Panotonomic is did not wear helmets. A high public alert education programme the higest mortality, and AMSAN is the higest mortality in children needs to implemented to prevent head injuries and death. patient. doi:10.1016/j.jns.2019.10.955 doi:10.1016/j.jns.2019.10.956 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 99

WCN19-1120 J.P. Duran Ayllóna, L. Sancheza, J.A. Gutiérrez Baqueroa, M.A. Silva Solera, A.M. Arredondo Gonzalezb aSan José Hospital – Bogotá Colombia, Neurology, Bogota, Colombia Poster shift 02 - Autoimmune disorders - Part I/CNS infections - bSan José Hospital – Bogotá - Colombia, Rheumatology, Bogota, Colombia Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Systemic lupus erythematosus (SLE) is a multisystem autoimmune systemic disease that affects connective tissue, with Longitudinally extensive transverse myelitis in systemic lupus hematogenous, articulate, cutaneous, renal, cardiac, and central erythematosus: An infrequent neuropsychiatric syndrome with nervous systems manifestations. Within the neuropsychiatric severe manifestations and poor prognosis: A case report syndromes, acute transverse myelitis (ATM) represents between 1% and 2% of the neurological manifestations due to SLE. Usually the prognosis is poor, the recurrence is common and the recovery is variable. We present a 23-year-old woman with a history of SLE that presented skin, joint, renal and hematologic manifestations and received multiple treatment regimens, including cyclophosphamide, mycophenolate and azathioprine. She complained of occipital headache fever, alopecia and malar rash, associated with paresthesias and weakness in lower limbs. Neurological findings were flaccid paraplegia and sensory level at T12. Paraclinics showed leukopenia, hypocomplementemia and anti- double-stranded DNA antibodies. Cerebrospinal fluid showed hypoglycorrhachia, pleocytosis and an increase in proteins. Magnetic resonance imaging (MRI) showed a hyperintense lesion in T2 and STIR that enhance with the contrast, which extends from C3 to the medullary cone, involving posterior region and gray matter. With all of the above, we consider a longitudinally extensive acute transverse myelitis as the main diagnosis. Plasma exchange was started, however right after the second cycle, the patient presents, hypotension, cardiac arrhythmia, cardiac arrest and finally death. The neuropaychiatric lupus is one of the major causes of morbidity and mortality in patients with lupus, with myelitis being one of the most severe presentations, so its early identification and management can influence the short and long term prognosis of the patient

doi:10.1016/j.jns.2019.10.957

WCN19-1129

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

Possible neuroprotective effects of Caveolin 1 inhibitor, curcumin with association of folic acid and Vitamin B12 on ICV STZ induced Alzheimer Disease in rats

M. Dhiman, G. Singh Rayat-Bahra University, Sahauran- 140104 SAS Nagar- Punjab- India, University School of Pharmaceutical Sciences, SAS Nagar, India

The oxidative stress, Caveolin 1, Glycogen synthase kinase 3 beta (GSK/3ß), tau hyperphosphorylation are the prominent targets for the Alzheimer Disease (AD). The present study has been designed to investigate the possible synergistic/interchangeable neuroprotective effects of Daidzein, Curcumin with combination of Folic acid

and Vitamin B12 on intracerebroventricular-streptozocin (ICV-STZ) induced Alzheimer condition in rats. Single bilateral ICV-STZ (3 mg/ kg) was used to induced Alzheimer’s disease in rats. Daidzein (10 mg/kg), Curcumin (50/100 mg/kg), Folic acid (2/4 mg/kg) and ARTICLE IN PRESS

100 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

a b a a c Vitamin B12 (50/100 μg/kg) treatment for 21 days shown significant M. Bharath , T.B. Arun , P.S. Kumar , A.B. Netto , Y.T. Chickabasaviah , improvement in ICV-STZ induced memory and learning impairment G. Periyasamyc, D. Sekarc dose dependently which were measured by Morris Water Maze, aBangalore Medical College and Research Institute, Neurology, Banga- Elevated Plus Maze and spontaneous locomotor activities. It was lore, India b noted that Daidzein, Curcumin, Folic acid and Vitamin B12 and their National Institute of Mental Health and Neurosciences NIMHANS, combinations significantly restored the oxidative stress, architecture Neurology, Bangalore, India of neurons which was assessed by TBARS, superoxide dismutase, cNational Institute of Mental Health and Neurosciences NIMHANS, reduced form of glutathione levels and histopathological examina- Neuropathology, Bangalore, India tions. Moreover, it was observed that the high dose of Curcumin, Folic Acid, Vitamin B12 was the best suitable dose in association Mrs. B, a 40 year old lady presented with weakness and with Daidzein that led to significantly improvement in neurode- parasthesias of both lower limbs of 5 year duration, weakness of generative disease which were confirmed by behavioural, oxidative both upper limbs of 2 year duration, exertional dyspnoea, postural and histopathological parameters. In conclusion Daidzein, Cur- giddiness and constipation of 1 year duration. She also had repeated cumin, Folic Acid and Vitamin B12 has ability to decrease the GSK/ burpings, early satiety, grittiness in eyes and dry mouth of 1 year 3ß activity & Tau hyperphosphorylation in STZ induced AD which duration. On examination, she was emaciated, higher mental may be associated with improvement of memory deficits in rats. functions were normal, cranial nerve examination was normal These findings suggested the possible synergistic/interchangeable except for sluggishly reacting pupils bilaterally. Motor system neuroprotective effects of Daidzein, Curcumin with combination of examination showed hypotonic areflexic symmetric quadriparesis. Folic acid and Vitamin B12 on ICV STZ induced Alzheimer condition Sensory examination showed a length dependent pansensory loss in rats. invovling all four limbs. Bedside autonomic function tests revealed significant dysautonomia. Her Barthel's index was 45/100.COMPASS- doi:10.1016/j.jns.2019.10.958 31 score was 39/100.On evaluation, routine hematological investigations were normal except for anemia & thrombocytopenia. Lactate, pyruvate, ABG, ANA profile, Serum protein electrophoresis were unrewarding. CSF analysis showed normal proteins, sugar&cells. WCN19-1131 Schrimer's test was positive bilaterally. Sympathetic skin response showed absent response in all four limbs.2D-ECHO showed hypertrophic cardiomyopathy with speckled appearance of interventricu- Poster shift 02 - Autoimmune disorders - Part I/CNS infections - lar septum. A previous nerve biopsy done in a centre elsewhere Part I/dementia - Part I/epilepsy - Part I/health economics and showed severe axonal loss, however no etiology was identified. We outcomes/neuroepidemiology and environmental and other planned for a lip biopsy since it would help diagnosing both amyloidosis and Sjogren's syndrome. It came positive for amyloid Familial amyloid polyneuropathy with transthyretin P.V173 deposits with typical apple-green birefringence. We retrieved the old mutation: A report of the FIRST case from India nerve biopsy slides for reassessment and it has come positive for amyloid deposits as well. We proceeded for targeted genetic analysis ARTICLE IN PRESS

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of Transthyretin(TTR) gene which showed a missense variation A-G WCN19-1133 on exon 3 at codon 277.Concluding,this is the ﬁrst time in India and only the third time globally the mutation is reported. Nerve biopsy can be erroneously negative, sequential biopsy helps. Amyloid Poster shift 02 - Autoimmune disorders - Part I/CNS infections - neuropathy can be a painless neuropathy, as was with our patient. Part I/dementia - Part I/epilepsy - Part I/health economics and NOTE:Patient and IRB approval taken outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.959 Сognitive disfunction after CABG and neuroprotective effect of citicoline ARTICLE IN PRESS

102 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

D. Ovchinnikova, V. Garnyukb, P. Beltiukovb, V. Grebennikc,E. Barantsevichd Introduction aAlmazov National Medical Research Centre, Outpatient clinic, Saint- In epileptic patients, the seizures may be precipitated by certain Petersburg, Russia factors that may be intrinsic or extrinsic. Non – compliance, bResearch Institute of Hygiene, Occupational Pathology and Human infections and sleep deprivation are common factors. There are few Ecology, Laboratory of molecular toxicol and experimental therapy, studies looking at precipitating factors of seizures in epilepsy from Saint-Petersburg, Russia the under- developed countries. cAlmazov National Medical Research Centre, Cardiothoracic Surgery Research Department, Saint-Petersburg, Russia Objectives dPavlov First Saint Petersburg State Medical University, Department of To determine the precipitating factors of seizures in epileptic Neurology, Saint-Petersburg, Russia patients in the ER.

The study aim was assessment of association of patient cognitive Methods dysfunction and serum systemic inflammatory markers after coro- This was a descriptive, cross – sectional, hospital based study that nary artery bypass grafting (CABG). enrolled 100 patients in Omdurman teaching Hospital. Seventy patients (mean age 62,4±5,7 years, males 57%)scheduled for CABG were included. They were divided into 3 groups: 24 patients Results on-pump operation without neuroprotective treatment, 24 - on-pump In this study, 41% were non –compliant. The commonest age with citicoline in perioperative period, 22 - off-pump operation). group was 21-30 years. Patients presenting with status epileptics Cognitive level decline was evaluated by neuropsychological tests. were 13%. Two thirds of the sample were on mono-therapy, 50% Concentration of cytokines (IL-1β, IL-1ra, IL-2. IL-4. IL-5, IL-6, IL-7, of which were compliant. Infections were reported in 14%; IL-8, IL-9. IL-10. IL-12 (p70), IL-13, IL-15, IL-17, basic FGF, eotaxin, G- undetermined factors in 12%, sleep deprivation 8%, stress 6%, CSF, GM-CSF, IFN-γ, IP-10, MCP-1 (MCAF), MIP-1α, MIP-1β, PDGF- catamenial 5%, exertion 5%, photo-sensitivity 3%, music 2% and BB, RANTES, TNF-α, VEGF) was evaluated a day before (Т0) and metabolic 1%. within 2 hours after surgery (Т1). Significant increasing of IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, MIP-1β, RANTES, IL-1RA levels were in T1 Conclusions point in all groups. IL-8, IP-10, MIP-1β, IL-1RA growth level was High burden of break through seizures (29%) was reported in the significantly higher in on-pump group comparing with off-pump age group 21–30 years. Non-compliance was more common in group. IL-1RA, IL-4, IL-5, иRANTES growth level was significantly patients with mono-therapy and in patients with non-idiopathic higher in citicoline group comparing with non-neuroprotective generalized epilepsy. Stress, sleep deprivation-related seizures were group and the opposite: IP-10, MCP-1 growth level was significantly reported in 6% and 8%, respectively. In 12% of the patients, the higher in non-neuroprotective group. The significantly decreased precipitating factor was cryptogenic. Reflex epilepsy and physical cognitive rate level occurred in both on-pump groups comparing exercise were reported in 5% and 3%, respectively. Alcohol was the with off-pump group. We have not found out difference in cognitive least factor (1%) in precipitating seizures. Status epileptics was decline between groups on-pump citicoline and on-pump without observed in patients on mono-therapy. neuroprotection. Association of cognitive decline on the 7 day after surgery and plasma сytokines level changes after 2 post-operative Keywords: Sudan, Seizures, Epilepsy, Omdurman hours was revealed for IL-6, IL-8, IP-10, MCP. The systemic inflammatory reaction occurs after CABG accompanied by cytokines levels elevation, that correlates with cognitive doi:10.1016/j.jns.2019.10.961 dysfunction. doi:10.1016/j.jns.2019.10.960

WCN19-1136

WCN19-1135 Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - outcomes/neuroepidemiology and environmental and other Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Factors affecting adherence to anti-epileptic medications among Sudanese individuals with epilepsy: A cross-sectional survey Precipitating factors of seizures in epileptic patients admitted to a b c d Omdurman teaching hospital emergency room 2015 M. Elsayed , N. Elsayed , S. Badi , M. Ahmed aUniversity Hospital Sharjah, Neurology, Sharjah, United Arab Emirates b M. Elsayeda, A. Alhabeebb, M. Saeedc Prime Care Medical Center, Internal Medicine, Abu Dhabi, United Arab a Emirates University Hospital Sharjah, Neurology, Sharjah, United Arab Emirates c b Omdurman Islamic University, Pharmacy, Omdurman, Sudan Omdurman Teaching Hospital, Neurology, Omdurman, Sudan d cNational Center for Neurological Sciences, Neurology and Neurophys- Milton Keynes University Hospital NHS Foundation, Department of iology, Khartoum, Sudan Medicine and HIV metabolic clinic, Melton Keynes, United Kingdom ARTICLE IN PRESS

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and several Tauopathies. It has been proposed that oligomers and Background non-fibrillar aggregates of Tau protein may produce alterations in the Non-adherence to medication is widespread in epilepsy and other morphology and normal functioning of neurons previous the chronic diseases. Studies reporting adherence to anti-epileptic formation of insoluble filaments. Nevertheless, the mechanism by medications are very limited in African countries. Adherence reports which Tau produces these alterations is still under investigation. In from low income African countries are few in contrast to multiple this study we evaluated the possible mechanism by which the studies from high income countries. The aim of this study is to overabundance of full-length Tau and several truncated variants alter measure the level of adherence to anti-epileptic medication in the organization of distinct membranous organelles including nuclei, Sudanese population. Golgi apparatus and plasma membrane in cultured neuronal and non-neuronal cells. We transiently transfected undifferentiated Methods neuronal and glial cell lines with plasmids encoding the sequence A descriptive cross-sectional study of 96 individuals with epilepsy of full-length Tau (hTau40), and distinct N- and C- termini truncated recruited from neurology outpatient clinics in 3 tertiary centers in Tau variants. After 48 hours of transfection cells were processed for Sudan. Data was collected by using a structured questionnaire multilabeling immunofluorescence and analyzed by confocal micros- containing Morisky Medication Adherence Scale-4 (MMAS-4) and copy. In cells expressing Tau we found extensive lobulation of the Belief about Medication Questionnaire BMQ and analyzed by SPSS. nuclei, fragmentation of the Golgi apparatus, and plasma membrane blebbing. These alterations were closely associated with Tau-induced ring-shaped microtubule bundles. These structures were highly Results resistant and were induced by either truncated or non-truncated About thirty five percent of patients were estimated to be non- Tau proteins. We proposed a new mechanisms of Tau toxicity adherent. Most of the patients (93%) acknowledged their need for implying structural changes in the subcellular organization of anti-epileptic drugs. However, 35% had high concern score. Adher- membranous compartments, all promoted by a mechanical force ence is affected by attitude towards (AEDs) and presence of side generated by Tau-induced ring-shaped microtubule bundles effects to AEDs. The relation between side effects and adherence was significant (P Value 0.000). Furthermore, there was a statistically doi:10.1016/j.jns.2019.10.963 insignificant relation between the number of drugs used and adherence (P Value 0.002). There was a significant relation between adherence, necessity mean score, concern mean score and necessity concern differential P value 0.000 for all. WCN19-1168

Conclusion Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Non-adherence to anti-epileptic medication was reported in almost in one third of individuals in this cohort. There were Part I/dementia - Part I/epilepsy - Part I/health economics and statistically signiﬁcant associations between non-adherence and outcomes/neuroepidemiology and environmental and other both side effects and number of medications used in the treatment of epilepsy. On neurology in context of philosophical anthropology, psychology and medicine doi:10.1016/j.jns.2019.10.962 M. Michailova, E. Neub, F. Braunb, M. Josephb, R. Neub, U. Welscherb,L. Zebuhrb, A. Hofstetterc, M. Hollerd, C. Luetgee, M. Schratzf, G. Weberg aInst. Umweltmedizin c/o ICSD e.V., Pharmaco-Physiology, Munich, WCN19-1146 Germany bInst. Umweltmedizin c/o ICSD/IAS e.V.- POB 340316- 80100 M.,, Int. Council Sci.Develop./Int.Acad.Sci. Berlin-Bratislava-Innsbruck- Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Muenchen-NewDelhi-Paris-Soﬁa-Vienna, Pharmaco-Physiology, Part I/dementia - Part I/epilepsy - Part I/health economics and Muenchen, Germany outcomes/neuroepidemiology and environmental and other cUniv. Muenchen, Klinikum Grosshadern Dir.a.D., Muenchen, Germany dUniv.Hamburg, Fac. Economics Ex-Dean, Hamburg, Germany Overexpression of Tau protein in neuronal and non-neuronal eTechn. Univ. Muenchen, Inst. Ethics Dir., Muenchen, Germany cells produces alterations in the organization of intracellular fUniv. Innsbruck, School Educ. Dean, Innsbruck, Austria membranous components and tubulin cytoskeleton gUniv. Luxembourg&Vienna, Fac. Psychology Dean, Vienna, Austria

F. Garcia-Sierraa, F. Rodríguez-Cruza, F. Torres-Cruza, J. Escobar Introduction Herreraa, H. Monroy-Ramirezb, J. Magaña-Aguirrec, G. Basurto-Islasd Neurology is related to anthropology-psychology-medicine: Fu- aCenter of Research and Advanced Studies of the National Polytechnic ture needs systematic interdisciplinary research in this scientific Institute, Cell Biology, Mexico City, Mexico area. bUniversity of Guadalajara, Cell and Molecular Biology, Guadalajara, Mexico Conception c National Institute of Rehabilitation, Laboratory of Genomic Medicine, A. PHILOSOPHICAL-ANTHROPOLOGY. An integral anthropology Dept. of Genetics, Mexico City, Mexico related to fundamental scientific question of Kant “what is the d University of Guanajuato, Division of Science and Engineering, human?” is considered by scientific-theory conc. reason/Vernunft- Guanajuato, Mexico Verstand-Urteilskraft, agaton/Platon, to ti en einai/Aristoteles, etc. B. PSYCHOLOGY. Modern occidental philosophy&psychology con- Abnormal intracellular aggregation of Tau protein is a patholog- sider human on level of normal and sub-consciousness (analytic ical condition leading to neuronal death in Alzheimer´s disease (AD) psychology: Freud-etc.), oriental holistic one in form of super- ARTICLE IN PRESS

104 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx consciousness (samadhi-nirvana-satori-etc.: Sri Aurobindo, B.Joseph- response to infection. The association of flaviviruses with TM has not son*, Dalai Lama*, C.F.von Weizsäcker-Gopi Krishna, others) in context been systematically studied. We aimed to characterize the associa- of future synthetic philosophy&psychology. Prominent scientists tion of flaviviruses with TM. reported on similar observations (Carrel*, Neuhäusler, Pauli*, Rhinne, Richet*, Vassilev/*Nobel Laureate) in concordance with neuro-elec- Methods trophysiological-experiments (EEG) with Yogis, Buddhist-monks Patients admitted to the National Hospital, Colombo, the largest (Anand, Chhina, Kasamatsu, Hirai, Ornstein). Mental disorders after tertiary-care hospital in Sri Lanka, were recruited and clinical, neurotic reactions can be antagonized by oriental psychosomatic laboratory and radiological data were recorded. Serum was tested practises. for IgM antibodies for dengue virus (DENV), Zika, West Nile (WNV) C. MEDICINE. Occidental&oriental psychosomatic therapy counter- and Japanese encephalitis (JE). Pan-flaviviral PCR and real-time PCR acts cardiac-neurological disturbances: arrhythmia/hypertension/ was done to detect infection with DENV. neurogenic-bladder/radiocystitis-etc. Observations on probands-patients (n=30, pb0.05-0.01): Respira- Results tory-motor-therapy (Chinese-Thai-chi, Indian-Yoga, Japanese-Zen Fifteen patients (10 males) were recruited with a mean age of 40 practises), mountains/climate-2000-3200m, music-therapy, also years (SD±16). Only 7 had associated or preceding fever. Fourteen had short hypothermia 37-0°C induce decreased cardiac&respiratory- a sensory level (thoracic); seven had CSF pleocytosis; five of 12 had frequency, blood-pressure 10-20% & positive psychic-item-changes: CSF:serum glucose ratio b0.5; two of 8 had demyelination on brain relaxed/open/clear/etc. upto 50%. Hyperkinesis-tremor, depression MRI; and five had longitudinally extensive transverse myelitis (LETM) can be also antagonized by these health practises. on MRI. None had thrombocytopaenia or bleeding manifestations. PCR for DENV-2 was positive in 4 patients (27%) of whom none had LETM. Conclusion PCR for pan-flaviviruses were negative in all. IgM antibodies to Theoretical&practical models for neurology in context of an integral flaviviruses were detected in 4 patients (1 dengue, 1 JE and 2 WNV) anthropology (A-C) could be considered in neurological education, supporting preventive-curative medicine in context of UNO- Conclusions Agenda21 for better health-ecology-etc. in all countries. WFN, EMINS Evidence of acute dengue infection of the central nervous system could help in this context. was seen in those with TM suggesting a possible aetiological Ref.: [1]-Neurology:WFN-2016-Santiago-de-Chile, J.Neurol. association between dengue in TM. Sci.357/S1, no.183,187,199,234. EAN-2015-Berlin, Eur-J-Neurol 22/ Suppl-1, F1007-1012. [2]-Philosophy-Anthropology: FISP-2008-Seoul doi:10.1016/j.jns.2019.10.965 DVD-2010/Vol.45:229-237, 4:101-108; 20:203-214; 37:195-202. [3]- Psychiatry-Psychology: WPA-2018-Mexico-City, Abs.-Book WCP18- 0584/-0625/-0643/-0654. 2011-Buenos-Aires, PO1.200. EPA-2018- Nice, Eur.Psychiatry 48/S1, S623&567&662. EFPA-2009 Oslo 55-56. WCN19-1188 WFMH-2016 Cairns/AUS (Mental Health). AB p.2-5. ICPM-2017- Peking Abs.-Book, ID: 647749,648493,648878,648895, ICPM-2011- Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Seoul AB:p.167/186/189. [4]-Medicine: ISIM-2018-Cape-Town, Abs.- Book 30/41/220/246; 2010-Melbourne, Internal-Med.J.40/1:144-5. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.964 Possible role of Sirtuin in neuronal mitochondrial energy cascade for memory cognition

WCN19-1182 A. Chandel, L. Thakur, R. Goyal School of Pharmaceutical Sciences, Shoolini University, HP 173212, Department of Neurology, Solan, India Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Background outcomes/neuroepidemiology and environmental and other Sirtuin (SIRT4) binds to adenine nucleotide translocator (ANT), which transports ATP into the cytosol and ADP into the mitochon- Association of ﬂavivirus infection in transverse myelitis drial matrix, thereby providing a substrate for ATP synthase.

A. Goonatilakaa, S. Dayarathnaa, L. Gomesb, J. Drucec, N. Malavigeb,T. Objective Changa To investigate the role of Sirtuin in mitochondrial energy aUniversity of Colombo, Department of Clinical Medicine, Colombo, Sri deprivation in 3-NP induced neurodegeneration model in rats. Lanka bUniversity of Sri Jayewardenapura, Centre for Dengue Research, Material and methods Nugegoda, Sri Lanka Adult Wistar albino rats (180-220 g) were clustered in 5 different cDoherty Institute, Victoria Infectious Diseases Reference Laboratory, groups, each comprising 6 animals (n=6). Saline treatment was Melbourne, Australia given to the animals of normal group. 3-NP (10 mg/kg i.p.) was administered to the animals of different test groups for 14 days to Objectives induce neurodegeneration. Test drugs like Resveratrol, a Sirtuin In the majority of transverse myelitis (TM) an aetiology remains activator (10 mg/kg, i.p.), Lithium chloride, a GSK inhibitor (10 mg/ elusive. Viruses, autoimmune disorders and demyelinating diseases kg, i.p.) and Haloperidol, a GSK activator (1 mg/kg, i.p.) were given st th are the commonest among the causes identiﬁed. Viral association of from 1 to 14 day to the animals. Behavioral assessments were st th TM could result from direct neurotropism or from the immune performed from 21 day to 30 day. ARTICLE IN PRESS

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Results motor dysfunction, 10.8% with bladder dysfunction, bulbar and Administration of 3-NP caused significant loss in contextual ataxic syndromes were fewer. By the clinical type, cerebra-spinal learning and memory (on Morris water maze); memory related form is 56.8%, the spinal form is 27%, the cerebral form is 13.5%, and motor coordination (on balance beam test); and loss of exploratory the optical form is 2.7%. In the future, we will study the clinical behavior (in open field test). Treatment with Resveratrol and lithium characteristics of MS and establish the clinical database of the disease chloride in individual group produced significant restoration of among the Mongolian population. memory dysfunctions, and the effect caused by resveratrol was inhibited due to haloperidol given concomitantly. Similarly, the level doi:10.1016/j.jns.2019.10.967 of oxidative stress: MDA and GSH in brain tissue was restored after test drug treatments.

Conclusion WCN19-1202 It may be concluded that Sirtuin is involved in mediation of memory and learning in neuronal oxidative damage in rodents. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Keywords: Huntington’s disease, 3-NP, Resveratrol, Mitochondria, Part I/dementia - Part I/epilepsy - Part I/health economics and Neurodegeneration outcomes/neuroepidemiology and environmental and other

Iatrogenic neurological complication post cosmetic surgery doi:10.1016/j.jns.2019.10.966 Y. Elyazori, R. Mir UAE- Abu Dhabi, SKMC, Neurology Department, Abu Dhabi, United Arab Emirates

WCN19-1190 Background Marginal mandibular nerve is a branch of facial nerve which supplies the muscles of the lower lip and chin Its main function is to Poster shift 02 - Autoimmune disorders - Part I/CNS infections - depress the lower lip whilst smiling. Part I/dementia - Part I/epilepsy - Part I/health economics and It can be injured during procedures of trans-facial approach or outcomes/neuroepidemiology and environmental and other others like Liposuction and Facelifts. Damaging nerve roots at the mandibular border will cause Clinical features of multiple sclerosis in third central hospital, paralysis of supplied muscles. Whereas a blunt trauma may cause Mongolia pseudo-paralysis of the nerve which will typically resolve after 6 weeks as reported in some cases. E. Bavaasan, M. Tugsbayar, D. Surenjav Mongolian Neurological Society, Department of Neurology, Third Central Method Hospital, Ulaanbaatar, Mongolia We report a case of Marginal Mandibular nerve pseudo paralysis, presented with asymmetrical smile after liposuction of neck. Multiple sclerosis (MS) is an autoimmune disease of the central nervous system characterized by inﬂammatory demyelinating and Case report secondary axonal degeneration. The disease usually begins between A 37 years old woman presented to the neurology clinic with th the ages of 20 and 50 and is twice as common in women as in men. asymmetrical smile after neck liposuction 8 day post procedure. The aim of the study is to determine the clinical characteristics and She was misdiagnosed as Bell’s palsy by the plastic surgeon who features of the MS. The study was carried out in the patient history of performed the procedure. She was seen by a neurologist and was the Neurology Department, The Third Central Hospital, Mongolia prescribed steroids for atypical Bell’s palsy. January 2014 to January 2017 by using a retrospective cohort study. She was seen in our neurology clinic as second opinion and the In total, 37 patients were diagnosed with MS. Out of total 86.5% (32) diagnosis of iatrogenic marginal mandibular nerve injury was patients are females and 13.5% (5) are male. In ages, the youngest of made. She was reassured and after further explanation mainstay the patients is 23 years old, the oldest is 69 years old and the average management of physical therapy and nerve stimulation was age is 47.4 ± 13.3. The ﬁrst symptom of the disease is 27% of all suggested. patients with one side optic neuritis, 18.9% of the pyramidal The patient did not return for follow up, however over the phone syndrome, 16.2% changes in the sensory symptoms, 13.5% ocular- she reassured us that her smile has progressively improved. ARTICLE IN PRESS

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Conclusion WCN19-1218 Although uncommon, physicians and neurologists should always consider the possibility of injury to the Marginal Mandibular Nerve after surgical procedure, and not to misdiagnose it for Bell’s palsy as Poster shift 02 - Autoimmune disorders - Part I/CNS infections - in our case here. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.968 Cognitive impairment in patients with chronic kidney disease treated with dialysis

WCN19-1208 K. Slotwinskia, A. Pokryszko-Dragana, M. Zagrajeka, P. Jurczyka, M. Koszewicza, S. Budrewicza, D. Kaminskab, K. Madziarskab,M. Krajewskab Poster shift 02 - Autoimmune disorders - Part I/CNS infections - aWroclaw Medical University, Neurology, Wroclaw, Poland Part I/dementia - Part I/epilepsy - Part I/health economics and bWroclaw Medical University, Clinic of Nephrology and Transplantation outcomes/neuroepidemiology and environmental and other Medicine, Wroclaw, Poland

The assessment of sensory pathway in chronic inﬂammatory Introduction demyelinating polyradiculoneuropathy (CIDP) Clinical data suggest that patients with chronic kidney disease (CKD) treated with dialysis may have a higher risk of cognitive E. Dziadkowiaka, M. Ejmaa, M. Wieczorekb, P. Peca, K. Slotwinskia,S. impairment. The frequency is assessed from 30 to 70%. Previous Budrewicza, A. Zimnyc, M. Koszewicza studies indicated the large variability of neuropsychological pattern aWroclaw Medical University, Neurology, Wroclaw, Poland with different profoundness. The typical proﬁle of cognitive distur- bUniversity of Wroclaw, Faculty of Earth Sciences and Environmental bances in patients with CKD treated with dialysis has not been Management, Wroclaw, Poland estimated yet. cWroclaw Medical University, General Radiology- Interventional Radi- The aim of the study was the analysis of cognitive function in CKD ology and Neuroradiology, Wroclaw, Poland patients treated with dialysis.

Introduction Material and methods Chronic inflammatory demyelinating polyradiculoneuropathy We assessed 20 patients with CKD, 12 male and 8 female, mean (CIDP) is an autoimmune polyneuropathy, predominately affecting age – 42 years old. All patients were examined neurologically, brain motor, less sensory fibers, sometimes with the central nervous MR was done in all of them. The neuropsychological test battery system involvement. The aim of the study was the assessment of the consisted of Auditory Verbal Learning Test (AVLT), The Rey- prevalence of peripheral and central sensory impairment, and their Osterrieth Complex Figure Test (TRF),Trail Making Test (TMT A and reciprocal reliance in patients with CIDP. B), and The Controlled Oral Word Association Test (COWAT). Emotional status was assessed in Beck scale. The results were Material compared with the age and sex - matched control group. 24 patients (mean 60.7 years old) diagnosed with CIDP, and 35 healthy controls, age and sex-matched. Results In CKD patients treated with dialysis the results of executive Methods function, selectiveness and divisibleness of attention and phonemic Multimodal (visual- VEP, brainstem auditory - BAEP, somatosen- fluency were significantly lower in the comparison to the controls. sory SEP) evoked potentials (EPs) were studied. The results were compared to neurographic parameters of sensory responses in Conclusions peripheral nerves. Neurological examination, cerebro-spinal fluid 1. The profile of cognitive impairment in CKD patients treated analysis, and brain CT/MRI were done in all participants. with dialysis is characterized by the disturbances of communication’s efficiency between different, co-operating brain structures. Results 2. The profile of the neuropsychological results suggests the Statistically significant negative correlations were obtained dysfunction of prefrontal cortex in CKD patients treated with dialysis. between BAEP and SEP responses (amplitude, latencies, inter- latencies) and the amplitude and sensory conduction velocity of doi:10.1016/j.jns.2019.10.970 peripheral nerves. There were no correlations between the P100 VEP latency and the peripheral sensory parameters. There were no structural changes of the central nervous system in neuroimages, and central symptoms in the neurological examination. WCN191219

Conclusions The authors conﬁrmed the presence of peripheral and central Poster shift 02 - Autoimmune disorders - Part I/CNS infections - sensory involvement in patients with CIDP. The severity of central Part I/dementia - Part I/epilepsy - Part I/health economics and damage correlates with the degree of peripheral nerve impairment. outcomes/neuroepidemiology and environmental and other Subclinical lesion of the central sensory pathways is possible. MEG resting-state oscillations and their relationship to clinical doi:10.1016/j.jns.2019.10.969 symptoms in benign childhood epilepsy with centrotemporal spikes ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 107

Y. Gao, X. Wang 6000 Hz and analyzed over eight frequency bands, namely, delta (1- Nanjing Brain Hospital, Nanjing Medical University, Department of 4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-30 Hz), gamma (30- Neurology, Nanjing, China 80 Hz), ripples (80-200 Hz), fast ripples (FRs, 200-500 Hz), and very- high frequency oscillations (vHFOs, 500-1000 Hz). MEG sources were Objective volumetrically localized with accumulated source imaging.^ Benign childhood epilepsy with centrotemporal spikes (BECTS) is the most common type of idiopathic epilepsy in children. There is a Results need to identify interictal electrophysiological biomarkers of epilepsy In comparison with neuromagnetic activities of HC, BECTS had that could be used to diagnose in a timely manner. Hence, we significantly higher odds of occurrence of 12-30 Hz in the medial intended to study the characteristics of the magnetoencephalogra- frontal cortex (p b .002). This was also seen in the peri-rolandic phy (MEG) in different frequency bands of BECTS. cortex in bands of 200-1000 Hz (p b .0001). (Fig.1) Source strength of BECTS was significantly higher than that of HC in bands of 80-200 b Methods Hz, 200-500 Hz, respectively (p .001). (Fig.2) In addition, source fi We collected fourteen patients with newly-diagnosed BECTS strength of interictal activity was signi cantly correlated with daily b (mean ± SD: 8.6 ± 2.0 yrs) and fourteen age and gender match seizure episodes in bands of 200-500 Hz (p .05, r = 0.571) and b healthy controls (HC) (8.3 ± 2.2 yrs). MEG data were digitized at 500-1000 Hz (p .01, r = 0.860). (Fig.3). ARTICLE IN PRESS

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Conclusions epileptogenic activity while low-frequency signals are predomi- Interictal activities in BECTS had higher spatially concordant in high- nantly related to epileptic propagation. frequency ranges (N80 Hz). Source strength of BECTS high-frequency signals had much closer relationship with seizure severity. We doi:10.1016/j.jns.2019.10.971 postulate that high-frequency signals are closely related to ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 109

WCN19-1220 even to other autoimmune diseases. Only few studies have reported the association between APS and polymyositis (PM)

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Case report Part I/dementia - Part I/epilepsy - Part I/health economics and The patient was a 52-year-old male complaining of proximal outcomes/neuroepidemiology and environmental and other muscle weakness. On the occasion, the patient showed increased level of muscle enzymes. Electromyography and biopsy of muscle Supervised machine learning for identifying connectivity patterns were compatible with inflammatory myopathy. Based on hypothesis in multimodal epilepsy imaging of PM, prednisone (1mg/kg/day) was initiated. One year after, the patient had deep venous thrombosis of lower limb and acute T. Gholipour mesenteric ischemia. The anticardiolipin IgM level was elevated The George Washington University, Department of Neurology, Epilepsy confirming the diagnosis of APS. The patient had been treated by Center, Washington DC, USA prednisone (10mg/day) and warfarine. After 6 years, he presented a sudden onset of focal neurologic deficit resulting from arterial brain Focal epilepsy is a heterogeneous entity that alters brain infarction. networks beyond the apparent focus. Functional connectivity MRI (fcMRI) analysis and positron emission tomography (PET) can Discussion and conclusion provide non-invasive windows into identifying affected networks. APS can be associated with a wide range of diseases. The fi Here we used a novel machine learning approach for integrate fcMRI concomitance of APS and PM has been rarely reported, and only ve and PET data in individual patients for classification, and as a cases have been described in the literature. The association of discovery tool for finding common pathways in focal epilepsy. As a anticoagulation and corticoids treatment reduces the risk of proof of principle, we used de-identified data from 20 patients with recurrence thromboembolic accidents, but refractory myopathy is left temporal-onset epilepsy. IRB waived formal approval of this possible. study. Resting state BOLD image for fcMRI, standardized uptake value doi:10.1016/j.jns.2019.10.973 (SUV) volume previously obtain for clinical PET, and an isometric T1 MRI for patient-specific anatomical segmentation were used. Data was divided into left and right hemisphere for comparison. A voxel- wise whole-brain connectivity analysis was performed and an individualized top-10% correlation cutoff was used for calculating WCN19-1230 degree of connectivity. We used neuroanatomical and functional parcellation atlases in FreeSurfer(v6.0) to average fcMRI data and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - PetSurfer tools to segment PET data and calculate partial volume Part I/dementia - Part I/epilepsy - Part I/health economics and corrected features for support vector machine (SVM, a supervised machine learning algorithm). Right and left hemisphere labels were outcomes/neuroepidemiology and environmental and other used to train SVM. Accuracies in learning pattern were compared between parcellation methods, fcMRI or PET alone, and in combina- Sinapic acid mitigates intracerebroventricular streptozotocin tion. In different iterations, using fcMRI alone achieved up to 79% induced oxidative stress and neuro-inflammatory changes in rats accuracy for right-left classification using functional parcellation method. Addition of PET data only slightly increased this accuracy D. Singh, V. Verma, R. Kh irrespective of parcellation method. Future studies are needed to All India Institute of Medical Sciences AIIMS, Department of Pharmacol- validate this method on larger prospective, more heterogeneous ogy, New Delhi, India patients. Oxidative stress and inflammatory cytokines play an important doi:10.1016/j.jns.2019.10.972 role in progression of Alzheimer’s disease (AD). Sinapic acid, a natural phenolic compound has shown neuro-protection by amelio- ration of oxidative stress and neuro-inflammation. Here, we evaluated the effect of sinapic acid on oxidative stress and WCN19-1227 inflammatory cytokines in intracerebroventricular streptozotocin (ICV-STZ) sporadic model of AD in rats. Male Wistar rats (260 ± 20g), were administered ICV-STZ (3 mg/kg) and sinapic acid (10 and Poster shift 02 - Autoimmune disorders - Part I/CNS infections - 20 mg/kg, orally) was administered for 21 days. Morris water maze Part I/dementia - Part I/epilepsy - Part I/health economics and and passive avoidance paradigm test was carried out on 0 and 21st outcomes/neuroepidemiology and environmental and other days. On 21st day rats were sacrificed, levels of MDA, GSH, TNF-α and IL-1β were estimated in cortex and hippocampus. The expression of Association between antiphospholipid syndrome and choline acetyltransferase (ChAT) was also assessed by western blot. polymyositis On day 21, STZ produced memory impairment as evidenced by increased escape latency (p b 0.001), decreased time spent in target S. Daoud, S. Sakka, N. Farhat, O. Hdiji, K. Moalla, H. Haj Kacem, M. zone in Morris water maze. Sinapic acid attenuated the increased Damak, C. Mhiri escape latency and improved the time spent in target quadrant at 20 st Habib Bourguiba University Hospital, Sfax -Tunisia, Neurology depart- mg/kg on 21 day (p b 0.05). STZ induced decreased transfer latency ment, Sfax, Tunisia in passive avoidance paradigm was also significantly increased. STZ induced changes in levels of GSH and MDA were significantly α β Introduction normalised by sinapic acid. STZ induced levels of TNF- and IL-1 fi b Antiphospholipid syndrome (APS) can be primary or secondary to were signi cantly (p 0.05) attenuated by sinapic acid 20 mg/kg. several conditions such as neoplasias, infectious diseases, drugs, or Moreover, sinapic acid ameliorated the STZ induced decreased ARTICLE IN PRESS

110 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx expression of ChAT in hippocampus. The results suggest that sinapic WCN19-1235 acid improves STZ-induced cognitive impairment by ameliorating oxidative stress and neuro inﬂammation in cortex and hippocampus. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - doi:10.1016/j.jns.2019.10.974 Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

Frontal presentation of Alzheimer’s Disease WCN19-1232 S. Daoud, N. Farhat, S. Sakka, O. Hdiji, K. Moalla, H. Haj Kacem, M. Damak, C. Mhiri Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Habib Bourguiba University Hospital- Sfax -Tunisia, Neurology depart- Part I/dementia - Part I/epilepsy - Part I/health economics and ment, Sfax, Tunisia outcomes/neuroepidemiology and environmental and other Introduction Prospective assessment of the impact of cardiac surgery on Besides its typical amnesic presentation, focal atypical presenta- cognitive function tions of Alzheimer’s disease (AD) have been described, such as frontal variant. It’s a rare phenotype described in patients presenting P. Reddya, A.O. Sarojaa, K.R. Naika, R. Saldanhab prominent behavioural deficits. aKLE Academy of Higher Education and Research, Neurology, Belagavi, India bKLE Academy of Higher Education and Research, Cardiovascular and Results Thoracic Surgery, Belagavi, India Three patients were diagnosed with frontal variant of AD. The age at onset of symptoms was 80 years. At the onset of the disease, all Background patients had predominantly inert behavior presentation. Neuropsy- Alteration of cognitive functions had been reported after surgery. chological tests showed impairment in global cognitive efficiency Cardiac surgery is associated with changes in hemodynamic status of (MMSE 15/30). There was an episodic memory deficit characterized patients perioperatively and could alter their cognitive status. This by a low free recall (free recall score = 1/10) not normalized with preliminary study aims at prospective evaluation of the cognitive cueing (total recall = 1/10). Mental flexibility and the abilities of functions in patients undergoing cardiac surgery. conceptualizing and programming were severely impaired on the copy of Rey complex figure. Dysexecutive deficits were present in all Objective patients (BREF Test = 8/18). One patient presented gestural apraxia. To assess the impact of cardiac surgery on overall cognition and Verbal fluencies were reduced, both in phonemic (score = 2/28) and different cognitive domains. categorical modalities (score = 2/28). Our patients were evaluated with the NPI. All of them had Material and methods severe behavioral and psychological Symptoms (Global score = 44/ Patients with no history of dementia were recruited after 144). Brain SPECT showed hypoperfusion in dorsolateral prefrontal obtaining informed consent. Demographic data, vascular risk factors cortex. CSF biomarkers showed low Aβ42 (329 pg/mL), high Tau and perioperative hemodynamic data were documented. All the (1073 pg/mL) and high P-Tau (97 pg/mL), in favor of an AD patients underwent Addenbrooke Cognitive Examination III (ACE-III) diagnosis. before and after one week of surgery. Discussion and conclusion Results Frontal variant of AD is a rare form in which patients present Sixty patients were recruited (38 men, 22 women) whose age severe behavioral and psychological Symptoms. By using physio- ranged from 24 to 78 years (55.21 ± 11.54) of whom 21 were illiterate, pathological markers, such as CSF markers, it is now possible to 38 monolingual, 12 bilingual and 10 multilinguals. Twenty-eight were establish a biological diagnosis of AD in these focal cortical operated on-pump and 32 off-pump. Preoperative ACE-III scores ranged syndromes, and to propose a specific treatment for them. from 38 to 98 with lower scores in illiterate subjects (69.47 ± 15.69) and women (71.27 ± 15.37). Postoperative ACE-III scores ranged from doi:10.1016/j.jns.2019.10.976 40 to 99 and the overall scores did not differ between preoperative (80.15 ± 13.64) and postoperative assessments (81.38 ± 14.28). Mem- ory domain scores increased postoperatively from 18.96 ± 4.97 to 20.08 ± 5.15 (P 0.013) with more pronounced increase in patients who WCN19-1239 were educated, younger than 55 years and were operated on-pump. There was no change in other domains of ACE-III. After surgery twenty Poster shift 02 - Autoimmune disorders - Part I/CNS infections - patients had reduction of ACE-III scores which was greater in patients with lower baseline scores. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Conclusion Postoperative cognitive decline is greater in patients with lower Overnight switching from levetiracetam to brivaracetam baseline scores and they require follow-up. S.P. Javier, M. Fañez, L. Abraira, E. Santamarina, S. Florez, M. Toledo doi:10.1016/j.jns.2019.10.975 Epilepsy Unit, Neurology, Barcelona, Spain ARTICLE IN PRESS

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Objective A prospective, observational study was performed to evaluate the overnight switching from levetiracetam (LEV) to brivaracetam (BRV).

Patients and method Adult patients N16 years old treated with LEV mono or polytherapy. LEV was inefﬁcient and/or induced adverse events. A decision to start BRV without titration was accepted by the patient.

Results 41 patients. 21 male. Mean age: 40.9 years (18-85). Etiology: structural focal: 60%; unknown focal: 15%; idiopathic generalized: 10%; unclassified: 10%; symptomatic generalized: 5%. Number of previous taken antiepileptic drugs: 3.3 (1-12). LEV baseline monotherapy: 37%. Reason to switch LEV: lack of efficacy: 53.6%; adverse events: 65.8%: irritability (48.4%), depression (32.3%), somnolence (16.1%), dizziness (3.2%). LEV mean doses: 1760,98 (500-5000 mg/ d). BRV mean doses: 141,95 (50-200 mg/d). Follow-up: 9.7 months (6-15). BRV efficacy: 25 unchanged to LEV (9 seizure-free); 11 50% reduction; 5 increased seizures. Adverse events after BRV: improved irritability 12/15; improved depression 7/10; improved somnolence 2/5; no change dizziness 1/1. The overnight switching was well tolerated in 75.6%. BRV retention rate at last visit: 74%. 7 out of 11 patients who abandoned BRV returned to LEV.

Conclusion The overnight switching from LEV to BRV was well tolerated. An improvement of neuropsychiatric adverse events of LEV was found. BRV treatment is a useful option in patients treated with LEV. doi:10.1016/j.jns.2019.10.977

WCN19-1244

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other

Extrapontinemyelinolysis (EPM) presenting as acute parkinsonism, successfully treated with immunomodulation therapy: Report of two cases

D. Wijesundara, B. Senanayake Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka

Introduction Isolated extrapontinemyelinolysis (EPM) is a rare manifestation of osmotic demyelination syndrome usually attributed to rapid correction of hyponatremia, carrying a poor prognosis. We report two patients who presented with acute Parkinsonism following a history of gradual correction of hyponatraemia who responded excellently to immunomodulation therapy.

Case reports Two male patients aged 27 and 65 years presented with acute typical pallidial sparing on MRI (figures 1, 2). Along with symptom- onset extrapyramidal features and confusion. Both had a history of atic management, both patients underwent plasmapheresis and the hyponatremia (Na-105 mmol/l) secondary to profuse vomiting, first additionally received intravenous immunoglobulin. Relative Correction had been done gradually. There were no other metabolic hyponatremia was maintained. Both patients improved significantly abnormalities. Diagnosis was confirmed by presence of bilateral over 4-8 weeks. A repeat MRI done in the first patient showed symmetrical T2 weighted hyperintensities in the basal ganglia with clearing of lesions (figure 3). ARTICLE IN PRESS

112 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

age-related occurrence of recurrent unprovoked generalized seizures in the absence of detectable brain lesions or metabolic abnormalities. Childhood and juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsies with generalized tonic–clonic seizures alone represent the most common IGE syndromes. Genetic factors play a predominant role in the etiology of common IGE syndromes. The objective of this study is to report clinical characteristics of a large family with IGE.

Methods A family of more than 50 related members is described. A clinical examination was performed in 17 of them and 10 subjects with IGE were listed. Blood samples for genetic analysis have not been made due to the unavailability of genetic laboratory in our country.

Results Of the 10 subjects with IGE, 7 were available, one had died and 2 others did not live in the city. There were 5 boys and 5 girls and the average age of onset of seizures was 6 years (range: 1.5 and 12 years). Of these subjects, all had epilepsy with generalized tonic- clonic seizures.

Conclusion A genetic predisposition exists during IGE with a complex heredity. Our study highlights clinical features and genetic research to identify genes involved requiring to be conducted.The diagnosis of Discussion epilepsy in resource-limited countries still suffers from a lack of As extrapyramidal features are masked by involvement of the genetic investigations that would describe different epileptic pyramidal tracts in centralpontinemyelinolysis (CPM), Parkinsonism syndromes. manifests only in isolated EPM. Pallidial sparing on MRI is a characteristic feature. Although the rapidity of hyponatremia correction is the primary etiology, its absence cannot rule out the diagnosis. doi:10.1016/j.jns.2019.10.979 Cases have been reported even with gradual correction. Management is mainly supportive. However, there have been reports of successful treatment with aggressive immunotherapy consistent with our ﬁndings. WCN19-1248

Conclusion Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Extrapontinemyelinolysis (EPM) can occur in the absence of rapid hyponatremia correction. This may be an indicator of relatively Part I/dementia - Part I/epilepsy - Part I/health economics and better response to immunomodulation and good prognosis. outcomes/neuroepidemiology and environmental and other doi:10.1016/j.jns.2019.10.978 The value of routine EEG prior to the admission of patients with refractory epilepsy to epilepsy monitoring unit

F. Babtaina, W. Balubaida, D. Atteyaha, K. Al Qadia, S. Bajammalab,N. WCN19-1247 Madanic, H. Kayyalia, Y. Al Saida aKing Faisal Specialist Hospital and Reseach Centre, Neurology, Jeddah, Saudi Arabia Poster shift 02 - Autoimmune disorders - Part I/CNS infections - bKing Fahad Hospital, Neurology, Jeddah, Saudi Arabia Part I/dementia - Part I/epilepsy - Part I/health economics and cKing Faisal Specialist Hospital and Reseach Centre, Neurology, Riyadh, outcomes/neuroepidemiology and environmental and other Saudi Arabia

Familial idiopathic generalized epilepsies: diagnosis challenge in Introduction limited resources setting The yield of EEG prior to admission to the longterm monitoring unit (EMU) is unclear for which, this study aimed to look at. O. Mukukua, M. Bugemeb aInstitut Supérieur des Techniques Médicales de Lubumbashi, Recherche, Methods Lubumbashi, Democratic Republic of the Congo We conducted a retrospective review of patients admitted to our bUniversity of Lubumbashi, Neuropsychiatric, Lubumbashi, Democratic EMU between January 2016 and December 2017. Data collected Republic of the Congo included demographics, duration of epilepsy, seizure frequency, number of antiepileptic drugs (AEDs), seizure classification, brain Introduction MRI findings, and results of the first EEG performed in our centre. The idiopathic generalized epilepsies (IGEs) affect up to 0.3% of Patients with incomplete data or those admitted for evaluation other the general population. The clinical features are characterized by the than refractory epilepsy were excluded. ARTICLE IN PRESS

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Results Keywords: Giant neurofibromatosis, Epilepsy, NF1, TACI We studied 102 patients. There was 35 (52%) females, with mean age of 25 years, and the mean duration of epilepsy is 13.8 years. Focal epilepsy was found in 87 patients (85%), generalized in 7 (7%), and unclassified in 8 (8%). The mean of number of AEDs used per patient doi:10.1016/j.jns.2019.10.981 was 2.5 (range; 1–5). Brain MRI was abnormal in 62 patients (61%). In the first routine EEG, IEDs were found in 40 patients (39%), where focal or multifocal IEDs was seen in 22 of them. A multivariate regression analysis (Fig.1) showed that for each increase in the WCN19-1256 patient’s age by one year, IEDswere 10% less likely to be seen (OR = 0.9, 95%CI; 0.8–0,9, p value 0.05), when adjusted for gender, epilepsy Poster shift 02 - Autoimmune disorders - Part I/CNS infections - duration and classification, and number of AEDs. No similar Part I/dementia - Part I/epilepsy - Part I/health economics and observation was noted with other variables. outcomes/neuroepidemiology and environmental and other Conclusions The rate of detecting epileptiform discharges on routine EEG in IGG4 mediated pachymeningitis with corneal ulcerations – A refractory epilepsy patients is not higher than epilepsy patients in novel association general. A Routine EEG performed prior to EMU evaluation might be an unnecessary procedure. P. Pulu Ishwara doi:10.1016/j.jns.2019.10.980 Father Muller Medical College, Neurology, Mangalore, India

Introduction IGG4 mediated immunological disorders affect multiple organ WCN19-1255 systems simultaneously and pose diagnostic and therapeutic challenge. We report a case of IGG4 associated pachymeningitis with corneal ulcerations. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and Case report outcomes/neuroepidemiology and environmental and other 38 year old lady presented with history of headache and double vision of 3 weeks duration. Headache was bifrontal, throbbing, Transchateter arterial chemoinfusion (TACI) in patient with giant continuous with nausea and photophobia with severity of 7/10 in neurofibromatosis visual analog scale. Patient had double vision on looking towards left side. On examination patient had Left eye peri orbital edema, left lateral rectus palsy and small multiple punctate corneal erosions C. Thursina Srie Setyaningrum confirmed by ophthalmologist with slit lamp examination. Rest of Gadjah Mada University, Department of Neurology, Yogyakarta, the neurological examination was within normal limits. Blood Indonesia investigations showed elevated erythrocyte sedimentation rate (48mm/hr), Anti nuclear antibody and Anti cytoplasmic nuclear antibody profile was negative. Serum IGG4 levels were elevated (3.9 Background g/dl (normal 0.3-2g/dl)). Cerebro spinal Fluid analysis revealed Giant neurofibromatosis (NF1) is an autosomal dominant genetic presence of 4 lymphocytes with normal glucose and protein levels. disorder with an incidence of 1 in 3000 live births. It has distinct Magnetic resonance imaging of the brain showed thickening of cafe-au-lait lesion, optical glioma, plexiform neurofibroma and tentorium cerebelli and posterior falx with hypointensity in all peripheral nerve sheet tumor. Transchateter arterial chemoinfusion sequences with contrast enhancement suggestive of granulomatous (TACI) was an invasive procedure for administration of the pachymenigitis. Patient was treated with pulse methyl prednisolone chemotherapy drug after targeted embolization.

Case report 32years oldmale presenting with multiple skin nodules followed with progressive swelling giant size of the left leg for 12 years. Patient also had uncontrolled absence epilepsy with and abnormal irritative diffuse pattern of electroencephalogram (EEG) and normal head computed tomography (CT) scan. Inoperable NF1 was concluded by clinical manifestation and left leg CT scan. This patient is planning for 7 times of TACI with interval procedure 1 until 2 months. The size of the diameter of left leg decrease for 11.8cm, decreasing pain from numeric pain scale (NPS) 7-8 to NPS 1-2 after the 3rdTACI.

Discussion Chemotherapy drug administration with TACI was an alternative therapy for inoperable NF1 patient. This is the ﬁrst case in Yogyakarta Dr. Sardjito General Hospital and need further follow- up for 1 years after the ﬁrst TACI.

Conclusion Inoperable NF1 was treated with TACI for 3 times from 7 times planning, and have good clinical outcomes. ARTICLE IN PRESS

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1g/day followed by tapering dose of oral prednisolone. At the end of WCN19-1257 1 month patient had complete resolution of headache and the corneal lesions. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Conclusions Part I/dementia - Part I/epilepsy - Part I/health economics and IGG4 related disorders are recently described granulomatous outcomes/neuroepidemiology and environmental and other diseases producing multisystem involvement. Although ocular manifestation is common, ours is only 2nd report to show corneal Clinical study of the Guillain-Barré Syndrome ulcerations associated with this disease. E. Bavaasan, M. Tugsbayar, D. Surenjav doi:10.1016/j.jns.2019.10.982 Mongolian Neurological Society, Department of Neurology, Third Central Hospital, Ulaanbaatar, Mongolia ARTICLE IN PRESS

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Background Methods Guillain-Barre Syndrome (GBS) is an acute demyelinating neu- A prospective descriptive study of 177 epileptic seizures was ropathy characterized by progressive generalized paralysis with conducted at the Centre Médical du Centre Ville of Lubumbashi. The areﬂexia. study was conducted from January 2016 to December 2017.

Aim Results To study the clinical characteristic and outcome of patient with The age of the patients ranged from 5 months to 86 years and Guillain-Barre syndrome. averaged 19.97 years. The male sex was found in 101 patients giving a sex ratio (M/F) of 1.33. The average age of patients with seizures was Method 13.1 years (range: 5 days-85.5 years). The average duration between It was a retrospective analysis conducted in the Department of onset of seizures and consultation was 83.5 months (range: 10 days- Neurology, Third Central Hospital of Mongolia from January 2014 to 440 months). 48 (27.68%) patients had a family history of epilepsy. December 2018. We assessed 10 patients history with GBS by Etiology was found only in 68 (38.4%) patients: neurocysticercosis Brighton criteria out of 39 patients who diagnosed with the acute (26.5%), meningitis (25%), cranioencephalic trauma (20.6%), neonatal polyradiculoneuropathy. pathologies (20.6%). Generalized tonic-clonic seizures were the most frequent (65.5%), followed by atonic generalized seizures (9.6%) and Result partial clonic seizures (8.5%).Conclusion. This study is a useful starting The gender ratio was 1: 1, the average age was 57.4 and point from which health programs and health professionals can work antecedent illness preceding diarrhea was 60% and 1 case was the to improve the diagnosis and quality of care. upper respiratory tract infection. All had progressive paralysis with areflexia, 90% had sensory loss, 20% had cranial nerve palsies and 1 doi:10.1016/j.jns.2019.10.984 case had respiratory paralysis with ventilation. The GBS subtype distribution as electro diagnostic studies was as follows: acute motor sensory axonal neuropathy (AMSAN) in 2 (20%), acute inflammatory demyelinating polyradiculoneuropathy (AIDP) in 7 (70%) and WCN19-1266 equivocal in 1 (10%). Steroids constituted the treatment given in majority of the patients (90%), 2 patients transferred to another hospital to having plasma exchange and intravenous immune Poster shift 02 - Autoimmune disorders - Part I/CNS infections - globulins (IVIG) was given to 3 cases. Part I/dementia - Part I/epilepsy - Part I/health economics and outcomes/neuroepidemiology and environmental and other Conclusion Most common antecedent event and presenting feature were Molecular imaging of Alzheimer's disease dementia by chemical diarrhea and progressive paralysis, respectively. Intravenous im- exchange saturation transfer MRI mune globulins and plasma exchange need to be implemented even further in our practice. H.Y. Rheea, K.C. Parkb a doi:10.1016/j.jns.2019.10.983 Kyung Hee University Hospital at Gangdong, Department of Neurology, Seoul, Republic of Korea bKyung Hee University Hospital, Department of Neurology, Seoul, Republic of Korea WCN19-1260 Chemical exchange saturation transfer (CEST) is a new technique which enables the indirect detection of molecules with exchangeable Poster shift 02 - Autoimmune disorders - Part I/CNS infections - protons and exchange-related properties. CEST makes MRI sensitive to Part I/dementia - Part I/epilepsy - Part I/health economics and the concentrations of endogenous metabolites and their environments. outcomes/neuroepidemiology and environmental and other Amyloid beta and tau proteins are involved in the pathogenesis of Alzheimer’s disease (AD) and we hypothesized that the characteristics Epidemiological and clinical profile of epileptic patients in a of chemical exchange proton pools on CEST MRI in patients with AD hospital cohort in Lubumbashi, Democratic Republic of Congo dementia (ADD) are different from those in cognitively normal subjects. We analyzed 19 subjects with ADD and 22 subjects with normal O. Mukukua, M. Bugemeb cognition. The full Z spectrum CEST MRI signal was obtained using the fi aInstitut Supérieur des Techniques Médicales de Lubumbashi, Recherche, 3D GraSE sequence and the full Z spectrum was tted by the Lorentzian Lubumbashi, Democratic Republic of the Congo method to obtain six substances which were amide, amine, hydroxyl, bUniversity of Lubumbashi, Neuropsychiatric, Lubumbashi, Democratic direct water saturation (DWS), nuclear overhauser effect (NOE) and Republic of the Congo magnetization transfer (MT) maps and to map the MTR asymmetry at 1 ppm, 3 ppm, and 3.5 ppm frequency offsets. The CEST effects revealed that amide, amine, and hydroxyl were higher in subjects with ADD Introduction especially in the frontal, parietal, and temporal regions. DWS, NOE, and Epilepsy is one of the most common neurological conditions. It MT were also higher in entire brain regions of subjects with ADD. MTR remains a serious disease in Africa due to late diagnosis and often asymmetry values at 1 ppm, 3 ppm, and 3.5 ppm were higher in the inadequate management. The majority of epileptic patients in sub- frontal, temporal, and occipital regions of in subjects with ADD. This Saharan countries do not receive appropriate treatment. In the DRC, study showed the different CEST effects in ADD and it is possible that particularly in Lubumbashi, very few epidemiological studies on abnormal protein accumulations make the difference. epilepsy have emerged. The purpose of our work is to study at the hospital level the profile of epileptic patients. This will enable us to doi:10.1016/j.jns.2019.10.985 analyze the socio-demographic aspects, the semiology of epileptic seizures as well as their etiologies. ARTICLE IN PRESS

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WCN19-1267 5. 2 days (range; 2–10 days). IEDs were detected in 15 patients (44%). Only 34 patients (7%) were found to have PNES. The likelihood of detecting IEDs increased by 64% for each additional day the patient Poster shift 02 - Autoimmune disorders - Part I/CNS infections - stayed in the EMU (adjusted OR = 1. 64, 95%CI; 1. 1–5. 5, p-value = 0. Part I/dementia - Part I/epilepsy - Part I/health economics and 04), adjusted for age, gender, duration of epilepsy, the presence of a outcomes/neuroepidemiology and environmental and other psychiatric disease, number of AEDs, and recording ictal changes.

The association between duration of video-electroencephalogram Conclusions (VIDEO-EEG) recording and detecting epileptiform discharges in IEDs are likely to be recorded in PNES with a longer EMU stay, yet patients with psychogenic non epileptic seizures (PNES) and the exact number of days to confirm this observation is unknown. epilepsy doi:10.1016/j.jns.2019.10.986 D. Atteyaha, W. Balubaida, S. Bajammalab, F. Babtaina, K. Al Qadia,H. Kayyalia, N. Madanic, Y. Al Saida aKing Faisal Specialist Hospital and Research Centre, Neurology, Jeddah, Saudi Arabia WCN19-1276 bKing Fahad Hospital, Neurology, Jeddah, Saudi Arabia cKing Faisal Specialist Hospital and Research Centre, Neurology, Riyadh, Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Saudi Arabia Part I/dementia - Part I/epilepsy - Part I/health economics and Introduction outcomes/neuroepidemiology and environmental and other Psychogenic non-epileptic seizures (PNES) coexisted with epilepsy in up to half of the patients, but are distinguished from Features of clinical symptoms and pathological findings of 7 epileptic seizures by lacking abnormal epileptiform discharges in demented cases (pure argyrophilic grain disease) EEG. The presence of interictal epileptiform discharges (IEDs) on EEG is helpful in making the diagnosis of epilepsy in patients with PNES. K. Iwaia, Y. Kobayashia, T. Yokoia, Y. Nosakia, M. Watanabea,Y. To study the relationship between duration of video-EEG and Hashizumeb detection IED in patients with PNES and epilepsy. aToyohashi Municipal Hospital, Neurology, Toyohashi-City, Japan bFukushimura Hospital, Neurology, Toyohashi-City, Japan Methods This is a retrospective case series study. Data were extracted from Background/aims adult patients with confirmed epilepsy admitted to epilepsy Argyrophilic grain disease (AGD) is a sporadic tauopathy and monitored unit (EMU) in our hospital from January 2010 to actually a frequent cause of late onset dementia. We aimed at December 2017. Data collected included demographics, duration of characterizing the clinical features and pathological findings of AGD. epilepsy, number of antiepileptic drugs (AEDs), length of stay in the EMU and history of psychiatric disorder. Patients found to have PNES Methods only were excluded. We performed retrospective evaluation of 7 patients with AGD.

Results Results 477 patients were admitted to the EMU during the study period and Those 7 cases were gradually developed rather severe dementia were conﬁrmed to have epilepsy (Table 1). The average EMU stay was until the last years of their life. The average age at autopsy was 86.3 years old. 3 cases are men, the evaluation revealed common clinical features which consist of memory disturbance, relatively preserved cognitive function and personality change characterized by emotional disorder with aggression, irritability or ill temper. 4 cases are women. Only in one case, personality change and emotional imbalance preceded memory failure. The other 3 cases showed neither personality change nor emotional disorder, and very gentle temper throughout the course. Pathologically, all 7 cases showed Saito Stage III, with argyrophilic grains (Gallyas silver positive, AT-8 positive) in hippocampus, parahippocampal gyrus, amygdaloid nucleus, insular lobes, cingulate gyrus and cortex of temporal lobes. Superﬁcial laminar spongiosis (layers II-III), neuronal loss and gliosis are present in cortex. Other neurodegenerative disorders were not present.

Conclusion AGD is a late-onset dementing disorder clinically characterized by amnesia, with other cognitive functions and ADL relatively spared. Neuropsychiatric features were different with each patient. Future studies are needed to elucidate whether these neuropsychiatric features are closely related with pathologic severity or not.

doi:10.1016/j.jns.2019.10.987 ARTICLE IN PRESS

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WCN19-1281 Introduction Transient global amnesia (TGA) is a clinical syndrome characterized by sudden onset of complete disruption of short term memory Poster shift 02 - Autoimmune disorders - Part I/CNS infections - without neurological signs or symptoms and resolves within 24 Part I/dementia - Part I/epilepsy - Part I/health economics and hours. Several known precipitators of TGA are physical exertion, outcomes/neuroepidemiology and environmental and other sudden temperature change, and emotional instability. Until date, the pathogenesis of TGA remained unknown. There are myriad of Herpes simplex virus limbic encephalitis in a Filipino man with differential diagnosis which sometimes can be fatal if misdiagnosed, advanced stage testicular cancer: A case report thus prompting full investigations to exclude possible lethal causes.

J.J. Mejosa, J.A. Vatanagulb Objective aPerpetual Succour Hospital, Internal Medicine, Cebu, Philippines To report a case of transient global ischemia in which extensive bPerpetual Succour Hospital, Internal Medicine,, Neurology, Cebu, investigations were done. Philippines Case Case report A 50-years-old male suddenly complained feeling blank for 30 A 66-year-old Filipino Male, Hypertensive, Diabetic, diagnosed minutes after vigorous exercises. He was disoriented in regard to with Advanced Testicular Cancer presented with a five day history of time and place but still remember his name. Besides confusion, no fever, productive cough associated with sudden onset of behavioral other symptoms were reported. He denied any head trauma nor changes, memory lapses and disorientation. On admission, the similar history previously. Neurological examination was normal. patient was disoriented, with poor comprehension and inability to Transient cerebral ischemia, migraine, and epilepsy were excluded follow commands. There were no focal motor deficits or signs of from the basis of clinical symptoms and normal results of head MRI meningeal irritation. Cranial CT scan and serum electrolytes were (Fig. 1). Cardiac evaluation yielded no possible explanation for his unremarkable. CBC showed leukocytosis with predominant neutro- symptoms. US Carotid revealed slightly hypo-acceleration of right phils, chest xray revealed pneumonia. Piperacillin+ Tazobactam and MCA (Medial Cerebral Artery) (Fig. 2). Azithromycin was started On the second hospital day, he had seizures manifested as blank Result fi stares, teeth grinding, lip smacking and fidgety movement of the Among full investigations done, his TGA was classi ed as benign right hand. Electroencephalogram showed epileptiform discharges in and resolve spontaneously. Most possible precipitator of his TGA was both frontal-prefrontal and both frontal-central regions. A cranial physical exertion which causes intracranial venous stasis leading to MRI with Contrast revealed high T2W and FLAIR signal changes and ischemia in the memory formation region (temporal lobe, hippo- edema in the mesial temporal lobes and right insula (Figure 1) and campus and parahippocampus). right lentiform nucleus (Figure 2). EEG and MRI findings are consistent with Limbic Encephalitis based on the diagnostic criteria Conclusion by Gultekin et al.1(2014). TGA was generally a benign disorder but extensive investigations fi A lumbar puncture yielded a colorless cerebrospinal fluid (CSF) are still important to exclude other causes in rst case. with normal opening pressure, normal RBC and WBC, lymphocytic predominance (96%), elevated CSF protein and normal CSF glucose. doi:10.1016/j.jns.2019.10.989 CSF Acid Fast Bacilli (AFB), KOH and India Ink were all negative. Further CSF analysis for neuronal autoantibodies specifically Anti- NMDA, Anti- Hu and Anti- Ma2 were likewise negative. Polymerase Chain Reaction (PCR) assay for Herpes Simplex Virus was positive for HSV-1. Intravenous Acyclovir was started at 15mg/kg per day. WCN19-1289 After three weeks of antiviral therapy the patient's condition improved. Poster shift 02 - Autoimmune disorders - Part I/CNS infections - Part I/dementia - Part I/epilepsy - Part I/health economics and doi:10.1016/j.jns.2019.10.988 outcomes/neuroepidemiology and environmental and other

A case report: multi-modal therapy and multi-subspecialty management in a patient with thymomatous myasthenia gravis WCN19-1285 and pure red cell aplasia

Poster shift 02 - Autoimmune disorders - Part I/CNS infections - M.A.L. Imperial, M.V.G. Manuel Part I/dementia - Part I/epilepsy - Part I/health economics and Quirino Memorial Medical Center, Department of Adult Neurology, outcomes/neuroepidemiology and environmental and other Center for Neurological Sciences, Quezon City, Philippines

Investigations in case of transient global amnesia after The triad of Thymoma, Myasthenia Gravis and Pure Red Cell weightlifting Aplasia is a rare occurrence. The literature shows that there has been no reported case in the Philippines. This aims to report a case of P. Tiffani, E.E. Suryawijaya, V. Hartoyo, Y.M.T. Siahaan Thymomatous Myasthenia Gravis and Pure Red Cell Aplasia. This is a Faculty of Medicine, Universitas Pelita Harapan, Neurology, Tangerang, case of a 55-year-old female who started to have easy fatigability and Indonesia pallor four years ago. Initial work-up showed Pure Red cell Aplasia ARTICLE IN PRESS

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and thymoma. Patient refused to undergo thymectomy and was lost a month-long of hospitalization with no subjective complaints. This to follow-up. Three months prior, she noted progression of weakness case emphasizes that a multi-modal therapy with thymectomy and with associated ptosis and occasional dysphagia which were more immunosuppressants, and a multidisciplinary team management are evident in the afternoon. Patient was then diagnosed to have vital to have a favorable outcome. Myasthenia Gravis pre-operatively. Patient was started on Pyridostigmine, continued on Prednisone, and had plasmapharesis doi:10.1016/j.jns.2019.10.990 before complete resection of thymoma. Patient was discharged after