Poster Abstracts Wednesday, November 9, 2005 $357

speech revealed that PP did not use the full capacity of their motor speech abilities when expressing emotions.

Our data suggest that perception and expression of emotional conmmnication is impaired in PP already in an early stage of the disease. These changes are non-motor and point to all impairment of processing of emotions. The findings may have are relevance for the therapeutic strategies in Parkinson's disease.

I011 A Prospective Study Of Falls In 113 Patients With Parkinson's Disease

Fung, VSC l, Latt, MD ~, Lord, SR a, Morris, JGL a. 1Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, Australia; 2Falls & Balance Group, Prince of Wales Medical Research Institute, Sydney, Australia

Background: Falls are a major cause of morbidity in patients with Parkinson's disease (PD). There have been few prospective studies exanffrfing the risk factors that predict falls in PD. Methods: Baseline data were obtained fi'om 113 conmmnity-dwelling subjects with PD (age 66 ± 95%CI 1.6 years, 66 male, height 171 ± 1.4 cm and weight 72 ± 2.9 kg), including clinical history, general medical and neurological examination, UPDRS, Hoehn and Yahr Staging, Timed Get-Up and Go test, MMSE, and the Frontal Assessment Battery. The number and nature of any falls and subse- quent injuries sustained over a twelve month follow-up period were detemrined prospectively using a falls diary recorded daily by patients and monthly telephone call perfonlled by one of the investigators (ML). Multivariate logistic regression analysis (backward stepwise method) was used to identify factors that independently predicted Falls. Results: Independent predictors of falls were a fall in the previous year (OR 3.9, CI 1.4 11.4, p -- 0.010), freezing of gait (FOG) (OR 3.5, CI 1.~9.8, p -- 0.017), frontal lobe intpaimtent (OR 4.3, CI 1.4 13.5, p - 0.009), higher levodopa dose (p - 0.020) and abnormal mxial posture (p -- 0.022). This model predicted 38/51 railers (sensitivity 75%) and 45/62 non-railers (specificity 73%). Conclusion: Falls in PD can be predicted by a history of falls, FOG, frontal lobe impairment, high levodopa dose and abnormal posture. These data are important in desigtffng therapeutic interventions that might prevent falls in patients with PD.

1012 Multiple coiling of subcutaneous leads in deep brain stimulation in Partdnson's disease: A rare Coulplieafion for lead nmltimetion

Goyal, V, Vaishya, S, Behari, M. AIIMS, New Delhi, India

Subthalamic deep brain stimulation (St DBS) is the treatment of choice in patients with Parkinson's disease, who develops uncontrolled levodopa induced dyskinesias. Tiffs 55 year old lady underwent bilateral St DBS for uncontrolled peak dose levodopa induced dyskinesias. On 2nd postoperative day she had serous collection in the pacemaker subcutaneous pocket, which was drained. At 3 months post operative period her head tremors during off period were not controlled and she had vigorous head tremors. Electrode impedance was very lffgh on left side, wlffch suggested lead malfunctioning, and lead replacement was planned. Intraoperatively on exploration of the subcutaneous lead track, both the lead were found coiled overreach other more then 15-20 times. Mechanism of such a rare complication will be discussed by disgrams.

1013 The role of G196A polymorptfisul in the brain-derived neurotroplfie factor (BDNF) gene in the cause of Parkinson's disease: a meta-analysis

Georgios M. Hadjigeorgiou l, Elias Zintzaras 2. 1Department Neurology, Neurogeneties Unit, University Hospital of Larissa, University of Thessaly School of Medicine, Papakyriazi 22, Larissa 41222, Greece; 2Department of Biomathematics, University of Thessaly School of Medicine, Papakyriazi 22, Larissa 41222, Greece

The association between Parkinson's disease (PD) and the G196A polymorphism in the brain-derived neurotrophic factor (BDNF) gene has been investigated in several case-control studies, producing contradictory results one study indicated that homozygocity of AA is associated with PD, another study produced the opposite result, whereas other studies urged there is no association. In order to investigate these contradicted findings, a meta-analysis of all available association studies between the G196A polymorphism and the risk of developing PD was conducted. Four out o f six identified studies included populations of East Asian descent, and two included population of European descent (Whites). Overall, the meta-analysis of the allele contrast (A vs G) suggested large heterogeneity between studies (p - 0.07, I z - 51%) and no association between G196A and the risk of developing PD: random effects odds ratio OR -- 1.00 [95%ci (0.85, 1.18)]. The sensitivity analysis (exclusion of two studies (one East Asian and one White) with the controls not in HWE showed large heterogeneity (p -- 0.10, 12 - 52"/o) and no significant association: random effects OR -- 0.94 [95%d (10.77, 1.15)]. The subgroup analyses for East Asians and Whites produced no significant association. In addition, the contrast of homozygotes, and the dominant and recessive models for allele 196A did not support a major role for the polymorptffsm in the pathogenesis of PD. There were no source of bias in the selected studies, and the differential magnitude of effect in large versus snmll studies was not significant. The meta-analysis results, suggested further exploration of the involvement of the BDNF gene in the susceptibility to PD with larger and more rigorous population association studies.

1014 How to treat hallucinous patients with Parkinson's disease

Kazuko Hasegawa, Elmko Horiuchi, Hisayuki Kowa. Department of Neurology, National Hospital Organization, National Sagamihara Hospital, Sagamihara, )'apart

Background and Aim: Hallucination is one of the major non-motor problems in advanced Parkinson's disease (PD). There are many medical procedures concenffng haw to manage PD hallucination in various treatment manuals. In many of them, first procedure is reduced dopanrinergic agents such as dopanffne agonist, anmtantadine, seregelin and so on. However, reduced dopaminergic agents produced to both deterioration of motor performance and diminished of self- efficacy. So that, these deterioration problems would tend PD patients to fall into a vicious cycle. We tried to manage to control of hallucinous PD patients without reducing dopanffnergic agents through a trial and error process. The purpose of tiffs report was to introduce our procedures concerning how to treat for hallucination in the patients with PD. Subjects and Methods: Out-and in-patients with PD in our hospital were about 250 cases. Several cases showed hallucination. Out-patients with PD who showed mild hallucination such as visual hallucina- tion were controlled with donebezil or quetiapine, rn case of moderate to severe hallucination, we added quefiapnie up to 200rag/day. However hallucination could not controlled with quetiapine, we added olanzapiene or risperidone without reduction of dopaminergic agents. Results anti Conclusions: We could control hallucinous patients without deterioration in motor performance.

1015 Urinary 8-hydroxydeoxyguanosine levels as a bioularker ior progression of earldnson's disease

$358 Wednesday, November 9, 2005 Poster Abstracts

Hattori, N, Sato, S, Mizuno, Y. Department of Neurology, Juntendo University School of Medicine

Background: Oxidative stress and mitochondrial respiratory failure are implicated as two major contributors to loss of dopanffnergic (IDA) neurons. Recently, urinary levels of 8-OHdG were measured in patients with cancer, diabetes mellitus, lupus erythematous, and atopic dermatitis to evaluate the clinical stage or the response to therapy 8-hydroxydeoxyguanosin (8-OHdG) has been used to evaluate oxidative stress. We investigated the levels of urinary 8-OHdG in Parkinson's disease (PD) patients and in normal and disease control groups. Methods: We studied 72 patients with PD (age: 67.3 ± 1.6 years, range: 47-88), 16 patients with multiple system atrophy (MSA) (age: 63.7±1.7 years, range: 51-79), and 48 normal controls (age: 57.5 ± 0.6 years, range: 41-85). Urinary 8-OHdG concentrations were measured using an enzDne-linked inmmnosorbent assay (ELISA) system using a monoclonal antibody specific for 8-OHdG (Nippon Yushi, Tokyo, Japan). Results: The mean urinary 8-OHdG/creatinine ratio for each PD stage was Stage I: 15.0± 1.1, range: 11.90-23.02, Stage II: 22.9 ± 1.8, range: 13.47-32.00, Stage III: 30.2 ± 3.2, range: 20.53-50.11, Stage IV: 36.9±2.3, range: 26.72-51.00, and Stage V: 46.6±2.0, range: 39.76- 68.69. The ratio increased significantly with the progression of the disease (p < 0.01, for Stage I and II, Stage II and IV, and Stage IV and V). Conclusions: Our results suggest that urinary 8-OHdG is a potentially useful biomarker for evaluating the progression of PD.

1016 Olfactory testing hdps tremor diagnosis and ~lOWS that patients with familial essential tremor are snper-smellers and resist aging

Hawkes, C, Findley, L, Muhammed, N, Shah, M. Essex Neuroseienee Centre, UK

Background: It is unclear whether patients with essential tremor (ET) have intact sense of smell. If olfaction was normal it would help distinction from tremor-dominant parkinson's disease (PD) where smell sense is usually impaired. Methods: 59 patients with ET were compared to 245 controls by the 40 odour University of Pennsylvania Smell Identification Test (UPSIT- 40) and to 74 controls by olfactory event related potentials (OERP). 64 patients with tremor dominant PD were also compared to the control group by UPSIT and OERP. Mean UPSIT scores were compared between groups using multiple regression of UPSIT on group indicators and gender, age and age squared as covariates. Mean latency and anlplitude was compared using nmltiple regression models with gender and a linear term in age as covariates. Results: On all olfactory tests healthy controls and ET patients were indistinguishable when allowance was made for the effects of age, smoking and gender (p - 0.016). There was a highly significant difference in mean values between ET and PD on both olfactory tests (p < 0.001). Fanfflial ET patients scored significantly better than controls on UPSIT (p < 0.001) and their age-related rate of decline was slower (iJ -- 0.035), but there were no differences for OERP. Conclusion: These differences between tremor group could be useful clinically. The finding of normal olfaction in suspected PD or abnor- mal smell in suspected ET warrants diagnostic review. The superiority of fanfflial ET subjects and their relative resistance to aging suggests the presence of a hitherto unrecogtffsed genetic protective mechanisnl.

1017 Early assessment of fluctuations in patients with Parldnson's disease

Silbur, PA ~, Vieira, BI 2, Danta, G 3, Siejka, SJ 4 , Schultz, DW s, Robinson, M K 6, Boyle, RS 7, Indetjeeth, CA s, McCrory, PR -~, Herawati, L i°. ~ Princess Alexandra Hospital, Brisbane, Australia," 2Osborne Park Hospital, Perth, Australia; 3The Canberra Hospital,

Canberra, Australia; 4private practice, Launeeston, Australia; SFlinders Private Hospital, Adelaide, Australia; 6Private Practice, Adelaide, Australia; 7Princess Alexandsa Hospital, Brisbane, Australia; SSir Charles Gardner Hospital, Perth, Australia; 9Box Hill Hospital, Melbourne, Australia; 2°Novartis Pharmaceuticals, Sydney, Australia

Background: Recent evidence suggests that as many as 38-48% of patients with Parkinson's disease (PD) experience motor and non- motor fluctuations as early as 2 years after starting levodopa treatment (Parkinson Study Group, 2000). Early identification may allow modi- fications of treatment to improve quality of life and optimise symptom control. Method: 95 patients diagnosed with PD less than 5 years previously and considered free of fluctuations completed a 19-item self-report End of Disease Wearing-Off (EODWO) questiomtaire (Stacy et al, 2003) during a routine neurology consultation. Results: Patients averaged 69 years (range 43-90), had a mean UPDRS motor score of 13 (range 2-47) and 75% were in Hoehn and Yahr stage 1 or 2. There were 56 (161%) patients assessed by the neurologist/geriatridan as fluctuating based on the questionnaire. Motor fluctuations were identified in 52 (157"/o) and non-motor fluctuations in 21 (23%). The questionnaire was straightforward, with 45 (49"/0) of patients completing it unassisted. Clinicians rated the questionnaire as 'very useful" or 'quite useful" for detecting motor fluctuations in 43 (77%) cases and for detecting non-motor fluctua- tions in 23 (143%) cases. Changes to treatment were considered for 34 (61%) patients identified with fluctuations, and in 23 (41%) cases the clinician reported the questionnaire influenced a decision to change treatment. Conclusions: Early and previously unrecognised motor and non- motor fluctuations are common in patients with PD. The EODWO questionnaire, readily applied in routine clinical practice, can assist timely identification of fluctuations and facilitate optimisation of PD treatment.

1018 Does Low Dose Pargolide Cause Serious Valvulopathy?

Isonishi, K ~, Moriwaka, F 2, Mikami, T 3, Sugawara, T ~, Muraki, M 1, Kitaguclff, M 1, Kaneko, S i, and Kaslffwaba, K i. 1Kashiwaba Neurosurgery Hospital, Sapporo, Japan; 2Health Sciences University of Hokkaido, Sapporo, Japan; 3Hokkaido University, School of Medicine, Sappor o , Japan

Background: Unexpeaedly high occurrence of valvular heart disease has been reported as a complication of pergolide in patients with Parkinson's disease (PD). However, the incidence and the critical dosage remain to be settled. Objective: The aim of tiffs study is to clarify the incidence and the severity of valvular heart disease in PD patients treated with low dose pergolide. Patients and Methods: From July 2004 to January 2005, 92 patients with PD were investigated. 40 patients (25 women and 15 men, mean age 71 ± 6 years) were taken pergolide, 0.7 ± 0.6mg/day ranging from 0.05 to 1.5mg/day for 4 7 ± 3 2 (from 2 to 115) months and the cumulative dose was 748± 641(from 14 to 2415) mg. Age matched 32 PD patients (20 women and 12 men, mean age 71± 7 years) in whom ergot derivative dopamine agorfists had never been taken were extracted as control. Echocardiograplffc exanffnation was performed. The states of aortic, mitral, pulmonary and tricusupid valves, i.e., thickening, restriction, tenting and regurgitation, were evaluated. Comparison was made between pergolide group and control group. The difference was analyzed with X 2 statistics. Results: Mild tricusupid regurgitation (TR) was found in 33% of pergolide group and was significantly higher than that in 13"/o of control (p < 0.05). As regard as aortic, mJtral, and pulmonary valves, there was no difference between pergolide group and control.