"Articles of Incorporation for a Reability Center"
SECOND SCIENTIFIC CONFERENCE “RESTAURACIÓN NEUROLÓGICA 2004” Havana City, February 24-27, 2004 Co-sponsors International Brain Research Organization International Society for Neurochemistry And the cooperation of: International Neuropsychological Society International Federation of Clinical Neurophysiology British Neuroscience Association European Neurological Society American Society for Neurochemistry Sociedad Iberoamericana de Informacion Cientifica (SIIC) ACNR Magazine (Advances in Clinical Neuroscience & Rehabilitation) Tuesday 24 february 2004 Precongress Course: Neurogenesis and brain repair 24A1 Restorative Neurology. Hopes and perspectives Jorge A. Bergado International Center for Restorative Neurology (CIREN) Havana, Cuba Restorative neurology is a new developing branch of Neurology, aiming to the recovery of nervous functions affected by disease or trauma. The concept and accumulated knowledge of neural plasticity have provided a conceptual frame to explain recovery and for the planning of new therapeutic strategies. Developments in basic Neurosciences have lead to new concepts and potential tools intended to improve efficacy of therapy. Neural transplantations have been tested with excellent results in animal models for Parkinson´s Disease. Results in humans have been limited by several factors, particularly the low survival rate of transplanted cells. Trophic factors with actions on nerve cells have been under intensive study during the last decades. Several factors have hindered its clinical application and new strategies are searched to open the ways to clinical practice of this powerful molecules. The most recent development in Neural Sciences have ended with the old dogma of no new neurons in the adult brain. Research on stem cell of neural or non- neural origin represents one of the more promising efforts for the future of Restorative Neurology. 24A2 Stem cells for brain repair Mendez Ivar Brain Repair Centre, Dalhousie University and Department of Neurosurgery, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada Brain repair, using restorative approaches such as stem cell neural transplantation holds the greatest promise for the treatment of neurodegenerative disorders and other incurable neurological conditions such as stroke and spinal cord injury. Stem cells are pluripotent and have the capacity to differentiate into neurons and provide us with unlimited neuronal populations of specific phenotypes such as dopaminergic neurons for the treatment of Parkinson‟s disease. This presentation will explore the concepts of brain repair using stem cell transplantation and intrinsic repair by resident adult stem cells. The potential applications of embryonic, adult and skin-derived stem cells in brain repair strategies for Parkinson‟s disease, stroke and spinal cord injury will be reviewed. Bioreactor technology for the standardized production of stem cells in large quantities will be discussed. Particular emphasis will be given to neural transplantation techniques and histological analysis of stem cell grafts in the mammalian brain. Behavioral tests used in assessing the ability of stem cells to restore function in animal models of Parkinson‟s disease, stroke and spinal cord injury will also be reviewed. Finally, the challenges of stem cell research and the potential of translating brain repair strategies using stem cells from the laboratory bench to the clinical setting will be discussed. 24A3 Programmed cell death of adult-generated hippocampal neurons is mediated by the pro- apoptotic gene Bax Ronald W. Oppenheim and Woong Sun Wake Forest University School of Medicine, Department of Neurobiology and Anatomy, Winston-Salem, USA In the dentate gyrus (DG) of the adult mouse hippocampus, several thousand new cells are generated daily, but only a small subset of these survive and differentiate into mature neurons, whereas the majority of the newly generated cells undergo programmed cell death (PCD). However, neither the intracellular machinery required for adult stem cell-derived neuronal death, nor the biological implications of the significant loss of these newly generated cells have been examined. Several markers for apoptosis failed to reveal cell death in Bax-deficient mice, and this together with a progressive increase in neurons number in the DG of the Bax-KO, indicates that Bax is critical for the PCD of adult-generated hippocampal neurons. In Bax-KO mice, doublecortin (DCX)-labeled early migrating neurons were ectopically localized in the hilus, and the majority of the DG neurons failed to express the mature DG neuronal marker, calbindin. Furthermore, in the absence of PCD in the DG, there were age-dependent perturbations of spontaneous locomotor activity in the Bax-KO mice. These results suggest that PCD in the adult brain plays a significant role in the regulation of adult neurogenesis and in its absence some aspects of hippocampal- mediated behavior are affected. 24A4 Neuronal differentiation potential of neural stem cells versus embryonic stem cells José-Manuel Baizabal, Mayra Furlán-Magaril, Yuri Ximello, Jesús Santa-Olalla, and Luis Covarrubias Departamento de Génética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Cuernavaca, Mor. 62210, México Recently, enormous interest in neural stem cells (NSCs) has arisen from both basic and medical points of view. Different NSC populations have been identified, which emerge in time and tissue specific manner during development. On the other hand, distinct diseases associated with reduction in specific neuronal populations affecting humans are urgently requiring of therapeutic procedures that use NSCs. The discovery of neurogenesis in the adult brain opens the possibility to induce specific neuronal regeneration from endogenous NSCs. In this regard, characterization of neurogenesis during development will play a fundamental role for the rational design of those therapeutic procedures. In order to study the in vivo differentiation potential of different NSC populations and the influence of the surrounding environment on NSC-specific differentiation, we have designed a system based on the implantation of NSCs in explant cultures of different developing nervous system regions. Our data indicate that NSCs in culture modify its original differentiation potential and that local factors influence their fate. Particularly, we found that neurosphere-derived cells in natural developing environments do not differentiate markedly into neurons, whereas NSCs derived from embryonic stem cells do. Finding the right NSC population and/or the factors guiding its specific differentiation will be the first step for the development of therapeutic procedures based on activation of NSC differentiation. This work is supported by DGAPA and CONACyT. Precongress course: Assesment and rehabilitation of memory disorders 24B1 Assessment and rehabilitation of memory disorders Hans J. Markowitsch Physiological Psychology, University of Bielefeld, Bielefeld, Germany Assessment of memory will be described as a theory-guided process which has to rely on knowledge of brain circuits engaged in time-based (short-term/working memory, long-term memory, anterograde/retrograde amnesia, encoding, storage, retrieval) and contents-based information processing (procedural memory, priming, perceptual, semantic, episodic memory, verbal/non-verbal memory). Furthermore, it will be emphasized that memory should never be assessed in isolation, but has to be embedded in a broad range of additional tests covering personality dimensions, attention and concentration abilities, intelligence, sensory and motor (including language) abilities, etc. The resulting intellectual profile will show preserved abilities and dysfunctions and provides a prerequisite for successful rehabilitation. Concerning rehabilitation, it is again necessary to base this on current theories of memory functioning, for example, on distinctions between implicit and explicit memory training programs (e.g., errorless learning, method of vanishing cues, method of loci, imagery, association learning procedures, internal and external memory strategies in general). Of special importance is that training is generalized to everyday situations and that a proper level of motivation has to accompany the patients' training program. Precongress course: Speech and reading mechanisms 24B2 Localisation of syntactic and semantic sentence processing using magnetoencephalography (MEG) Elisabet Service ab , Paivi Heleniusc , Sini Mauryb and Riitta Salmelinc a Cognitive/Clinical Neuroscience Unit, Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada, b Department of Psychology, University of Helsinki, Helsinki, Finland, cBrain Research Unit, Low Temperature Laboratory, Helsinki University of Technolo gy, Helsinki, Finland Finnish is a morphologically rich language in which nouns can occur in 15 different cases. Case inflections are used both to signal syntactic (e.g., subject vs. object) relations and semantic (e.g., location in vs. movement from within something) relations. Participants were presented with written sentences that ended in normally inflected nouns, nouns in the wrong case, verbs instead of nouns, or nouns that were correctly inflected but made no sense in the sentence context. The data were analysed in three ways: 1) MEG raw data from nearby channels were averaged to area activations, 2) equivalent current dipoles were modelled, 3) minimum current estimates were modelled. The three methods of analysis supported each other, revealing two major sources of activation correlated with incongruent sentence-ending words. In a time window from 350 to 450 ms, semantically anomalous last words gave rise to the highest activation in the left temporal lobe with clear activation of the same sources also for incorrect word class words and morphological errors. Weaker activation was seen in homologous areas in the right hemisphere. In a later time window, 600–700 ms after word onset, the largest activation was seen to words of incorrect word class and morphological errors at the ends of sentences. Semantically anomalous words did not deviate from correct words in this time window. This activation was localised to more posterior bilateral sources in the temporal lobe. 24B3 Dynamic visual processes in normal reading: implications for developmental dyslexia? Piers Cornelissena, Kristen Pammera, Ruth Lavisa and Peter Hansenb a School of Biology, University of Newcastle, Newcastle, UK, b Centre for Cognitive Neuroscience, FMRIB Centre, Oxford University, Oxford, UK Data from two studies relating visual task performance to contextual reading are presented. The first study investigated the relationship between contextual reading and, a) relative spatial encoding for symbol arrays, and b) central versus peripheral sensitivity to the frequency doubling illusion. In the first study, thirty school children were measured on their ability to solve a foveally-presented spatial encoding task, as well as their sensitivity to the frequency doubling illusion across the retina. Their performance in the frequency doubling and spatial encoding tasks was uncorrelated, suggesting that these tasks tap independent visual processes. Peripheral (but not central) sensitivity to frequency doubling, and spatial encoding, predicted statistically significant, independent proportions of variance in contextual reading (Neale Analysis of Reading). These effects persisted even when variance due to age, IQ, phonological skill and short-term memory was statistically accounted for. The data suggest that successful reading requires not only information about letter identity, but also at least two additional sources of information, probably related to spatial processing of words. The first is a central mechanism that may define the relative spatial location of letters within words, and the second is a peripheral mechanism that we speculate may be related to the attentional processes involved in coarse-scale localisation within a body of text. Consistent with this speculation, we found in the second study, that reading accuracy for dyslexic readers was most impaired relative to chronological- and age-matched controls when contextual material was presented in whole paragraphs, rather than line-at-a-time or word-at-a-time reading conditions. 24B4 Dissociated semantic access for spoken words and environmental sounds Guillaume Thierrya, Anne-Lise Giraudb and Cathy Price c a School of Psychology, University of Wales, Bangor, UK, b Cognitive Neurology Unit, J.W. Goethe University, Frankfurt am Main, Germany, cWellcome Department of Imaging Neuroscience, Institute of Neurology, London, UK Left hemispheric dominance for language processing has long been established. Recently, in an attempt to tease apart the neural substrates involved in manipulating verbal and nonverbal information using Positron Emission Tomography, we have found signs of functional dissociation between the left and the right superior temporal cortices for accessing the meaning of spoken words (Words) and environmental sounds (Sounds), respectively (Thierry, Giraud and Price, 2003, Neuron, 38:499-506). We have then sought converging evidence for the dissociation from Event- Related Potentials (ERPs). In a context of dichotic listening, acoustic signals from the left ear are better received by the right auditory cortex and signals from the right ear are better received by the left auditory cortex. Therefore, when a Word is presented to the right ear while a Sound is presented simultaneously to the left ear (Optimal condition according to the previous P ET study), semantic integration should be easier than when the sides of presentation are permuted (Crossed). Fifteen participants were asked to perform semantic congruency judgement on dichotic pairs of Words and Sounds which had the same meaning or not and which were presented as Optimal or Crossed pairs. We expected to find a classical N400 ERP modulation induced by semantic incongruence and a further N400 modulation for Crossed versus Optimal presentation. We found that N400 peak latencies were delayed by approximately 60 ms for Crossed pairs as compared to Optimal pairs, irrespective of semantic congruency. This is consistent with a functional lateralisation of semantic access depending on stimulus symbolism. 24B5 Lexical stress and sublexical phonology influence spoken word recognition mechanisms: an ERP study John F. Connollya and Jing Tian Wanga,b a Cognitive/Clinical Neuroscience Unit, Department of Psychology, Dalhousie University Halifax, NS, Canada, b Cognitive Electrophysiology Laboratory, NY Psychiatric Institute - Unit 6, NewYork, NY, USA Theories of spoken word recognition can be divided into two major themes: “sequential” and “goodness of fit.” A third class of model proposes that prosodic or stress features of speech are critical for word identification. This study describes research that used ERP to hypothesis test between theories that do or do not account for stress. ERP were recorded to the terminal words of sentences in five conditions: Congruent (“Three people were injured in a highway accident”); Non- initial stress & prime (“She told the lost tourist to turn right at the traffic polite (light)”; Initial stress & prime (“Eight minus seven equals wonder (one)”; Non-initial stress/initial prime (“The pirate wore a patch over his idea (eye)”; Incongruent (“The spider sat in its web awaiting a closet (fly).” Also, 120 fillers were used (“The girl had long brown hair.”). Two components, the phonological mismatch negativity (PMN) and the N400, were differentially affected by these manipulations. The PMN to both the Incongruent and Eye/Idea conditions differed from each other and were both larger than the PMN seen in the other three conditions. The N400 proved to be sensitive to both stress and sub-lexical phonology with larger amplitudes seen in the Incongruent condition compared to the Eye/Idea and One/Wonder conditions which, in turn, were larger than those seen in the Light/Polite and Congruent conditions. Both the PMN and N400 findings support the importance of word stress in spoken word recognition and its relevance to any theory of spoken word recognition (e.g., the MERGE model). Precongress course: Face to face with MCI 24B6 Clinical Markers to Predict Progression from Mild Cognitive Impairment to Alzheimer Disease M.Borrieab , M. Smithb , J. Wellsab , J. Mowatb a Division of Geriatric Medicine, University of Western Ontario. b Aging Brain Clinic, Parkwood Hospital 801 Commissioners Road East, London, Ontario, Canada N6C 5J1 Mild Cognitive Impairment (MCI) is an evolving concept in the field of dementia. To date, there is no way to predict which patients with this diagnosis are more likely to progress to Alzheimer disease. The purpose of this retrospective analysis was to examine whether measures of daily function could predict who would progress to Alzheimer disease following a diagnosis of MCI. Methods. Analysis of longitudinal data from patients with the diagnosis of Mild Cognitive Impairment was examined. Variables related to cognitive and functional measures were assessed and, based on conversion status at 2 years, predictor variables were analyzed. Mini-Mental Status Examination total score and Lawton-Brody Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scale (PSMS) subscale and total scores were analyzed.Results. Eight of the patients (40%) progressed to Alzheimer disease over the following 2 years. Subscale analysis revealed that there was a significant difference between groups with respect to their ability to plan and prepare meals (p<0.05). This difference was independent of gender. There was no significant difference in age (p>0.05), gender (p>0.05), or baseline MMSE scores (Conversion = 27.0 vs Non- Conversion = 27.3, p>0.05). Total IADL and PSMS scores did not predict conversion. Discussion. Subscale IADL items are more sensitive to change than cognitive screens or total IADL scores. The relative impact of particular IADL‟s may be lost in Total ADL scores. Outcome scales such as Goal Attainment Scaling of individualized activities may be a more sensitive measurement technique to predict conversion of people with MCI to dementia. 24B7 Mild cognitive impairment – fact or fiction? Anna Marriot, Roger Bullock Kingshill Research Centre, Victoria Hospital, Sw indon, UK MCI is a clinically significant syndrome, but remains poorly characterised and unlinked to patient perceptions of the impact of the condition. It is generally considered a pre dementia syndrome, but the objective of this paper is to argue that within the current accepted MCI spectrum more than one area of cognition can be demonstrated, functional decline can be measured reliably and patient and carer aspects of life are altered. The methods used are analysis of cognitive testing in controls, MCI patients and AD patients from the memory clinic database, a correlation of the Bayer-ADL scale with a staging instrument and focus groups of patients and informants with both MCI and AD. Results show a spectrum of cognitive impairments, not just memory, increasing in severity even before research criteria standards for dementia are met; significant changes in all items on the Bayer-ADL scale between Global Deterioration Scale 2 and 3 and focus group informants showing under reporting of problems by the patients with MCI – in a manor very similar to that previously described in dementia studies, plus a patient perspective of MCI that mirrors a lot of difficulties faced by those with very mild AD. These results thus suggest that the current definitions of MCI do meet most diagnostic criteria for dementia, and pose the question as to why the “diagnosis” is needed. Several possible explanations will conclude the presentation. 24B8 Self-Administered Mild Cognitive Impairment Touch Screen Tests: The CANS-MCI Study Emory Hill. Seattle, WA, USA This presentation examines the validity of a fully self-administered instrument, the Computer- Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI), with respect to its ability to provide useful screening information about the need for full diagnostic evaluations of dementia. The CANS-MCI can generate automated graphical reports of longitudinal findings in languages other than those used for test administration and using images that are country-specific. 310 elderly community-dwelling volunteers enrolled in a 3-year longitudinal NIA-funded study in the US. Baseline, and 6-month data are presented. Analyses include confirmatory factor analysis of baseline data on CANS-MCI tests along with concurrent Weschler Memory Scale, WAIS Digit Symbol and Mattis DRS scores. ANCOVAs examined changes at 6- months a, controlling for baseline scores. Results: The validity of the CANS-MCI as a screening instrument for MCI was supported. Confirmatory factor analyses supporting a 3-factor model (Memory, Language/Spatial Fluency and Executive Functioning) provided the basis for testing change scores within cognitive domain factors. Normal and MCI groups for each factor were determined by standardized test scores. Significant group differences over 6 months time were found within each factor for CANS-MCI tests (p<.05). Conclusion: The CANS-MCI is an easily administered screening tool measuring all cognitive dimensions that predict the need for treatment. Analyses indicate respectable levels of validity, three primary factors predictive of Alzheimer‟s, and the ability to distinguish between MCI and normal functioning over time. The CANS-MCI provides change scores that signal the need for full neuropsychological evaluations early enough in the pre- clinical phase of the disease to enhance the timing of treatment decisions. 24B9 Homocysteine: a new risk factor for cognitive decline, vascular and Alzheimer’s dementia Angeles Garcia Associate Professor, Medicine Queen’s University, Kingston, Ontario, Canada In recent years, the impact of serum tHcy on cognitive function in the older population has started to emerge. Several studies have shown a relationship between tHcy and dementia and between tHcy and cognitive decline associated with aging. Homocysteine is a B-vitamin dependent aminoacid produced during the metabolism of methionine. Elevated tHcy results form low levels or function of folic acid, cobalamin (Clb) or B6, therefore it might be possible to reduce tHcy levels with vitamin therapy, raising the hope for possible preventive treatments. Elevated serum tHcy has been found to be an independent risk factor for the development of Alzheimer‟s disease. In a recent 8-year follow- up study from the Framingham Study cohort, the authors found that elevated tHcy was an independent risk factor for the development of Alzheimer‟s disease 8 years after baseline, and that the risk increased with higher levels of tHcy. Similarly, an association between elevated tHcy and dementia has been described in other populations. Results from the UK have shown that serum tHcy levels are significantly higher among patients with Alzheimer‟s disease (AD) than in the normal elderly population. In a recent study elevated tHcy was found to be more common among patients with vascular dementia than in patients with AD. Cross-sectional studies in the healthy elderly have yielded conflicting results. Some authors have found significant associations between tHcy levels and cognitive function while others did not. Early studies in a small sample of an Italian healthy elderly population showed no significant correlations between the Mini-Mental State Exam (MMSE) scores and tHcy levels. However, the same authors later found, in a much larger population group, that the risk of lower MMSE scores increased with increasing levels of plasma tHcy, and that tHcy had an independent graded association with cognitive impairment. Cohort studies on the relationship between tHcy levels and scores of cognitive function tests have yielded more consistent results. An early study by McCaddon et al., showed that elevated tHcy at baseline could predict lower verbal and visuospatial deficits at 5-year follow-up. Although initial results from a nested case-control study from the Rotterdam cohort showed no relation between tHcy levels at baseline and decline in scores of the Mini-Mental State Exam (MMSE) (by more than 1 point/year) 2.7 years after baseline, in a population that included younger adults (age >55), follow- up studies from the same Rotterdam cohort showed significant associations between elevated levels of tHcy and scores in a battery of psychometric tests, including the Stroop test, among subjects whose baseline MMSE was lower than 26/30. Recently, in a large cohort study (the Maastricht Aging Study, or MAAS) that included normal subjects 30 to 80 years of age, Teunissen et al found significant correlations between tHcy levels at baseline and scores of tests of cognitive performance, including the Stroop and the Word Learning Test, at baseline and at follow-up. In our cohort study of community living, cognitively normal older adults (with a mean MMSE of 28.4 at baseline and follow-up), we found that tHcy levels at baseline and increases of tHcy levels from baseline to follow-up 2.3 years after, were significantly related to lower scores in the Stroop test at follow-up, independently of other variables, and that the rate of change of tHcy from baseline to follow-up was inversely and negatively correlated with the rate of change in the Stroop scores. Interestingly, declines in the Stroop score were even seen in subjects whose tHcy levels were in the upper range of the normal limit, suggesting that what is considered as “within normal” tHcy levels might already contribute to cognitive deterioration. In conclusion, serum levels of tHcy have been associated with cognitive function in older adults. High levels of tHcy and increases of tHcy over time confer a significant risk of worsening of cognitive function and dementia. There are no published treatment trials aimed at decreasing levels of tHcy, and therefore, it is not known if supplements of B-vitamins can prevent or revert cognitive damage in this population. Given the magnitude of the disease, such studies are warranted. Wednesday 25 february 2004 Plenary lecture 25A1 Growth Factor Gene Therapy in the Central Nervous System Mark Tuszynski, Armin Blesch, James Conner, Mary Pay University of California-San Diego, La Jolla, California. USA Growth factors influence nervous system development, functional plasticity, and responses to injury. The neurotrophin family of growth factors (NGF, BDNF, NT-3 and NT-4/5) is the most extensively characterized of nervous system growth factors. NGF prevents injury-induced and age- related degeneration of basal forebrain cholinergic neurons in rodents and primates, ameliorates spatial memory decline in rodents, and reverses declines in cholinergic systems in a mutant mouse model of amyloid over-expression. Satisfactory means of delivering neurotrophins to focal brain regions, without exposing non-targeted neurons to growth factors, is required for the practical implementation of growth factor delivery in the clinic. Gene delivery is one means of potentially meeting growth factor delivery requirements to the brain. Based upon extensive efficacy and safety data in primates, we have begun a clinical trial of growth factor gene delivery in Alzheimer's disease (AD) to test the hypotheses that 1) NGF delivery will prevent cholinergic neuronal decline in AD, and 2) that reducing the extent of cholinergic neuronal degeneration will ameliorate cognitive decline in AD. Neuroplasticity and brain repair 25A2 Extensive cortical rew ir ing follow ing brain injury Numa Dancause a, Scott Barbaya, Shawn B. Frosta, Erik J. Plautza , Daofen Chenc and Randolph J. Nudoa,b a University of Kansas Medical Center, Department of Molecular and Integrative Physiology, b Kansas University Medical Center, Center on Aging, cNational Institute of Neurological Disorders and Stroke, USA In a previous publication, we showed that the ventral premotor cortex (PMV) underwent neurophysiological remodeling when examined a few months after injury to the primary motor cortex (M1). In the present study, we examined cortical connections of the reorganized PMV. We provide evidence that PMV substantially increased its connections with the primary somatosensory cortex (S1). These results support the hypothesis that following a cortical injury, as might occur in stroke, cortical areas distant from the injury undergo major neuronatomical reorganization, involving sprouting of corticocortical axons over long distances. Cortical rewiring over such distances has not been demonstrated previously in adult subjects, and is likely to contribute to behavioral recovery after stroke. 25A3 Motivational consolidation of LTP. Mechanisms and effects of aging. William Almaguer-Meliana , Jorge A. Bergadoa, Sabine Freyb and Julietta U. Freyb a International Centre for Neurological Restoration (CIREN), La Habana, Cuba. b Leibniz Institute for Neurobiology, Magdeburg, Germany Long-term potentiation (LTP) is a form of synaptic plasticity expressed in excitatory synapses in form of an activity-dependent increase in synaptic efficacy, which might be involved in learning, and rehabilitation. It has been shown that LTP can be modulated in its duration by emotional/motivational factors (motivational consolidation, MC). However, the mechanisms involved in such interaction are not known. We have studied this issue, and the consequences of aging on motivational reinforcement of LTP in the dentate gyrus, combining behavioral, electrophysiological, pharmacological, and biochemical methods. Results show that the amygdala is a key structure in MC. Its stimulation mimics the effect of behavioral reinforcers and its temporal or permanent inactivation blocks MC. This effect seemed to require the mediation of septal afferents. Lesioning the fimbria-fornix abolishes MC while stimulating the septum mimics the effect of behavioral reinforcers. The pharmacological studies indicate a role for noradrenergic systems. Antagonists (propranolol) block MC, while agonists (norepinephrine) cause a similar reinforcing effect. A role for cholinergic systems have also been shown, but resulted controversial in pharmacological experiments using antagonists (atropine) or agonists (oxotremorine). MC requires protein synthesis as is completely blocked by anisomycin. Microdialysis-biochemical studies have shown an increase in acetyl choline and a reduction in norepinephrine and serotonine release at the dentate gyrus after amygdala stimulation; while behavioral reinforcing paradigms showed changes in glutamate and glycine, suggesting that different sub-systems might mediate different forms of reinforcement. Finally we have shown that aging, associated with cognit ive impairments have a profound effect impairing mechanisms of motivational consolidation, induced both by a behavioral reinforce or the stimulation of the amygdala 25A4 The contribution of the basal forebrain cholinergic system to cortical plastic ity ass ociated with normal learning and functional recovery follow ing brain injury James M. Conner and Mark H. Tuszynski Department of Neurosciences, University of California San Diego, La Jolla, CA., USA Cortical plasticity, and the reorganization of cortical sensorimotor representations, has been proposed as a substrate for normal learning and recovery of function following brain injury. The physiological and cellular mechanisms responsible for cortical reorganization have not been fully elucidated. In our recent studies, we investigated the contribution of the basal forebrain cholinergic system in modulating plasticity associated with cortical motor representations. We first investigated the effects of specific basal forebrain cholinergic lesions upon cortical reorganization associated with learning a skilled motor task and addressed the functional/behavioral consequences of blocking cortical map reorganization. Results from this study demonstrate that disrupting basal forebrain cholinergic function significantly impairs, but does not abolish, acquisition of a new motor skill. Electrophysiological mapping techniques indicated that skilled motor learning was associated with a significant 30.3 ± 7.7% expansion of the caudal forelimb representation in the cortex controlling the trained limb. In animals with selective lesions of the basal forebrain cholinergic system, the expected expansion is completely blocked. Additional experiments demonstrated that the basal forebrain cholinergic lesions did not lead to deficits in i) global attention associated with performing the reaching task, ii) other forms of learning such as associative fear conditioning or iii) general sensorimotor function. Taken together, these results support the hypothesis that the basal forebrain cholinergic system may be specifically implicated in forms of learning requiring plasticity of cortical representations. 25A5 The development and function of mammalian motoneurons following their rescue from programmed cell death by deletion of the pro-apoptotic gene Bax Ronald Oppenheim, David Prevette, Sharon Vinsant and Thomas Gould Department of Neurobiology and Anatomy, Wake Forest University Medical Center, Winston- Salem, North Carolina, USA Genetic deletion of the pro-apoptotic gene Bax (Bax KO), a member of the Bcl-2 family, permanently rescues many populations of developing neurons, including motoneurons (MNs) from apoptotic programmed cell death (PCD). Because normally 50-60% of all post-mitotic embryonic MNs undergo PCD, Bax deletion results in the survival of thousands of excess neurons into postnatal and adult stages. Although this sub-population of “undead” MNs initially differentiate normally and innervate peripheral muscle targets, by perinatal/early postnatal stages, two populations of MNs can be identified: approximately one-half of all MNs appear cytologically normal and maintain innervation of target muscles, whereas the remaining sub-population (“undead” cells) have small atrophied cell bodies and peripheral axons that appear to reach no further than the ventral root or proximal sciatic nerve. We reasoned that the failure of the sub- population of “undead” MNs to grow normally and sustain muscle innervation may be due to limiting amounts of target-derived neurotrophic factors (NTFs). To test this idea, we have provided Bax KO mice with excess amounts of one potent NTF, GDNF, during either embryonic, postnatal or adult stages. GDNF but not BDNF treatment was able to prevent the atrophy and loss of innervation in Bax KO mice when available to the embryo and reversed the atrophy and denervation of the “undead” MNs when GDNF treatment occurred postnatally or in the adult. Preliminary studies suggest that following postnatal treatment with GDNF, the rescued “undead” MNs in the Bax KO mice may contribute to motor behavior. Studies are in progress to examine disease progression in a mouse model of ALS (the SOD1 mutant) when crossed with the Bax KO (i.e. will Bax deletion or Bax deletion plus GDNF rescue the disease phenotype). 25A6 Involvement of DNA damage and repair systems in neurodegenerative process Daniela Uberti, Giulia Ferrari-Toninelli, Maurizio Memo Department of Biomedical Sciences and Biotechnologies. University of Brescia Medical School, Brescia, Italy Preservation of genomic stability is an essential biological function. Cells engage very efficiently mechanisms involving DNA surveillance/repair proteins that work to maintaining inherited nucleotide sequence of genomic DNA over time. After DNA damage, that can arise during duplication or after genotoxic stimuli, cells activate intracellular pathways which are able to recognize the damage, to arrest cell cycle, to recruit DNA repair factors, to repair the damage or induce apoptosis. This definitely relevant process is finalized to prevent the generation and the persistence of impaired cells which may ultimately be detrimental to the organism. Very little is known about the role of DNA damage sensors and repair factors in terminally differentiated, not proliferating cells, like neurons. It is well recognized that mutation of genes related with DNA damage repair are associated with specific cancer-prone syndromes. Interestingly, many human pathological conditions with genetic defects in DNA damage responses are also characterized by neurological deficits. These neurological deficits can manifest themselves during many stages of development, suggesting an important role for DNA repair during the development and maintenance of the brain. Here I will present recent data from my group underlining the contribution to neurodegeneration of at least two transcription factors known to be involved in DNA damage sensing and repairing: the tumour suppressor gene p53 and the component of the DNA repair system MSH2. Both proteins participate in the cancer prevention machinery for the body as well as in the neurodegenerative process. Moreover, they interact with each others to orchestrate DNA repair functions. 25A7 The injection of the fraction 25-35 of amyloid-ß into hippocampus of neonatal rats produces changes on cognitive, morphological and biochemical tests E-M Cuevasa, J-F Guevarab , L-J Solisa , A-E Osorioa, F-A Diaza , I-M Garcíaa, and I-D Limóna. b Instituto Nacional de Neurología y Neurocirugía México D.F. and a Laboratorio de Neurofarmacología FCQ-BUAP. Puebla, México In Alzheimer‟s disease (AD), the neuropathologycal hallmarks includes extracellular deposits of b- amyloid in senile plaques, reactive astrocytes and intracellular deposits formation of neurofibrillary tangles, the loss of neuronal cells and synapses. Histopathological, behavioral and biochemical research suggest that the amyloid-ß protein produce a toxic effect and start the injuries. It‟s unclear how or when this protein is aggregated into hippocampus and cortex.The aim of this work were evaluated the effect of 25-35 fraction Aß injected into neonatal hippocampus and cortex, on learning, memory, histopathological and biochemical test. The animals used, were PD7 male and female Wistar rats pups. The pups were treated uni and bilateral with 1 µL of 25-35Aß (100µM) into hippocampus by stereotaxic surgery (AP=+1.5, L=±2.3, P=-2.0). After twelve and fourteen weeks were evaluated spatial learning and memory in the radial maze, respectively. The program was (number trial /number opportunities. 1st day 3/8, 3/7 y 3/6, 2nd day 1/6, 3/5, ¾ y 2/3, 3st.day 3/5, ¾, 3/3, and for memory test 8/3. We found in female rats deficits 18% and 32% uni-bilatral lesion on spatial memory, respectively. In the hye, PASS and Bielschowsky stained we found a decrease 40% in the neuron number in CA1 region. We found until 25% reactivity antibodies to GFAP. Moreover, we found a 23% of increase for NO levels at four hours after deposit the 25-35 fraction Aß. However, we didn‟t found amyloid deposits using the antibody to Aß. Those results suggest that 25-35 Aß fraction produce neurotoxicity in CA1 neuron of hippocampus and decrease the spatial memory since neonatal stage, maybe NO way. 25A8 Cerebellar and pontine norepinephrine contents after motor recovery in rats Rigoberto González-Piñaa , Antonio Bueno-Navaa, Carmen Escalante-Membrillob , Sergio Montesb , Angélica González-Macielc, Fructuoso Ayala-Guerrerod a Laboratorio de Plasticidad Cerebral y Proliferación Celular, InCH-CNR, SSA México, b Instituto Nacional de Neurología y Neurocirugía MVS, SSA México, cLaboratorio de Microscopia Electrónica, INP SSA México, d Laboratorio de Neurociencias, Fac. de Psicología, UNAM, México Motor cortex ablation induce motor deficits such as hemiplegia in rats. A spontaneous recovery that can be enhanced by either cerebellar infusion of norepinephrine (NE) or administration of NE agonists has been reported. These suggest that cerebellum (C) and pons (P), that contains the NEergic locus coeruleus, can play an important role in the recovery after motor brain injury. However, there are not data that relate directly the cerebellar and pontine NE contents with motor recovery. In order to assess the status of the NE contents in P and C after functional recovery, we trained 21 male wistar rats (280-320 g) to obtain their basal gait prints. Then animals were allocated into two groups: sham operated (n=10) and injured by right motor cortex ablation (n=11). After 6 hours post-surgery, gait prints were recorded every 6 hours during 48 hours. Subsequently, animals were decapitated and the left and right hemispheres of P and C were processed for NE extraction and HPLC analysis. The remained brain was fixed in formalin-buffer 10% in order to be stained with Nissl's method to verify the extension of the lesion. Length, width and angle were measured in the gait prints. Results showed that gait parameters were fully recovered 48 hours after performance of the lesion, while NE contents were increased in left and right P and decreased in left and right C. We conclude that recovery observed could be a result of a reorganization in the NE pathways, which also could involve to other cerebral structures. 25A9 Proechimys guyannensis rat: an animal model of resistance to epilepsy Esper Cavalheiro Neurologia Experimental-Escola Paulista de Medicina- São Paulo - Brazil The potential interest of Proechimys Guyannensis (PG), a spiny rat living in the Amazonian region, as an animal model of anti-convulsant mechanisms prompted the investigation of the susceptibility of PG to different epileptogenic paradigms. The findings pointed out a remarkable resistance of these animals to different models of experimental epilepsy: 1) Amygdala kindling development – Proechimys animals demonstrated a striking resistance to reach the stage 5 of kindling. From 43 Proechimys rats submitted to the kindling process only 3 animals reached the stage 5. From 40 animals that did not reach the kindled state, 16 did not extended beyond stage 1, 15 from stage 2, 7 from stage 3 and 3 from stage 4. Amygdala electrical stimulations were followed by very long after- discharges, mainly in stages 1-4. 2) Intrahippocampal kainic acid (KA) – A remarkable sensibility to intrahippocampal KA was noticed in PG. One-tenth of the KA dose usually used in Wistar rats elicited self-sustained electrographic status epileptus in PG animals which lasted for more than 48h with increased mortality rate. On the other hand, none of the surviving animals presented spontaneous seizures in the long-term observation period (up to 120 days). Neuropathological examinations of the hippocampus of Proechimys animals after KA injection showed a complete neuronal destruction at the injected hippocampal formation, more pronounced in CA1/CA3 areas, and with less marked changes in the contralateral hippocampus. 3) Pilocarpine – Pilocarpine (350- 380 mg/kg – doses regularly used in Wistar rats), when administered to PG induced severe tonic seizures followed by death of all animals. Dose slightly lower (300 mg/kg) than those previous ly mentioned was able to induce repetitive electrographic and behavioural seizures that culminated in status epilepticus 20-30 min following pilocarpine. However, pilocarpine-induced SE in PG had a shorter duration, rarely exceeding 2 hours, clearly in contrast to the 8-12 h long SE in the Wistar rat.From 60 animals injected with pilocarpine, 48 presented SE and only 2 presented some spontaneous seizures (approximately 1/week for 8 weeks) after silent periods of 60 and 66 days.The histological analysis of the brain of these 2 animals revealed neuronal loss in the CA3 area, in the hilus of the dentate gyrus (DG) and mossy fibers sprouting in the supragranular layer of DG and in the stratum radiatum of CA3. Altogether these data indicate that PG, although extremely sensitive to chemical convulsants (ie, KA and pilocarpine) and presented longer afterdischarge following electrical stimulation of the amygadala, is unable to establish a circuitry appropriated to the elaboration of spontaneous seizures, ie, epilepsy. In other terms, it seems probable that limbic circuitries, such as those found in the amygdala or the hippocampus, is highly affected by excitatory stimulation. However some “external factors” such as inputs originating in extra-limbic areas seem to prevent or inhibit the formation of a true epileptic focus. Some behavioural aspects observed in PG during the 3 experimental situations described above could give some hints to justify this hypothesis. During amygdala kindling stimulation and also during the seizures observed after systemic pilocarpine or intrahippocampal KA, a cataleptic behaviour was clearly observed in PG animals characterized by opistotonus and S tail suggesting the participation of the opiate system in this process.These findings indicate that PG rats may have natural endogenous antiepiletic mechanisms and further investigations (anatomical, biochemical, etc) need to be carried out to clarify this phenomenon. 25A10 Subacute electrical stimulation of parahippocampus and gaba system of patients with temporal lobe epilepsy Luisa Rocha Depto. Farmacobiología. Centro de Investigación y de Estudios Avanzados. México, D.F. We previously reported that subacute electrical stimulation of the parahippocampal cortex (PHC) reduces electrographic and clinical seizures in patients with intractable mesial temporal lobe epilepsy (MTLE). The present study was carried out to evaluate the GABA system and neuronal loss in PHC of patients with MTLE who received subacute electrical stimulation and presented antiepileptic effects. GABA tissue content, GABAA and benzodiazepine (BDZ) receptor levels as well as cell density were determined in PHC of patients with MTLE who received subacute electrical stimulation (130 Hz, 450 µs, 200-400 µA, continuously during 16-20 days) in this brain area and demonstrated a significant decrease of interictal spikes and seizures (ESAE group, n=5). Values were compared with those obtained from patients with MTLE plus electrical stimulation but without antiepileptic effects (ESWAE group, n=4) and those with MTLE in whom no electrical stimulation was applied (MTLE group, n=4). Autopsy material acquired from subjects without history of epilepsy was considered control PHC (C group, n=4 obtained from 3 subjects). ESAE group demonstrated high GABA tissue levels (219%), as well as a significantly higher cell count (58.5%) when compared with the MTLE group. Both the MTLE and ESAE groups demonstrated decreased GABAA receptor values compared to controls with no significant differences in BDZ receptor values. The present results suggest that subacute electrical stimulation of PHC electrical stimulation is more effective in patients with less severe epilepsy, and effect associated with a high GABA tissue content and a low rate of cell loss. 25A11 Localization of the epileptogenic zone in temporal lobe epilepsy by ictal V -EEG compressed spectral arrays analysis. L. Morales Chacon, Carlos S Catasus, Rolando Palmero, J Bosch Bayard , L. Lorigados, M.E. Garcia, J. Bender, A. Sanchez. International Center for Neurological Restoration. Havana Cuba Objective: Localizing the seizure onset and temporal evolution of ictally dominant frequencies in patients with temporal lobe epilepsy submitted to successful Standard Anterior Lobectomy and evaluate the role of this methodology in lateralization diagnosis when Resonance Magnetic Imaging shows normal or bilateral abnormalities. Methods: The onset of the ictally dominant frequency and its temporal evolution was studied in eight patients using Compressed Spectral Arrays Analysis. Five clinically and electroencephalographic representative seizures were selected, the time period chosen was 20 s before and 16s after the electroencephalographic seizure onset. Sources of EEG activity were determined with an inverse solution method called Variable Resolution Electrical Tomography (VARETA), which provided a spline-distributed solution. We also compared the lateralization diagnosis provided by this methodology with the information showed by neurofunctional techniques. Results: In all patient an ictally dominant and consistent frequency of 5.90± 1.31 Hz could be determined, however in 6 of 8 patients a second dominant frequency peak between 4.24-8 Hz was found. The use of linear inverse solution will allow to control that the analyzed frequency is generated approximately within the brain region whose resection rendered all patients seizure free. The lateralization and localization of the main dominant frequency during the evaluated period around the ictal EEG onset corresponds well with the lateralization proposed by other neuroimaging techniques such a interictal/ictal SPECT, and Cho/Cr ratio measured by MRS (x2 (18)=42.5 p=0.009. Conclusions: Our data suggest, that the ictally dominant frequency analysis and inverse solutions can be reliably used to detect ictal seizures onset arising in mesial temporal lobe epilepsy. Combination of ictal EEG using spectral analysis, SPECT and ERM improved the reliability of the localization and lateralization diagnosis in Temporal Lobe Epilepsy patients much more important when the Resonance Magnetic Imaging shows normal or bilateral abnormalities. 25A12 Excitatory Amino Acid Transporter Activity and Oxidative Stress J. G. Ortiz and N. Berríos-Cartagena Dept. of Pharmacology & Toxicology, Univ. of Puerto Rico School of Medicine, San Juan, Puerto Rico The activity of high-affinity, sodium-dependent, glutamate transporters (EAAT 1-5) terminates synaptic transmission, prevents extracellular glutamate (Glu) from reaching excitotoxic levels, and controls synaptic spillover. EAAT regulation is rather complex involving phosphorylation/dephosphorylation states, internalization/surface expression and redox status. The possible reversal of EAAT activity has been the focus of the last decade. However such approach is impractical as it would require precise knowledge of EAAT status in orde to be of theapeutic use. In addition to excessive Glu receptors activation, elevated [Glu] levels are likely to interfere with the cystine amyolateral sclerosis (ALS) directly increases EAAT activity and partially prevents veratridine- induced EAAT inhibition.. Moreover, chlorpheg, a cystine-glutamate exchange inhibitor, significantly increases EAAT activity in rat hippocampal slices in the presence of 50 µM Glu and partially prevents the inhibitory effects of veratridine on EAAT activity. These results suggest that modulation of EAAT activity may be accomplished by separate mechanisms; directly as with riluzole and indirectly via cystine 25A13 Post-traumatic epilepsy Pierre Jallon Epilepsy Unit, Geneva University Hospital, CH.1211 Geneva.14, Switzerland Objectives: to evaluate the frequency, the clinical presentations and the therapeutic management of post traumatic seizures and post traumatic epilepsy . Methods: we analysed and compared the recent studies concerning early post traumatic seizures and late post traumatic epilepsy in children and adults. Results: Early seizures were more prevalent among subjects 0-15 years of age with severe head trauma than among individuals over 15 years of age. A majority of early seizures are focal and of those 75 % are partial motor seizures. The fits may be single or repetitive. Status epilepticus or acute repetitive seizures are more common in children than in adults. The occurrence of early seizures is an indication for repeating imaging even in case of mild head injury. EEG plays only a limited role in the evaluation of early seizures. The incidence of late post traumatic seizures differs largely with age, type of trauma, neurological or neuroradiological signs attesting the severity of the trauma. Incidence varies from 7 % in civilian injuries to 35 % in military injuries. Conversely to early seizures, late seizures are less common and more delayed in children than in adults. The spectrum of all types of partial seizures as well as generalised seizures can be observed except bilateral myoclonias and absences. The issue of using antiepileptic drugs (AEDs) to prevent post traumatic seizures remains very controversial. Phenytoin remains the drug of choice for preventing and treating early post traumatic seizures because its efficacy and the possibility to use intravenous administration. All other AEDs can be used in treating late seizures. 25A14 Preliminar study of the anticonvulsant and anxiolytic like effects of GABA-amides derivated from n-GABA-3-(R-fenil)-2-E- propenamide in mice Ma.Eva González-Trujano a, Teresa Zapateroa, Magadalena Briones Velascoa, Lino Joel Reyes Trejob , Andrés Navarrete Castrob . a Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñíz”, Av. México-Xochimilco No. 101. Col. San Lorenzo Huipulco. C.P. 14370, México, D.F. b Facultad de Química de la Universidad Nacional Autónoma de México. Ciudad Universitaria Coyoacán. C.P. 04510, México, D.F.México. Both etiology and treatment of anxiety and epilepsy have been associated with the GABAergic system. It is well known that GABA can not cross the blood-brain barrier. A direct substitution therapy in neurological diseases attendant on GABA deficiency is therefore not possible. This report concerns the relationship between ten GABA-AMIDES synthesized from GABA and R- propenamide group in order to get major liposolubility as a fundamental strategy to develop therapeutic alternatives as anticonvulsant and anxiolytic drugs. Taconic mice maintained at standard conditions were used. GABA-AMIDES were obtained by synthesis and diacepam was tested as positive drug. Mice were injected with pentylenetetrazol, strychnine and 4-aminopyridine to record occurrence of the first episode of clonic or tonic seizures and mortality. Anxiolytic like effect was carry out on a exploration model. Effects on the coordination motor and miorelaxation were also assayed. The R-propenamide group increased liposolubility of GABA, important factor to produce effect on the central nervous system, but not a determinant factor to produce anxiolytic like effect, because it was not observed a direct relation between pharmacological effect and log P data. Number and position of constituents appears to play an interesting roll in these pharmacological properties. It is because, two GABA-AMIDES with the chemical group metoxi on positions 2,4 or 3,4 were the most active. Agree with LD50 data, all active GABA-AMIDES were no toxic. One of them showed anticonvulsant activity. These results suggest that GABA-AMIDES have anxiolytic like effects without adverse effects, it is an advantage over drugs clinically used. Differential effect of these GABA-AMIDES could involve different mechanism of action to the GABAergic system. 25A15 CaM kinase II- Mediated Modulation of GABAA Receptor Phosphorylation in Status Epilepticus A. Rana a, P.D. Franksa, J.T. Parsonsa, A. de Blase e, S.B. Churna,b,c,d Departments of a Neurology, b Anatomy and Neurobiology, cPharmacology and Toxicology, and d Physiology, Virginia Commonwealth University, Richmond, VA USA. e Physiology and Neurobiology, University of Conneticut, Storrs, CT USA Calmodulin-dependent kinase II (CaM kinase II) activation has been shown to positively modulate both agonist and allosteric modulator binding, and agonist-induced anion currents. Prolonged status epilepticus (SE) has been shown to result in both inhibition of CaM kinase II activity and loss of γ- amino butyric acid (GABA) receptor function. This study was designed to determine if the SE- induced inhibition of CaM kinase II activity also resulted in loss of GABAA receptor phosphorylation. The pilocarpine rat model of SE was utilized, and SE level was determined both behaviorally and by EEG measurements by surface electrodes. Following SE or sham treatments, animals were decapitated, and crude synaptic membrane fractions isolated by differential centrifugation. Standard CaM kinase II assays were performed, GABAA receptor subunits isolated away from synaptic proteins by detergent solublization, immunoprecipitation and resolution onto SDS-PAGE. Phosphate incorporation into GABAA receptor subunits was quantified by direct counting of resolved protein bands on either SDS-PAGE or western blots (Instant Imager, Packard Instruments).There was poor correlation between behavioral seizures and loss of kinase activity. However, all animals that progressed into continuous seizure activity measured by EEG recordings, displayed a significant loss of kinase activity in brain fraction homogenates. In crude synaptic membrane fractions SE resulted in an approximate 41% inhibition of CaM kinase II activity towards exogenously added substrates (Autocamtide 3, Calbiochem). In parallel reactions, SE resulted in approximately 40% inhibition of CaM kinase II-mediated phosphorylation of GABAA receptor α1 subunit (27.8 vs. 16.6 amol/mm2/min). Furthermore, SE resulted in approximately 37% inhibition of GABAA receptor β 2/3 subunits that co-precipitated with α1 subunit protein. Since CaM kinase II activation has been shown augment both GABAA receptor agonist and allosteric modulator binding and agonist-induced current, the data suggest a mechanism whereby SE results in loss of GABAA receptor operation. RO1-NS39970, P50-NS25630 25A16 The hyperthermia induced seizures produce transient gabaergic cell death in the hippocampus of the rat Sandra A. Orozcoa, Misael Gonzáleza , Sebastián Castillob and Alfredo Feria c. a Unidad de Investigación Medica en Enfermedades Neurológicas, Hospital de Especialidades, b Unidad de Investigación Medica en Enfermedades Oncológicas, Hospital de Oncología, CMN, Siglo XXI, IMSS, México D.F. y cUnidad de morfología de Alta Resolución,CUCBA, Universidad de Guadalajara, Guadalajara, Jal. México. The febrile seizure is the most prevalent age-specific seizures in infant and young children. Whether they result in long term sequels such neuronal lost and lobe epilepsy, it is controversial. Some studies of human febrile seizure have found no adverse effects on the developing brain. However, adults with temporal lobe epilepsy have a history of prolonged febrile seizures in early life. This study is aimed to know if hyperthermia-induced seizures produced neuronal death in infant and developing brain. Infant rats were subject to hyperthermic seizures (a model of prolonged febrile seizure). Neuronal death was assessed in sections of forebrain, stained by DAPI nuclear stain, in situ terminal deoxynucleotidyl tranferase dTUP nick-end labeling (TUNEL stain), annexin V antibody and electronic microscopy. We used two neuron marker, NeuN antibody by neurons and GAD65/67 antibody by GABAergic cells. The studies were carried at 24 hrs after the seizure and 5, 15, 20 and 30 days after seizures. The results showed TUNEL and annexin positive cells in hippocampal formation mainly in the CA1, CA3, and dentate gyrus, 24 hrs after seizures and few TUNEL and annexin positive cells at 5, 15 and 20 days after seizures. The 100% tunnel positive cells, 30% co-localized with GAD65/67 positive cells and 20% co-localized with NeuN positive cells. The electronic pictures showed some apoptotic neurons with dispersed chromatin and some neurons with necrotic characteristics. These results showed the prolonged febrile seizures resulted in transient neuronal death in immature hippocampus involved death of GABAergic neurons. The loss of these neurons could be enhanced susceptibility to further limbic seizures. 25A17 Anticonvulsant valproic acid induces differentiation in human neuroblastoma cells A.M. Ferreri, P. Rocchi Department of Experimental Pathology ,University of Bologna, Bologna, Italy Valproic acid ( vpa,2-propylpentanoic acid ) is an established drug in the long-term therapy of epilepsy During the past years ,it has become evident that vPA is also associated with anti-cancer activity .the present study was aimed at evaluating the effect of sodium valproate on differentiation and proliferation in the human neuroblastoma cell lines AF8 and TS12.Neuronal differentiation was assessed by means of morphological and cytochemical parameters,i.e. neurite outgrouth and acetylcholinesterase specific activity Growth curves and colony-forming assay were performed in order to determine cell growth inhibition Sodium valproate induced inhibition off cell growth (demonstrated by growth curves) and reduced the colony forming ability in a dose dependent manner in both cell lines. Inhibition of cell proliferation was accompanied by morphological features of neuronal differentiation: on both cell lines valproate induced neuritogenesis in a dose dependent fashion. Biochemical differentiation was demonstrated by the increase in the acetylcholinesterase specific activity,an enzime widely used as biochemical marker for neuronal differentiation in neuroblastoma cells.these results underline the role of HDACs inhibitors as new cancer drugs and suggest the evaluation of sodium valproate for cytodifferentiation therapy in the treatment of neuroblastoma. Posters 25P1 Subacute electrical stimulation w ith antiepileptic effects modifies GABAergic system in patients w ith intractable temporal lobe seizures Manola Cuéllara, Marcos Velascob , Francisco Velascob , Ana Luisa Velascob , Sandra Orozcoc and Luisa Rocha a a Farmacobiologia,CINVESTAV-IPN. b Hospital General de México. cHospital de Especialidades, México, D.F, Mexico. Experimental studies demonstrated that high frequency stimulation (HFS) of cerebral regions reduces seizures in patients with refractory temporal lobe epilepsy (TLE). We suggest that HFS in these patients induces the activation of Gabaergic system. Methods: Tissue cerebral were obtained from 3 groups: control (C, n=3), TLE (n=6) and TLE with HFS (HFS, n=6). HFS consisted of continuous stimulation with biphasic pulses (duration: 0.45 sec; frequency: 130 Hz; amplitude: 0.2- 0.4 mA). Ammon´s horn (AH) in hippocampus and parahippocampal cortex (PC) GABAA and BZD receptors system were evaluated using autoradiographic technique. GABA and Glu content were determinated by high performance liquid chromatographic analysis. Neuronal population count was performed using Nissl staining technique. Results : Concerning hippocampus TLE showed a decrease for GABAA and BZD receptor binding, tissue content of amino acids and neuronal count were similar to previous reports. HFS exhibited increased for GABAA receptor levels in AH (1086%) compared with TLE, BZD receptor binding was increased in AH compared with C (339%) and TLE (207%). GABAA receptor binding in PC (85%) exhibited decreased values compared with C, whereas BZD receptor binding did not show changes in this region. The regions AH (46%) and PC (44%) exhibited increased neuronal population count compared to TLE. There was a direct correlation between increased levels of the GABA and Glu in PC with decreased percentage of interictal spikes from the HFS. Conclusions: These results suggest that the antiepileptic effects of HFS involve increase GABAA and BZD receptors in AH, enhanced GABA and Glu amino acid levels and less neuronal loss in PC. 25P2 Inhibitory effect of 5-HT1A receptors on experimental limbic seizures in rats María-Leonor López-Meraza,b , Leticia Neri-Bazána, María Eva González Trujanob & Luisa Rocha a a Centro de Investigación y de Estudios Avanzados del I.P.N., México D.F., b Instituto Nacional de Psiquiatría “Ramón de la Fuente”, México, D.F. The purpose of this investigation was to evaluate the participation of 5-HT1A receptors on pentylenetetrazol (PTZ, 60 mg/Kg i.p.), kainic acid (KA, 10 mg/Kg i.p.) and amygdala kindling (daily 1s train of 1ms pulses at 60 Hz and 400 mA)- induced seizures in male Wistar rats, employing two agonists (8-OH-DPAT 0.01, 0.1, 1 mg/Kg and indorenate 1, 3, 10 mg/Kg) and an antagonist (WAY100635 1 mg/Kg) of these receptors. Neither of these 5-HT1A ligands modified the latency to the PTZ- induced clonic-tonic seizures. However, 8-OH-DPAT enhanced twice the number of clonus induced by PTZ, effect associated with decreased mortality. On the other hand, 8- OH-DPAT and indorenate augmented the latency to the first wet dog shake (WDS) (44-58% and 67%, respectively) induced by KA, effect that was blocked with the antagonist. Additionally, 8-OH- DPAT diminished the frequency of WDS (44-59%) and generalized seizures (GS) (78-84%) during the KA- induced status epilepticus (SE). Similarly, Indorenate decreased in 69-75% the number of GS. Interestingly, WAY100635 decreased non significantly the number of WDS and GS. In addition, 8-OH-DPAT and indorenate diminished the percentage of animals with SE (63-83%). In contrast, the evaluated drugs did not alter the kindled seizure expression. Nevertheless, indorenate decreased the seizure susceptibility during the postictal depression (34%), effect reverted by WAY100635. These results suggest that 5-HT1A receptors induce inhibitory effects on the KA- induced SE and during the postictal depression associated with the amygdala kindled seizures. Supported by CONACyT (scholarship 153240). 25P3 Increase P-glycoprotein expression in several limbic brain regions in the phenytoin resistant amygdala-kindled rats Graciela Jiménez-Rubioa , Sandra Orozco-Suárezb , M. Eva González-Trujanoa , Luisa Rocha c a Instituto Nacional de Psiquiatría "Ramón de la Fuente" and Centro de Investigación y Estudios Avanzados, Sede Sur, Farmacobiología, Instituto Politécnico Nacional. México, D.F., bUnidad de Inv. Médica en Enfermedades Neurológicas, H de Especialidades, CMN, Siglo-XXI, IMSS. México, D.F., cCentro de Investigación y Estudios Avanzados, Sede Sur, Farmacobiología, Instituto Politécnico Nacional. México, D.F. Studies have shown that multidrug transporter P-glycoprotein (PGP-1) is overexpressed in endothelial cells (EC) from brain blood vessels of patients with refractory temporal lobe epilepsy (TLE), suggesting the role of PGP-1 in pharmacoresistance to antiepileptic drugs (AEDs). In this study we used the amygdala-kindled rats, a refractory model to AEDs, to evaluate the PGP-1 expression in limbic brain regions thought to be involved in TLE. Male Wistar rats (250-350 g) were kindled by basolateral amygdala stimulation. After kindling acquisition, four independent acute phenytoin (75 mg/kg i.p.) trials were done. Response to phenytoin was determined using a threshold after-discharge; the response was sensitive (KSEN), variable (KVAR) or resistant kindled rats (KRES). PGP-1-expression was analysed 24 h after the last kindled seizure by immunohistochemistry. Cerebral cortex, hippocampus and amygdala were examined by confocal and fluorescence microscopy. In kindled rats PGP-1 staining was observed in EC, astrocytes in hippocampus and cortex, and neurons in amygdala. In KSEN rats PGP-1 staining was observed in EC and astrocytes, whereas in KVAR rats it was found in EC, glia and neurons both in all testing areas. The KRES rats showed an increased PGP-1 expression in EC and astrocytes in cortex and hippocampus; neurons and glia in amygdala. The data indicate that PGP-1 over-expression in KVAR and KRES rats mainly in capillary endothelial and glial cells of the blood brain barrier is likely to reduce the penetration of AEDs into brain parenchyma, which could explain the variability of the response and the phenytoin resistant in this epilepsy model. 25P4 Febrile seizures modify the benzodiazepine receptor binding in the developing rat brain González Ramírez Ma, Orozco Suárez Sa, Salgado Ceballos Ha,Briones Velasco Mb , Rocha Arrieta Lc a Unidad de Investigación Médica en Enfermedades Neurológicas H. Especialidades CMN SXXI IMSS. bDivisión de Neurociencias, INP “Ramón de la Fuente” y cDepto. De Farmacobiología, CINVESTAV del IPN, México DF. It has been described that immature brain is more susceptible to seizures than the mature one and that febrile seizures early in life may lead to epilepsy. The present study was carried out to evaluate the benzodiazepine (BDZ) receptor binding in specific brain areas of immature rats at different times. So, pups of 10 days old were placed on the floor of a 3 l glass container and an air stream was directed ~50 cm above them. Hyperthermia was maintained for 30 min, aiming for a core temperature of 41°C. Thereafter, rats were placed on a cool surface, monitored for 15 min, and then returned to their home cages for rehydratation by the mothers. The control group was normothermic temperature. Animals were sacrificed by decapitation 30 min, 24 h and 20 days after seizures and their brains were used for autoradiography assay with the purpose to determine BDZ receptor binding in different brain areas. Animals sacrificed at 24 h increased BDZ receptor levels in cingulated cortex (79.55%), frontal cortex (70.51%), parietal cortex (70.53%), striatum (23.94%), basolateral amygdaloid nuclei (51.29%), central amygdaloid nuclei (32.16%), medial amygdaloid nuclei (49.88%), entorhinal cortex (35.09%) and substantia nigra, compact part (33.41%). In contrast, the groups sacrificed at 30 min and 20 days after febrile seizures did not present significant changes as compared to the control ones. The results indicate that the febrile seizures do not induce permanent BDZ changes in the immature rat brain. Moreover, it is possible that the enhanced BDZ receptor levels 24 h after febrile seizures may play a protective effect in the immature brain. 25P5 In vivo study of transgene expresión of pgfa2-GAD67 into rat hippocampus Cecilia Zavala a, Paula Vergara b , José Segovia b and Luisa Rocha a a Farmacobiología. b Fisiología, Biofísica y Neurociencias, CINVESTAV-IPN, México, D.F., MÉXICO. Decreased GABAergic inhibition has been suggested to induce hyperexcitability. The present study evaluates the potential for preventing seizure generalization by increasing local GABAergic inhibitory activity by applying of a new technique: to express the GABA-synthesizing enzyme GAD67 in the host‟s own astrocytes. Using a transgene in which the activity of GAD67 is under the control of a glial fibrillary acidic protein (GFAP) promoter, it confers astrocyte-specific expression. The rats were transfected with 1,2 and 4 µg of gfa2-GAD67 (GAD) or pgfa2-Lac-Z (LZ) into hippocampus. Sham control rats (CSh) were not transfected. Three days following microinjection of the transgene, the rats received a single administration of pentylenetetrazol (PTZ, 70 mg/kg i.p.). The latency and duration of the seizures were evaluated. The hippocampal tissue samples were obtained 24 hours after of administration of PTZ and expression of transgene was detected by RT- PCR. In the GAD group the latency to the first clonic seizure was decrease in 76% compared to CSh. Nevertheless, an increase of duration of postictal period was observed in the GAD groups. The duration of mioclonic seizures was significantly decreased in the GAD group (2 µg) (4.8 ± 0.6 sec) compared to CSh (16.14 ± 5.2 sec). The duration of tonic seizures was decreased in the GAD group (1µg) compared to CSh (28.67 ± 16.29 sec and 52.67 ±18.8 sec, no significant). Increased expression of GAD67 was found in animals transfected with pGfa2-GAD67 transgene. The present results suggest that transfection with pGfa2-GAD67 have inhibitory effects on the PTZ-induced seizures. 25P6 Immunological disorders in epileptic patients are associated to the epilptogenic focus localization Lourdes Lorigados, Lilia Morales, Nancy Pavón, Teresa Serrano, María de los Angeles Robinson, María Eugenia García, Juan Bender Centro Internacional de Restauración Neurológica (CIREN), Havana, Cuba Clinical and experimental data support the role of immune mechanisms in the pathogenia of epilepsy. The purpose of this work is to study the immunologic aspects in 30 epileptic patients with complex partial crisis resistant to antiepileptic drugs. The patients were evaluated by EEG-Video and they were grouped attending to epileptogenic focus localization in: temporal (n=16), lateralized (n=6) and extratemporal (n=4). We also studied a group with psychogenic epilepsy (n=4); this group was diagnosed after EEG-Video evaluation. The following immunologic evaluations have been carried out: levels of serum immunoglobulins (IgG, IgM e IgA) by radial immuno-diffusion test and lymphocyte subpopulations using immuno-cytochemical methods. We measured the percent of lymphocytes T and B (CD3 and CD20), lymphocyte T helper/inductor (CD4), suppresor/cytotoxic (CD8), interleukine-2 receptor (CD25) and human leukocyte antigen (HLA- DR). The results show a significant increase of CD8+ lymphocytes (p<0.05) and in the activation markers (CD25+ and HLA-DR+ cells). The evaluation of immunologic parameters applied to different group of epileptogenic focus localization showed that the increase of CD8+ lymphocytes is limited to temporal and lateralized patients (P<0.01). The patients with extratemporal localization of focus and the psychogenic cases showed normal values for the evaluated immunologic lymphocytes markers. We did not find a deficit in the humoral immunologic aspects. Taking into account that patients diagnosed as psychogenic received an antiepileptic drug treatment identical to that of the other group, the observed immunologic changes might be related with the pathogenia of certain epilepsy variants associated with the focus localization and not with the medication. 25P7 Biochemical and morphological parameters in temporal lobectomised patients Lourdes Lorigadosa, Lilia Moralesa, Sandra Orozcob , Leticia Neryc, Ivan García a, Barbara Estupiñana , Barbara Paula f, Luisa Rocha c a Centro Internacional de Restauración Neurológica, Havana, Cuba, bCentro Médico, DF, México, c CINVESTAV, SedeSur, DF, México, f Hosp. Carlos J Finlay, Cuba Temporal lobe epilepsy (TLE) is one of the most frequent types of human focal epilepsy. The main goal of the present work was to examine some biochemical markers in cerebrospinal fluid (CSF) and tissue from 8 lobectomized patients (TLE) and to determine the contribution of apoptotic mechanism to epileptic process in these patients. Patients and methods: levels of amino acids were measured by HPLC method in tissue and CSF. We studied the evolutive levels of amino acids in CSF; the samples were taken before and after (1 and 6 months) surgical treatment. The CSF control group (n=10) was obtained from surgical patients who did not present neurological diseases and the tissue control group (n=4) was obtained from death not-neurological patients. The immune- histochemical evaluation was carried up using the following cellular markers: enolase, Neun, GABA and GAD 67/65. The apoptosis study was carried out for the occurrence of terminal deoxynucleotidyl transferase-mediated UTP nick end labeling (TUNEL) and Anexin-V markers. The final evaluation of cerebral tissue was done by confocal microscopy. The results showed increased levels of glutamate in cerebral tissue. There are significant decreased of glutamate levels between pre-treatment and before (6 months) treatment. Numerous TUNEL-positive cells were observed whereas Anexin V-positive cells were not significant. We found a decrease of enolase, Neun, GABA and GAD 67/65 positive cells. The results evidence there is death but not only by apoptotic phenomena but also by necrosis. The surgery process can restore the amino acids levels. 25P8 Effect of carbamazepine on convulsive activiv ity and brain damage induced by administration of kainic Acid Fructuoso Ayala-Guerrero, Alfonso Alfaro, Rosa María Romero, Graciela Mexicano-Medina and Angélica González-Maciel. Facultad de Psicología, Universidad Nacional Autónoma de México; Instituto de la Comunicación Humana-CNR and Instituto Nacional de Pediatría, México. Several animal models of epilepsy have been used in order to evaluate drugs with anticonvulsant efficacy. Since administration of Kainic Acid (KA) causes physiological and anatomical disturbances similar to those in temporal lobe epilepsy of humans, the kainate treated rat has been considered as an experimental model of temporal lobe epilepsy. Carbamazepine, an antiepileptic drug, has been utilized in clinical for controlling certain types of epileptic attacks. The objective of this work was to analize the action of carbamazepine on convulsive crisis and brain damage induced by KA administration. Experiments were carried out on chronically implanted wistar white rats. One group of five rats was treated with KA (10 mg/kg ) alone, while other similar group was pretreated with carbamazepine (25 mg/kg) 30 minutes before administration of KA. Ten hour polygraphic recordings were continuously obtained under the two mentioned conditions. Under general anesthesia,, brain were removed from the skull for histological analysis ten days after administration of drugs. Animals receiving administration of KA alone presented convulsive activity and brain damage. Carbamazepine pretreatment induced a slight decrement of convulsive activity but brain damage was still present. 25P9 Epilepsy surgery. A preliminary Study Iván García Maeso, Juan E. Bender, Lilia Morales Chacon, Margarita Báez, Lourdes Lorigados Pedre, Bárbara Estupiñán, Maria Eugenia García, Carlos Sánchez Catasús, Rolando Palmero. Group of Epilepsy Surgery Project. International Center of Neurological Restoration, Havana, Cuba. Epilepsy surgery dates back to more than two millennia and the first intervention was cranial trepanation. This pathology occurs in 0.1% of the population. Its initial medical treatment only achieves control of crisis in a 50% to 80%; the remaining 20% is considered medically untreatable and surgically remediable. Method and Material: 8 patients with refractory temporal lobe epilepsy, of 23 candidates for surgical treatment were operated in the second semester of last year. The surgical technique used was the adjusted temporal lobectomy. Transoperatory Electrocorticographic recordings before and after resection were performed. A follow-up of the cases took place at one, three and six months for a posterior evaluation in a year time. Results: 88 % of operated patients are free of crisis and only one has suffered an occasional crisis. The complications were as follows: three patients with hemosiderotic meningitis, one with a transitory dysfunction of the type III cranial pair; one a diminishing of the verbal memory whereas another patient presented an inadequate syndrome of the antidiuretic hormone. Conclusions: Resective surgery of temporal lobe is the technique that we had selected for the treatment of refractory temporal epilepsy and the patient had a satisfactory evolution. 25P10 Antiepileptic effect of an extract of Ambrosia paniculata (Willd.) O. E. Schultz (mug-w ort) in several models of experimental epilepsy María T. Buznego, Héctor Pérez-Saad Department of Experimental Epilepsy, Institute of Neurology and Neurosurgery, Cuba. The acute effect of Ambrosia paniculata in several animal models of epilepsy was studied. Intraperitoneal injections (0.01 mL x g of body weight) of a decoction of the dry leaves significantly enhanced the latency of the first convulsion and the survival time in mice injected with picrotoxin (7mg/kg) or isoniazid (210 mg/kg). Epileptic spikes were induced by topical application of penicillin -a glass electrode filled with penicillin-agar-saline mixture- and recorded in sensorimotor and occipital cortices. The plant decoction reduced significantly the spike amplitude in both sites. The same decoction was not effective against the electroshock-induced convulsions in mice. Since convulsions induced by isoniazid, picrotoxin and penicillin -differing from electroshock- implicate a disruption of the GABAergic neurotransmission, these results suggest that Ambrosia paniculata, like several conventional antiepileptic drugs, has a selective effect on this neurotransmitter system, that explain the traditional use of the plant in epilepsy. 25P11 Therapeutic effect of ozone in the brain ischemia: mechanism of action seems to involv e hydrogen peroxide JD García-Salman, M García, A Cuba, RM Coro, H Perez-Saad Department of Experimental Neurology, Institute of Neurology and Neurosurgery, 29st and D, Vedado, Havana 10400, Cuba. Brain can be considered as a main target organ for active oxygen species. It is the highest oxygen- demanding organ, has a high content of unsaturated fatty acids, a poor antioxidant defense and a high ferrum ion content. During brain ischemia, free radical reactions increase. There are some evidences suggesting that SOD activity reduces edema, mortality and infarct volumes. Other findings found links between hydrogen peroxide and selective gene expression, differentiation and neuronal plasticity. On the other hand, therapy with ozone is based in the generation of ozonids, including hydrogen peroxide. Then, ozonids could be carried by body fluids to the target tissue and exert therapeutic effects. It has been suggested that maximal effects be obtained after a period of preconditioning. In that sense, we treated Mongolian gerbils with intrarectal ozone (1 mg/Kg) for three weeks before ligation of the right carotid artery. Treatment prevents impairment of spontaneous exploratory activity, observed 7 days after ligation in oxygen-treated gerbils. In these animals a significant damage in CA1 pyramidal neurons of the right hippocampus was found, compared with the contralateral hemisphere. In another experiment, the spontaneous exploratory activity before and 7 days after 5 min bilateral carotid occlusion was tested. Ozone was administered in the six subsequent days of reperfusion. The results show that ozone treatment also prevents impairments of the spontaneous exploratory activity. These findings suggest that ozonids - particularly hydrogen peroxide - are protecting memory and learning-related synapses through improving survival of brain cells. 25P12 Three-synaptic hippocampal response during repeated electric al stimulation of entorhinal cortex in the Mongolian gerbil. Effect of clonidine Héctor Pérez-Saad, Margarita Bu Wong and Nora Sánchez Rodríguez. Department of Experimental Neurology, Institute of Neurology and Neurosurgery, 29 and D st. Vedado, Havana 10400, Cuba. The Mongolian gerbil (Meriones unguiculatus) has been considered as a model of temporal lobe epilepsy, which involves the hipocampal formation. In the present work the effect of clonidine and fenitoin on the electrophysiological response of dentate gyrus to electrical stimulation of entorrinal cortex was studied in anaesthetized gerbils (20 % urethane, 0,01 mL x g of body weight). Intracerebral electrodes -following the stereotaxic atlas of Loskota- were used. The amplitude of the population spike was obtained after averaging 20 stimuli (500 µA, 1 Hz and 100 µs). Clonidine (100 µg/kg ip.) and fenitoin (10 mg/kg ip.) reduced significantly the spike amplitude 1 h after injection. In a group of animals the entorrinal cortex was stimulated with a 7 Hz frequency: a second and third population spikes appeared about 20 seconds after the starting the stimulation. These two spikes immediately disappear after coming back to the initial 1 Hz frequency and reappear again with 7 Hz stimulation; this process can be repeated several times with similar results. These spikes also disappear if the 7 Hz stimulation persists for the next 30 to 60 seconds. Fifteen minutes after clonidine injection (100 µg/kg ip.) the primary spike was not modified, but the second spike was retarded to about 20 seconds, with an increased latency and decreased amplitude; the third spike –with very low voltage- completely disappeared. These results show a particular hipocampal hyper excitability of the seizure-sensitive gerbils and new data about the mode of action of coniine in epilepsy. Memory and language 25B1 Functional neuroimaging of amnesic disorders Hans J. Markowitsch Physiological Psychology, University of Bielefeld, Bielefeld, Germany Memory disorders constitute the most frequent accompanies of brain damage as well as of psychiatric disorders such as posttraumatic stress disorder or schizophrenia. In fact the neural mechanisms leading to problems in encoding, consolidation, storage, and retrieval of memory may be similar in patients with psychiatric and neurological disorders. Studying a number of patients with either organic brain damage or with memory disorders due to psychic stress or trauma conditions were studied in order to elucidate brain circuits and brain mechanisms leading to memory problems. Extensive neuropsychological testing static and dynamic neuroimaging was used; in addition, data on the social and personal background were collected. Results indicate that there are a number of so-called bottleneck structures, embedded in certain neural circuits, which are crucially involved in either the formation or retrieval of information. Dysfunction of these bottleneck structures can occur as a consequence of focal brain damage or as a result of changes in the release of stress of hormones (glucocorticoids). As a consequence, especially recent results from functional neuroimaging suggest strong similarities between neuronal and psychiatric patients with respect to the neural networks needed for appropriate memory processing and thereby provides important implications for the therapy of memory disorders. 25B2 Brain activity related the emotional valence of familiar faces Bobes, M.A.a, Perez H., Ja, Lopera, Fb ., Perez, Aa., Acosta, Y.a, Valdes-Sosa, M.a a Centro de Neurociencias de Cuba , La Habana, Cuba. b Grupo de Neurociencias, Universidad de Antioquia, Medellín, Colombia Familiar faces possibly activate two different routes, related to semantic information and affective valence respectively. Evidence for these two routes (obtained from normal subjects and a prosopagnosic patient) is presented here. Two oddball paradigms using frequent unfamiliar faces as standard stimuli were used to obtain P300 in normals. The two paradigms used different infrequent targets: newly learned faces (devoid of emotional associations) in one case, and faces of close relatives in the other. Despite similar target-detection in both tasks, they elicited different P300. The P300 evoked by newly-learned faces was later in time and showed a centro-parietal distribution, whereas that obtained for faces of relatives exhibited two sub-components, an early one located at left frontopolar sites, and the same centroparietal P300 as above. These sub-components could be activated by affective and semantic knowledge respectively. This idea was supported by studies of covert face recognition in the prosopagnosic patient FE, for whom the P300 elicited by faces of (unrecognized) close relatives resembled the early frontal sub-component found in normal subjects for faces of close relatives but not for new-learning faces. An fMRI study with FE and controls showed larger brain activation for familiar then for unfamiliar faces in ventromedial cortex. This suggests that the emotional valence of faces activates ventromedial cortex and generates the frontal P3, which possibly mediates covert recognition in FE. 25B3 Massed practice in neurorehabilitation: Intensive short-term intervention in patients w ith chronic aphasia leads to improved language functions and correspondent changes in brain physiology Marcus Meinzer, Gabriela Barthel, Daniela Djundja, Rockstroh Brigitte Department of clinical psychology, University of Konstanz, PO-Box 25, 78457 Konstanz, Germany The aim of the present study was to collect evidence for the effectiveness of 3 different types of intensive language therapy for patients with chronic aphasia after vascular stroke (> 12 months after stroke). Evaluation criteria included neurolinguistic testing (Aachen Aphasia Test Battery) as well as questionnaires on the quality and the amount of everyday communication. Functional brain imaging was performed using magnetoencephalography (MEG), coregistered with structural magnetic resonance scans (MRI). 35 patients of three intervention groups [1. Constrained-Induced Aphasia Therapy (Pulvermüller et. al. 2001), 2. a modified version of CIAT, adding a written language module and additional training, with relatives, 3. Model-based aphasia therapy] were investigated and received 30 hours of language therapy over a period of 2 weeks. Neuropsychological testing and MEG assessment were performed before and after therapy as well as 6 months after therapy. All intervention groups improved on average. Single case analysis revealed significant improvements in about 90% of the patients. The amount of day-to-day communication was enhanced, furthermore relatives rated communicative abilities as improved. There was no difference between intervention groups concerning improvements in language performance which emphasises the importance of massed practice irrespective of treatment specific factors. Perilesional dysfunctional slow wave activity decreased in about 60% of patients that improved in the AAT, which might be an indicator of re-recruitment of these areas. An increase of perilesional activity in 9 patients with improved language functions might be explained by further segregation of dysfunctional components from the speech network with correspondent slow wave synchronisation. 25B4 Aphasia: Characterization and Treatment M. González Murgado and N. Armenteros Herreras International Center for Neurological Restoration (CIREN), Cuba. The patients who developed encephalic static lesions are liable to suffer neurolinguistic alterations like aphasia. This language impairment is determinant for the individual ´s quality of life, from this, the importance of the rehabilitation. Due to the complexity of this disorder and the manifestation of its clinical status, it is necessary to perform a solid and efficient approach. The objective of our investigation was to characterize a sample and to emphasize a strategy for intervention. For this reason 30 aphasic subjects were studied as sample, which were therapeutically approached and characterized using Svietkova´s modified method. This method was used as assessment scale before and after the therapeutic approach. 70% were men, 60% of them, intellectuals who had lost their work link, 67% were bearers of mixed aphasia predominantly motor impairment; and 100% willingly accepted the applied therapy. A 40% of them overcame the impressive deficit. In a 100% of patients with total lack of expressive language, functional verbal emissions appeared. A regression analysis showed no relationship between the improvement of language skills and variables like age, professional and education level. Only the type of aphasia was relevant to the treatment, obtaining mixed aphasia patients significant scores in the final evaluation (p: 0.02). A significant correlation (-0.37) between time from onset and the impressive and expressive final evaluation support the importance of starting the aphasia therapy early. Time from onset could be a prognostic factor for the clinical recovery. 25B5 Efficacy of the Neurological Restoration Program in the treatment of aphasic patients Fernandez E., Alvarez E., Bringas M.L., Salazar S. International Center for Neurological Restoration, Havana, Cuba Recovery of language is one of the most complex aspects within neuropsychological practice. A reason why for a long period of time, multiple rehabilitation techniques have been emphasized. The objective of this work was to evaluate the evolution of verbal communication, performed on a sample of 14 patients with aphasic syndrome as a result of ischaemic vascular lesions of the left side. These patients were submitted to the Neurological Restoration Program at CIREN´s department of Logopedics. Patients were classified as to the type of diagnosed aphasia. The sample was conformed of 3 anomic, 1 global and 10 motor ones. The analysis of renderings was performed through the adaptation into Spanish of the Boston‟s Neuropsychological test for the evaluation of aphasias which was applied before and after treatment. Wilcoxon test was used for the comparison of treatment effectiveness between two evaluative situations in this group of patients. Results show that language abilities of chronic aphasic patients can be thus improved in a short period of time by using rehabilitation methods that have significant differences as to their comprehension capacity. The level of severity in aphasias was evaluated through Boston‟s severity scale which evidenced qualitative changes in patients within the same level, but not sufficient enough to pass to another range. There were no significant differences in the patient‟s communicative capacity in his/her daily lives. 25B6 Interferon alpha2B recombinant improved the cognitive dysfunction in patients w ith relapsing remitting multiple sclerosis J.A. Cabrera-Gómez, N. Echazábal-Santana, P. Porrero-Martín, C. Valenzuela-Silva, C.A. Rodríguez, I. Fuentes-Suárez, L. Pérez-Ruiz, A.M. Ramos-Cedeño, J.A. Cabrera-Núñez. Center for Biological Research, La Habana, Cuba Introduction. Some experimental, Phase II clinical trials and the preliminary reports of the Cuban Phase III clinical trial indicate that alphaIFN (IFN) may be useful in relapsing-remitting (RR) multiple sclerosis (MS). The reports in Cuba showed that 70% of the MS patients have cognitive dysfunction. Objective. To assess the efficacy of IFN alpha 2b recombinant in the cognitive dysfunction of RRMS. Patients and methods. 57 RRMS clinical definite (Poser et al) patients from the randomized, double blind, placebo controlled study of 225 patients with RRMS and brain MRI confirmed. Patients were randomly assigned to receive intramuscularly IFN alpha2b (HeberonR ®) 10 million IU (high dose), 3 million IU (low dose) or placebo twice week for 2 years. Outcome results were blinding evaluated considering changes in the following tests: Luria, WAIS, Benton and PASAT3. Adverse events and side effects were not evaluated to maintain physician blinding. Results. The initial comparison of the groups did not show any differences among the placebo (n= 20), low dose (n= 18) and high dose (n= 19) considering age (p= 0.234), gender, ethnic group (p= 0.012), years ill (p= 0.787), EDSS (p=0.203) and rate of relapses (p= 0.432). The Luria‟s Test showed an improved in the low dose group from 2.50±1.34 to 1.39±1.85 (p= 0.029) and in the high dose group from 3.22±1.89 to 2.17±1.50 (p= 0.006) vs. placebo 2.85±1.66 to 2.90±1.97 (p=0.723). The results of the Benton‟s test demonstrated that the low dose group had an improved from 5.50±1.10 to 6.22±1.31 (p= 0.047), in the high dose group from 4.87±1.85 to 5.78±1.35 (p= 0.005) where as in the placebo group worse from 5.15±1.76 to 5.05±2.11 (p= 0.893). The WAIS test showed the same results, the low dose group increased from 5.17±1.34 to 6.06±1.21 (p= 0.022), the high dose group from 4.56±1.38 to 5.39±1.29 (p= 0.007) and the placebo group worse from 5.25±1.25 to 5.05±1.57 (p=0.354). Finally, the PASAT3 test increased in the IFNs groups: from 45.72±10.61 to 49.94±11.68 (p= 0.015) in the low dose group, from 42.67±11.04 to 48.72±8.84 (p= 0.03) in the high dose group, but in the placebo group worse from 44.55±10.86 to 41.95±13.74 (p= 0.655). Conclusion. IFN alpha improved the cognitive dysfunction in RRMS patients. The higher dose is more beneficial. Neuroimaging studies of reading and speech processing in dyslexia 25B7 Neuropsychological assessment of neurological patients using cognitive event-related potentials John F. Connolly Cognitive/Clinical Neuroscience Unit, Department of Psychology, Dalhousie University Halifax, NS, Canada Assessment of neuropsychological function in brain injured, non communicative populations represents a major health care problem. Difficulties with assessment often lead to reduced/refused rehabilitative interventions because apparent incapacity is assumed to reflect genuine incapacity. It was within this context that the Innovative Methods of Assessment Program (IMAP) was developed. IMAP uses cognitive event-related potentials (ERP) in lieu of verbal/motor output as the patient‟s response to neuropsychological tests. In IMAP, neuropsychological tests are adapted for computer presentation and simultaneous ERP recording. Its application has been to provide neuropsychological assessment in non communicative patients who are impossible to assess traditionally and to monitor progress during rehabilitation. In effect, the ERP measures obtained in these standardized tests have proven to be a valid and reliable substitute for verbal/motor behaviour. Even in patients able to be assessed traditionally, IMAP has proven to be a valuable ancillary measure. Traumatic brain injury (TBI) and stroke data will be presented to demonstrate the applications and utility of IMAP. These methods have also been used to differentiate good from poor readers and in revealing the mechanisms by which a phonologically-based reading remediation program improves the reading skills of problem readers. A particularly interesting feature of these ERP changes to remediation is that they precede behavioural signs of reading improvement. The ability of cognitive ERP to monitor non communicative patients and neuroplastic changes to behavioural interventions demonstrates the value of this neuroimaging modality and its rightful place in the armamentarium of the cognitive or clinical neuroscientist. 25B8 Differences in between readers w ith developmental dyslexia and normal readers as revealed by MEG Elisabet Service Cognitive/Clinical Neuroscience Unit, Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada, and Department of Psychology, University of Helsinki, Helsinki, Finland A series of studies used magnetoencephalography (MEG) to explore brain activation in adult competent readers with a history of reading problems and readers who had not experienced such problems. A study of single-word reading revealed an early abnormality in the dyslexic readers with impaired activation in the left inferior temporo-parietal area at 150 ms after stimulus presentation. Dyslexic readers also lacked activation in the middle and superior parts of the left temporal lobe between 200 and 400 ms, showing instead activation in left frontal inferior areas (Broca‟s area). A second study focussed on sentence reading revealed similar responses to anomalous sentence- ending words in both dyslexic and normal readers, these N400m activations being 100 ms delayed in the dyslexic group. When sentences were presented aurally, the same pattern was seen, now with a 50 ms delay in the dyslexic group. Later experiments explored the early posterior abnormality in brain activation seen in single word processing in dyslexic readers. The area in question was found to specifically respond to letter strings. When other visual stimuli were used that gave rise to activation in partly overlapping areas, responses were found to be similar for dyslexic and normal readers, suggesting that the abnormal lack of response was functionally and not physiologically determined. 25B9 Dynamic visual processes in normal reading: implications for developmental dyslexia? Piers Cornelissena, Kristen Pammera, Ruth Lavisa and Peter Hansenb a School of Biology, University of Newcastle, Newcastle, UK, b Centre for Cognitive Neuroscience, FMRIB Centre, Oxford University, Oxford, UK Data from two studies relating visual task performance to contextual reading are presented. The first study investigated the relationship between contextual reading and, a) relative spatial encoding for symbol arrays, and b) central versus peripheral sensitivity to the frequency doubling illusion. In the first study, thirty school children were measured on their ability to solve a foveally-presented spatial encoding task, as well as their sensitivity to the frequency doubling illusion across the retina. Their performance in the frequency doubling and spatial encoding tasks was uncorrelated, suggesting that these tasks tap independent visual processes. Peripheral (but not central) sensitivity to frequency doubling, and spatial encoding, predicted statistically significant, independent proportions of variance in contextual reading (Neale Analysis of Reading). These effects persisted even when variance due to age, IQ, phonological skill and short-term memory was statistically accounted for. The data suggest that successful reading requires not only information about letter identity, but also at least two additional sources of information, probably related to spatial processing of words. The first is a central mechanism that may define the relative spatial location of letters within words, and the second is a peripheral mechanism that we speculate may be related to the attentional processes involved in coarse-scale localisation within a body of text. Consistent with this speculation, we found in the second study, that reading accuracy for dyslexic readers was most impaired relative to chronological- and age-matched controls when contextual material was presented in whole paragraphs, rather than line-at-a-time or word-at-a-time reading conditions. 25B10 Electrophysiological investigation of implicit and explicit phonological processing in dyslexia Guillaume Thierry, Tim Fosker and Claire Williams School of Psychology, University of Wales, Bangor, UK In a series of experiments we attempted to characterize phonological impairments of dyslexic adults as indexed by auditory Event-Related Potentials (ERPs). First, we addressed the question of implicit phoneme awareness by looking at ERP correlates of phoneme expectancy during a lexical decision task involving alliterated stimuli. The P300 elicited by non-alliterated deviants in controls was not found in dyslexic adults, suggesting deficient phonological awareness in the latter. Furthermore, P300 peak amplitudes correlated significantly with individual reading scores obtained in a pre-test. Second, we used a phoneme deletion task to characterise phonological awareness when attentio n is devoted to phonological manipulation. The P300 observed in dyslexic adults was not significantly different from that seen in adult controls. We concluded that well-compensated dyslexic adults display normal phonological awareness when their attention in focussed on phonological manipulations. Third, we used a 2x2 paradigm developed by Connolly and Philips (1994) to compare implicit phonological processing and semantic integration stages. We presented 12 dyslexic adults and 12 matched controls with sentences ending with words of different Cloze probability regarding their meaning and their first phoneme. Preliminary results indicate that the N400 ERP modulation induced by semantic mismatch is virtually identical in dyslexic adults and controls whereas the N200 modulation induced by phonological mismatch (Phonological Mismatch Negativity) is delayed in dyslexic adults. Overall, these results suggest that well-compensated dyslexic individuals are impaired both at the level of implicit and explicit phonological processing, although the time-course of semantic processing appears to be normal. 25B11 Measuring phonological awareness and remediation in dyslexic children with ERP John F. Connollya, Randy Lynn Newmana, Marianne Hellmanna,b and Elisabet Service a,c a Cognitive/Clinical Neuroscience Unit, Department of Psychology, Dalhousie University Halifax, NS, Canada, b Faculty of Psychology, University of Maastricht, Maastricht, The Netherlands, cDepartment of Psychology, University of Helsink, Helsinki, Finland We have discovered an ERP component called the PMN (phonological mismatch negativity) that is associated with phonological processing of spoken words. Our early studies elicited both a PMN and a N400 often making it difficult to see the PMN clearly. Two paradigms have been developed that elicit the PMN in the absence of the N400; one task involves cross modal priming while the other has adapted a clinical test (the Rosner test) involving phoneme deletion. The new paradigms not only isolate the PMN but address issues related to the nature of this response – in particular, whether the response is pre- or postlexical. Data demonstrating the PMN‟s prelexical nature will be presented. Also, the phoneme deletion task has been used to examine the PMN in poor readers. In this experimental protocol, participants were asked to select the correct aural representation of “Clap /klæp/ – without the /k/ sound.” Good readers showed clear PMNs to incorrect choices (e.g., /kæp/, /æp/) while problem readers either failed to show PMNs or showed small and significantly delayed PMNs to the incorrect choices – a result that supports clinical findings that phonological awareness is deficient in problem readers. Recent experiments have tracked problem readers through a reading remediation program and found changes in phonological processing mechanisms as reflected by the PMN and behavioural measures. The PMN appeared during the remediation process in previous non-responders while problem readers who showed small and delayed PMNs also responded positively to remediation with increased PMN amplitude and a normalization of its latency. Posters 25P13 Generalized dystonia is sensitive to bilateral palidotomy: preliminary report on Neuropsychological concerns Dora Ma. Chongo Almerall, Carlos Maragoto International Center for Neurological Restoration.Havana, Cuba Dystonia is a severe motor disease, which imposes a substantial burden on individuals and society as a whole. The majority of previous movement disorders research has been found on clinical and psychological evolution after conventional or surgical therapies in Parkinson‟s disease. Considering recent evidences of usefulness of pallidotomy for treatment of dystonia, we have proposed a Neuropsychological battery (NPB) to be include in the protocol which will evaluate the efficacy and safety of this surgical approach to dystonia treatment taking into account results from the first 5 patients with generalized dystonia submitted to bilateral pallidotomy. We performed a Neuropsychological Battery (Short Neuropsychological Test in Spanish. NEUROPSI, Auditory Verbal Learning Test, and Intelligence test of Progressive Matrix for Adults. Raven) and the Hamilton Scale for Depression, before and 6, 12 months after bilateral pallidotomy. The reduced sample permits us only to report a descriptive characterization of effects, if any, of the surgical procedure on different domains of cognition and emotion. Attention and memory functions showed a positive outcome at 6 and 12 month‟s post-surgery (60% of patients). Additionally, depressive symptoms exhibit a marked decrement, (4/5 patients). We suggest that the observed changes were related to the improvement of patient‟s quality of life as well as the improvement of particular disease symptoms. It will be important include those tests that permit us subtle distinctions within different levels of health perceptions, physical / mental health, physical /mental role in social daily activities in patients. 25P14 Neuropsychological evaluation of epileptic operated patients Ma. Eugenia García,Lilia Morales, Ivan García, J. Bender, I. Sarduy, Sonia Salazar International Center for Neurological Restoration, Havana, Cuba The description of the patient‟s cognitive status is among the objectives of the neuropsychological evaluations to the epileptic population resistant to pharmacological treatment, to determine the patient‟s profile allowing to evaluate the risk or benefits of surgical intervention; and thus to evaluate the success in post surgical neuropsychological evolution. The objective of the present paper is to show the neuropsychological evolution related with general cognition and memory process, in a sample of 8 patients diagnosed with temporal epilepsy, which had been operated, in a post-operative period ranging from six months to a year. Results. We observed a tendency to an increase in rendering in general cognition, so much at six months as a year after surgery. In mnesic tasks, in those cases that present a diminishing in rendering, this cognition is presented in oral modality when it is ipsilateral to the lesion. In the visual modality the tendency is to increase rendering independently of the side of surgery. Conclusions. In a general way, the findings coincide with reports in the literature. The evolutive explorations in these patients allow us to appreciate the effects of surgery as to the quality of life and therefore, to determine the evolutive profile of epileptic patients and in this way to offer information in relation to epileptic patients candidates to surgical treatment. 25P15 Verbal Fluency in Parkinson`s Disease(PD) Casabona E; Bringas ML, Álvarez L, Salazar S. Neuropsychology Department and Mov.Disod.Clinic.CIREN, Havana, Cuba Disturbances in cognitive functions in PD has been reported and defined as a frontal ´like´ syndrome, including working memory dysfunction, visuospatial disorientation and a disexecutive syndrome .One of the main component of the last one is the alteration of verbal fluency. This impairment appears as a very good marker of frontal dysfunction and is easy to explore. Frontal dysfunction could promote or amplified motor behavior disturbances. We have conducted a study to define both verbal and semantic fluency in early and advanced stages of PD and to define the correlations of the degree of impairment of the verbal fluency with sociodemographics, motor performance and cognitive state. Study design includes an extense neuropsychological battery and the UPDRS score¨ Hundred eighteen patients were enrolled and studied between Jan 2001 to Sept 2003 and all of them complete the evaluation. Patients were stratified according age, school level, stage and severity of the disease. Phonological verbal fluency was more affected than semantic in all groups and both categories were significant altered when compared with health controls. There is a high correlation (p 0.005) between age, evolution time, educational level and severity and verbal fluency. We observe a high correlation with MMSE and the Frontal Assessment Battery scores. It is very significant that verbal fluency is affected in the very early stages of the disease. Our preliminary results have some implications in the explanation of the motor behavioral d speech disturbances and in the design of rehab programs in PD. 25P16 Speech training and verbal fluency in patients with neurodegenerativ e diseases A. Aguiar Rodríguez, S. Salazar, E. Casabona International Center for Neurological Restoration, Havana, Cuba The phonologic and semantic verbal fluency tests are used to evaluate the semantic storage capacity, the information retrieval capacity and the indemnity of the executing functions. Such skills deteriorate with age according to studies carried out by others. Objective: To evaluate the impact of the therapy to improve the verbal fluency in patient with neurodegenerative diseases. Sample: 29 patients, (age between 50 and 60 years) 5 of them with cognitive impairments, 4 of them with Supranuclear palsy (PSP) and 20 with Parkinson disease. We applied the Mattis Scale (DRS), semantic and phonologic verbal fluency subtests from the FAB (frontal assessment battery) as the starting and ending control test. We applied a logopedic strategy to stimulate the verbal fluency in a cycle of 28 days of therapy. In order to analyze the verbal fluency behavior according to the different neurological diseases, we used T-Test for dependent samples and Wilcoxon Matched Pair Test. Results: In the general analysis, there is more deterioration for the phonological fluency than the semantics. The patients with Parkinson‟s disease presented a better evolution than the other patients, in the semantic (p:0. 000089) and the phonological fluency (p:0. 000356). Patients with cognitive impairments showed an improvement (p:0. 043) only in the semantic fluency test after the treatment. PSP patients didn‟t reach statistical significance comparing their performance before and after treatment. We conclude that it‟s possible to improve verbal fluency in short periods of time, which favors the communication capabilities and quality of life of patients with neurodegenerative diseases. 25P17 Visuo-spatial memory and its relationship w ith age Maria L. Bringas, Enrique Casabona, Sonia Salazar International Center for Neurological Restoration, Havana, Cuba We tried to determine the relation of visuo-spatial memory to age by means of a computerized task. Fifteen pairs of figures are distributed randomly on the screen and are initially all face down. The subject can flip up only two figures at a time and must try to identify and remember where each pair is located. When a pair is flipped consecutively it disappears, the test ending when no figures are left. Dependent measures were TIME needed to complete the test as well as the NUMBER OF FLIPS used. Independent variables were AGE, search STYLE (random or systematic) and the level of training (on a scale of 1 to 5). The sample studied comprised 33 normal subjects with an educational level higher than 12th grade, with an age range from 18 to 81. The NUMBER OF FLIPS was modeled by a generalized linear model with a Poisson link function which showed that AGE was not a significant covariate, while the amount of TRAINING, search STYLE and their interactions were. Log transformed response TIME was modeled by a linear model in which AGE, TRAINING and STYLE were all significant. For both outcome measures the systematic search STYLE, was most efficient. Thus elderly people take more time because they processed information more slowly but they can be just as efficient at this task as younger subjects using an appropriate search strategy. Consequentially this aspect of visuo-spatial memory might be trained, independently of the age of the subject. Technologies for Restorative Neurology and Neurosurgery 25C1 Multi-modality approaches to brain imaging Frederic H. Fahey Children's Hospital Boston, Boston, Massachusetts, USA A variety of approaches to brain imaging have been developed. Some are generally anatomic such as computed tomography (CT) and magnetic resonance imaging (MRI). Others provide images of physiology and function, such as single photon emission computed tomography (SPECT), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Typically, these functional modalities do not provide the same anatomical detail as CT and MRI. Thus, approaches that combine the functional capability of SPECT, PET and fMRI with the anatomical information of CT and MRI are of great utility in brain imaging. Both hardware and software approaches have been derived to provide such multi-modality presentations. Hybrid PET-CT and SPECT-CT scanners are commercially available in the USA that provide good correlation between modalities. For clinics without such technology, software approaches are more appropriate. These involve three steps: converting both image sets to a common computer platform, registering one of the images sets to the other and displaying the results. The registration can be performed either manually or automatically. In turn, there are three approaches used for automatic image registration: fiducial or point-based, surface-based or voxel-based methods. Once the image sets have been registered to each other, an appropriate interface must be used for the display and analysis of these multi-modality image sets. In this presentation, we will review both hardware and software approaches to image fusion as well as the optimal ways to display and analyze these data sets. 25C2 EEG/MEG Tomography and beyond: Multimodality Image Fusion Pedro A. Valdes-Sosa Cuban Neuroscience Center, Havana, Cuba During the past decade our group has contributed to the establishment of an EEG/MEG tomography. The inherent non-uniqueness of the electrophysiological Inverse Problem has been overcome by the use of anatomical information obtained by the structural MRI, as well as by imposing variable smoothness constraints (VARETA). The resulting neuroimaging modality has a spatial resolution in the order of several mm. and an unlimited temporal resolution. It does suffer, however, from a depth bias that emphasizes sources nearer the sensors. This bias can be overcome to a certain degree by the use of Statistical Parametric Mapping techniques for electrophysiological tomography, also developed at the Cuban Neuroscience Center. In particular a frequency domain application of these methods has lead to the development of Tomographic qEEG (qEEG). Several examples show the potential clinical usefulness of this method in the evaluation of stroke patients and in looking for early signs of Alzheimer‟s disease. It is documented in both examples that significant increases of specificity and sensitivity of Tomographic over Topographic analysis can be obtained. Further improvements in EEG/MEG tomography will come from two directions: inclusion of anatomical connectivity information obtained from Diffusion Tensor MRI and of functional information obtained by fMRI. The direct and inverse problems for these new sources of information are discussed. Image Fusion is achievable by Bayesian statistical methods that are outlined. A particularly favorable situation occurs when joint EEG/fMRI recordings are available. In this case a dynamic image fusion method is possible. The applications of this method are shown for an analysis of the alpha rhythm. It is discussed that multimodality image fusion will provide a new generation of Neuroimages with higher temporal and spatial resolution than any current technique. 25C3 Control of EMG signals for computer-based communication systems Eric Fimbela, Martin Arguinb a Institut universitaire de gériatrie de Montréal AND Laboratoire d'environnements de synthèse et interfaces avancées, École de technologie supérieure de Montréal; b Institut universitaire de gériatrie de Montréal AND Groupe de recherche en neuropsychologie et cognition, Département de psychologie, Université de Montréal Computer-based communication systems greatly improve the quality of life of persons with severe motor impairments, like locked-in or quadriplegic patients. In EMG-based interfaces, the user controls the computer by means of myoelectric signals. This non-invasive technique is applicable in any patient with some preserved motor function, e.g., eye movements. However, the efficiency (throughput) of the communication system directly depends on the controllability of the EMG signals. We studied the controllability of EMG signals in face and hand muscles with 40 young healthy volunteers. A visual feedback indicated the amplitude of the EMG signal in real time. The subject had to reach a target (i.e., an interval of amplitude) in either of two modalities: impulsion or sustained, i.e., the subject had to stabilize the signal within the target interval of amplitudes for a duration of 1 s. Two levels of precision were used by dividing the range of amplitudes in 4 intervals (low precision) or 8 intervals (high precision). No significant difference of speed or accuracy was found between facial and distal muscles. However, accuracy was significantly lower for intermediate amplitudes relative to the smallest or highest amplitudes. Finally, a clear tradeoff between speed and accuracy was observed across response modalities: the sustained modality was associated with slow but highly accurate responses whereas the impulsion modality allowed faster but less precise responses. The average speed and error rate allow calculating a theoretical upper bound for text entry with EMG interfaces of 2.5 bit/s, i.e., above 15 words/minute. 25C4 Automatic system for three-dimensional anatomic-physiological correlation during stereotactic and functional neurosurgery Juan Teijeiro Amador, Raúl J. Macías González, Juan M. Morales Oliva, Gerardo López Flores, Lázaro M. Alvarez González, Carlos Maragoto Rizo, Eduardo Alvarez González, Iván García Maezo. International Center for Neurological Restoration.Havana, Cuba. This paper describes the automatic 3D-graphic possibilities that are offered by a PC-based software to facilitate the anatomic-physiological targeting during stereotactic and functional neurosurgery, using deep brain recording. This software has been developed to substitute complex electronic equipment with a PC for deep brain electrical activity recording, display and processing. It also allows greater possibilities for on-line graphic analysis, automatic management of the recorded information and flexibility to implement different forms of signal analysis. This software has been made using a combination of two programming languages. A low level one (Assembler) was used for the on-line working modules. For the rest of the system a high level language (Pascal) and its compiler were used. The system uses an analog-digital converter card and allows to record, show, process and store up to two simultaneous signals with 12 bits accuracy. The software can also automatically show a 2D- and/or 3D-representation of the electrode track with the superimposed electrophysiological findings, and the corresponding sagittal, coronal and axial view of a brain anatomic atlas, after its automatic scaling for each patient. It allows graphic analysis of the recorded information and its correlation with the anatomy, even during the surgical procedure. This software has already been successfully used in Spain, Chile and Cuba in more than 400 neurosurgeries, allowing to increase the targeting accuracy and safety. 25C5 A method for accurate determination of the first target in functional neurosurgery Maylen Carballoa , Rafael Rodrígueza, Gerardo Lópezb . a Brain Images Processing Group, bDepartment of Neurosurgery. International Center for Neurological Restoration (CIREN), Havana, Cuba Accuracy in target determination is one of the fundamental requirements of any surgical planning systems. We developed a system for intraoperative planning of frame-based stereotactic neurosurgery that integrates, in one complete module, all of the basic facilities that are present in other advanced programs. All of the techniques used for our system were optimized in order to increase the performance and precision of the system, especially facilities involved in functional neurosurgery. Based on the vector approach used for calculation of stereotactic coordinates we developed an algorithm for correction of first target in functional neurosurgery. A vector method can be used to determine a frame-independent coordinated system from the coordinates of anterior commissure (AC), the posterior commissure (PC) and another point located on the interhemispherical line, considering the intercommissural middle point as origin. For any point in the images we have AC/PC-based coordinates independently of its frame-based coordinates. Likewise this correction can be used for calculations of target‟s trajectory. Due to its generality this corrective procedure can be used with any stereotactic frame included in our planning system and overcomes geometrical errors that are introduced when the intercommisural line and interhemisphere plane are not parallel and orthogonal to transaxial images respectively. Nuclear Neuroscience Symposium 25C6 Mild cognitive impair ment and brain SPECT Carlos A. Sánchez Catasús Department of Nuclear Medicine, CIREN, Havana, Cuba. There is an imperative need to develop sensitive biomarkers as adjuncts to current clinical and neuropsychological tests to improve detection of early brain changes suggestive of Alzheimer's disease (AD), particularly as new agents to delay the onset of dementia become available. The subtle onset of AD suggests that most of the patients pass through a prodromal phase of mild cognitive impairment (MCI) before dementia is diagnosed. Previous neuroimaging studies have revealed that structural and functional changes are already present in this stage of the disease. Based on basal SPECT data, longitudinal studies have shown acceptable percent of correctly identified MCI subjects who progressed to AD. An ongoing research project of our group is presented in this conference. This project is intended to address if the acetazolamide test by SPECT can improve preclinical prediction of AD. The hypothesis is based on: 1) previous data strongly support that sporadic AD is first provoked by premorbid vascular-related events; and 2) other reports show preserved vascular reserve, but not normal, in patients with probable AD. The first results of the project are presented. 25C7 Tow ard clinical application of neuroactivation probes with SPECT Ingeborg Goethals Nuclear Medicine Division, University Hospital Gent, Gent, Belgium The review presents neuroimaging studies which explored the functional anatomy of a variety of cognitive processes represented by the prefrontal cortex (PFC). Overall, these studies demonstrated that standard prefrontal neuroactivation tasks recruit a widely distributed network within the brain of which the PFC consistently forms a part. As such, these results are in keeping with the notion that executive functions within the PFC rely not only on anterior (mainly prefrontal) brain areas, but also depend on posterior (mainly parietal) brain regions. Moreover, intervention of similar brain regions in a large number of different executive tasks suggests that higher-level cognitive functions may best be understood in terms of an interactive network of specialized anterior as well as posterior brain regions. 25C8 Radionuclides in nuclear neurology José Morín Zorrilla Isotope Center, Havana, Cuba This conference is a review of the sources of the most commonly used radionuclides in Nuclear Neurology, the state and evolution of the market in this field and the possibilities of the local supply of these products. It is also considered the installation and operation of a cyclotron as the most promising and feasible source of radionuclides in this area. A comparison of the existing imaging technologies is given in the framework of the available radionuclides, including a brief summary of the most commonly used radiopharmaceuticals for diagnostic and therapeutics in this particular field. The presentation shows the view of the Cuban national producer of radiopharmaceuticals and its necessary interaction with the final user. 25C9 Analysis of brain SPECT studies Filip Jacobs Nuclear Medicine Division, University Hospital Ghent, Belgium Nowadays, with the most powerful computers and software packages available, the analysis of brain images is not the most difficult part of a brain SPECT study. The most difficult questions are encountered before the actual analysis, namely while choosing the study design, the tracer, the acquisition protocol, the collimators, the reconstruction algorithms, the physical processes to correct for, the existence of confounding factors, the inclusion criteria, etc. Many problems during the analysis of brain images may be avoided by carefully designed study. Therefore, we first give an overview of the most important issues to be solved before the data acquisit ion. Once the data have been acquired and the images are reconstructed, one can start analysing the images. In order to focus our attention, only two important and well known software packages are discussed, being "Statistical Parametric Mapping" (SPM, Wellcome Department of Imaging Neuroscience, UCL, London, UK) and "Brain Registration and Analysis of SPECT Studies" (BRASS, Nuclear Diagnostics Ltd, Northfleet, UK). The former is designed to address most research questions concerning brain studies, while the latter has been optimised for use in a routine clinical setting. Both the idea behind each package and their use will be covered. Posters 25P18 Topographic evaluation of bilateral subthalamothomy using an MRI-based analysis Rafael Rodriguez Rojasa, Maylen Carballoa, Rolando Palmerob , Gerardo Lopezc , Lazaro Alvarezd , Raul Macíasd a Brain Images Processing Group, b Static Lesions Clinic, c Department of Neurosurgery, dMotor Disorders Clinic, CIREN, Cuba The result of stereotactic ablative surgery is critically dependent of the exactitude of the lesion localization. The aim of this work was to develop a methodology to obtain a precise anatomic localization of stereotactic lesions and perform an accurate audit of the precision of our stereotactic target placement. METHODS: Postoperative MRI studies of 15 parkinsonian patients submitted to bilateral subthalamotomy were examined. Each MRI study was transformed into Talairach space using an automatic algorithm to determine non-linear transformation between the individual volumes and a model brain. Individual and average X, Y and Z coordinates of center of gravity (COG) of the lesions were determined for each hemisphere, and used as input into the software Talairach Daemon (TD), which shows the anatomical region labels corresponding to the calculated x-y-z coordinates. RESULTS: According to TD, average coordinates in Tailarach space correspond with subthalamic nucleus. Differences in lesion location between hemispheres did not achieve statistical significance. CONCLUSIONS: This study has proved that surgical methodology applied at CIREN is accurate enough for determining optimal lesion localization. This type of analysis may also be used to examine the results of other types of stereotactic procedures in the subcortical nuclei. As well, careful anatomic analysis can be useful in demonstrating the characteristics of lesion resulting in known complications of this surgery. 25P19 Subthalamic nucleus targeting and spatial variability G. López-Flores, R. Fernández-Melo, L. Álvarez-González, J. M. Morales, R. Macías González, J. Tejeiro-Amador, E. Palmero, C. Maragoto Rizo, E. Álvarez-González, J. Guridi J, J. Obeso. International Center for Neurological Restoration, Habana, Cuba The goal of this study was to assess the effectiveness of anatomic localization (EAL) of the subthalamic nucleus (STN) and to analyze the contralateral symmetry (SCN). The authors conducted a retrospective analysis of 11 consecutive patients submitted to bilateral subthalamotomy with ablative lesioning. To assess EAL - the percentage so much of first trajectory (p1) as to the total of trajectories (pt) that hit the target - the rest of subthalamic nucleus average distance (d) was calculated. The anatomic localization error (e) is determined as a difference between first trajectory coordinates with those of medial determined nucleus point, through electrophysiological data as to the statistical significance of this error. SCN is analyzed by contrasting equality hypothesis at the nucleus maximum height along both sides of a trajectory, average electrophysiological position center and spatial distribution of all intranuclear recordings found in each hemisphere in all patients. The pi, pt and d obtained values were 86.36%, 86.13% and 1.41±1.01 mm respectively. The e value was greater in anteroposterior direction of 1.11±0.83mm without statistical significance. The average number of recorded trajectories for the first procedure was 6.45 and 6 for the second. The asymmetry of contralateral nucleus was not significant. An indirect method with CT brain images and a new electrophysiological mapping method with a multiunit recording for first and second nucleus is safe enough and it yields a high effectiveness in anatomic and functional nucleus localization. The nuclei of a same patient are symmetrical. There is little space variability among patients non-related to the differences in the intercommisural distance. 25P20 Dynamics of digital EEG pattern in operated patients with Moyamoya disease Pushkina E.A., Svadovsky, A.I. Neuroaesculap Clinic, Moscow, Russia Purpose of study. Our goals were investigate a different parameters in 12 patients with Moyamoya disease. The treatment of Moyamoya disease (nonatherosclerotic obstructive vascular disease) remains difficult problem in neurology and neurosurgery. Material and methods. The clinical picture demonstrated transient ischemic attacks (TIA; 6 cases), transient optical complications (2 cases) and epileptiform paroxysms (4 patients). All patients (male 7, female – 5) were underwent surgical treatment. Mean age 34 years. We performed our method of surgical revascularisation of brain – arterioencephaloanastomosis (unilateral 8 cases and 4 bilateral). All operations were performed after long unsuccessful medical treatment for reduce cerebral ischemia. Diagnostic methods till and after surgery included transcranial Doppler (TCD), magnetic resonance angiography (MRA), and digital EEG examinations with standard functional tests (fotostimulation, hyperventilation). We performed EEG at the time 3-6-12 months after surgical tretment. Results. In preoperative period EEG registrated seizure pattern, slow activity, three Hz spike-slow waves and photo-paroxismal response. After surgery all patients showed in EEG alpha rhythm and alpha variant rhytms; paroxysmal activity absent. Therefore, in follow-up period the results of surgery were beneficial. Conclusion. We support surgical treatment lead to reduce cerebral hypoxia/ischemia and neurological deficit. It can explain better of brain. Dinamic EEG data might indicate that arterioencaphaloanastomosis is effective treatment of Moyamoya disease. 25P21 Diffusion Tensor in Magnetic Resonance Imaging and its applications Pedro Antonio Valdés Hernández. Neurophysics Department, Cuban Neuroscience Center, Havana, Cuba It is presented a review of methods based on Diffusion Tensor Magnetic Resonance Imaging for the estimation of neural fiber mean directions in each voxel of the brain. Two indexes calculated from diffusion tensor are mentioned briefly which help in tissue segmentation and disease detection. Also, it is made a review of the algorithms used in calculating neural fibers and probabilistic paths taking into account anisotropical tensor geometrical shape. Those algorithms are based on the methods mentioned before. Finally, a brief discussion of the potential application of such fiber pathways in the inference of anatomic connectivity measures between different zones in the brain is done. 25P25 Transcraneal doppler sonography in brain death diagnosis Anselmo A. Abdo, Roberto Castellanos, Francisco Gómez, Javier Figueredo, Aldo Alvarez, Jorge Lage Centro de Investigaciones Medico Quirúrgicas, Ciudad Habana, Cuba The Transcraneal Doppler (TCD) is a useful technique to confirm cerebral blood flow alterations. Objective: To evaluated the TCD usefulness in the brain death diagnosis. Method: A prospective study was made in 21 neurocritical patients admitted in the Intensive Care Unit of the Centro de Investigaciones Medico Quirurgicas, in the year 2002. TCD pattern were collected and if clinical brain death was present. Sensibility, specificity, and Kappa index was calculated. Results: Clinical brain death was present in 10 cases. The TCD patterns most frequently in these cases were oscillating blood flow (reverberating flow) in 5 cases, and short systolic spikes in 4 cases. The relationship between this TCD pattern and clinical brain death were 100% in sensibility and specificity. Conclusions: The TCD method is useful and reliable to determine the absent cerebral blood flow. 25P23 Model for calc ulation of temperature distribution in resistiv e magnetic resonance scanner Aylin Martínez Bermello Centro de Biofísica Médica, Universidad de Oriente, Santiago de Cuba, Cuba The magnetic resonance (MR) scanners are medical equipment for imaging diagnostic of central nervous system illnesses mainly: cerebral infarcts, cortical and cerebral atrophies, skull traumatisms, some degenerative illnesses. These equipment works due to the action of magnetic field on the tissues. When a resistive magnet is used for generation of magnetic field the intensity, homogeneity and temporary stability of the magnetic field define the clinical images quality. The thermal behavior of winding and therefore, the characteristics of the magnet and of their cooling system exercises decisive influence on these magnetic field parameters. In this paper a physical- mathematical model for the thermal process description of resistive MR scanners is presented. The model was applied to Cuban equipment, and the analysis of the temperature distribution in winding facilitated a valuation of constructive parameters and design of the cooling system heat exchangers. The model was developed according to the laws of the thermodynamic and the heat transfer. Their effectiveness was proven for a level of significance of 0.05. The temperature maps of the magnet were obtained. The maximum temperatures to nominal electric current are around the 146°C. These temperatures are not dangerous for the materials of winding. The heat transfer in radial sense is significantly bigger that in axial one. This aspect should consider as design approach for future equipments. The winding is compact and the heat exchangers were assembling appropriately. 25P24 Age-related perfusion changes by brain SPECT in healthy subjects M. Cisneros Cué a, C. Sánchez Catasúsb , N. Pérez Lache a, R. Rodríguezb , A. F. Aguila a a Department of Neurology, ISMM; Havana, Cuba. bDepartment of Nuclear Medicine, CIREN, Havana, Cuba. This study characterizes the effects of aging on brain perfusion using HMPAO – SPECT in healthy subjects. The study population consisted of 10 women and 19 men with age range of 20 - 79 y. Their past medical histories, physical examinations, and laboratory screening tests were normal. The sample was divided in three age groups (GI: 20 – 39 y; GII: 40 – 59 y; GIII 60 – 79 y). HMPAO – SPECT scans of the brain were performed with a standardized acquisition and processing protocol on a single -head camera equipped with high-resolution collimator. A Butterworth filter and a correction for uniform attenuation were applied after back projection reconstruction. Brain perfusion evaluation was performed both visually and by a relative quantification method using the cerebellum as the reference region. To that end, cortical bilateral and regular regions of interest (ROIs) were drawn on adjacent SPECT slices. Group comparison were performed using ANOVA. Brain perfusion decreased significantly with age in frontal and parietal regions (groups GII and GIII less than GI, p < 0.01). These results are in agreement with previous reports. As a conclusion, aging significantly affects brain perfusion in healthy subjects. It decreases in parietal and frontal region and it seem to occur after thirties. The brain perfusion appears to remain relatively stable throughout middle age. 25P25 Contribution of brain SPECT to the presurgical evaluation of temporal lobe epilepsy: CIREN experience Morales Chacón L, Sánchez Catasús C , Aguila A, Bender J, García I. Epilepsy Surgery Program, CIREN, Havana, Cuba The aim of this study is to show the contribution of interictal and ictal brain SPECT to localize the epileptogenic zone in patients with Temporal Lobe epilepsy (TLE) submitted to surgery at CIREN. As part of presurgical evaluation, interictal and ictal SPECT scans were performed to assess cerebral perfusion in 18 patients with pharmacoresistant TLE. A double –head gamma camera was used (SMV DST Xli, SMV International) connected to a workstation IBM RISC System 6000, provided with a processing system Vision 5.0 (SMV America, Inc). After visual analysis, cerebellar perfusion ratios were calculated on irregular regions of interest (ROI), drawn on lateral and mesial lobe and basal ganglia. Also, asymmetry indexes were calculated between homologous ROIs (including the cerebellum). Visual analysis detected focal hypoperfusion involving the whole temporal lobe in 100% of the patients. The hypoperfusion was extended into the frontal lobe in 50% of them. Quantitative analysis using the ROIs method showed that the changes in lateral temporal perfusion were the most suitable lateralizing indicator of the seizure. It was ipsilateral to the epileptogenic zone defined by surgery in 87.4 % (p< 0.0001). Interhemispheric asymmetry indexes of 13 % and 28 % were found in left and right TLE, respectively. Ictal SPECT showed mesiolateral temporal lobe hyperperfusion ipsilateral to the epileptogenic zone in all patients and also demonstrated contralateral cerebellar activation in 25 % of them . In addition ipsilateral basal ganglia activation was observed in 75 % .Interictal SPECT defined an extensive functional deficit zone in TLE patients. Ictal and interictal SPECT changes are a reliable lateralizing indicator of epileptogenic zone in TLE. 25P26 Epider mal Growth Factor receptor hr-3 monoclonal antibodies radiolabelled w ith rhenium-188 in the adjuvant treatment of high grade astrocytomas Gerardo López, Ramses Fernández Melo, Angel Casaco, Leonel Díaz, Juan Batista, Alejandro Pereira, Rene Leiva, Yamilé Peña, Marco Coca, Olga Torres, Tania Crombet, Mayelín Martines, Leslie Ramos, Zaida Amador. International Center for Neurological Restoration, Habana, Cuba Intralesional radioimnmunetherapy (RAIT) may improve the management of malignant gliomas whose prognosis is, at present, very poor. Current treatment modalities cannot prevent tumor recurrence. This study was performed to evaluate toxicity, dosimetry, biodistribution and clinical efficacy of the h-R3 monoclonal antibodies labeled with Re-188 after intralesional RAIT in cases of malignant gliomas. Following surgical operations, radiotherapy and chemotherapy, 4 patients with recurrent malignant gliomas, 2 with anaplastic astrocytomas and 2 with glioblastoma underwent RAIT with h-R3 antibodies raised against epidermal growth factor receptor (EGFr) labeled with rhenium-188 in different escalating doses. The dosimetry and biodistribution had been performed using Single Photon Emission Computerized Tomography (SPECT), whole body and quantification studies. In these patients the follow-up study period ranged from 6 to 12 months. No significant life- threatening toxicities were observed. Acute side effects following treatment were seizures and worsening of pre-existing neurological symptoms. Late side effects were radio necrosis in 1 case. Objective response consisted in one patient with tumor stabilizations during 6 months and two with complete remissions. RAIT is safe and an effective procedure, mainly in cases with peripheral and reduced tumor border. Further investigations should focus on optimizing the dose delivery to the surrounding tissue and should be set up to confirm these findings. 25P27 Brain perfusion SPECT in schizophrenic patients with negativ e symptoms N. Pérez Gonzáleza, C.Sánchez Catasúsb , J.Pérez Milána,R. Rodríguezb , A. Aguila Ruizb a Hospital Psiquiátrico de La Habana; b Department of Nuclear Medicine, CIREN, Havana, Cuba. One of the polemic aspects in schizophrenia deals with the Cerebral Blood Flow (CBF) in patients with negative symptoms. The most frequent finding is frontal hypoperfusion. In the present study we intended to evaluate CBF by SPECT in a relatively homogenous sample of schizophrenic patients with negative symptoms and compare them to a control group of healthy subjects, using a semiquantitative methodology for CBF quantification. Ten male healthy volunteers and 15 male patients with a clinical diagnosis of residual schizophrenia (295.60 points according to the DSM-IV criteria) and without inability for communication were studied. Their ages ranged between 32 and 50 years (mean 44.6 years), and the evolution time, between 10 and 24 years (mean 16 years). All patients were being treated with Haloperidol and Fluofenazine. The positive and negative symptom scale (PANSS) was used for the evaluation of these symptoms. In each patient or healthy subject an evaluation of the CBF by 99mTc-HMPAO SPECT was performed both visually and by a relative quantification method using the cerebellum as the reference region. Cortical bilateral and regular regions of interest (ROIs) were drawn on SPECT slices. An index of asymmetry was also calculated (IA) for every pair of homologous ROIs. The results showed significant differences (less CBF in the group of patients) bilaterally in the frontal and temporal regions (p< 0.05). In the group of patients, the asymmetries found were not different from those observed in the normal group. As a conclusion, a symmetrical bilateral decrease in the frontal and temporal lobes seems to characterize schizophrenic patients with negative symptoms. 25P28 Dose assessment and individual monitoring of workers and public during the first phase of the clinical study for the radioimmunotherapy of cerebral tumors in Cuba Amador Balbona, Z.H., Pardo Ayra, F.E., Torres Berdeguez, M.B. Isotope Center,Havana, Cuba. Taking into account the international experience and the approval of the regulatory authorities, last year it began in the Republic of Cuba the first phase of the clinical research of the humanized monoclonal antibody h-R3 labeled with 188Re, for radio-immune therapy (RIT) of cerebral tumors This monoclonal antibody was obtained in the country and it is required to evaluate its toxicity, biodistribution and interna l radiation dosimetry. Five groups of three patients of each one with an administered activity from 0.37 GBq to 1.1 GBq are considered. The aim of this work is to assess workers and public doses for this research and to compare projected doses with the first results related to the individual monitoring. The contribution to the total effective dose and equivalent dose in extremities are calculated with the code Micro shield Version 4.0 by each activity level, operation and total quantity of patients, considering the results of the radioactive decay calculation for 188Re. It is demonstrated that individual doses are acceptable and lower than world average effective annual dose of natural radiation background (2.4 mSv), because for the operations of more risk are considered the use of individual protection means. Nevertheless, it is identified that nurses are the most exposed. The projected maximum equivalent dose to hands is 3 mSv and it belongs to the neurosurgeon. Five workers and public (four individuals) are monitoring with direct reading dosimeters DOSICARD and TLD for extremities. The conservative assumptions in the assessment and the compliance with established safety procedures determine that the registered doses are lower than those were projected. 25P29 Relative indexes of brain perfusion by 99 mtc HMPAO SPECT utilizing a mean value of the visual cortex to the cerebellum ratio derived from normal subjects C. Sánchez Catasús, R. Rodríguez, M. Cisnero, R. Palmero, O. Díaz, A. Aguila. Department of Nuclear Medicine, CIREN, Havana, Cuba. Previous results show the cerebellum (CER) is the best reference to calculate relative indexes of brain perfusion (IP) by HMPAO SPECT. It cannot be used on patients with CER perfusion deficit. In such cases the visual cortex (VC) or others reference values are recommended. The use of different references makes the comparison of SPECT scans almost impossible. We developed a method for calculating IP using a reference value, which acts as a model of "normal CER counts". This value was designated as CER* and it was calculated using the mean value of the VC/CER ratio derived from a normal database. We tested statistically the VC/CER ratio on a group of 60 scans from individuals without involvement of VC and CER. To demonstrate that IPCER* » IPCER, we calculated the mean value of the absolute differences <|IPCER - IPCER*|> on two groups of scans: 10 normal subjects (GI) and 40 patients without involvement of VC and CER (GII). Using an indirect procedure the method was tested on a third group of scans of 30 patients with CER perfusion deficit (GIII). The VC/CER ratio was constant at a 95% confidence level; <|IPCER - IPCER* |> for GI and GII was less than the replicability of the HMPAO SPECT studies; and it was proved in GIII that CER* is comparable to CER as reference value with the only condition being that perfusion in subject‟s VC must be unaffected. The method allows generalizing CER as a reference value, inapplicable only in those cases with concurrent hypoperfusion on VC and CER. 25P30 Absolute quantific ation of cerebral blood flow by SPECT Rogelio Díaz Moreno, Carlos A. Sánchez Catasús, Angel F. Aguila Ruiz. Department of Nuclear Medicine. CIREN, Havana, Cuba Quantification of cerebral blood flow (CBF) is useful in pat ients with neurological diseases because of the diagnostic and therapeutic implications of such quantification. CBF quantification by SPECT can be achieved in relative or absolute units. Relative quantification is more used due to it is less time consuming and because most of the absolute quantification methods require a more expensive instrumentation or blood sampling of the patient, which makes absolute quantification an invasive procedure. In 1992, a new method was developed by the Japanese investigator H. Matsuda without those previous handicaps. This method substitutes the blood sampling by a graphical procedure, which is applied to a first-pass dynamic study. Mean CBF (mCBF) can be calculated by this way for both brain hemispheres. Regional CBF values (rCBF) can then be calculated using the Lassen correction for the distribution of the radiotracer estimated with a standard SPECT study. We implemented Matsuda‟s method in ten healthy individuals using 99mTc - ECD. Values of mCBF were between 44 ml/min/100g and 50 ml/min/100g for all individuals. Values of rCBF in gray matter were around 70 ml/min/100g. Values of rCBF in white matter were around 20 ml/min/100g. These values are similar to those reported by Matsuda. We concluded that Matsuda‟s method is simple, not invasive and can be implemented with the technology of our country. This method can become a valuable tool to enhance clinical diagnosis and research in other important neurological problems. 25P31 A way to reduce radius of rotation in brain SPECT w ith a single-head system C. A. Sánchez Catasúsa, M. Rodríguez Castillob , R. Rodrígueza , N. Rodríguez a. a Department of Nuclear Medicine, CIREN, bDepartment of Nuclear Medicine, INOR, Havana, Cuba. To optimize spatial resolution in SPECT it is essential to minimize the radius of rotation (rrot). In brain studies, different solutions have been employed in order to avoid the shoulder interference when rrot is minimized: rectangular fields of view, modifications to the shielding around circular detectors and fan or cone beam collimators. However, few single-head systems can utilize these developments, particularly old cameras. A non-standard image acquisition method to reduce rrot in brain SPECT with a single-head gamma camera is presented. The method applies a defined transformation to the original acquired images, keeping all the brain inside the field of view without possible to reduce rrot to 16 cm and to obtain a transaxial spatial resolution of 15.98 mm, 3.5 mm less than standard method used in our laboratory. This procedure was implemented for a gamma camera Siemens Gammasonics ZLC 3700 and has been validated through single-slice brain phantom studies. The method has the advantage of not introducing any complex or costly hardware implementations. 25P32 Quality assurance in brain SPECT Angel F. Aguila Ruiz, Carlos A. Sánchez Catasús, Rogelio M. Díaz Moreno Department of Nuclear Medicine, CIREN, Havana, Cuba SPECT is a highly sophisticated technology, which needs a strict quality assurance, if one wishes the data generated by this procedure to be reliable. The objective of this paper was to evaluate different functioning parameters of the gamma camera at our department, in order to establish which parameters most affect the quality of brain SPECT images and to find out with which periodicity they are to be evaluated. This study was performed for a year by making periodic evaluations. A double –head gamma camera was used (SMV DST Xli, SMV International) connected to a workstation IBM RISC System 6000, provided with a processing system Vision 5.0 (SMV America, Inc). Sources of 99m Tc were used to perform different tests, as well as a SPECT phantom, props for radioactive source, ruler, syringes, disposable vials, lead containers and other materials to perform the tests were also utilized. The obtained results show an annual mean value of 2. 69 % for tomographic uniformity; and an annual mean value of 1.2 mm for the displacement of the center of rotation. As a conclusion, we can assert that such parameters that most affect the quality of SPECT brain images are: the displacement of the center of rotation and tomographic uniformity. Tomographic uniformity and the displacement of the center of rotation should be evaluated weekly and monthly, respectively, in order to assure the optimum quality of brain SPECT images. 25P33 Stroke due to vasculitis associated to Systemic Erythematosic Lupus in children. A case presentation Carmen Rosa Alvarez Gonzalez, Erduy J Infante Velásquez, Gilda Martinez Aching, Carlos Sánchez Villar International Center for Neurologic Restoration (CIREN). Havana, Cuba Colagenosis is a multisystemic disease with a great evolutive variability. In the case of Systemic Erythematose Lupus, the neurological commitment is present in almost half of all cases and it provokes vasculitis by convulsions caused by stroke or brain hemorrhage. Diagnosis is established with the aid of Computer Tomography. The objective of our work is the presentation of a clinical case. Material and Method. A case under pediatric age with an autoimmune disease of the vascular- type is presented. The disease provoked a motor sequel of the left-hemiparesia. We applied the evaluation of motor function (at the beginning and end of neurorestorative treatment). Discussion of results and conclusions. Keeping in mind the patients peculiarities, we evidenced that with an adequate structured application and by giving special attention to different developmental areas with the use of the Intensive Multifactorial Neurorestorative Program at the Children‟s Clinic of Neurology progress can be obtained. From a quantitative viewpoint the Gross Motor Scale was applied to the patient at the beginning and end of treatment. The results showed that in the initial evaluation, the patient reached a 22,2% and 37,5% in the final one, for an improvement of 15,3%. This made possible to conclude, that it is possible to improve the patient‟s quality of life. 25P34 New scale for the classif ication of paraplegic patients after a spinal cord lesion Edgar N. Galarraga Triana and Carlos. Sánchez Villar Neuropediatric Clinic, International Center of Neurological Restoration, Havana, Cuba Medullar lesions constitute one of the more frequent causes of disability in the world. This is produced by the rupture of nervous pathways. These axons, once broken, are unable to regenerate causing loss of sensitiveness, and permanent and irreversible paralysis below the lesion level. In our work we tried to validate a test we made to demonstrate that it is reliable to quantify and classify the restoration in the physical sphere of paraplegic patients due to a medullar lesion. The test we present here is a variant to the Barthel index where we included only physical items. This investigation was carried out at CIREN‟s Neurology Clinic for Children and the Clinic of Spinal Lesions. The sample was composed of 33 patients with ages between the 3 and 40 years old, all diagnosed with spinal lesion, either congenital or acquired. They were subjected to a period of rehabilitation of 28 days, and were evaluated with the test mentioned before, during and after treatment. To establish the validity of the test, we used the statistical technique of product moment of Braves Pearson, and for reliability, we used variance analysis. The results demonstrate the validity and reliability of the test proposed to evaluate the recovery of a paraplegic patient. 25P35 Influence of physic al exercis es on patients bearers of muscular dystrophy of Duchenne and Baker type Elia Aguero Pacheco, Rebeca Gutiérrez de los Santos., Alexis Rodríguez Aldama, Gabriel Rodríguez García. International Center for Neurológical Restauration (CIREN), Havana, Cuba Until recently, dystrophies have not been considered for rehabilitation treatment due to the course of the disease, the role of fatigue on affected muscles and the absence of therapeutic effects of muscular exercises. Today, it can be asserted that considering dystrophies as a kind of paralysis is wrong. The total absence of the muscular activity will hinder patients from the stimuli that provoke energetic reactions, which are necessary to keep the functional value in the patient. Immobilization is said to be harmful as it disturbs deep circulation. From this, the role of rehabilitation is important to keep functional possibilities to a maximum. Purpose: To demonstrate the influence of an integral rehabilitation treatment to patients bearers of muscular dystrophy of the Duchenne and Baker type. Material and method: We performed a retrospective study to selected sample of patients diagnosed with Duchenne \ Becker muscular dystrophy for children. Each child was submitted to a rehabilitation treatment approximately between four and eight weeks with 6 weekly frequencies. We performed basic motor tests at the psychomotor integral evaluation lab (LEIS) at the beginning and the end of treatment. Patients were evaluated in their gross motor function (GMF) and muscular test or Daniel„s test of each body segment in order to determine the level of improvement reached during treatment. Results: A significant improvement was obtained in treated patients. 25P36 Chiropractic treatment for lumbar disc herniations Raul Carrillo Rodriguez Eduardo Ahumada Northwestern Health Sciences University, USA A total of 100 patients between 25-35 years of age. with proven disc herniations on MRI, with grade II classifications were treated with chiropractic specific adjustments to the lumbar spine where the segments involved were mainly l4 and l5, with pain at site of palpation, muscle spasm, radicular pain into legs and feet, paresthesias, some loss of strenght on leg muscles and 15% presented with neurovascular reflexes with ankle and foot swelling. A series of 15 chiropractic adjustments were performed with 50% of symptoms resolved within the first 5 visits, other patients improved gradually up to 90-98% recovery on the 12th visit. The most common symptom to prevail was the numbness at distal portion of the involved extremity. Only 10 patients needed to have a epidural steroid spinal block and only 3 of them discontinued conservative management to undergo selective endoscopic discectomy. This patients were treated with 5 adjustments first week, 3 adjustments per week the following two weeks and once a week the following four weeks, no medications were prescribed only i.m. vit. B12 and icing the involved area of pain 20 mins every hour the first 2 days then 3 times a day for 5 days. No adverse effects were presented with the adjustments and only 2 patients had adverse allergic reaction to the vit. B12. The patients were all evaluated with a full spine view 14x 36 and lls, flexion-extension views of lumbar spine in order to identify vertebral misalignment and pelvic instability that influences the pressure vectors over the disc and facet joints of the motor unit involved, as well as MRI with gadolinium contrast where all patients had grade ii disc herniations with symptoms related to disc compression all th is imaging performed preceded by chiro/ortho/neuro examination to determine ivdh classification and the site of vertebral subluxation complex. Three had questionable symptoms and a bone scan (gamagram) performed to rule out sacroilitis 2 were negative and 1 positive for sacroilitis, this patient was removed and replaced from the treatment group for ivdh. Conclusions were made upon taking chiropractic treatment as a primary conservative approach to treat ivdh. of the lumbar spine with radicular ssx with excellent results to avoid spinal surgeries. 25P37 Effect of cellular metabolism increase and decrease on lipoperoxidation process after traumatic spinal cord injury Sergio Torresc, Hermelinda Salgado-Ceballosa ,b , Gabriel Guízar-Sahagúna,b , José Luis Torrese, Martha E. Vázqueze, Araceli Díazd , y Camilo Ríos-Castañedac,d. a Research Medical Unit in Neurological Diseases, CMN, S. XXI, IMSS, b Proyecto Camina A.C., c Metropolitan Autonomous University, Iztapalapa, dNational Institute of Neurology and Neurosurgery, eResearch Unit in Oncology Diseases, CMN, S. XXI, IMSS, Mexico city, Mexico Traumatic spinal cord injury (TSCI) often results in permanent paralysis. The final lesion results not only from the physical trauma to the tissue, but also from the progressive cellular damage that expands the injury to caudal and rostral levels of the spinal cord. This secondary injury includes ischemia where mitochondrial function fails and ATP concentration drops within minutes, and reperfusion process which promotes autodestructive phenomenons like tisular damage by reactive oxygen species (ROS) and lipoperoxidation process (LP). With the aim to evaluated the effect on LP process, metabolism activity was increased and decreased using the cocarboxilase non degradable (CND) enzyme and 5 mitochondrial inhibitors respectively in 48 Long Evans, female, adult rats divided into 8 groups: Group 1, laminectomy without TSCI; Group 2, TSCI plus physiologic solution; Group 3, TSCI plus CND; Groups 4, 5, 6, 7, and 8 plus rotenone, 3- nitropropionic acid, antimycin A, sodium azide, and cyanide respectively. Animals were subjected, under anestesic conditions, to a moderate TSCI (T-9) using the NYU impactor system. Treatments were injected intraperitonealy 5 minutes after TSCI. The effects of CND and mitochondrial inhibitors on NADH dehydrogenase, succinate dehydrogenase, cytochrome oxidase and LP process were evaluated 24 hr after treatment. CND treatment increased LP processes (p<0.05), while all mitochondrial inhibitors, except cyanide, decreased the LP process, specially rotenone and sodium azide (p<0.05). Our results suggest that the decrease in metabolism activity, early after a TSCI could be an autoprotective response instead a secondary mechanism of damage since it could reduce LP process. 25P38 Treatment w ith laser on ischemic ulcers for patients with medullar lesions Carlos Rafael Leyva Barrientos. M. H.” Dr Luis Días Soto”, Habana, Cuba A clinical trial was made based on controlled, descriptive and prospective analysis of patients admitted at the military hospital Dr. “Luis Diaz Soto” between February 2002 to February 2003 suffering from medullar lesions and other neurological dysfunctions with ischemic ulcers. It‟s a ten- patient sampling. Subjects were selected at random and equally grouped into two sections with 5 cases each. The first group of patients was treated with 1% Cetavlón in order to wash ulcers, later rinsed with 0.9% serum following the lesion necrotic tissue debridement, careful wiping and an application of infrared Hene laser by means of a Fisser-III-brand equipment made in Cuba at 7 Joule/cm2 and 25 watts (MW) of power which optic fiber device is placed perpendicular to the lesion ridge for 60 second/point. The second group was treated with washing and debridements process the same as in the previous case. This time, however, a light coat of skin growth ointment applies. In each case, sterilized dressings were placed on the ulcers until the last day of the treatment in order to evaluate the action of laser rays in the cicatrisation process. The subgroup composed of 15-19 year-of-age patients (60%) prevailed male individuals (80%) who had car accidents (50%) resulting in paraplegia; major sequel found in 8 patients. 25P39 Bladder education with nurse neurological restoration strategies J. Ignacio Escalante, Jaqueline Garriga, M.Angeles Peña, Marlen Savigñon, Mirna Alvaro-Diaz Spinal Cord Injury Clinic, International Center for Neurologic Restoration, Havana, Cuba The study and follow up of neurogenic bladder in spinal cord injuries are of vital importance for the multidisciplinary team that cares for this patients. We presented a prospective and retrospective study of 601 patients admitted in Spinal Cord Injury Clinic of International Center for Neurological Restoration during the period between January 2000 and September 2003. The main goal was to obtain bladder reeducation. We used the urological scale and the nurse evaluation during reception in 100% of the patients being able to conclude that 95% of the patients came without bladder education and with history of urinary infection in 97%, as principal consequences of bladder neurogenic dysfunction. We obtained, with our intervention, the reduction of complications related with this disease. 25P40 Neurological restoration in paraplegy: The CIREN experience Juan E. Bender del Busto. International Center for Neurologic Restoration (CIREN), Havana, Cuba We will perform a review of principal aspects related to multifactorial management in paraplegic patients at the Spinal Cord Injury Clinic of the International Center of Neurological Restoration, Havana, Cuba. The results will be shown too. All patients were studied using haematologic, imagenologic and neurophysiologic tests before the beginning of neurological restoration. The Barthel index, spasm, motor and Asworth scales were applied too. Physical rehabilitation, occupational and speech treatment were performed. A good evolution was found in our casuistic and life quality was significantly increased in 25 evaluated patients. 25P41 The w ritten language, an actual alternative for patients bearers of cervical medullar lesion Mercedes Caridad Crespo Moinelo, Oscar Oliden Torres Carro, Tania Francia González, Ana María Montero International Center for Neurologic Restoration (CIREN), Havana, Cuba Spinal cord lesions can produce different motor disorders according to the level of alteration suffered by the spinal cord. When segments between C4-C8 are lesioned, superior limbs are most frequently affected, and as a consequence, skilled hand activities. With the aim of evaluating the influence of the system of therapeutic activities, developed for the correction of the functional disorders of the superior limbs, the Oligraf quantitative scale for writing (created by CIRENS Clinic of Movement Disorders and Neurodegenerations) was applied. We applied this scale to 20 patients with high spinal cord lesions (C4-C7) divided into three groups according to the level of lesion, before and after therapeutic intervention. The patients were evaluated using the LEIS Standard Scale (CIREN. Alterations in writing were found in the majority of the sample, where macrographia, agglutination and expansion of writing predominated in patients with C6-C7 lesion. Upward, downward and agglutinated writing was found in patients with C5-C6. Writing on top of the other letter was found in patients with C4-C5 lesions. OLIGRAF quantitative scale influenced in a positive way the identification of alterations in writing in almost the totality of the sample. 25P42 Effect of a physic al rehabilitation program on gait and Independence level in paraplegic patient w ith spinal cord injury Yosvani Acea Cruz, Ernesto Cossío García, Alexander Echemendía del Valle. International Center for Neurological Restoration (CIREN), Havana, Cuba Introduction: Spinal cord injury is one of the most common causes of disability in adults. Trauma over the spine can develop a fracture, luxation or ligament damage. Objective: to evaluate the effect of a rehabilitation program on the gait and the independence level in paraplegic patients. Methods: we selected 10 patients with dorso-lumbar spinal cord injury. We evaluate patients with the Barthel index and the preparatory activities for the gait (mattress work and stand work) before and weeks after an intensive rehabilitation program. Results: nine patients increased the ability in mattress work, according to repetition of the exercise (15 repetitions over baseline in hip‟s flexion). Barthel index increased in all patients (mean of 20 points). Conclusions: an intensive rehabilitation program seems to be effective for training the gait an increase the independence level of paraplegic patients 25P43 Post-paralitic sinkinesis in peripheral facial palsies Marta Brown, Aymee Hdez, Judith Cañizares, Ana E. Fdez. Dpto. de Neurofisiología Clínica, Hospital Carlos J. Finlay, Ciudad de la Habana, Cuba In the facial neuropathies with an axonal lesion very predominant or exclusive axonal, takes place in a systematic way, an aberrant regeneration that produces a clinical phenomenon named facial cross-innervation, so called post-paralytic hemifacial spasm. In these cases, the answers R1 and R2 of the Blink Reflex are obtained in other facial muscles outside of the muscle Orbicularis oculi, as the Frontal, Orbicular oris or Cutaneous of the neck. The physiological explanation commonly accepted is the arrival of the nervous fibers belonging to the muscle Orbicularis oculi to other facial muscles in the regeneration process. In such a sense, we gave ourselves to the task to explore the existence of this phenomenon, also called post-paralytic sinkinesis, in patients with peripheral facial palsies in different moments of the illness's evolution. In this study we present the Blink Reflex obtained in the Orbicularis oris muscle bilaterally of 4 cases with an important facial palsies in which was obtained electrophysiological confirmation of aberrant regeneration of the facial nerve, in some cases even before the clinics signs appear. This study could be used as a therapeutic guide in the treatment of the post-paralytics syndromes of the peripheral facial palsies. 25P44 A comprehensible program for the rehabilitation and restoration of the neurological dysfunction for Multiple Sclerosis patients and their caregivers in Cuba Padilla Ma, Cabrera-Gómez JAb , Real González Yb , Luna Rodríguez-Gallo Ja, Gómez AOa, Brunet Gómez Da, Cid Ja , González Acosta Da a Multiple Sclerosis Rehabilitation Hospital,¨ Dr Faustino Pérez ¨, Sancti Spíritus, Cuba. b Multiple Sclerosis Society of Cuba, Havana, Cuba INTRODUCTION: The recent disease-modifying drugs have not eliminated the need of rehabilitation strategies in the management of MS. Even if there were that could fully prevent progression of the disease, hundreds of thousands of patients worldwide would still be left with residual neurological damage and the associated impairment and disability. OBJECTIVE: To introduce a comprehensive rehabilitation and restoration program for MS patients and their caregivers in a natural rehabilitation hospita l in Cuba. DESIGN-METHODS: The multidisciplinary team of rehabilitation and restoration has developed and integrated, comprehensive and intensive rehabilitation program for MS patients. This multidisciplinary team is composed by: neurologists (with training in MS), physiatrist, psychologists, neuropsychologists, social workers, occupational therapist, natural medicine specialists and nurses. The program is an intense short term rehab in 6 weeks 2 sessions for each patient and will have a single physiotherapist (one to one) and a neuropsychologist. The evaluation of the rehabilitation and restoration include the physical and cognitive disability and the clinical evaluation by means of international disability scales (EDSS, Guy Scale), quality of life scales (MSQLI), psychological and neuropsychological tests (Luria, WAIS, Benton, PASAT-3) to evaluate the efficacy of the program. Finally, we will teach to the MS patient and her/his caregiver to learn, at their own home, the exercises for the physical and cognitive dysfunction when the patient left the rehabilitation MS hospital. RESULTS: The results will be presented at the meeting. CONCLUSIONS: This is one of the most extensively program for physical and cognitive rehabilitation / restoration for MS patients and their caregivers in a Latin-American country. 25P45 Multiple Sclerosis in the Cuban women. An update Real González Y, Cabrera-Gómez, JA, Romero García Karina Multiple Sclerosis Society of Cuba. Havana, Cuba Objective: To evaluate the clinical and social-economical status of the Cuban women with MS. Introduction: Multiple sclerosis (MS) is the cause of greater disability in the young woman in Cuba. Design and Method: Epidemiological study: We carried out a case-control study, in 57 women with MS clinical definite (Poser et al) and their relatives. The evaluation was gotten by means of the questionnaire of Boiko et al. Clinical, disability and social-economical studies: 271 women with clinical definite MS. The clinical, demographic and social-economical data were taken from the Cuban Computerized Register of MS. Results: Epidemiological study: The risks factors were: High educational level (OR= 2.293; 95% CI= 0.9-5.4), 2 or more children (OR= 2.84; 95% CI= 1.22 - 6.59), 4 or more pregnancies (OR= 3.60; 95% CI= 0.69-18.7), 3 or more deliveries (OR= 1.939, 95% CI= 0.44-8.4), measles infection (OR= 2.042; 95% CI= 0.76-5.47), migraine (OR= 2.538; 95% CI= 0.81-7.94), stress (OR= 3.768; 95% CI= 1.64-8.62), and insomnia (OR= 2.95; 95% CI= 1.14-7.14). Clinical, disability and social-economical studies: MS was observed, in women of 30 to 51 years, relapsing-remitting form with family history of autoimmune and psychiatric disorders and 8% with one or more relatives affected. The disability met, 62.57% of the women with moderate or severe impairment of the ambulation and 20% of them are in wheelchair or on bed. The Cuban women with MS have a high educational level, but 50% are divorced/single, received low or not annual salaries or are vacated. Conclusions: It is mandatory to carry out a program in Cuba in order to improve the medical attention, the disability and the social-economical level of the women with MS. 25P46 Neurological restoration in Multiple Sclerosis: the CIREN experience E. Hernández, JE Bender, F Zamora, F Araujo, E Infante International Center for Neurological Restoration (CIREN) Havana, Cuba Multifactorial therapeutic was used in patients with Multiple Sclerosis at the International Center for Neurological Restoration, Havana, Cuba. Our proposal was the evaluation of this therapy in Multiple Sclerosis patients. We studied 20 patients that were admitted at CIREN during 2000-2002 with different clinical manifestations. They were evaluated within the first week and after 4, 8 and 12 weeks. The Kurztke, Hauser, Cronic fatigue and Asworth scales were applied. Sympthomatic and specific treatment, biophysical stimulation, phsysical therapy, occupational and speech treatment were performed. The best results were observed and life quality was increased in all patients. Our conclusions show that Neurological Restoration is an important aspect in order to improve the life quality in patients with Multiple Sclerosis. 25P47 Results of LEIS evaluation on patients with multiple sclerosis after a neurorestorative treatment Gilda T. Martínez Aching, Juan Enrique Bender, Alexander del Valle Echemendía, Carmen Rosa Alvarez González International Center of Neurologic Restoration (CIREN) Havana, Cuba Multiple sclerosis (ME) is a demyelinizing disease affecting the brain and the spinal cord. The fundamental objective of this investigation was to show the improvement reached by 17 patients with multiple sclerosis, after a 28-day rehabilitation cycle, through initial and final evaluations of tests applied to measure strength, breathing capacity and gait. All studies were performed at the Psychomotor Integral Evaluation Lab (LEIS) in CIREN. The tests applied at LEIS have the required reliability and sensitiveness to detect changes undergone by the patients during their rehabilitation. Statistical tests applied (Wilcoxon matched pair test) showed results under the significant levels. Results. After having analyzed and compared the results of both evaluations, we verified that the patients obtained positive results in the evaluated items after a treatment cycle. Conclusions. Of the 17 evaluated patients, 7 increased their strength (41,17%); 16 changed their gait possibility (94,11%) and 14 increased their breathing capacity (82,35%). The positive changes observed in the treated patients confirm the efficacy of the rehabilitation program applied. Thursday 26 february 2004 Plenary lecture 26A1 CIREN’s strategy and results for Neurological Restoration and Stereotactic Neurosurgery during its first fifteen years Raul Macias Gonzalez International Center for Neurological Restoration (CIREN) Havana, Cuba During this last fifteen years, the International Center for Neurological Restoration have been developing novel focus in the way to treat neurodegenerative diseases and sequels of neurological disorders. These are based on a program to treat sequels call Neurological Restoration Program and the necessary technology to perform stereotactic neurosurgery. The Neurological Restoration Program is carried out by a multidisciplinary team guided by neurologists. It comprises: the correct diagnosis of disease, incapacity quantification and objective definitions for pharmacological treatment and multidisplinary intensive -personalized rehabilitation. Treatment cycles are organized for periods of 28 days. Functional recovery in the patient neurological conditions is based in neuroplastic changes in the central nervous system organization and processing. These mechanisms had been evaluated in animal models and human being with different tools, like: long-term potentiation, transcranial magnetic stimulation, fRMI, etc. Synaptic changes in learning and memory process, amplification and reorganization of the motor cortical maps and function redistribution between hemispheric cortices are documented. On the other hand, Stereotactic Neurosurgery technology are composed by: a stereotactic frame (Estereoflex), a general computerized planning system for neurosurgery (STASSIS), an electrical deep brain structure recording system (NDRS) and a general team training system. Main characteristics of those components and the accumulated experience transferring these technologies to more than 11 hospitals will be described. Neurorestorative Treatments 26A2 Chromaffin cells exposed to ELF EMF can be used as transplant material in Parkinson’s disease and induce expression of TH positive cells in lateral ventric les. Leticia Verdugo-Díaza , Oscar Arias-Carriónb , Arturo Hernándezb and René Drucker-Colínb . a Depto. De Fisiología, Fac. de Medicina, b Depto. de Neurociencias, Instituto de Fisiología Celular, UNAM, México. Cultures of neonatal rat chromaffin cells in presence of Extremely Low Frequency Electromagnetic Fields (ELF EMF) show morphological and ultrastructural changes (Drucker-Colín et al, 1994; Feria-Velasco et al, 1998), different rates of catecholamine release (Verdugo-Díaz et al, 1998), biochemical and electrophysiological modifications (Morgado-Valle et al, 1997). The efficacy of ELF EMF differentiated chromaffin cells transplanted into a Parkinson‟s disease (PD) patient was tested and neurological, motor and pharmacological changes were determined. A PET-scan study was also done prior to transplant and 7 months after (Drucker-Colin et al,1999). We investigated the effects to applying ELF EMF in vivo into an animal model of PD. Male Wistar rats were subjected to the unilateral destruction of the substantia nigra by applying 6-OHDA and transplanted with neonatal chromaffin cells. The application of ELF EMF (60Hz, 0.7mT) was daily 2 hours in the morning and 2 hours in the afternoon for a period of 2 months. ELF EMF were produced by a pair of Heltzmohtz coils. Chromaffin cells were stained prior to implant with FluoroGold or 5- bromo-2‟-deoxyuridine (2 fold daily). The main results obtained in vivo application of ELF EMF were: 1) Improvement in motor deficits and an over expression of Tyrosine Hydroxilase (TH) positive cells in both lateral ventricles of the nigro-striatal lesioned rats with chromaffin cell transplant; 2) No migration of implanted cells and differentiation of progenitor cells of both subventricular zone. In sum, it seems that ELF EMF, can be used as therapy for patients having PD. 26P3 Roles of D1 and D2 receptor subtypes in levodopa-induced dyskinesias in a mouse model of Parkinson disease. N. Pavóna, Martín ABb , Alberti Ib , Grandy Db and Moratalla Rb . a Centro Internacional de Restauración Neurológica, Ciudad de la Habana, Cuba. b Instituto Cajal, CSIC, Madrid, Spain Treatment with L-DOPA is today the most efficacious, non-invasive therapy for Parkinson‟s Disease. However, chronic treatment with L-DOPA induces in most of the patients the appearance of abnormal involuntary movements known as dyskinesias. The molecular mechanisms underlying these abnormal movements are unknown, although the implication of dopamine receptors as well as other neurotransmitter receptors interacting with the - system is suspected. In the present work, we have studied the contribution of D1 and D2 receptor subtypes in levodopa-induced dyskinesia. In this experiment dyskinesias were induced with intermittent doses of L-DOPA in unilateral 6- OHDA-lesioned mice. Rotational tests were carried out in a rotometer system that counted completed turns (360º) only and the abnormal involuntary movements we have divided in four different types: orofacial, forelimb, locomotive and dystonia, and evaluated. In wild-type animals chronic treatment with L-DOPA induced abnormal involuntary movements that including horizontal or vertical abnormal jaw movements, ballistic movements of the contralateral forelimb and axial dystonia. We have found that inactivation of D1 dopamine receptors completely abolished orofacial dyskinesia, did not affect axial distonia and slightly reduced forelimb dyskinesia. By contrast, knock out mice lacking D2 receptors showed an increase in orofacial dyskinesia after L- DOPA treatment but axial dystonia and forelimb dyskinesia were not present. In summary, our result demonstrate that D1 and D2 receptors play a differential and complementary a role in L- DOPA-induced dyskinesia and that the integrity of the D1 and D2 receptors is critical for different aspects of levodopa-induced dyskinesias. 26A4 Ex vivo VEGF gene transfer does not increase grafted dopamine neuron survival C.E. Sortwella, W.J. Bowersb , H.J. Federoffb , M.F. Fleminga , D.M. Marchioninia , N.M Kanaana, B. Terpstraa, K. A. Steece-Colliera and T.J. Colliera, a Neurology, Rush-Presbyterian, Chicago, IL, USA; b Neurology., Univ. Rochester, Rochester, NY, USA. Specific conditions associated with the post-transplantation interval render grafted mesencephalic dopamine (DA) neurons susceptible to apoptotic and necrotic forms of cell death. Immediately following transplantation, grafted cells are dependent upon diffusion of oxygen and blood-borne materials from the host vasculature until they establish circulation with the host brain. Vascular endothelial growth factor (VEGF) is the primary endogenous endothelial cell mitogen involved in both vasculogenesis and angiogenesis. The present study investigates the ability of ex vivo transduction of mesencephalic reaggregates with a helper virus-free Herpes simplex virus (HSV) amplicon vector encoding VEGF to increase DA neuron survival after transplantation. Mesencephalic reaggregates were generated from E14 F344 rat pups and transduced immediately with either helper virus-free HSV-vegf, HSV-lac (MOI = 1.0 or 2.0) or no vector. Four days post- transduction (PTD4) reaggregates were analyzed for VEGF release to the culture media and levels of VEGF within the aggregates themselves using immunoassay and grafted to the denervated striatum of Fisher 344 rats. On PTD4 HSV-vegf-transduced reaggregates released at least 250 fold more VEGF protein into the culture media and contained at least 130 fold more VEGF protein than HSV-lac or non-transduced control reaggregate cultures. Although these in vitro assays yielded promising results, results of HSV-vegf ex vivo transduction of grafted mesencephalic reaggregates on behavioral and morphological outcome measures were not posit ive. The present results demonstrate that ex vivo gene transfer of VEGF is not successful in augmenting the survival of mesencephalic grafts. Supported by: AG21546, AG000844, Rochester Nathan Shock Center. 26A5 Administration of different doses of methylprednisolone in adult rats with traumatic spinal cord injury of different intensity and at different spinal cord levels . H. Salgado-Ceballosa,b, S. Torres-Castilloa ,c, J.L. Torres-Verae, D. Zabaleta a, A. Zavala a, S. Orozco-Suáreza, R. Capine, A. Feria-Velascod a Research Medical Unit in Neurological Diseases, CMN, S. XXI, IMSS, b Proyecto Camina A.C., c Metropolitan Autonomous University, Iztapalapa, dCIATEJ SEP-CONACYT,eResearch Unit in Oncologyc Diseases, CMN, S. XXI, IMSS, Mexico city, Mexico. After series of preclinical and clinical works, methylprednisolone (MP) became the standard of care in traumatic spinal cord injury (TSCI). However, in some studies MP failed to demonstrate consistent and significant effect on functional outcome. With the aim to test if the injury intensity or the injured level could affect the response to the MP treatment, adult rats were subjected to mild (30 g/cm), moderate (75 g/cm) or severe (150 g/cm) TSCI at cervical (C6), thoracic (T9) or lumbar (L2) level using a standardized weight-drop contusion model. Groups were divided into subgroups that received vehicle or MP at 15, 30 or 45 mg/kg of body weight. Using the thiobarbituric acid reaction, malondialdehyde (MDA) levels, resulting from lipid peroxidation were obtained. Morphometric studies were done by light and electron microscopy and motor function using the BBB scale. Mild thoracic and mild and moderate lumbar injuries showed motor recovery with MP at 15mg/kg, while 30 and 45 mg/kg were as deleterious as in cervical and lumbar severe injuries. Non motor recovery was observed in moderate cervical and thoracic injuries, where the mortality was increased. In severe thoracic injuries motor recovery was observed with all doses of MP, specially with 30 mg/kg (p<0.03). However, in all groups where MP produced motor recovery by protecting axons and myelin sheaths from the secondary injury, it inhibited axonal collateral emission. MDA levels correlated with morphometric parameters and motor recovery. Response to MP treatment after TSCI seams to depend of the intensity and the injury level. 26A6 The administration of tw o new derivates of xanthines (A15ET and A15BU) reversed the locomotor impairments in rats with dopaminergic lesion Carmen Parra a, Miriam Alonsoa, Rogelio Maxila , Alejandro Muñozb , Jesús Sandovalb , Daniel Limóna a Laboratorio de Neurofarmacologia, Facultad de Ciencias Químicas-BUAP, bCentro de Investigaciones FCQ-Benemérita Universidad Antónima de Puebla. Puebla, México. In Parkinson‟s disease therapy is symptomatic. The L-dopa like is alternative in this pathology when is administrated by long time. Because of it is necessary to research new drugs about this pathology. One of them are the A2A antagonists that improve some Parkinson motor behavior in patient. In our University new derivates of xanthines like A15Et and A15Bu have been synthesized. The aim of this work was to evaluate the effect of new A2A antagonist (Al5Et and A15Bu) on motor behavior in rats with dopaminergic lesion. One group the rats were injected with 2 ml of 6- OHDA(8mg/ml) in SNc. The lesioned groups were evaluated in the drug induced turning behavior model, and in this condition were administrated A15Et or A15Bu (1mg/kg). The A15Bu was also evaluated in the star case test. Others groups of intact rats were evaluated in locomotors activity in and cataleptic behavior. We found that new A2A antagonist A15Et and A15Bu decreased 50% and 25% the turning behavior 70 and 80 minutes after administration. In the staircase the ability of reach pellets improved in 98%, the catalepsy behavior was reversed by injection of A15Bu 50% and did not modify the locomotor activity in intact rats. These data suggests that A15Et and A15Bu improve the motor function of rats with dopaminergic lesion. 26A7 Calpain inhibitor prevents axonal degeneration a Hokoç, J.N.; bCouto, L.A.; b Narciso, M.S. and b Martinez, A.M.B. a Instituto de Biofísica Carlos Chagas Filho and bDepartamento de Embriologia e Histologia, ICB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil The ultrastructural change that characterizes the onset of Wallerian degeneration is the disintegration of axoplasmic microtubules and neurofilaments, followed by myelin breakdown. The mechanism underlying such processes is an increase in the amount of intracellular calcium, leading to activation of proteases called calpains. The aim of this study is to evaluate whether nerve fibers can be preserved by the use of calpain inhibitor, after optic nerve crush. The left optic nerve of eight opossums (Didelphis aurita) was crushed (Group A) and four of them received the calpain inhibitor- 2 that remained in the crushed area (Group B). Right optic nerves were used as control. After 96 hrs the nerves were dissected and processed for electron microscopy. Group A presented degenerating fibers, besides disorganization of the optic nerve structure. Group B maintained the structure of the optic nerve, which was organized in fascicles, thus preventing the dispersion of the fibers. The quantitative analysis showed that the Group B presented more normal fibers (25.36 ± 7.83) than Group A (21.47 ± 7.27), p<0.05, and less degenerating fibers (7.65 ± 2.80) compared to group A (10.22 ± 4.33), p<0.001). We also calculated the G ratio (axonal area/fiber area), which showed that the Group B presented G ratio (0.45 ± 0.29), close to normal values (0.44 ± 0.19). However Group A presented the largest G ratio (0.85 ± 13.57), when compared to the other two groups (p<0.01). In conclusion, our findings suggest that calpain inhibitor is capable to provide neuroprotection after a crush lesion. 26A8 Striatal trophic factor pleiotrophin augments dopamine neuron survival and neurite outgrowth Deanna M. Marchioninia, Elin Lehrmannb , William J. Freedb and Timothy J. Colliera a Rush University Medical Center, Dept. Neurological Sciences, Chicago, Illinois, USA, b National Institute on Drug Abuse, Baltimore, Maryland, USA Transplantation of embryonic ventral mesencephalic (VM) tissue is an experimental therapy for Parkinson‟s disease. Both survival of grafted neurons and reinnervation of the striatum are essential for functional recovery. Our aim was to identify genes/factors that are upregulated during time points critical to nigrostriatal development and synaptogenesis. We utilized a microarray to profile gene expression in the rat E15 lateral ganglionic eminence, P1 and adult striatum. We identified genes that are upregulated during development, and tested their ability to promote dopamine neuron survival and neurite outgrowth in culture. Microisland cultures of E14 rat VM were exposed to pleiotrophin. On day 4 in vitro, cells were processed for tyrosine hydroxylase immunoreactivity (THir). Cell counts of THir neurons yielded 114.7 ± 8.0, 113.9 ± 11.0 and 134.3 ± 4.5% of control for cells treated with 10, 50 and 100 ng/ml pleiotrophin, respectively. Furthermore, neurite outgrowth was significantly increased in pleiotrophin treated cultures, 158.5 ± 21.3, 150.2 ± 18.1, 180.2 ± 20.1% of control for cells treated with 10, 50 and 100 ng/ml, respectively (p<0.05). Pleiotrophin may be an important cue in the establishment of nigrostriatal circuitry. Grafting of embryonic dopamine neurons in conjunction with pleiotrophin may promote reinnervation and functional recovery in Parkinson‟s disease. Molecular mechanisms of neurodegeneration 26A9 Parkin and Ariadne share redundant functions Sangram Parelkara, Kim Chula, Tanja Godenschwege b , Zhouwei Wanga, Rachel Sugala , Rodney K. Murpheya,b and Lawrence M. Schwartza,b a Molecular and Cellular Biology Program and bDepartment of Biology, Morrill Science Center, University of Massachusetts, Amherst, MA. 01003 USA Parkinson‟s Disease is characterized by the presence of Lewy Bodies and the loss of dopaminergic neurons. Long thought to be a causative factor in neurodegeneration, Lewy bodies may in fact serve a protective role. Patients with Autosomal Recessive Juvenile Parkinsonism (AR early onset of symptoms and the absence of LB formation. Many of these individuals carry germline mutations in the ubiquitin E3 ligase Parkin. We have found that Ariadne, the closest structural homolog to Parkin, can substitute for Parkin in many cellular functions. Both Parkin and Ariadne bind to the same substrates in vitro, and both can support the formation of Lewy body-like aggresomes in cultured cells. The aggresomes they produce are indistinguishable and are - synuclein sequestration, and a dependence on intact microtubules. In parallel studies, we are examining the role of Parkin and Ariadne in neuropathology using the fruit fly Drosophila as a model. Working with wild-type and Parkin null flies, we are assessing the ability of wild-type and mutant human Parkin and Ariadne to rescue cellular defects. Ultimately, we hope to understand why dopaminergic neurons are selectively compromised in AR-JP. 26A10 Effects of 6-hydroxydopamine lesion on glutamate and GABA release in the pedunculopontine nucleus Lisette Blanco Lezcanoa, Lisis Martínez Martíb , Lázaro Alvarez Gonzálezc , Nancy Pavón Fuentesd , Ma. Elena González Fraguela e, Teresa Serrano Sánchezd , Raúl Macías González f Yovani Bouzà Calderíne, Yovani Coroa , Juan C. Rosillo Martíb , Luisa L. Rocha Arrieta g ,, Magdalena Briones Velascog , Leticia Nerig . a Experimental Neurophysiology Department CIREN, Cuba, bNeuromorphology Laboratory CIREN, Cuba, cMovement Disorders Clinic CIREN, Cuba, d Neuroinmunology Laboratory CIREN, Cuba, e Neubiochemistry Laboratory CIREN, Cuba, f Basic División CIREN, Cuba g CINVESTAV sur, Mexico DF, Mexico. The pedunculopontine nucleus (PPN), co-localized with the mesencephalic locomotor region, has been proposed as a key structure in the physiopathology of Parkinson‟s Disease (PD). The goal of the present study was to assess if the amino acid neurotransmitter release in the PPN is modified by the degeneration of dopaminergic cells, from substantia nigra pars compacta (SNc) in 6- hydroxidopamine (6-OHDA)-lesioned rats. Simultaneously it was studied the amino acid neurotransmitter release in the PPN of rats with lesion of the subthalamic nucleus by quinolinic acid (100nM) intracerebral injection. The extracellular concentrations of glutamic acid (GLU) and gamma-aminobutyric acid (GABA) were determined by brain microdialysis and high performance liquid chromatography (HPLC). Rats were assigned to five groups: SNc lesioned (n=11), Sham- operated (n=7), STN lesioned (n=7), Double lesion SNc+STN (n=9), and untreated rats (n=13). The extracellular concentration of GLU in 6-OHDA lesioned rats, was significantly increased in comparison with the others groups (F(4, 42) =16.35 p<0.001). Extracellular GABA levels exhibited a significantly increase in all lesioned groups (SNc, STN, SNc+STN) in comparison with untreated and Sham operated rats (F(4, 40) = 12.81 p<0.001). The infusion of artificial cerebrospinal fluid with higher potassium (10mM) induced an increase in the GLU and GABA concentrations in all groups, which confirm the neuronal origin of the extracellular content. These results are in agreement with the current model of basal ganglia functioning and suggest the role of STN-PPN projection in the physiopathology of PD. 26A11 An animal model of ALS-PDC based on consumption of cycad toxins mimics the Human Disorder CA Shawa, JMB Wilsonb , J Schulzb , E Hawkesb , C Meldera, M Petrika a University of British Columbia, Department of Ophthalmology, bUniversity of British Columbia, Graduate program in Neuroscience, Canada ALS-parkinsonism dementia complex is a complex neurodegenerative disorder of the island of guam which can express as classical ALS, as a form of Alzheimer's dementia with strong parkinsonism features, or as some combination. Epidemiological data of Kurland and colleagues linked the disorder to the consumption of neurotoxins contained in the flour of seeds of the local cycad palm, a traditional food source. We have duplicated the disease in an animal model by feeding male laboratory CD-1 mice a diet containing cycad flour. Exposed mice show both behavioural abnormalities of motor, cognitive, and olfactory function, in addition to neurodegeneration in corresponding neural subsets, including cortex, hippocampus, substantia nigra, and olfactory bulb. Biochemically, the same areas show profound decreases in EAAT2 glutamate transporter expression, elevated protein kinase C, CDK5, and other protein kinases, and a loss of tyrosine hydroxylase in striatum. Affected regions show the presence of activated astrocytes. MRI analysis shows volume changes in these areas. These features of abnormal neural function and morphology are found in various other mouse strains, but can be attenuated or potentiated by various genetic alterations. Apo E wild type mice are as profoundly affected by cycad feeding as CD-1 mice, but knockout Apo E mice appear to be largely neuroprotected. In contrast, mSOD1 G93A mice show enhanced neural degeneration following cycad exposure. These results support the notion that cycad is a key factor of ALS-PDC. The isolation of the putative toxin, a sterol glucoside, suggests that similar molecules may contribute to related age-dependent neurological disorders elsewhere. 26A12 Protective actions of S-allylc ysteine on quinolinate- and b-amyloid peptide-induced oxidative neurotoxic ity in rats Francisca Pérez-Severianoa, Mayra Rodríguez-Péreza, Raquel Salvatierra-Sánchezb , José Pedraza- Chaverríc, Jorge Guevara d and Abel Santamaría b a Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía, México D.F., México, b Laboratorio de Aminoácidos Excitadores, Instituto Nacional de Neurología y Neurocirugía, México D.F., México, cDepartamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, México D.F., México, d Laboratorio de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, México D.F., México We investigated the effects of S-allylcysteine (SAC), an aged garlic extract compound with well- known antioxidant properties, on the in vivo oxidative neurotoxicities produced by the intrastriatal injection of quinolinate (QUIN) and the intrahippocampal injection of amyloid-( peptide 25-35 (Abeta(25-35)) in rats, as experimental models of Huntington's (HD) and Alzheimer's diseases, respectively. QUIN is an excitotoxin acting at the N-methyl-D-aspartate receptors, whereas Abeta(25-35) is the toxic fragment of the amyloid-( peptide accumulated in Alzheimer's brains. Reactive oxygen species (ROS), lipid peroxidation (LP) and activities of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase, were evaluated in striatum and hippocampus 120 min after QUIN (240 nmol/µl) and Abeta(25-35) (100 µM) injections. Both QUIN and Abeta(25-35) significantly increased ROS and LP, whereas pretreatment with SAC (300 mg/kg, i.p.) decreased these markers in both models when administered 30 min before the lesions were done. Except for the significant recovery of the QUIN-induced decrease in Cu,Zn-SOD activity after SAC treatment, all other enzyme activities were found unchanged in both models after SAC or toxins administrations. In addition, SAC significantly reduced the QUIN-induced circling behavior in rats, an specific marker of striatal neurotoxicity. In summary, SAC ameliorated the in vivo QUIN- and Abeta(25-35)-induced oxidative toxicities by mechanisms related to its ability to scavenge free radicals, decreasing oxidative stress and preventing cell damage in striatum and hippocampus, respectively. For the HD model, the preservation of the striatal activity of Cu/Zn- SOD also seems to account for neuronal protection. SAC is likely to be a promising therapeutic agent. 26A13 Effects of the chronic administration of L-dopa on learning, spatial memory and malonyldialdehide levels in rat with dopaminergic lesion Evangelina G. Quiroga, Liliana M. Mendieta , Rogelio Maxil and Daniel Limón. Benemérita Universidad Autónoma de Puebla, Facultad de Ciencias Químicas, Laboratorio de Neurofarmacología, Puebla, Pue. México. L-3-4-dihydroxyphenylalanine (L-Dopa) has been administered for long periods of time in Parkinson disease (PD) to alleviates the symptom such as motor functions. Unfortunately, many problems such as dyskinesias, wearing-off and on- phenomenon arise over the years. This chronic administration can be associated with cognitive deficits, and the L-Dopa metabolism to contribute to disease progression through free radicals (FR) generates. Another markers of stress oxidative such as malonyldialdehide are present too. In this work we evaluate, the effect of chronic administration of L-Dopa on spatial learning and memory in water maze were studied. After that we measured malonyldialdehide levels in rats with 6-hydroxydopamine (6-OHDA) lesion into sustantia nigra pars compacta (SNpc) was studied. The control group was administered SSI and the experimental group received L-Dopa/Carbidopa (200 mg/kg) for 60 days. Under these conditions, the spatial learning and memory was evaluated in both groups. After that malonyldialdehide levels were also measured from striatum and cortex by tiobarbituric method. We found that learning and spatial memory decreased 50% and 20% respectively. The malonyldialdehide levels decrease 93%, 65% and 90% in the striatum, frontal and temporoparietal cortex of the rat with L-Dopa. This facts suggest that there are relation between stress oxidative and deficits on learning and memory by chronic administration of L-Dopa. 26A14 Glutathione depletion by buthionine sulfoximine potentiates cerebral oxidativ e stress ME González Fraguela and JY Bauza Calderin Neuroinmunochemistry Dpto. International Center for Neurological Restoration, Havana City, Cuba Oxidative damage to biomolecules has been postulated as a common molecular mechanism underlying brain aging and neurodegeneration. A marked brain glutathione deficiency by buthionine sulfoximine (BSO), an irreversible inhibitor of glutathione synthesis, provoke an imbalance in the cellular redox state towards the pro-oxidant status causing lipid peroxidation, protein oxidation and DNA damage. The toxicity of BSO to the brain has not been extensively studied, but appears to be chiefly related to its effect on cerebral oxidative metabolism. The activities of the enzymes superoxide dismutase, catalase, glutathione peroxidase, glutathione and malondialdehyde content were studied in several rat brain areas following the intracerebroventricularly (icv) BSO lesion. The animals were assigned to both experimental groups: icv BSO lesioned 24 and 48 hours, control groups: icv saline lesioned 24 and 48 hours and intact groups. The SOD and CAT activity levels in the BSO lesioned group were higher than the values detected in saline lesioned and intact animals in 24 and 48 hours. Concerning CAT activity showed an increase, non-significant, with regard to the saline lesioned group in 24 hours. We found both, SOD and CAT activity, the saline lesioned group exhibited higher levels than the intact animals in 24 hours, in contrast, the saline lesioned group showed a slight increase, non-significant, with regard to the intact group in 48 hours. In addition the increment of SOD activity in the BSO lesioned groups in 24 hours with regard 48 hours was statistical significant but in the CAT activity only showed a non-significant tendency. 26A15 Mechanism of ethanol-induced glial apoptosis. Site of trophic protection S. Nahuel Villegas, Fernando A. Polleta, Mirta Reynaldo and Néstor G. Carri IMBICE(CONICET-CIC), CC 403, 1900 La Plata, Argentina. We have previously shown that GDNF protects glial cells in culture from ethanol induced apoptosis. The aim of the present work is to investigate the mechanisms involved in ethanol- induced glial cell death and in trophic mediated glioprotection. Briefly, B92 glial cells were plated over glass coverslips with 100 ml D-MEM at 30,000 cells/cm2. After 24 h medium was replaced by treatment medium with 86, 172 mM EtOH, during 1 or 2 h, alone or supplemented with GDNF (30 ng/ml). After fixation, cells were prepared for immunochemistry, cytosqueleton kit detection, and for DAPI nuclear staining to identify apoptotic nuclei. We observed that active JNK (pJNK), a MAP kinase involved in apoptotic signal transduction, is unusually placed as stress fibers, and co- localized with actin filaments. After ethanol exposure cells lose their stellated form and acquire circular morphology. They exhibit a significantly higher amount of ring-formed actin cells, and a more diffuse organization of actin filaments. In the meantime, pJNK can be observed in the nucleus and perinuclearly. This data suggest that cytosqueleton may play a protective role abducting pJNK and thus, ethanol noxious effects may be drived by the disorganization of actin cytosqueleton through the release of pro-apoptotic actin associated pJNK. In turn, GDNF protective treatment fails to prevent actin disorganization indicating that it may be involved into an alternative mechanism of firstname.lastname@example.org/UNESCO 02-2000 and CONICET PIP-2580 Grants. Posters 26P1 Evaluation of the neurorestorative effects of the murine beta-nerve growth factor infusions in old rat with cognitive defic it. María R. Castellanosa, Jorge Aguiarb , Caridad I. Fernándeza, William Almaguera, Carmen Mejiasc, Alfredo Varela c. a International Center of Neurological Restoration, Havana City, Cuba, b Center for Genetic Engineering and Biotechnology. Havana City, Cuba, cUNAM Neurobiology Institute, Queretaro, Mexico. Nerve Growth Factor (NGF) is known to participate in the regulation of the expression levels and activity of the choline acetyltransferase (ChAT) in the Nervous System. This enzyme is sensitive to the degenerative changes found in Alzheimer‟s disease. We compared the effectiveness of intraparenchymal and intracerebroventricular administration of the murine b-NGF (b-NGFm) purified in our laboratories, through the evaluation of ChAT expression levels by reverse transcription and polymerase chain reaction (RT-PCR), the determination of ChAT activity by a radiochemical method, and through the evaluation of spatial memory and learning of aged rats with cognitive deficit in the Morris water maze tasks. Our results indicate that intracerebroventricular infusion of b-NGFm stimulates the expression levels of ChAT gene in the striatum of old rats. Remarkable losses in the ChAT activity was observed in the septum and striatum of old rats. b- NGFm infusions produced significant increases of ChAT activity in these brain regions differentially according to the administration pathway. The molecular and biochemical changes observed in the expression levels and activity of ChAT after b-NGFm infusions is related with the significant reversion of the memory deficiency. The results of the behavioral test suggest that the intraparechymal pathway offers the best results for a neurorestorative treatment. 26P2 Evaluation of bone marrow mononuclear cells surviving when are transplanted in rats injured w ith quinolinic acid Esteban Albertia Rocío García a, Teresa Serranob , Lissette Blancoc, Lisis Martíneza , Yssel Mendoza d , Juan Carlos Rosilloa , Karelys de la Cuétara a, Lázara Castilloa a Department. of Neurobiology, International Center for Neurological Restoration, Havana City, Cuba, bDepartment of Neuroinmunochemestry, International Center for Neurological Restoration, Havana City, Cuba cDepartment of Experimental Neurophysiology, International Center for Neurological Restoration, Havana City, Cuba, d Growth Factor Department., Center for Genetic Engineering and Biotechnology, Havana City, Cuba The transplant of bone marrow mononuclear cells is one of the novel alternative therapeutic options for the treatment of neurodegenerative diseases, and its aim is to achieve a substitution of neural cells lost during the development of the disease. The objective of this work was to study the capacity of BMMC to survive the transplant and to look for a method that allow in vivo detection of implanted cells. BMMC were extracted from rat‟s femur using a Ficoll - Hypaque gradient. These cells were genetically modified with an adenovirus, which expresses the Green Fluorescent Protein (GFP), or they were labelled with Hoechst reagent. Labelled cells were implanted in the striatum of rats with lesions caused by quinolinic acid. The viability of genetically modified cells was low, while the viability of the labelled cells with Hoechst reagent was bigger than 90%. Implanted cells survived, at least one month, after transplant and they were dispersed from the entrance place toward corpus callosum and cortex in the brain. In conclusion, BMSC has characteristics, which allow them to be considered as novel cellular source for transplantation. In our conditions, we consider more advantageous the use of Hoechst reagent for in vivo detection of these cells. 26P3 Comparison of fresh and hibernated rat ventral mesencephalon cells transplanted in a rat model of Parkinson’s disease. Karelys de la Cuétara-Bernal, Lázara Castillo-Díaz, Lisis Martínez-Martí, Lisette Blanco-Lezcano, Nancy Pavón-Fuentes, Juan C. Rosillo- Martí, Yosvany Coro-Grave de Peralta, Alain Y. García- Varona Centro Internacional de Restauración Neurológica (CIREN) Havana, Cuba Despite the therapeutic potential of such transplants, there remain practical difficulties for widespread adoption of this promising therapy. One approach to overcome some of these constraints is to develop tissue storage procedures, which also have several further advantages. To evaluate whether hibernation of rat ventral mesencephalon cells influences graft survival and function in vivo, we transplanted either freshly and prepared or hibernated cells suspension into the striatum of 6-hydroxydopamine-lesioned rats. Fragments of rat ventral mesencephalon were stored in hibernation medium at 4°C for 3 and 7 days. The cells suspension was prepared and implanted in lesioned animals. To monitor graft function amphetamine-induced rotation was measured. After sacrifice, histological methods were used to compare fresh cell and hibernated cell transplants with respect to graft survival, differentiation and integration. Hibernated cells were founded to be either equivalent to fresh cells with respect to rotational correction, graft survival, total graft volume, total cell number (TH+), neuronal diameter and neuronal area. There was no significant difference between fresh and hibernated grafts (F(2,28) =2.96 p>0.05 n.s.). There were significant differences (p<0.05, U Mann Whitney) between neuronal density in fresh and hibernated 7 days grafts, showing an increase of neuronal density at 7 days of hibernation. In conclusion, these results indicate that it is feasible to hibernate rat ventral mesencephalon cells for a week prior to transplantation in animal model of Parkinson‟s disease without a loss of their survival and functionality. 26P4 In vitro survival of dopaminergic neurons hibernated for 7 days. Karelys de la Cuétara-Bernala, Lázara Castillo-Díaza , Lisis Martínez Martíb , Alain Y. García- Varonaa a Departamento de Cultivo de Tejido Nervioso, b Departamento de Neuromorfología, CIREN, Havana, Cuba The use of fresh tissue in neural transplantation presents considerable logistical difficulties and limits their clinical applicability. One approach to overcome some of these problems is to develop tissue storage protocols that did not affect the viability and survival of dopaminergic cells after transplantation. In this study we examined the influence of hibernation for 7 days on in vitro survival of mesencephalic tissue compared with fresh tissue. Fragments of rat ventral mesencephalon were stored in hibernation medium at 4°C for 1, 3, 5 and 7 days. We determined the TH+ cells in fresh as well as in hibernated cultures. Comparison of hibernated with fresh ventral mesencephalon cell suspensions showed no significant difference with respect to cell viability. The morphology of cultured dopaminergic neurons after hibernation was very similar to that of fresh cells. There was no significant difference between the TH+ immunoreactive cells at 1, 3 and 5 days of hibernation. The lower survival was observed at 7 day of hibernation. There were significant differences between the TH+ cells in fresh and hibernated tissue. Despite the significant differences founded when compared fresh and hibernated tissue, this procedure guaranty the in vitro survival of TH+ neurons at first 5 days of hibernation. This method could be considered a useful procedure for conserving neural tissue to be used in clinical transplantation. Moreover, further research is needed on survival and functionality of hibernated cells after being transplanted into animal models, in order to evaluate their application in the neurorrestorative therapy. 26P5 Rat bone marrow stromal cells produces NGF and GDNF Rocío García a , Jorge Aguiarb , Esteban Albertia , Karelys de la Cuétaraa, Nancy Pavónc, Lázara Castilloa, Alain García a a Department. of Neurobiology, International Center for Neurological Restoration, Havana City, Cuba, bGrowth Factor Department., Center for Genetic Engineering and Biotechnology, Havana City, Cuba, cDepartment. of Neuroinmunochemestry, International Center for Neurological Restoration, Havana City, Cuba. Bone marrow stromal cells (BMSC) have attracted interest through their possible use for cell therapy in neurological diseases. Recent reports demonstrated that these cells are able to migrate and have potential for neuronal differentiation after transplantation into brain parenchyma. The objective of this work was determine whether rat BMSC express NGF and GDNF, in order to study its potential application for treatment of neurodegenerative diseases. BMSC were harvested from male rats and cultured in DMEM supplemented with 20 % fetal bovine serum. At passage 6 the total RNA was isolated using TriZol reactive. RT-PCR reactions to evaluate the expression of NGF and GDNF using specific primers were carried out. The PCR reaction products were run in an agarose gel and compared with DNA molecular weight markers. Ours results indicate that rat BMSC have potential to produce NGF and GDNF. The production of NGF by these cells was reported in the literature; nevertheless, we have not found any report in favor of GDNF production by rat BMSC. Whether rat BMSC could produce CNTF, IGF-1 and BDNF is currently under research. 26P6 Bone Marrow stromal cells cultured in N2-supplemented medium Lazara Castillo- Diaz, Karelys de la Cuétara-Bernal, Alain García-Varona Centro Internacional de Restauración Neurológica , Cuba Generation of brain cells from adult bone marrow stromal cells (MSCs) has evidenced their great plasticity and potential usefulness for cell therapy in the nervous system. Most of the culture system for in vitro maintenance and neural differentiation of MSCs use synthetic media supplemented with 10 or 20% fetal bovine serum. Serum, however, is comprised of unknown quantities of undefined substances, which could interfere the effect of exogenous substances on neural differentiation of MSCs. Here we describe survival of MSCs cultured in culture conditions where serum was reduced at 0.5 and 1 % using Bottenstein and Sato´s N2 formula (1979) and poly-L- lysine (PLL)-coated substrate. Survival of MSCs cultured in N2 supplement was reduced at about 40% of that observed in 10% FBS containing medium. Under these conditions cell morphology was also affected. However, when N2 containing medium was supplemented with FBS at 0.5 or 1% a significant increase of survival with respect to that observed in N2- supplemented cultures was observed. Cells seeded on PLL -coated surface increased their survival by contrast with their homologous cultures seeded on uncoated surface. This culture system, which combines N2 formula with FBS 1% and PLL-coated surface, is useful for the maintenance of MSCs. We speculate that these conditions could offer advantages for the study of neural differentiation of these cells. Currently, experiments aimed to evaluate the effect of EGF and FGF on MSCs using this culture system are being carried out. 26P7 Transplantation of cultured fetal human brain cells into injured spinal cord of adult rats. Maria Aleksandrova a, Oleg Podgornya , Rimma Poltavtseva a, Aleksandr Revishchinb , Maria Mareyd , Dmitry Karpenkoc , Georgiy Stepanovc , Leonid Korochkinc , Gennadiy Sukhikhd . a Koltsov Institute of Developmental Biology, Russia, b Institute of Gene Biology, Russia, cCentral Institute of Traumatology and Orthopedy, Russia, dCenter of Obstetrics and Perinatology, Russia We examined the survival ability of in vitro-expanded human neural stem/progenitor cells transplanted into damaged spinal cord of adult rats. Experimental group was undergone mechanical injury at the spinal cord level T-8-9 and bilateral injection of 6 ml suspension (300000 cells/ml) fetal cells expanded in culture during 14 days and control group was undergone damage only. Grafts were investigated after 7, 15, 30 and 60 days following the surgery by histology and immunohistochemistry. The control animals had damage zone with necrosis and forming cysts and glial scar. In experimental group human nuclei-immunopositive grafted cells located alone or by groups and migrated along white matter fiber and blood capillaries. Double immunostaining for nestin and human nuclei revealed that part of transplanted cells maintained non-differential phenotype. Double immunostaining for human nuclei and GFAP and immunostaining for β-III- tubulin revealed glial and neuronal differentiation. In this group we did not observe forming cysts. There was glial reaction in the damage zone, but glial scar was absent. Thus, our results show that human neural stem/progenitor cell grafted into damaged adult rat spinal cord successful survive and positive influence for posttraumatic processes. 26P8 9-O-acetyl ganglioside is expressed by prolif erating cells in the subventricular zone of adult rats Ana C. M. Leão, Marcelo F. Santiago and Rosalia Mendez-Otero Laboratório de Neurobiologia Celular e Molecular, Instituto de Biofísica Calos Chagas Filho, Centro de Ciências de Saúde, Universidade Federal do Rio de Janeiro and Millennium Institute for Tissue Bioengineering, Brazil. 9-O-acetyl GD3 ganglioside is important in migration and neuritogenesis during the development of the nervous system and remains expressed in adult brain SVZ, described as a niche of neurogenesis and from where neural stem cells have been isolated. In this work we are trying to characterize SVZ cells by the expression of known markers and 9-O-acGD3. To identify proliferating cells in the CNS, adult rats were treated with BrdU. The brains were sliced or the tissue was dissociated into single cells. After immunocytochemistry we were able to observe BrdU incorporation and 9-O- acGD3 expression in situ and in single cells and that both are present preferentially on the same regions of the lateral ventricles. By confocal microscopy, we could detect colocalization of these antigens. To characterize 9-O-acGD3 positive cells, we performed immunocytochemistry reactions for antigens present in SVZ cells, like GFAP, nestin and PSA-NCAM and for the ganglioside. By confocal microscopy, some 9-O-acGD3 positive cells were also positive for those antigens. In this work, we could observe that the expression of 9-O-acGD3 occurs at the same regions of high cell proliferation in adult brain. The colocalization of the ganglioside and BrdU shows that it is expressed by proliferating cells in the SVZ. The co-expression of 9-O-acGD3 and GFAP or nestin suggests that it could be present in the cells described as neural stem in the adult brain and may remain expressed by neuroblasts as some was positive for PSA-NCAM. At the moment, we are quantifying all those populations by flow citometry. 26P9 Effect of sw im stress on 5-HT1A receptor density in different mouse brain regions Alfredo Brionesa, Luisa Rocha b , Joel Lomelía , Ofir Picazoa. a Escuela Superior de Medicina del I.P.N; b Departamento de Farmacobiología, CINVESTAV, México D.F, Mexico. Several stressful agents induce synthesis and expression of 5-HT1A receptor; for example, forced swimming-induced stress produces changes in RNAm synthesis, as well as modifications in 5- HT1A binding in the hippocampus rat. In the present work we have studied the effect of an acute swim stress session on 5-HT1A receptors in amygdala, dorsal and ventral raphe nuclei, hippocampus, hypothalamus and thalamus. Swiss Webster male mice were used. The stressful session consisted on putting each mouse into a cylinder filled with water at 25ºC. Mice were divided in two groups; one of them was forced to swim for 15 min and 24 hr after, sacrificed by cervical dislocation. A non-stressed second group was used as a control. The brains of all animals were removed and immediately frozen. Slices measuring 20 µm were obtained in a -20oC cryostat. Quantitative autoradiography experiments were carried out labeling the 5-HT1A receptor of the above mentioned regions with [3H]8-OH-DPAT. An increase in density of 5-HT1A receptors in hypothalamus, thalamus and amygdala was observed in stressed animals, accompanied by a diminution of this subtype receptor in raphe nuclei and hippocampus. These findings can be interpreted as a compensatory mechanism of the diminution in the serotonin levels observed after stressing. Furthermore, it has been reported that stress induces an increase in corticosteroids brain levels, which diminishes the synthesis of 5-HT1A receptor in hippocampus rat. Taken together, these evidences show that some aversive agents such as forced swimming-induced stress are able to induce synaptic changes in the central nervous system. This work was supported by CGPI and COFAA-I.P.N. 26P10 Pinacidil reduces neuropathic pain by activation of different potassium channels Teresa Mixcoatl-Zecuatl, Vinicio Granados-Soto Departamento de Farmacobiología, CINVESTAV-IPN, México, DF., MEXICO. Previous studies have shown that peripheral administration of pinacidil reduces carragenin- and prostaglandin E2-induced mechanical hyperalgesia in the rat. Besides, spinal or supraspinal administration of pinacidil produces antinociception in mice. It is believed that pinacidil-induced antinociception is produced only by activation of ATP-sensitive K+ channels. However, it is likely that other K+ channels could participate in its antiallodynic effect. In this work we assessed the effect of different K+ channel blockers on pinacidil-induced antiallodynia. L5 and L6 left spinal nerves were ligated to female Wistar rats and fifteen days later animals were anesthetized to insert a spinal catheter. Five days after surgery, withdrawal threshold was assessed (with von Frey filaments) as a measure of allodynia. Reduction of withdrawal threshold was considered as the antiallodynic effect. Spinal administration of pinacidil (1-10 µg) reduced withdrawal threshold in a dose-dependent manner in neuropathic rats. Glibenclamide (50 µg, ATP-sensitive K+ channel blocker), apamin (3 ng) and charybdotoxin (1 ng, small- and large-conductance Ca2+-activated K+ channel blocker, respectively), but not margatoxin (10 ng, voltage-gated K+ channel blocker), partially reversed spinal pinacidil-induced antiallodynia. K+ channel blockers, by themselves, were not able to modify neuropathic pain. In conclusion, data suggest that the antiallodynic effect of pinacidil could be produced by opening of ATP-sensitive, small- and large-conductance Ca2+- activated, but not voltage-gated, K+ channels. In addition, K+ channel openers could be useful to treat neuropathic pain in humans. 26P11 Synergistic interaction between spinal gabapentin and oral B vitamins in a neuropathic pain model. H.I. Rocha-Gonzáleza , G. Reyes-Garcíab , R. Medina-Santillánb and V. Granados-Sotoa. a Departmento de Farmacobiología and bSección de Estudios de Posgrado e Investigación, ESM- IPN, México, D.F. CINVESTAV-IPN, México, D.F. Experiments in animals have shown that vitamins B1 (thiamin), B6 (pyridoxine) and B12 (cyanocobalamin) and their combination have antinociceptive activity against chemical- and heat- induced pain. The mixture of B vitamins is often used in neuropathic pain, however, there is no evidence about the efficacy of this preparation in this kind of pain. Therefore, the purpose of this study was to assess the analgesic activity of B vitamins (B1, B6 and B12), gabapentin and the co- administration of gabapentin and B vitamins in a neuropathic pain model. Rats were submitted to the ligation of the left L5 and L6 spinal nerves. Tactile allodynia was assessed daily by von Frey testing on the injured paw. B vitamins (75-600 mg/kg, p.o.) and gabapentin (25-200 µg, i.t.) produced a dose-dependent reduction of tactile allodynia. However, the antiallodynic effect of gabapentin was significantly higher than that produced by B vitamins. The co-administration of gabapentin and B vitamins also produced a dose-dependent reduction in allodynia. Isobolographic analyses revealed a synergistic interaction between spinal gabapentin and oral B vitamins, suggesting that this combination could be useful to relive neuropathic pain in humans. 26P12 Participation of peripheral and spinal cox-1 in the inflammatory pain. J.E. Torres-Lópeza,b and V. Granados-Sotob . a DACS-UJAT, Villahermosa, Tabasco México, bDepto. De Farmacobiología CINVESTAV-INP, México. Formalin produce a biphasic nocifensive response of the injected paw. Whilst peripheral inflammation following formalin injection is evident. Nonsteroidal anti-inflammatory drugs (NSAIDs), when administered systemically or intrathecally, fail to affect the first phase of the formalin response, but attenuate the second phase. It is not clear whether this is peripherally or centrally-mediated. The aim of the present study was to improve the understanding the contribution of peripheral and spinal ciclooxigenases 1 and 2 (COX-1 and COX-2) to the development of inflammatory pain. Female Wistar rats aged 6-8 weeks were used in this study. All experiments followed the IASP guidelines for investigation of pain in animals. 50 µl, 1% formalin was injected into the dorsal surface of right hind paw. Local injection of the selective COX-1 inhibitor, resveratrol and the non-selective COX inhibitor, diclofenac produced antinociception, while the selective COX-2 inhibitor celecoxib was ineffective. Inthrathecal injection of COX-1 or COX-2 inhibitors produced antinociception as well as the non-selective COX inhibitor. In summary, these data suggest that the participation of COX-1 rather than COX-2 is important at peripheral level, whilst, both COX participate at spinal level. The analgesic effect of conventional NSAIDs is not accounted for solely by COX-2 inhibition and requires the inhibition of both COX-1 y COX-2. 26P13 B vitamins increase the anti-allodynic effect of dexamethasone in neurophatic rats. Nadia L. Caram-Salasa, Gerardo Reyes-Garcíab , Roberto Medina-Santillanb , and Vinicio Granados- Sotoa. a Departamento de Farmacobiología, CINVESTAV-IPN and bSección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina-IPN, México, D.F., Mexico. In this work we evaluated the antiallodynic effect of dexamethasone and B vitamins in a neuropathic pain model in female Wistar rats (Chung Model). Neuropathy was produced by tight ligation of L5 and L6 left spinal nerves. Twelve days after surgery, the withdrawal threshold was assessed (with von Frey filaments) as a measure of allodynia. Reduction of withdrawal threshold was considered as an antiallodynic effect. Subcutaneous administration of dexamethasone (4-32 mg/kg), vitamin B1 (75-600 mg/kg) and vitamin B12 (0.75-12 mg/kg), but not vitamin B6 (75-600 mg/kg), significantly reduced in a dose-dependent manner withdrawal threshold in neuropathic rats. Doses necessary to produce a 30% of reduction of allodynia (ED30) were 5.41 ± 1.2, 178.4 ± 20.1 and 1.26 ± 0.0 mg/kg for dexamethasone, vitamin B1 and vitamin B12, respectively. In addition, co-administration of dexamethasone and either vitamin B1 or B12 reduced in a dose-dependent manner mechanical allodynia. Experimental ED30 for the dexamethasone-vitamin B1 and dexamethasone-vitamin B12 combinations were (50.1 ± 3.4 and 1.8 ± 0.0 mg/kg, respectively) significantly lower than theoretical ED30 (91.9 ± 10.1 and 3.7 ± 0.6 mg/kg, respectively), thus suggesting a functional synergism between these drugs to reduce allodynia. In conclusion, our results suggest that these combinations could be useful to treat neuropathic pain in humans. 26P14 Abstract not available 26P15 Neural plasticity in the MPTP-treated parkinsonian monkey: dissociated responses of cognitive and motor performances Sebastián J. Lipina, Jorge A. Colombo. Unidad de Neurobiología Aplicada (UNA)(CEMIC-CONICET), Buenos Aires, Argentina Evidence of dissociation in cognitive and motor performances was found in three groups of adult Cebus apella monkeys: females (Group1: N=3), males (Group2: N=4; Group3: N=3). A spatial delayed response task (SDR) was administered at A (pre-MPTP), B (post-MPTP) and C (post- surgery) stages. Performance was recorded until reaching the maximum possible delay (<1, 2, 4 , 6, 8, 10 seconds). Before B all groups received MPTP hydrochloride (0.5 mg/kg i.m. per day; total dose: 21 mg). After B astroglial or "sham" transplants into the neostriatum were performed [Group 1: unilateral; Group 2: bilateral (N=2) and "sham" (N=2); Group 3 with no surgical intervention and two series of testing in A]. All monkeys performed efficiently in SDR with delays of up to 8-10 seconds in A. Non spontaneous motor recovery was observed [6 to 10 points in Smith et al. (1993) scale of parkinsonism]. Efficiency was severely altered in Groups 1 and 2 in B. The "sham" individuals did not modify this performance. Animals from Groups 1 and 2 receiving transplants improved their performance nearly reaching the levels of delay observed in A. No statistical differences were observed between groups in the number of sessions and trials received in A. Mesencephalic sections showed significant reduction of TH-immunoreactivity in all MPTP-treated cases. Residual plasticity in system(s) subserving cognitive performances was apparent in MPTP- treated monkeys expressing a full fledged motor parkinsonism. Results encourage the possibility of cognitive improvement in clinical parkinsonism, in which a combination of interventions could be applied. Acknowledgements. Emprendimientos San Jorge, Chevron-Texaco, Fundación Conectar, FONCYT (PICT # 01-03465), Fundación René Barón. 26P16 Neurogenesis and gliogenesis in the spinal cord of juvenile turtles : A multidisciplinary study Anabel Fernándezab , Milka Radmilovichc , Raul Russob , Cecilia Realia , Omar Trujillo-Cenózab a Lab. Neuroanatomía Comparada Instituto de Investigaciones Biológicas Clemente Estable, Montevideo-Uruguay, b Universidad de la Republica Facultad de Ciencias, Uruguay cDpto. Embriología e Histología , Facultad de Medicina. Uruguay Since the 60' it has been demonstrated postnatal neurogenesis at several brain regions of vertebrates. However few are known about spinal cord postnatal neurogenesis. Studies in turtles have provided novel evidences of postnatal neurogenesis at the spinal cord level. We have recently demonstrated by the use of " in vivo" BrdU injections that proliferating neural cells are present both in the gray and white matter along the spinal cord. Larger densities of BrdU- labeled- nuclei occurred in the so-called central gelatinosa (CG).Different methods have been applied to know the cellular composition of CG. Two morphological types can be recognized by mean of Golgi technique that could correspond to different stages of differentiation of neuronal or glial lineages. Electron microscopy studies demonstrated synaptic contacts on putative Golgi-stained neuroblast. Immunohistochemical labeling allowed us to clearly confirm that S-100 positive cells (early glial marker) and Huc/d positive cells (early neuronal marker) are intimately associated in the ependymal epithelium of spinal cord. Double-labeling experiments indicated that BrdU labeled cells expressed S-100 in animals fixed 1-hour post injection, however the BrdU labeled cells only expressed Huc/d 30 to 60 days after. Double labeling immunocytochemical studies revealed GABAergic and serononinergic botouns making contact with Huc/d positive somas. Whole cell patch clamp recording from CG showed three different electrophysiological phenotypes: 1) cells without signs of membrane active properties (putative glial or stem cells); 2) cells with high input resistance and outward rectification that did not generate spikes (putative neuroblast) and 3) cells that generate action potential (neurons). Epidemilogy, accelerators and risk factors in AD 26B1 The primary pathogenetic role of vascular hypoperfusion, mitochondria failure and oxidative stress in Alzheimer disease Gjumrakch Alieva , George Perrya, Jiankang Liubc , Mark E. Obrenovicha, Mark A. Smitha, Bruce N. Amesb,c and Jack C. de la Torre a a Institute of Pathology, Case Western Reserve University, Cleveland, OH, USA and bDepartment of Molecular Cell Biology University of California, Berkeley, CA & cChildren Hospital Oakland Research Institute, Oakland, CA, USA Vascular insufficiency, with concomitant chronic hypoxia/hypoperfusion, may play a key part in the initiation of Alzheimer disease (AD). However, the role of vascular abnormalities and their participation as pathogenic factors during the development and maturation of AD is controversial. Adding to this complexity are the mechanisms by which reactive oxygen species (ROS) participate in the development of vascular insufficiency-induced chronic hypoxia/hypoperfusion, which also may play an important role in the pathogenesis of AD. We studied the cellular and subcellular features of vascular lesions and mitochondria in brain vascular wall cells from human AD brain biopsies, human short postmortem brain tissues, yeast artificial chromosome (YAC) and C57B6/SJL transgenic positive (Tg+) mice overexpressing amyloid beta precursor protein (AbPP) and in aged rats given selective mitochondrial antioxidants (Lipoic Acid and ALCAIR). In situ hybridization, using mitochondrial DNA (mtDNA) probes for human wild type, 5kb deleted and mouse mtDNA, was performed in conjunction with immunocytochemistry using antibodies against AbPP, 8-hydroxyguanosine (8OHG) and cytochrome c oxidase (COX). We found a higher degree of amyloid deposition in the cerebrovascular walls in the human AD cases, YAC and C57B6/SJL Tg (+) mice when compared to aged-matched controls. In addition, vessels with more severe lesions showed immunopositive staining for AbPP and possessed large, lipid-laden vacuoles in the cytoplasm of endothelial cells. Significantly more mitochondrial abnormalities were seen in microvessels, where lesions occurred, in human AD specimens, YAC and C57B6/SJL Tg (+) mice and old aged rats without treatment. However, the animals that received treatment showed an absence of any cellular or subcellular abnormality in brain cellular compartments. In situ hybridization, using wild type and chimera (recognizing mtDNA with the 5 kB deletion) mtDNA probes, revealed positive signals in the damaged mitochondria from the vascular endothelium and in perivascular cells of lesioned microvessels in human AD, YAC and C57B6/SJL Tg (+) mouse tissues. This damage was proximal to regions of large amyloid deposition. Interestingly, these features were absent in undamaged regions of human AD tissues, YAC and C57B6/SJL Tg (+) mouse tissues and in aged-matched control subjects. In addition, vessels with atherosclerotic lesions revealed endothelium and perivascular cells, which stained positively and in clusters when probed with wild and deleted mtDNA probes. These mtDNA deletions were associated with increased amounts of immunoreactive AbPP, 8OHG and COX in the same cellular and subcellular compartments. The mtDNA deletion and expression of oxidative stress markers in vascular wall cells of the AD brain indicate that energy deficiency and oxidative stress, in AD, selectively affects the brain vascular tree and whole populations of vulnerable neurons. We hypothesize that vascular abnormalities, especially mitochondrial lesions and increased oxidative stress, in the cellular and subcellular compartment are responsible for regional blood flow alterations. Further, this alteration can lead to blood brain barrier failure and breakage during the development of AD. We theorize that by using selective pharmacological agents to block the underlying oxidative stress stimuli and damage that it will be possible to normalize the actions of the endogenous antioxidant systems in vascular wall cells. We theorize also that similar stimuli-blocking intervention strategies will help to normalize the antioxidant systems in AD patients and in aged individuals. Future studies, which examine the importance of mitochondrial pathophysiology in different cellular compartments may provide important insight not only into neurodegenerative and/or cerebrovascular disease pathobiology but may provide targets for treatment approaches in these conditions. 26B2 The Cuban Dementia and Alzheimer’s Study Playa (EDAP). LLibre Rodríguez, Juan de Jesús; Fernández García, Yuriem; López Medina, Ana M; Otero Esteve Marta; Marcheco Teruel Beatriz; Contreras Hernández, Nereyda; Alvarez Rodríguez, José; Collado Fernández, Hector; Bayarre Vea, Hector ; Guerra Hernández Milagros; Ortiz Calderón Zeylin. University of Medical Sciences, Habana, Cuba Background and Objectives: Cuba is a developing country, with a health profile similar to that of developed countries. With a population of 12 million people Cuba will become the second oldest country in Latin America by the year 2020, when those aged 60 years and over will account for 25% of the population. The Cuban Dementia and Alzheimer‟s Study Playa is a multicenter, population-based study with a sample of 18 351 people over the 65 years. It constitutes one of the most extensive prevalence studies in Cuba and Latin American. The core objectives were to know the prevalence of Cognitive disorders, the dementia syndrome and its different causes in people over 65 in Playa municipality, Havana City, as well as risk factors including the genetic factors and the impact that these dementia syndromes cause in families. Methodology: A door to door study was carried out, in which 18 351 people over 65 were studied by means of the application of the Mini Mental State Examination (MMSE), the Clinical Dementia Rating Scale (CDR) and an interview based on risk factors. Different criteria such as: the DSM-IV, the NINCDS-ADRDA, the NINCDS-AIREN and others established for specific dementias were used in the diagnosis of dementia syndrome. Conclusions: The prevalence of dementia syndrome was 9,25/100 people over 65. Alzheimer‟s disease followed by vascular dementia were the most frequent causes. Stroke, Parkinson disease, advanced age, occupation, family history of dementia, depression, the antecedent of cranial trauma, and the low school level were the factors that mostly influenced on the appearance of the dementia syndrome. 26B3 A rat model of MCI upregulates hippocampal nitric oxide and precedes memory loss and Ab 1-40 accumulation after chronic brain hypoperfusion J.C. de la Torre a M.R. Emmerlingb G.B. Stefanoc G. Alieva a Institute of Pathology, Case Western Reserve University, Cleveland, Ohio, USA, b Pfizer Global Research, Ann Arbor, Michigan, USA, cState University of New York, Neuroscience Research Institute, New York, USA Chronic brain hypoperfusion (CBH) using permanent occlusion of both common carotid arteries in an aging rat model, has been shown by us to mimic human mild cognitive impairment (MCI), an acknowledged transition stage that often converts to Alzheimer‟s disease. Purpose: An aging rat model was used to determine whether hippocampal nitric oxide (NO) is abnormally expressed following CBH for 2 or 8 weeks. At each time point, spatial memory, hippocampal A$ 1-40/1-42 and amperometric measures of constitutive NO were measured. Results: Two weeks after CBH, NO hippocampal levels were upregulated nearly 4-fold when compared to non-occluded rats but no alteration in spatial memory or A$ products were observed at this time point. By contrast, NO concentration had returned to control levels by 8 weeks but spatial memory was significantly impaired and A$ 1-40 (but not A$ 1-42) had increased in the CBH group when compared to control non-CBH rats. Since changes in shear stress are known to upregulate eNOS but generally not nNOS, these results suggest that shear stress induced by CBH hyperactivated vascular NO derived from eNOS in the first 2 weeks as a reaction by the capillary endothelium to maintain homeostasis of local cerebral blood flow. The return of vascular NO to basal levels after 2 weeks of CBH may have triggered metabolic changes within hippocampal cells resulting in spatial memory impairment and accumulation of A$ 1-40 peptide. These findings support the notion that CBH in aging rats mimics human MCI and may explain, at least in part, some of the molecular events that can trigger memory impairment at a pre-clinical stage to Alzheimer‟s disease. 26B4 Role of reactiv e oxygen species in brain ageing Gregorio Martínez-Sánchez, Eduardo Candelario Jalil and Olga Sonia León-Fernández Centre for Research and Biological Evaluations, Institute of Pharmacy and Food Sciences, Havana University, Cuba. There are more than 300 theories to explain the aging phenomenon. Many of them originate from the study of changes that accumulate with time. Among all the theories, the free radical theory of aging, postulated first by Harman, is the most popular and widely tested, and is based on the chemical nature and ubiquitous presence of free radicals. Tight linkage between aging and oxidative stress is indicated by the observations that reactive oxygen species generated under various conditions of oxidative stress are able to oxidize nucleic acids, proteins, and lipids and that aging is associated with the accumulation of oxidized forms of cellular constituents, and also by the fact that there is an inverse relationship between the maximum life span of organisms and the age-related accumulation of oxidative damage. Nevertheless, validity of the oxidative stress hypothesis of aging is questioned by (i) the failure to establish a causal relationship between aging and oxidative damage and (ii) lack of a consistent correlation between the accumulation of oxidative damage and aging. The present discussion is focused on the complexity of the aging process and suggests that discrepancies between various studies in this area are likely due to the fact that aging is not a single process and that the lack of consistent experimental results is partly explained by individual variations. Even so, there is overwhelming support for a dominant role of oxidative stress in the aging of some individuals. 26B5 Aluminum-triggered structural modifications and aggregation of b-amyloid Paolo Zatta and Fernanda Ricchelli CNR-Institute for Biomedical Technologies, “Metalloproteins” Unit, Department of Biology of the University of Padova, Padova, Italy Amyloid b-peptides, as insoluble fibril deposits, is the major component of the senile plaques that characterize Alzheimer‟s disease brain [Behl (1999) Progress Neurobiology 57: 301] The - amyloid (Ab) fragments 1-40 and 1-42 have been studied at physiological pH, with the aim to get clues into the modality of metal binding. As probes of conformation we used the variations of the intrinsic tyrosine (Tyr) fluorescence and the fluorescence quenching by acrylamide. Ca2+ and Mn2+ did not affect the amyloid conformation. Cu2+, Zn2+, though binding to the same hydrophilic N-terminal domain [Miura et al., (2000) Biochemistry 39: 7024] caused, respectively, a burial and a high degree of exposure of Tyr residues. The most relevant effects on the peptides conformation were found upon binding of Al3. Amyloids 1-40 and 1-42 were also tested for their hydrophobicity and aggregation properties by following the increase of the fluorescence intensity of 8-anilino-1-naphthalene sulfonic acid (ANS) and Thioflavin-T (ThT), respectively. The surface hydrophobicity and the assembly process were more pronounced for the 1-42 peptide, as compared to 1-40, and Al3+ was the most efficient cation in inducing aggregation. Electron microscopy experiments ascertained that only Zn2+ and Al3+-induced Ab1-42 aggregates led to formation of fibrils with Al3+ promoting the process at much lower concentration than Zn2+. The conformational and aggregational effects of Al3+ were specifically abolished in the presence of desferoxamine mesylate, a trivalent metal ion chelator used in therapy to treat toxic Fe3+ and Al3+ overload conditions. 26B6 Excitotoxicity and oxidative stress induce activ ation of cell-cycle proteins and DNA repair systems in primary neurons Maurizio Memo Department of Biomedical Sciences and Biotechnologies, University of Brescia Medical School, Brescia, Italy The possible link between excitotoxicity, oxidative stress and the induction of cell cycle-related factors has been matter of extensive investigation during the last 5-10 years and it is now supported by several in vivo and in vitro data offering significant answers in the AD ethiopathogenic mechanisms. In particular, in vitro studies have elucidated the role of p53 in apoptosis induced by excitatory amino acids (EAA). Exposure of primary cultures of cerebellar granule neurons to neurotoxic concentrations of glutamate was found to induce a significant, short-lasting increase of p53 expression (Uberti et al. 1998; Grilli and Memo, 1999). Transcriptional activity of the over- expressed p53 was demonstrated by an increased p53 DNA binding activity and the concomitant enhancement of waf1/cip1 kinase inhibitor p21. The direct correlation between p53 expression and glutamate-induced apoptosis in cerebellar granule cells, has been suggested by the finding that under the same experimental conditions, a p53 specific antisense oligonucleotide prevented both glutamate-induced p53 expression and apoptosis. We have recently further extended this concept by demonstrating the induction of p53 and Gadd45 in primary cortical neurons exposed to NMDA. The mechanism(s) by which glutamate induces activation of cell cycle related factors and apoptosis is not clear. We hypothesize that over-stimulation of ionotropic glutamate receptors, possibly by generating oxygen free radicals (ROS), may induce DNA damage. A single and/or double-strand DNA breaks caused by excitotoxicity has indeed been suggested by numerous studies (Didier et al., 1996, Liu et al., 1996, Chen et al., 1997). In summary, we suggest that, similarly to proliferating cells, postmitotic neurons may respond to (EAA-induced) DNA damage by activating a cascade of events involving DNA damage sensors and repairing factors. In this regard, we have found that the expression of the DNA mismatch repair factor MSH2, which is a p53 downstream gene functioning in recognition and repair of a several types of DNA damage, is significantly increased in primary cultures of cerebellar granule cells after glutamate exposure as well as in CA3 hippocampal neurons after kainate treatment. Challenging views of AD therapy I 26B7 Current status and future development of pharmacological treatment of AD: Strategies towards dis ease modifying therapy M. Windisch, B. Hutter-Paier, E. Schreiner, R. Wronski JSW-Research GmbH, Graz, Austria Most approved drugs for treatment of mild to moderately severe Alzheimer‟s disease (AD) are choline-esterase inhibitors, showing modest but reproducible improvement of cognitive performance, global function, and activities of daily living. Their effect size is similar, but they differ in the side effect profile. Expectations about long term effects were not fulfilled. The new choline-esterase inhibitors Phenserine induces decrease of APP expression by direct interaction with the 5‟UTR on translational level, lowering Aß 1-42 and Aß 1-40. The ongoing clinical program is designed to investigate, if this results in fast cognitive improvement and slowing of disease progression. Memantine modulating NMDA signalling has been recently approved by FDA for treatment of severe AD patients. Targeting amyloid metabolism, new compounds to block activity of gamma- or beta-secretase are under development. The enthusiasm about the anti-amyloid vaccination cooled down after occurrence of severe side effects in the phase II clinical study. Approaches for safer vaccination are under investigation, stimulated by reports about cognitive effects in the initial clinical trial. Passive immunisation is explored as safe alternative. Cholesterol lowering and modulating drugs are addressing Aß-production and aggregation. Recent drug developments are investigating inhibitors of GSK-3ß to prevent tau hyperphosphorylation. Substances interfering with formation of paired helical filaments and stimulators of phosphatases are also discussed. These developments are promising because cytoskeletal pathology shows good correlation to disease severity. Enormous efforts of basic research and industrial drug development give raise to the hope that in the near future efficacious therapy of AD might be available. 26B8 Neural stem cell surviv al is compromised in the aged brain Daniel A. Peterson, Letia D. Peterson Laboratory of Neural Repair and Neurogenesis, Department of Neuroscience, The Chicago Medical School, North Chicago, IL 60064, USA Most research investigating the competence of neural stem cells to differentiate and the capacity of the brain to support their survival and differentiation has been conducted in neonatal or young adult brain. However most patients likely to benefit from structural repair by neural stem cells require therapy for stroke or neurodegenerative disease would be in the sixth decade of life or older. Little is known of the capacity of the aged brain to support either endogenous or grafted stem cells. We examined the rate of neurogenesis by confocal stereology and investigated the ability of this region to support the survival and differentiation of grafted young neural progenitor cells. Aging profoundly impairs neurogenesis in the olfactory bulb with a 70% decline in new cells. Over 90% of newly generated cells differentiate into mature neurons in both young and aged animals suggesting that differentiation signals remain intact. We grafted neural progenitor cells derived from young adult animals into the aged bulb and hippocampus to determine if these regions could support their differentiation. In contrast to robust neuronal differentiation in young adult recipients, few cells survived in the aged brain and differentiated into astrocytes. These results suggest that it is not only the competence of the stem cell, but the environment in which that cell is placed that must be considered for the development of structural brain repair strategies. The aged brain may require environmental enhancement before use of neural stem cells for brain repair will be possible. Supported by: NIH-AG20047. 26B9 Restoring complex circuits and functional recovery with cell replacement and environmental manipulation in aging and disease: A unifying hypothesis C.I. Fernándeza, J. Collazoa , E. Albertib , M.E. Gonzálezc , M.R. Castellanosb , , L. Lorigadosc , Y. Bauzac , L. Martínezb J.C. Rosillob a Biomodels Lab; b Molecular Biology Dpt; cNeuroimmunochemistry Dpt, Basic Division . Intl Ctr Neurological Restoration (CIREN) Havana City, Cuba Neurodegenerative diseases, including Parkinson's disease and Alzheimer‟s disease exhibit a selective loss/dystrophy of specific subsets of neuronal populations whose underlying causes are not clear but they are key features to the impaired condition. Over most of the past century, it was thought that the adult brain was completely incapable of generating new neurons. New research showing that (i) neurogenesis is not restricted to embryonic development, but normally also occurs in limited regions of the adult mammalian brain (ii) that there are significant numbers of multipotent neural precursors in many parts of the adult mammalian brain (iii) that it is possible to induce functional recovery even in the aged brain, via manipulation of endogenous multipotent precursors in situ with complex stimulus i.e. housing environment complexity and; (iv) that non neural stem cells can survive and differentiate to neurons after grafting. Results from motor/cognitive impaired aged rats as recipient of bone marrow stem cells (BMSCs) grafting and/or long term housing in complex environment in relation to biochemical, functional and behavioral concerns (Submitted Ann NY Acad. Sci). Our hypothesis attempts to explain, at least in part, the observed results after two different neurorestoration modalities evidencing that age, oxidative damage, and altered neuroimmunotrophic signaling contribute to the age-associated functional impairments which can be reversed after direct/indirect manipulation of affected neuronal populations, demonstrating that the aged brain still has appreciable plasticity in terms of functional recovery. The hypothesis contribute to novel concepts and programs in prevention/reduction both, incidence/severity and outcome of age-associated neurodegenerative 26B10 Neuroprotection of adult human sensory neurons against prolonged anoxia and trauma Ivan Sosaa, Onix Reyesb , and Damien P. Kufflerc a Section of Neurosurgery, b Dept. of Orthopedic Surgery, cInstitute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, San Juan PR. CNS injury due to trauma, anoxia, and disease leads to unpredictable and unpreventable neurological deficits. Ischemia and trauma kill neurons immediately, while over the subsequent 48 hours secondary causes related to the trauma and ischemia kill an even greater number of neurons. To minimize ischemia/trauma-induced immediate and long-term neurological losses, the number of neurons killed during ischemia and reperfusion must be reduced. Clinical attempts to reduce neuron death have focused on decreasing the energy requirements of spinal cord neurons using protective agents such as hypothermia, barbiturates, and antioxidants. However, none are so successful as to become the standard of care. Work on animal and in vitro models have found that alkalinization, calcium channel blockers, and NMDA receptor antagonists also provide neuroprotection. But, most neuroprotective procedures involve only the use of one such agent and still many neurons die. In experiments on isolated intact adult human DRG we found combinations of neuroprotective methods that increase the yield of viable neurons through prolonged ischemia and glutamate insult by more than a 500 fold. The primary neuroprotectors are hypothermia (20oC) and alkalinization (pH 9.3), although together with sodium channel blockers and NMDA receptor blockers neuroprotection is enhanced. Currently we are studying the influences of additional agents, including antioxidants and neurotrophic factors, for their ability to further enhance neuroprtection of adult human neurons, and will begin testing these combinations for their efficacy on the adult swine spinal cord model. We believe some of these combinations of agents will also be effective in assisting in recovery from various neurological diseases. Subsequently, successful methods will be tested clinically. 26B11 Zn2+ dyshomeostasis and neuronal injury Stefano Sensi Dept. of Neurology, University of California-Irivine, Irvine., USA, Dept. of Neurology, University “G. d’Annunzio”, Chieti, Italy Zn2+ is potently neurotoxic “in vitro”and “in vivo” trans-synaptic movement of Zn2+ from pre- to post-synaptic neurons contributes to ischemic neural injury. Zn2+ can enter neurons through NMDA channels, voltage sensitive calcium channels (VSCC), and AMPA/kainate channels (Ca - A/K channels). Mechanisms by which Zn2+ exerts its potent neurotoxic effects are still largely unknown. We have recently suggested that an important factor could be the Zn2+ dependent disruption of mitochondrial function. Neuronal mitochondria play an important role in restoring Zn2+i homeostasis but this Zn2+ uptake leads also to prolonged mitochondrial depolarization and free radicals generation. These injurious and likely necrotic effects are particularly evident upon the large and rapid Zn2+i rises (D[Zn2+]i) resulting from Zn2+ entry via the Ca-A/K channels. Interestingly, more moderate D[Zn2+]i, triggered by Zn2+ entry via VSCC, promote release of pro- apoptotic factors such as cytochrome-C or Apoptosis Inducing Factor, suggesting that different degrees of cytosolic D[Zn2+]i might activate distinct injurious pathways. In addition to roles in acute injury, Zn2+ might play roles in the selective neurodegeneration associated with aging and and Alzheimer‟s disease (AD). Indeed, cumulative effects of repeated Zn2+ exposures could contribute to the oxidative damage and mitochondrial dysfunction seen in AD. Moreover, recent studies have suggested that the cation promotes the aggregated state of b-amyloid peptide. Zn2+ is in fact found in high concentrations in mature amyloid plaques in human tissue, and its chelation favors the disaggregation and dissolution of the plaques. A better understanding of the mechanisms involved in neuronal Zn2+ homeostastasis seems therefore highly desirable. 26B12 Reversal of symptoms of Alz heimer disease follow ing omentum transposition to the brain H.S. Goldsmith University of Nevada School of Medicine Reno, Nevada. USA Objective: To show that patients who have Alzheimer‟s disease (AD) can have their cognitive and neurological symptoms reversed by placing the omentum directly on the brain Method: The omentum is separated from the transverse colon and from the proximal portion of the stomach leaving the gastroepiploic vessels in the omental apron. The omentum is surgically lengthened and then brought up through a subcutaneous tunnel developed along the chest and neck and behind the ear. A craniotomy is performed, the dura opened and the omentum laid on the brain. Results: Alzheimer patients can have their symptoms reversed most probably because of increased CBF following omental transposition (OT) to the brain. It is theorized that improvement in cognitive symptoms results from increased vascular and biochemical substances originating from the omentum which allow viable but deteriorating neurons to be “rescued” by augmenting neuronal energy (ATP production) that leads to cognitive improvement. Conclusion: It is possible to reverse cognitive and neurological symptoms of biopsy-proven AD patients as a result of OT to the brain. vessels in the omental apron. The omentum is surgically lengthened and then brought up through a subcutaneous tunnel developed along the chest and neck and behind the ear. A craniotomy is performed, the dura opened and the omentum laid on the brain. Results: Alzheimer patients can have their symptoms reversed most probably because of increased CBF following omental transposition (OT) to the brain. It is theorized that improvement in cognitive symptoms results from increased vascular and biochemical substances originating from the omentum which allow viable but deteriorating neurons to be “rescued” by augmenting neuronal energy (ATP production) that leads to cognitive improvement. Conclusion: It is possible to reverse cognitive and neurological symptoms of biopsy-proven AD patients as a result of OT to the brain. Posters 26P17 CDK5 and GSK3 are key factors in tau aggregation and tangle formation in vivo Wendy Noblea , Veeranna a, Dennis Dicksonb and Karen Duffa a Center for. Dementia Research, Nathan S Kline Inst., Orangeburg, NY, 10962 USA bMayo Clinic, Jacksonville, FL, USA Cdk5 and GSK3 are implicated in tau hyperphosphorylation and pathogenesis. To examine whether phosphorylation impacts tauopathy in vivo, transgenic mice over-expressing the cdk5 activator, p25, were crossed with the JNPL3 line that over-expresses mutant (P301L) tau. JNPL3 mice accumulate insoluble, somatodendritic tau in several brain regions and develop tangles, mainly in the brainstem and spinal cord. P25/JNPL3 double transgenics showed significantly enhanced pathogenic tau formation, including an increased number of argyrophilic neurons in the brainstem and cortex relative to matched JNPL3 controls. This suggests that overactive cdk5 enhances tau aggregation and tangle formation in mice with abnormal tau. We then examined the effect of lithium-mediated GSK3 inhibition on pathogenic tau formation in the JNPL3 line. Mice with moderate tauopathy treated with LiCl for one month showed a dramatic reduction in insoluble tau, whereas younger mice with milder pathology treated for the same time showed an increase in insoluble tau. Interestingly, LiCl treatment of younger mice resulted in induced cdk5 activity and as tau in younger JNPL3 mice is more axonally distributed compared to older mice, the combination of axonal tau under the influence of enhanced cdk5 may explain the unexpected increase in insoluble tau in these animals. These results suggest that kinases such as cdk5 and GSK3 are involved in pathogenic tau formation, but other factors (tau distribution, conformational or aggregation status, or the action of other modulating agents) may impact the outcome. These findings may have significant implications for the timing of administration of kinase inhibitors for therapeutic use. 26P18 Caloric restric tion in primates and practical implications for aging and age-related disease George S. Roth GeroTech Inc., Baltimore, MD, USA If the dozen major causes of death in developed countries were eliminated today, the gain in mean lifespan would only be about fifteen years. Moreover, since the quality of life in those extra years is equally, if not more, important than the quantity, it will be necessary to attack both the diseases/disabilities of aging and the underlying mechanisms. For many years, our own research focus has been on dietary caloric restriction (CR), the ONLY intervention conclusively shown to slow aging and maintain health and vitality. CR studies have spanned the evolutionary scale of experimental animal models from invertebrates to primates. Most recently, optimistic researchers have extrapolated from this work to include the possibility of CR benefits for humans. In theory, at least, there is much to be said for lowering the risk of diabetes, cardiovascular disease, cogn itive deterioration, and cancers, all of which can be reduced by CR. However, in practical terms, it would be very difficult for most people to adopt the thirty to forty percent reduction in caloric intake necessary for optimal health and life prolongation effects in animals. For this reason, we introduced the concept of CR mimetics in 1998. These agents, which include potential pharmaceuticals, nutraceuticals, and other dietary supplements, exert many of the same beneficial effects as CR (including anti-disease effects such as neuroprotection and reduction in circulating insulin levels), but WITHOUT limiting food consumption.....in essence, "having one's cake and eating it too." The race to develop CR mimetics for human use has recently become extremely competitive, with many academic, government, and industrial laboratories now actively pursuing this quest. The history and current status of the field will be critically reviewed and prospects for the future realistically assessed. 26P19 New evidences on the role of cyclooxygenase isoenzymes in oxidative stress and neuronal injury follow ing cerebral ischemia E. Candelario-Jalil, O. S. León Department of Pharmacology, University of Havana (CEIEB-IFAL), Havana, Cuba. Three cyclooxygenase isoenzymes (COX-1, COX-2, and a recently-identified COX-1 splice variant termed COX-3) are involved in the biosynthesis of prostaglandins and thromboxanes from arachidonic acid. Brain is one of the few tissues that constitutively express COX-2 under normal conditions and several evidences suggest that COX-2 expression is related to synaptic function. Unlike COX-1, COX-2 has been shown to be rapidly and significantly increased within neurons and vascular cells after cerebral ischemia and other insults that result in neurodegeneration. COX-2 mediates ischemic brain injury by producing reactive oxygen species and toxic eicosanoids, supporting and sustaining the inflammatory response after cerebral ischemia. We emphasize the most recent findings linking COX-2 activity to increased oxidative stress and neuronal death following cerebral ischemia. A summary of the main results obtained by our research group is discussed. In addition, the role of the constitutive isoform COX-1 on ischemic cerebral damage is also discussed. A clearer understanding on the precise role of each COX isoform in cerebral ischemia could potentially influence treatment choices and care of patients suffering from stroke. 26P20 Transplantation of human neural stem cells into rat brain after hypoxy: approach to the vascular dementia and stroke treatment Oleg Podgornya , Maria Aleksandrova a , Irina Heyfetsb , Rimma Poltavtseva a, Maria Mareyd , Aleksandr Revistchinc , Elena Loseva b , Leonid Korochkinc, Gennadiy Sukhikhd a Koltsov Institute of Developmental Biology, Russia, b Institute of Higher Nervous Activity and Neurophysiology, Russia, cInstitute of Gene Biology, Russia, dCenter of Obstetrics and Perinatology, Russia. The goal of study was to reveal the possibility of human neural stem cells (HNSC) survival in the brain of rats submitted to acute hypoxic hypoxia, and their effect on recipient cognitive functions. Four animal groups passed experiments: hypoxia; hypoxia + HNSC transplantation; hypoxia + physiological solution; and the norm. Next day HNSCs, initially cultured 65 days in vitro, were transplanted into hippocampal region (volume about 3 µl, containing 1.5 x 105 cells/µl). All rats were conditioned to bilateral escape (BEC) on 4, 9 and 23 days after hypoxy. On the 27th day cryosections of rat brain were investigated by immunohistochemically. Results demonstrated that transplanted HNSCs survived in all cases. They were found in the cortex, hippocampus and partially in thalamic structures by stain with human nuclear antibodies. Expression of nestin, ß – tubulin Ш and vimentin had been observed in them. Transplants did not resolve from recipient tissue by glial scar. In some cases migration of HNSCs in cortex and hippocampus was observed. Behaviour tests demonstrate that HNSC transplantation does not affect activity of rats submitted to hypoxia, and significantly normalizes conditioning to BEC. HNSCs transplantation may provide a cell source to treat stroke and vascular dementia. 26P21 Abstract not available 26P22 Effects of nutritional supplementation on the aging mammalian brain: in vivo magnetic resonance spectroscopy of brain mitochondrial metabolism Chardonnay J. Vance a,c, Moriah E. Thomasonb , David B. Claytonc , Bruce N. Amesa, a Division of Biochemistry and Molecular Biology, University of California at Berkeley, USA, b Neurosciences Program, cDepartment of Radiology, Stanford Medical School, Stanford CA, USA Mitochondrial decay in tissues and organs, including the human brain, can impair the cellular processes of detoxification, DNA replication and repair, osmotic balance, and the capacity to generate ATP. Despite the critical role of mitochondria in the aging process, there currently exists no protocol for non-invasive in vivo assessment of mitochondrial metabolism in the mammalian brain. With recent advances in large bore high field nuclear magnetic resonance (NMR) hardware and instrumentation, it is now possible to monitor in vivo brain metabolites with high spatial and temporal resolution. Concentrations of key mitochondrial metabolites (ATP, ADP, phosphocreatine, and inorganic phosphate) contain phosphorous (31P) and are indicators of normal or abnormal mitochondrial function. 31P and proton (1H) NMR spectroscopy at a field strength 3 Tesla will allow researchers to non-invasively acquire information on the immediate and long term changes in brain mitochondrial metabolism after ingestion of the mitochondrial cofactors alpha- lipoic acid and acetyl-l-carnitine. A dual-tuned volume coil has been custom built in order to acquire both 1H-decoupled 31P NMR spectra and high-resolution 1H and 31P NMR images. This hardware enables the registration of changes in mitochondrial function localized within brain substructures and with a temporal resolution of approximately 30 minutes. Current progress in the performance testing of the coil and preliminary results obtained from subject and control rats will be presented. After testing in rats, a similar protocol will be used with populations of healthy aging primates and humans. Restoration of motor function in adult patients 26C1 Reorganization of cortical motor function in patients after stroke Lázaro Gómez Fernández, Eduardo Alvarez González, René Macías González, Reynaldo Galvizu, Elizabeth Padilla Puentes. International Centre for Neurological Restoration. Havana. Cuba Changes in cortical maps are related to motor recovery in patients after stroke as an expression of neuronal plasticity, and physical rehabilitation can modulate some of these changes. To find out which are the effects of a neurological rehabilitation program in cortical motor maps in patients after stroke, we studied 2 groups of patients who suffered a cerebral ischemic stroke 1-3 years ago, with partial recovery of their motor function (Barthel index >85, modified Rankin scale =<2); all of them gave their written informed consent. One group of 5 patients was evaluated twice without any treatment; and another group of 15 was included in an intensive and integral rehabilitation program 10 hours a day for 28 days, and were evaluated before and after treatment. Besides clinical evaluation, we carried out a motor mapping procedure with transcranial magnetic stimulation (TMS) of the resting first dorsal interoseus muscle in all of them. Enlargement of motor cortical map with displacement of its center in the affected hemisphere was the most frequent finding in patients; ipsilateral motor responses to TMS was observed only in three patients. After treatment significant changes in motor area determined by TMS were seen in both hemispheres (affected and not affected (non affected: Z=2.36, p=0.017; affected: Z=2.66, p=0.007) in the group of treated patients. No significant differences were detected in the non-treated group between evaluation 1 and 2(p>0.05). In conclusion motor recovery in patients after stroke in response to therapy is related to an enlargement of motor responses area. 26C2 Multidisciplinary approach to stroke sequels : Evaluation of efficacy of the Neurological Restorative Program Álvarez E, Rodríguez L, Palmero R, Carballo M, Fernández E. Internacional Center for Neurologic Restoration. Havana, Cuba. Introduction: Stroke is a main source for impairment disability and handicap for patients. Motor sequels and speech disturbances are the most common consequences, which are liable to change, based on the brain plasticity properties. An intensive, multidisciplinary and personalized therapy program has been developed at our hospital in the last ten years to improve disability, handicap, motor and language performance in chronic stages of stroke, this program was called Neurological Restorative Program (NRP). Patient and Methods: A pilot open-label and controlled clinical trial in 29 patients with chronic sequels of stroke was conducted to assess the efficacy. This assessment included Barthel Index (BI) and Scandinavian Stroke Scale (SSS) at the beginning and after 4 weeks of treatment. The data obtained were analyzed by descriptive statistic; match pairs test and correlations variables. Results: The mean of age was 56±14.4, the mean of the disease was 2±2.43, and 72% of the patients have severe and moderate disability. Average improvement was 15% for the BI and 10% for SSS after 4 weeks of treatment. The patients with severe and moderate disability obtained the most important benefit, which was dependent of a bigger recovery of the walk. The patients with lesions of dominant hemisphere and non-hemisphere showed a bigger improvement in the SSS (16%) that was dependent of a bigger recovery of the language and capability of walk. Round table: Restoration in neuro pediatrics 26C3 Integral approach to pervasive development disorders Carlos Maragoto Rizo, Maria Eugenia Navarro García, Idelys Sarduy, Gabriel Rodríguez García. International Center for Neurological Restoration, Havana, Cuba Pervasive development disorders include interesting and numerous conditions. Autism and autism/like behavior were under research in the last ten years. Based on the demonstrated concept of neuroplasticity, we applied in our clinic an integral, personalized an intensive program called Neurorestoration program. In PDD we include the diet therapy (gluten and casein-free foods), pharmacological therapy for symptoms (hyperactivity, repetitive movements and so on), a TEACH method and a speech therapy and kinesiologic therapy. We show the preliminary results of 9 children under this program. 26C4 Integral management of cerebral palsy Gabriel Rodríguez García, Carlos Maragoto Rizo, Andrés Garcia Cruz, Lilia Esther Dulzaides, Verónica Morales, Nayoy Rodríguez Verde Center: International Centre of Neurological Restoration. Havana, Cuba. Cerebral palsy is one of the most common causes of disability in children. Two to 5 of 1000 children at school age have motor disability. Several evidence support the concept of neuroplasticity in children. In our clinic we develop a strategy that help to recover function in this patients, called Restoration Program. We discuss the step and explain how can we manage these patients. Neurorestorative program have 2 steps: evaluation according to neurological sequels and application of standard scale, the second is the pharmacological, neurosurgical and neurorehabilitation of the patients. Besides, we expose preliminary results of a blind and controlled study of 18 patients treated with this program. Further studies will tray to demonstrate this fact. 26C5 Integral Handling of Dystonia in physical rehabilitation Tamara B. González Ramírez, Mirbia Marichal Figueroa, Carlos Maragoto Rizo International Center for Neurologic Restoration (CIREN), Havana.Cuba. Dystonia is a neurological syndrome characterized by involuntary, sustained muscle contractions that provoke trunk repetitive muscular contractions or abnormal postures. Dystonic movements can affect various muscular groups, are present at rest, and can be enhanced during voluntary movements (action dystonia). Dystonia fluctuates and its clinical expression can be modified by diverse sensorial stimuli, being frequently associated to tremor. Local or distal pain is usually associated, being one of the principal causes of discapacity. Objective: To present our experience and results with dystonic patients assisted at CIREN´s Neurology Clinic for Children. Patients and methods: A retrospective study was performed on 15 cases with the same diagnosis, which were evaluated using motor tests (gross motor) at the beginning and the end of treatment. Results: In all cases, positive changes were observed in socializing, on gross motor and in quality of life. Conclusions: The results achieved can be considered satisfactory, keeping in mind, the complexity of the disease. Restauration of motor function in children 26C6 Comprehensive physical therapy management of young children with brain injury Karen R. Voogt Old dominion University, Norfolk, Virginia, USA The purpose of this oral presentation is to describe the comprehensive physical therapy management of the very young child with severe neurological impairment. The subsequent motor sequelae is well documented, however, long-term physical therapy management and intervention are less understood and must be established to ensure optimal outcome and recovery. The cognitive emotional communication and behavioral issues surrounding neurological impairment significantly complicates the role of physical therapy intervention. A comprehensive approach to physical therapy will be presented for infants through adolescents. The objectives of this presentation are to: 1. Demonstrate the impact of motor sequelae on the child's daily life routine, 2. Demonstrate the integral role of the parents or caregivers on motor outcome, 3. Demonstrate various therapeutic interventions including handlign, positioning, casting and recreatonal activities to enhance motor outcomes. 26C7 Integral management of spinal cord lesion in paediatric age Gabriel Rodríguez García, Carlos Maragoto Rizo, Andrés García Cruz, Maria de los Ángeles Ortega, Ernesto Cossio, Carlos Sánchez. International Center for Neurological Restoration, Havana, Cuba Spinal cord lesions are relative uncommon in people under 16 years. Several evidence support the concept of neuroplasticity in children. In our clinic we develop a strategy that help to recover function in this patients, called restoration program. We discuss the step and explain how can we manage these patients. Neurorestorative program have 2 steps: evaluation according to neurological sequels and application of standard scale, the second is the pharmacological, neurosurgical and neurorehabilitation of the patients. We presented our experience in 41 patients with spinal cord lesion, 18 of them with mylomeningocele, 12 with traumatic spinal cord lesion. The results of the program were measure throughout ASIA scale, Barthel index. Further studies will tray to demonstrate this fact. 26C8 Utility of the tiz anidine in the treatment of the spasticity in children with cerebral palsy Vásquez A. Pérez A., Arellano M. Renán L. Centro Nacional de Rehabilitación. DF, Mexico Objective: To evaluate the effect of Tizanidine on spasticity of patients with cerebral palsy. Material and Methods: We included for randomized assignation in a double blind study 10 children‟s treated with Tizadine ( 1 mg per day) and 30 with placebo for a 6 month period and the same physical and occupational therapy scheme. Both groups were matched in age ( p=0.54), weight (p=0.64), height (p=0.81), and gender ( p=0.29) with basal p>0.05 in all the depend variables ( spasticity Asworth scale, length of lower limbs, posture control scale, reflex scale, contractures, activity of daily living, and liver function test OGT, PGT). Results: From the second through to seventh measurement spasticity in Tizadine group reducing spasticity at 78.85% vs. 7.64% of placebo. (p=0.0001 for differences between groups and p=0.0001 for differences between time of administration) Without reported adverse effects. The liver function test remain normal. Conclusion: Tizanidine produce significant reduction of spasticity in pediatric patients. 26C9 Prevalence and incidence rate of the Spinocerebellar Ataxia in Cuba Luis Velázquez Pérez, Gilberto Sánchez Cruz, Luis Almaguer Mederos, Edilberto Martínez Góngora, Mercedes Velázquez Manresa, Karel Escalona Batallán, Yosvanis Rodríguez Almira, Julio Rodríguez Díaz, Lisandra Prieto Avila, Rubén Reynaldo Armiñán Center for Research and Rehabilitation of the Hereditary Ataxias. Holguín,.Cuba. The most frequent molecular form in Cuba is the Spinocerebellar Ataxia type 2 (SCA2). The SCA2 is caused by a trinucleotide (CAG) expansion in the coding region of the ataxin 2 gene on chromosome 12q. It is characterized by a dominant autosomic pattern of inheritance. This epidemiological study is aimed at determining the prevalence and incidence of hereditary ataxias in Cuba and comprise a descriptive study of 757 patients suffering from this disease and 7 068 at risk in the country. 1548 non-symptomatic first-degree relatives of SCA2 patients from 101 families with SCA2 were identified by polymerase chain reaction. As a result, it was found out that the rate of prevalence in Cuba is 7 cases per 100 000 inhabitants with one province having the highest rate reaching 43 cases per 100 000 inhabitants, whereas the mean incidence was 4.39 cases per 100 000 inhabitants in Holguin Province and one municipality (Cacocum) has the impressive figure of 18 cases per 100 000 inhabitants. The age group most affected was that between 30-39 years old. The prevalence in this group is about 64 cases / 100 000 inhabitants. Approximately 62 is the rate / 100 000 inhabitants of sick people living in the rural area, practically the double of the rate of prevalence in those living in Urban areas. The most frequent symptoms in the SCA2 are gait ataxia, cerebellar dysarthria, dysmetria and adiadochokinesia. 26C10 Cuban national-international cooperative study on clinical, epidemiological, virological and inmunogenetical data in Multiple Sclerosis and demyelinating diseases Cabrera-Gómez, JA, Pérez-Ruiz L, Luis-González S, Echazábal-Santana N, Ocaña-Gil MA, Apollinaire-Pennini M, Hernández E, González-Quevedo A, Porrero P, Aguilera O, Herrera O, Gómez A, Martínez-Góngora G, De la Vega W, Batista-Iturriaga A, Rivas-López V Multiple Sclerosis Society of Cuba (CUBACTRIMS. Havana, Cuba) BACKGROUND: Multiple sclerosis (MS), optic neuromyelitis syndrome (NMO) and inflammatory myelopathies (IM) are one of the most commonly diagnosed disabling neurological disorders of young to middle-aged adults in Cuba. OBJECTIVES: To assess the epidemiological, clinical, virological and immunogenetic data of MS, NMO syndrome and IM data in the population of Cuba. MATERIAL AND METHODS: The study population consists of patients identified with MS, ONM syndrome and IM in Cuba (11 millions inhabitants). The national health system structure in last years has changed to the organization based on family doctors who are the general practitioners. Patients will be identified from different sources. We will compare the frequency of immunogenetic markers in the patients as well as in two unrelated healthy from de same areas. The diagnostic criteria will be for Multiple Sclerosis, (McDonald et al); NMO (Wingerchuck et al) and for IM according to the primary diseases. A Case Report Form (CRF) will be used to record the history of each patient: the personal data, ethnicity, family history, date and age at onset, type of onset, symptoms, clinical course, functional systems, the clinical localization & diagnosis, EDSS, complementary tests (blood, CSF, evoked potentials, MRI), final diagnosis and clinical evolution. The genealogical questionnaire will be performed by the genetics and, for the immunogenetical studies, appropriate patients for blood sampling will be choosing, when the family history is known. For the epidemiological study the day of the prevalence will be determinate. RESULTS: The final data will be available by October 2004. CONCLUSIONS: This is the most expansively national cooperative study on clinical, epidemiological, immunogetical and virological data on MS and other demyelinating diseases in a Latin-American country. Posters 26P23 Evaluation of the rehabilitation method applied to patient Leonardo Alemán International Health Center La Pradera , Cuba The different rehabilitation methods face the challenge of presenting evidences of their effectiveness, in this work a sample of 20 paraplegic patients is presented assisted in the International Center of Health "La Pradera ", which received two months of intensive rehabilitation that it includes a program of integral physical preparation in a personalized way and in group, preparation program and training for the march with ortesis and other auxiliary devices, pre-sports games, psychological attendance, pharmacological modulation and employments of biophysical means as ozone therapy, magneto therapy and electric stimulation, with a frequency of Monday to Friday (6 daily hours). These patients were evaluated with simple and reliable scales as index of Barthel, ambulatory index of Hauser, scale of Ashworth before and after the treatment, with the objective of measuring the effectiveness of the used rehabilitation method. 85% of the patients achieved a functional march that allowed them the independent displacement inside the house and 95% obtained a final qualification in the index of Barthel of more than 60 points, what means that these people are qualified to carry out most of the activities of the daily life. 26P24 Qualitative and quantitative analysis of the gait in patient hemiplegics as consequence of cerebrovascular disease Roberto Díaz Capoteª, Roberto Díaz Márquezª International Center for Neurological Restoration (CIREN), Havana City, Cuba The work was carried out at the International Center for Neurological Restoration (CIREN) selecting a sample of ninety patients, with the objective of checking the effectiveness of the current program of physical rehabilitation on hemiplegic patients after stroke to promote the recovery of gait, as well as on its qualitative aspects. Patients received two months of physical rehabilitation while two standard evaluation tests were measured at the beginning and at the end of the treatment. The results were statistically processed using the method of two-way ANOVA and MANOVA. A biomechanical study of the gait for using the Movement Analysis System (designed and validated at the ISCF) was also carried out. The cinematic analysis of the gait cycle showed improvements in the quality of gait. The treatment resulted in very significant differences in the measured tests, appreciating an increase of the autovalidism and contributing to the social reincorporation of the patients. 26P25 The use of the Tinetti scale to evaluate the recovery of the gait in patients with static lesions of the nervous system Roberto Díaz Capote, Joaquín García Martínez, Roberto Díaz Márquez, Eduardo Álvarez González International Center for Neurological Restoration (CIREN), Havana City, Cuban This investigation was developed at the Adult Brain Static Lesions Clinic belonging to the International Center for Neurological Restoration (CIREN) in Cuba. We selected 20 patients with static lesions as consequence of stroke to evaluate the recovery gait after applying a physical restoration program designed in our institution. At the beginning and at the end of the treatment (4 weeks) the Tinetti Scale was applied. The results were processed using the Wilcoxon´s non- parametric test to verify the significance of the results. Patients were divided into two groups of ten each. The first group formed with those showing focal motor deficits (hemiplegics) and the other with different sequels (ataxias and paretic disorders). Once the treatment was concluded the effectiveness of the program of Physical Rehabilitation was evaluated, as well as the sensibility and viability of the Tinetti Scale to evaluate the recovery of the gait and the balance in patients with Static Lesions of the Central Nervous System. 26P26 Alternativ es for augmenting the mobility and articulatory amplitude of fingers in patients with hemipharesis-like sequel of encephalic static lesions Estela Quesada Rodríguez, J. Nodarse Ravelo, Y. Vizcay Valiente, M. Torres, T. Francia González, M. Crespo Molinelo International Center for Neurological Restoration (CIREN), Havana, Cuba In order to achieve one of the objectives of the occupational therapy program at CIREN for treat patients with sequels of encephalic static lesions, we have elaborated a system of activities to accomplish an improvement of amplitude, and articulatory movements of the fingers in the affected hands. These activities were applied to twenty cases with common characteristics: normal intellect, traces of movements, important hemiparesis (as main motor deficit), pain in different levels of fingers and time of evolution from zero to 3 years. Two treatment periods of twenty-four days, six frequencies a week, one hour daily, were applied. Initial goniometric and active final exams were performed at the Psychomotor Integral Evaluation Laboratory (LEIS) measuring: flexion (methacarpophalangical, interphalangical and distal), abduction and adduction to compare the results before and after treatment. The cases studied improved significantly, both quantitatively and qualitatively. The results were analyzed comparing average improvement of each controlled variable using the Wilconxon Matched Pairs non-parametric test to determine the degree of significance of the final results. 26P27 Treatment w ith occupational therapy increase mobility and articulation of shoulders in patients w ith sequels we to Encephalic Static Lesions Jenny Nodarse Ravelo, Maydané Torres Aguilar, Tania Francia González, Mercedes Crespo Moinelo, Estela Quesada Rodríguez International Center for Neurological Restoration (CIREN), Havana, Cuba One of the main objectives included in the program for the treatment with occupational therapy applied to patients with sequels of Encephalic Static Lesions. We elaborate a system of activities to increase the width and mobility to articulate the shoulder. This program was applied to 20 cases with the following characteristics: normal intellect, hemiplegia or hemiparesia, and time of evolution from 0 to 5 years. With this system we carried out an experimental study to demonstrate their influence during two months of treatment. We performed an initial and final goniometrical test for the flexion (L.E.I.S), extension, abduction and adduction of this articulation. The patients improved considerably according to results of statistical comparisons (Wilcoxon Matched Pairs statistical test). 26P28 Treatment w ith occupational therapy to increase mobility and movement degree of the wrist applied to patients with Sequels of Encephalic Static Lesions Maydané Torres Aguilar, Jenny Nodarse Ravelo, Tania Francia González, Mercedes Crespo Moinelo, Estela Quesada Rodríguez International Center for Neurological Restoration (CIREN) Havana, Cuba We present the results of the program for the treatment with occupational therapy to hemiplegics patients bearing motor sequels. A system of activities has been elaborated to increase the movement degree of the wrist. This was applied to 15 patients with common hemiplegic characteristics and motor deficits, but showing normal intellect, between 0-3 years of age. The treatment was applied one hour daily for two months. We performed initial and final goniometrical tests measuring: extension, abduction and adduction of the wrist pain in order to compare results. The patients improved considerably and we results were significant (Wilcoxon Matched Pairs test). 26P29 Training in w riting for patient with right hemiparesis as a result of stroke Tania Francia González, A. Vernis González. Calvo, Mercedes Crespo, Jenny Nodarse, Maydané Torres, Estela Quesada International Center for Neurological Restoration(CIREN),Havana, Cuba. Vascular brain diseases are considered to be the most frequent disorders resulting from a primary lesion of brain blood vessels. In most cases, the neurological damage is unilateral, manifesting itself in hemiplegia or hemiparesis of contra lateral hemibody, with total or partial loss of voluntary motor ability, affecting writing among other abilities. In our work we intend to evaluate the improvement of the writing ability through a training program for the setup and automation of correct patterns of writing in hemiparetic patients due to stroke. The investigation was carried out in a sample of 10 patients between 40 and 60 years. These were subjected to an initial and a final test in writing and evaluated through a quantified scale for writing (created at Ciren‟s Occupational Therapy Department). During the intermediate period they received an occupational therapy rehabilitation treatment for 35 days of 1 hour daily. The treatment consisted of an initial physical preparation followed by the setting-up and automation for correct patterns of writing. The results obtained showed considerable improvements in the ability to represent basic forms of writing of patients under study, which demonstrate that the activities applied in the study were effective. 26P30 Evidences on the modulating effect of treatment in occupational rehabilitation in the neuroplastic process. A case report Yoanne Vizcay Valiente, Lázaro Gómez, Estela Quesada, Maydané Torres, Jenny Nodarse, Ana M. Montero Centro Internacional de Restauración Neurológica (CIREN Havana, Cuba The recovery of motor functions in the hemiparetic patient through the practice of certain movements, induces plastic changes in the "cortical representation of movement", an aspect of transcendental importance which gives way to the design of therapies, aimed at facilitating the expression of certain processes, and to inhibit others. We present the treatment of a patient at the International Center of Neurological Restoration (CIREN), with a patient suffering from left hemiparesis as a sequel of a brain attack in the right medial cerebral artery territory. The patient received a rehabilitative program for 28 days as part of an intensive multifactorial neurological restoration program that included the strategy of intervention through the development of manual dynamic coordination activities. The influence of this strategy on the recovery of motor functions on patients with cerebral lesion was assesed. The motor mapping using transcranial magnetic stimulation showed positive evidences about the modulatory effect of occupational and physical therapy on the reorganization of the activity from motor function to cortical level. 26P31 Kinesiolgic Handling of patients with Cerebral Palsy at CIREN Neurology Clinic for Children Lilia Esther Dulzaides Reyes, Maritza Alonso Vasquez, International Center of Neurologic Restoration ( CIREN), Havana, Cuba We can assert that the neurorestorative program used at clinic is valid for the handling Cerebral palsy. This condition is characterized by movement alterations and posture along with other affectations as: epilepsy, mental retardation, motor affections, etc. It is necessary to give the patients a series of activities allow the achievement of habits and motor abilities. Objective: To demonstrate the effectiveness of intensive-integral kinesiologic treatment for patients with Cerebral Palsy. Materials and methods: A sample of 20 children, diagnosed with cerebral palsy, was used. These children received kinesiologic treatment at our clinic for an average period of 84 days. They all received the neurorestorative program developed at our Center for this type of pathology. By using the Motor Gross Functional Evaluation Scale (at the beginning and end of each period) the motor evolution reached by these children was assessed. Results: Positive results were obtained in all the patients included in the sample. Conclusions: This study demonstrates the validity of the intensive and integral rehabilitation program used for therapy of Cerebral Palsy. 26P32 Efficacy in the application of the physic al rehabilitation program of CIREN'S neuropediatric c linic of spastic ity and increase of the motorial capacity in children w ith cerebral pals y Ivette Martínez Rodríguez , Gisela Castellanos Torres Rehabilitation Department, International Center for Neurologic Restoration, Havana, Cuba Cerebral palsy (cp) is one of the symptoms that most frequently cause physical or mental limitations among the children's population. Its occurrence varies from 1.5 to 2.5 for 1000 born alive, without the evidence of a tendency to diminish through the years. Spasticity can be defined as a hyper- excitability of the muscular stretching reflex, whose result is an increase of "dependent speed" of the muscular tone or tonic-stretching reflex, with an exaggeration of osteondinosic reflexes. At our center there is an outstanding experience in the treatment of spastic cp. related with reached evidences in the last decade that there are neuroplastic properties during pediatric ages. and that one of the forms of plasticity is obtained through the treatment of cortical areas; we apply an intensive multifactorial program of physical rehabilitation. To make this work come true we performed a retrospective study of two years' time, on all spastic patients with cp selecting 35 of them. It has as a main objective to evaluate the effects of the program according to their neurological conditions and functional capacities. Scales were applied before starting therapy and after 8 weeks of the rehabilitation program, where there were improvements in each of the evaluated areas. Preliminary results demonstrate that in the evaluated patients there was a diminishing of one point in Asworth's scale and the percentage of improvement increased. In a preliminary way, the efficacy of the physical rehabilitation program applied to children with cp of the spastic quadriparesia and diparetic type can be appreciated. 26P33 Ethiological characterization of a hundred patients with diagnosis of Cerebral Palsy Reinaldo Galvizu Sánchez, Rene Macías Betancourt, Teresa Morgado Vega, Judith Plá Morét, Velasco Acosta, Ohilda Rodríguez Coca, Alexander Valdés Trejo. International Center for Neurological Restoration (CIREN) Havana, Cuba The Cerebral Palsy (CP) is a non-progressive overthrough of the muscular tone, the posture and the movement, due to an aggression to the CNS in a period when the maturation and development of the System is not yet finished. A hundred children with this diagnose were studied at the CIREN for an etiological classification. The diagnose of all the patients was confirmed. The etiological agents of this pathology were established through interview to their relatives. EEG and cranial CAT were also done. The frequency distribution and the test x2 according to the used variable were analyzed. It is found that the perinatal etiology was the most frequent. Among the main etiological agents were: premature childbirth (42 cases) and low-born-weight (38 cases). The ephastic diplegia was the more frequent clinical form (56 cases), 46% of the patients presented convulsive crisis, and 36% of them had epilepsy. A significant association between these variables and the different etiological groups were not found (x2=1.611, P=0.4470; x2=0215, P=0.8982 respectively). It is concluded that EEG alterations had a real preponderance in the anterior regions (fronto-temporal) and the tomographic study showed to be a useful diagnostic method in the identification of the structural alterations in children with CP. It was also found that the periventricular leucomalacy and the cortico- sub-cortical atrophy are the more frequent in the newborn etiological group. It is recommended to do a correct etiological characterization of the patients with CP and a careful search of the etiological agents mainly in the patients that come to the Health Tourism Centers. These results were compared with the one reported in a national research done in Cuba in the year 2002-2003 showing similar results with those reported in this work. 26P34 Occupational Therapy Treatment for Children w ith Cerebral Palsy after the use of Botulinic Toxin Type-A Verónica Morales Pedroso, Noelia Romero Borrego, Leonides Castellanos Fuentes, Carlos Maragoto Rizo, Niurka Junco Cortés International Center for Neurological Restoration, Havana, Cuba Cerebral palsy (CP) is defined as “a movement and posture disorder due to a defect or lesion of the immature brain”. According to its clinical manifestations it is classified in: spastic, of cerebellose basal ganglia-type, or mixed. The application of Botulinic Toxin type-A on these patients is supposed to have therapeutic advantages over other treatments, as it permits to act directly on affected muscles without repercussion over the patients‟ general status. Objective: To demonstrate the effectiveness of the use of Botulinic Toxin Type-A for allowing occupational therapy treatment. Material and Method: We performed a retrospective study where all clinical and defectologic records of the patients hospitalized at the International Center of Neurologic Restoration at the Neurology Clinic for Children, at Havana, Cuba, were revised. The sample was composed of 13 patients (8 males and 5 females) diagnosed with Spastic Cerebral Palsy. Their ages ranged from 2 to 10 years that received treatment for a period of 3 months. At the beginning and end of treatment, the modified Asworth‟s Scale and Susana Matas‟ Early Intervention Forms were used to evaluate the degree of spasticity. Conclusion: We appreciate a favorable evaluation as to the variation in the muscular tone and the development of new manipulative abilities. The patients with Spastic CP were benefited with the application of Botulinic Toxin Type-A and occupational therapy rehabilitation treatment, which comprises an Early Stimulation Program. 26P35 Neurophysiological Markers for the identif ication of modifiers genes and other factors of the clinical expression of the SCA2 Luis Velázquez Pérez, Gilberto Sánchez Cruz, Luis Almaguer Mederos, Edilberto Martínez Góngora Center for Research and Rehabilitation of the Hereditary Ataxias. Holguín,.Cuba. The SCA2 is a dominantly inherited cerebellar ataxia. It has a prevalence of 43 per 100 000 inhabitants in Holguín province, which is the highest one reported worldwide. 202 patients from 56 families with SCA2 and Fifty-five non- symptomatic first-degree relatives of SCA2 patients were identified by polymerase chain reaction and sequenced. First-degree relatives (sons) were studied 5 times over a period of 17 years. The Peripheral and Central Nervous System of these patients were subject to clinical studies and electrophysiological eva luation. Correlation analysis were made between the CAG repeat and various electrophysiological parameters. In 188 of them, ataxia of the gait was the first symptom of the disease, while gait ataxia with cerebellar dysarthria was present in 12 patients. All patients had ataxic gait, cerebellar dysarthria, dysmethria and dysdiadochokinesia. The main abnormality found in the patients and presymptomatic relatives was a reduction of sensory action potential as well as increase in the latency of the P40 component. The severity of these electrophysiological changes was found to be related to the CAG repeat. Our electrophysiological results agree with the loss of ganglion cells in the dorsal root ganglia. This studies have proved that while the number of CAG repetitions increase, bigger electrophysiological alterations are produced in patients, until they get to total blockade of the afferent conduction as a sign of severe neurodegeneration. It is speculated that a rise in CAG repeat might lead to increased toxicity of the SCA2 gene product which subsequently accounts for more neuronal loss in the Peripheral and Central Nervous System. 26P36 Phenotipical characteriz ation of the Cuban SCA2 Gilberto Sánchez Cruz, Luis Velázquez Pérez, Edilberto Martínez Góngora, Mercedes Velázquez Manresa. Center for Research and Rehabilitation of the Hereditary Ataxias. Holguín,.Cuba. Autosomal Dominant Cerebellar Ataxias are a heterogeneous group of neurodegenerative disorders characterized by varying degrees of brainstem and cerebellar pathology and dysfunction. Translated CAG repeat expansions encoding polyglutamine tracts are found in the six genes: SCA1, SCA2, SCA3, SCA6, SCA7 and SCA17. The Cuban SCA2 is the highest prevalence in the world. The study was performed in 553 patients from 101 families with a molecular diagnosis of SCA2. This group of patients was composed by 284 male and 269 female, onset age mean 32,75 (range 2-75). The mean time of evolution was of 14.6 years. The studied included clinical, biochemical studies and electrophysiological evaluation. All patients were gait ataxia, cerebellar dysarthria, dysmetria, adiadochokinesia, tremor, hypotonia, abnormal reflexes and slowed and limited eye movements. No patients had optic atrophy, spasticity, pigmentary retinal degeneration and endocrine dysfunctions. In patients with severe disability there was involvement of the peripheral and central nervous system regulating autonomic function, such as vasomotor disorders, constipation, urinary and rectal incontinence, tachycardia at rest, exocrine gland disorders, and a syndrome of cachexia with bulimia and sleep disorders. Biochemical finding demonstrated oxidative stress. The main abnormality found in the experimental group was the reduction of the sensitive potential amplitude, in all studied sensitive nerves. This electrophysiological characteristic continues evolving and it is more accentuated in the patients with the longer evolution time in the disease. The increase in the sensitive potential latency and the slowing of the sensitive conduction velocity were the other two abnormal characteristics also seen in this group of subjects. The analysis of the changes in the variability of the heart rhythm demonstrated a hyperfuntion of the Simpatetic Nervous System with slight hypofuntion of the Parasimpatetic. 26P37 Multidisciplinary Approach to Cerebellar Ataxias: Preliminary Report Diaz de la Fe A.,Morgado T.,Padron A.,Pedroso I.,Alvarez L. Movement Disorders Clinic,CIREN,Ciudad Havana,Cuba Cerebellar Ataxia is the second most frequent movement disorder in our Clinic. This syndrome is associated with impaired locomotion, manipulation, and communication as well as severe disability. Non-pharmacological or surgical approaches are useful to control the motor impairments or to improve functional capabilities. Conventional physical therapy, training of gait by different techniques and isolated speech therapy has demonstrated transitory improvement but there is no report describing the effect of combined techniques to train motor performance. From June 2002 to June 2003 we conducted and open, uncontrolled, clinical trial to assess the efficacy of a multidisciplinary therapy, structured in periods of 4 weeks. The study includes 23 patients with this motor disorder. The follow up protocol define the same battery of evaluation, i.e.: the International Cerebellar Ataxia Rating Score (ICARS, WHO, 1999), the subtest for coordination and gait from an standard system for motor performance (LEIS), the Bartell Index and the SF-36 Questionnaire to asses both functional state and quality of life, at baseline and after ending each cycle of treatment. The preliminary results show an average improvement of motor performance of 31,6% in the group with higher degree of reduction in the ICARS total value for most handicapped patients and better results for the patients who extend the training for more than two periods. Bartell Index improves in about 20 %and the Qlo (Sf-36) do not reach statistical significance. In conclusion, multidisciplinary therapy can improve both motor performance and functional capabilities but further studies with more patients should be done. 26P38 Use of the International Cooperative Ataxia Rating Scale to evaluate the recovery of movement of upper limbs in patients with ataxia as a result of neurodegenerative disorders Yoanne Vizcay Valiente, Amado Díaz de la Fe, Ana M. Montero Suárez, Estela Quesada Rodríguez Centro Internacional de Restauración Neurológica, Havana, Cuba Ataxia is a common landmark for a group of degenerative diseases. These illnesses can have a progressive course, however, some symptoms can be alleviated by a skilled and rational treatment. This investigation has the objective of checking the effectiveness of the International Cooperative Ataxia Rating Scale, ICAR (World Neurology Federation) to measure the evolution of ataxic patients after being subjected to rehabilitation treatment. A sample of 12 patients, were treated with occupational therapy (one daily hour) for 45 days. We applied ICAR scale to evaluate movement in superior limbs. A comparison was carried out between results with this scale and coordinative capacities tests performed at the Psychomotor Integral Evaluation Laboratory (LEIS). Indicators of manual skills as: dismetry, tremor, and irregularity of movements were measured. The decrease of the punctuation of these indicators coincides with the decrease in the number of errors (evaluation indicator) of the coordinative capacities tests (LEIS). Both evaluations showed 52,9 and 27,2% of improvement respectively, with regard to initial evaluations. ICAR scale supplemented our information about the evolution of the ataxic patient. 26P39 A comparative study on the physiatric treatments of bell´s peripheral facial paraly sis Carlos Rafael Leyva Barrientos. M. C. H. Dr Luis Días Soto, Habana, Cuba A descriptive-retrospective study was made in patients assisted at the Military Central Hospital Dr: “Luis Díaz Soto” referred by neurological services in order to evaluate the physiatric treatment effectiveness in those who underwent a 1-year-long-peripheral facial paralysis. Two groups of patients were treated; in the first one prevailed 20-year-old males (66.6%), while in the second one there were 11 individuals within 30 to 39 accounting for (36.6%). Hyperesthesia was present in 20 patients (66.6%) following retro-auricular pain and hyperacusis present in 18 and 17 cases in each age group, as major neurological signs related to the hemiface damaged. Whilst lip and eye orbicular muscles were seriously damaged in (100%) of the cases, the (90%) of them did not show muscular contraction at the beginning of the physiatric treatment, however, at the end of it (46.6%) of the cases presented “normal” contractions and only 7 individuals (23.33%) had a “poor” muscular contraction level. Ultra-frequency treatment; electric stimulus, facial massage and mimicry exercises exerted optimal effects (46.6%), while the other treatment reached only (36.6%) of effectiveness. The healing process was evident in 20 patients (66.67%) being 14 cases under the first group and only 6 in the second one. 5 patients (16.6%) of the first group and 4 of the second one were grouped under the middle-level healing process. The latter proved to have the worst diagnosis as permanent sequels occurred. 26P40 Congenital Multiple Arthogriposis. A case presentation Carmen Rosa Alvarez Gonzalez, Erduy J Infante Velásquez, Gilda Martinez Aching International Center for Neurologic Restoration (CIREN). Havana, Cuba Congenital Multiple Arthogriposis (CMA) is a term that defines the presence of contractures in the articulations at a child‟s firth. The objective of our work is the presentation of a clinical case. Material and Method. A case under pediatric age with a Congenital Multiple Arthogriposis diagnosis is presented. We applied the evaluation of motor function (at the beginning and end of neurorestorative treatment). A 4 year old female patient at nine months of pregnancy, the mother had a delayed birth work, delayed crying of the baby after birth, cyanosis and low weigh of only 2800 grams, remaining in an incubator for 10 days. The patient presented an evolutive retardation in psychomotor development in all the spheres of neurodevelopment. At the moment, the child presents significant disorders is her self-validism, especially in gross and fine motor functions, language and its psychopedagogig learning. At the physical exam, retardation in the maturation and language requisition was observed. She did not sit up; sedestation and standing up biped station were impossible. A 28-day cycle of the Neurorestorative Program was performed. She obtained some improvement of the muscular strength and superior limbs (scapular waist) and improvement of the articular amplitude of limbs and the child remains seated without support. Conclusions. The evaluation of function initially showed a 10,5% level and a final 15,2%, for a 5,3% increase in only one cycle of rehabilitative treatment. 26P41 Gait evaluation at the integral psychimotor evaluation lab on patients w ith motoric sequels due to cranioencephalic trauma Gilda T. Martínez Aching, Armando Sentmanat Belison, Carlos Suárez Monteagudo, Alexander del Valle Echemendía, Carmen Rosa Alvarez González, Bárbara Sánchez González International Center of Neurologic Restoration (CIREN) Havana, Cuba Nature and environment expose us to multiple situations that can cause cranioencephalic trauma. Gait alterations are often derived from accidents, which also can hinder the normal capacities to develop motor skills impairing the patient‟s social life. The fundamental objective of this work was to evaluate patients with gait motor sequels caused by encephalic trauma. These evaluations were carried out in a sample of 52 patients assisted at CIREN. We have collected numerical eva luations of the patients gait problems. These evaluations were performed at the initial state and after evolution in their rehabilitation. Evaluated tests on gait were: amplitude of average steps and frequency of steps in 10 meters (amount of steps and frequency of performance). Of the 52 evaluated patients, 38 changed their gait amplitude. 26P42 Inflammation and multiple sclerosis. An integral survey from intratecal immunity and antioxidant activity Maria Robinson-Agramonte, Milena Rodriguez Álvarez, Martha Nápoles, Teresa Serrano Sánchez. Bertha Willson, Elizabeth Hernández. Hansotto Reibera, Yozvany Bouza, Reynaldo Galvizu Centro Internacional de Restauración Neurológica. Ave 25. No 15805 e/ 158 y 160, Playa. CP 11300. Ciudad de la Habana. Cuba. a Neurochemistry Lab, Gottingen University, Germany. Inflammation and oxidative stress are refereed as biological markers from different fluids in ME, looking for some evidences helping to a more integral understanding of the course of the disease. CSF analysis is a main tool in the study of these biological markers; nevertheless, no less important markers from peripheral fluids add information on the pathological events of the disease. We show an integral result of the immune-inflammatory response and oxidative stress in-patients with the diagnosis of ME and control subjects. The analysis included the evaluation of intrathecal immune response using Reibergram program, the quantitative determination of cytokines (IL 1b, TNFa) following ELISA method as well as the quantitative estimation of antioxidant activity referred to the evaluation of variables relatives to oxidative (GPX) and nitrative (ON) stress. The probable interaction between all this parameters was analyzed too. A differential Reibergram pattern of oligoclonal intrathecal fraction was observed while the antibody polyspecific response to neurotrophic viruses showed an increased AI with a differential frequency of combination to each patient. Also, ME patients showed a significant difference to TNF a and GPX activity (p<0.05) as well as some interaction level with the former with antioxidant nitrative activity The results underline the inflammatory mechanism in ME and tag the reactive oxygen species as cellular messenger instead a simple pathogenic agents to the disease, in add to their potentiality to evaluate the progression/ activity of the disease. 26P43 Acupuncture treatment for neurologic restoration Carlos M. Méndez Alonso, Tahimí Cardoso Suárez, Irene Jiménez Ortiz Holistic Medicine Department, International Center of Neurological Restoration. Habana, Cuba. Introduction: Asian Traditional Medicine (ATM) and within it Acupuncture is a diagnosis and treatment system approved by WHO and promoted by our National Public Health System. There is a growing interest on ATM efficacy in chronic affections of the CNS, as its use has been reflected in the clinical practice, and in the increasing number of investigation on this issue. Our center is one of the pioneers in incorporating this source of knowledge so much in attention care as in investigation. Objective: to describe and analyze the diagnostic, the therapeutic strategy, and the patient s´ evolution in some of the more frequent neurological affections at our Center. Development: The bases for ATM are described here, so much as to the traditional conception as from the results of present-day investigations. The diagnosis process is described here, the design of the therapeutic strategy and treatment as well as evolution of different affections are explained in detail in relation with encephalic static lesions due to occlusive cerebrovascular disease. Conclusions: Acupuncture implies an individualized and therapeutic approach based on diagnosis. there are investigation in which acupuncture seems to have a neuroprotective action and its use favor recovery of patient neurological affections. Basing ourselves on our experience, we can assert the value of its integration to the Intensive Multifactorial Rehabilitation Program. 26P44 Risk factors and carotid steno-occlusive lesions Liván Rodríguez Mutuberría, Carlos Suárez Monteagudo, Yusimí Serra Valdés International Center for Neurologic Restoration(CIREN),Havana, Cuba. Cerebro – vascular disease is one of the most frequent issues of urgent neurological assistance, which constitutes a serious problem for public health. According to World Health Organization, Cerebro – vascular disease is the third cause of death and the first of disability in adults. Aterotrombosis stroke due to carotidean ateromatosis is a frequent form of presentation of such disease. We performed a prospective study on 60 patients hospitalized at the Clinic of Encephalic Static Lesions, all affected with aterotrombotic stroke, to evaluate the behavior of carotid steno – occlusive lesions as a risk factor of ictus recurrence, as well as those factors that condition this type of lesion. Data were conformed according to the medical exam practiced on these patients and other complementary studies, including carotid Doppler study of the Duplex – type. Work was performed on age and sex variables, risk factors, percentage of patients with carotidean lesions and severity of stenosis. We based ourselves on the study performed by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the lineal descriptive method was used for the registering and tabulation of the data. The results showed the presence of steno – occlusive lesions in 58.3 % of studied patients, the greatest amount corresponded to lesions above 50 % and most important risk factors were Essential Arterial Hypertension and hyperuricemia. 26P45 Spirometric alterations in patients w ith high spinal cord lesions Gilda T. Martínez Aching, Ma. del Carmen Padín Hernández International Center of Neurologic Restoration (CIREN). Havana, Cuba Breathing inadequacy is a frequent complication in the medullary lesioned patient. The fundamental objective of this work was to study the results of spirometric evaluations of the Breathing Vital Capacity on patients with high medullar lesions. We use a sample of 30 medullary-lesioned patients assisted at CIREN. Tests to evaluate the breathing capacity (vital strength capacity by using a Multispiro Sensor with an international scale: ECCS). Results. After initial and final evaluations, we verified the majority of cases were not able to vary their category as to restrictions (severe, moderate, slight) of the breathing capacity, however we observed positive modifications in all cases after receiving breathing therapy. 26P46 Response to the breathing therapy in the cervical medullary injured patient María del Carmen Padín Hernández, Mayda Nelia López Hernández International Center for Neurological Restoration, Havana, Cuba OBJECTIVE: to Demonstrate the utility of the logopaedic therapy on the recovery of patients with Cervical Medullar Lesions. MATERIAL AND METHOD: We use a sample of 20 patients with cervical medullar lesions, assisted in the Raquimedullar Clinic in our center during the year 2000. Patients received from 1 to 4 treatment cycles (28 days each), with a frequency of a daily hour. An initial study was carried out that included chronometric, inspirometry, numeric count, spirometry, vocalizations during an espiration and the evaluation of the possibility of coughing, to expectorate and to sneeze. DISCUSSION: It was possible to establish the appropriate breathing type (costodiafragmatic). The inhaling exercises and exhaling resulted in the increase of the breathing capacity in an average of 300 cc and the appropriate coordination. The exercises for the dosage of the air during verbal emission contributed to normalize the vocal emission in 100% of the cases. The whole group of procedures allowed the variation of the rest of the controlled vital functions: 50% achieved expectoration without help; 45% achieved audible cough. CONCLUSION: Improved the quality of life of the patients with cervical medullary lesions can be achieved with our therapeutic program. 26P47 Determination of the antigen HLA-DR2 15 in patients w ith multiple sclerosis Guadalupe Zaldívara, Julio Granadosb , Carlos Sosa c. a Facultaty of Medicine, Autonomous University of Querétaro, bDepartment of Inmunología and Reumatología National Institute of the Nutrition "Salvador Zubirán", cDirector of the Natural Faculty of Sciences of the University Autónoma of Querétaro. The Multiple sclerosis (MS) is an inflammatory demyelinating disease of the nervous central system (SNC), characterized generally for an initial boss of exasperations and cyclical references, evolving to a chronic progressive course. Even that the MS is one of the most common neurological diseases, it is an entity of which, the reason and the pathogenesis are unknown. Is observed with major frequency in persons that carry the antigen HLA-DR2-15, by which there is presumed that the persons who carry this antigen are more capable of suffering MS. The aim of this work was to determine the above mentioned antigen in hybrid Mexicans with diagnosis of clinical MS and by magnetic resonance. Material and Methods: one determined the antigen HLA-DR, 15 with PCR (Polymerase Chain Reaction) in 8 subjects with MS. Also it was determined: age, sex, place of birth and time of residence, personal precedents of sufferings, family precedents of sufferings, nourishing habits, alcoholism, nicotine poisoning, current place of residence, trips, education, profession, socioeconomic status, anomalies of the sexual function and if they live together or not with animals. Result: The analyzed patients are 6 women(wives) and 2 men, of socioeconomic average way. Nobody has MS's familiar(family) precedents. They all have lived in cities of the country, none lived out of the country during its infancy, and they come from latitudes that do not correspond to the areas of high. Friday 27 febraury 2004 Plenary lecture 27A1 Compensatory mechanisms and motor functions of the basal ganglia: lessons from Parkinson´s disease Jose A. Obeso Department of Neurology-Neurosurgery, Clinica Universitaria and Medical School, University of Navarra, Pamplona, Spain. The revitalization of surgery for Parkinson´s disease (PD) has provided new opportunities to examine the effects of focal lesion of the basal ganglia and the adequacy of current pathophysiological concepts. Modern studies have shown that pallidotomy in Parkison´s disease(PD) induces significant improvement of movement parameters, restores thalamo-cortical activity and eliminates levodopa-induced dyskinesias without causing any major deficit of movement control. In patients with hemichorea-ballism or dystonia, pallidotomy also induce marked amelioration of the dyskinesias with no associated deficit. Lesion of the subthalamic nucleus(STN) in PD is also associated with marked motor benefit. Subthalamotomy may produce hemichorea.ballism in many patients but this is usually self-resolving over a few days or weeks. Thus, there is a spontaneous resolution of the dyskinesias. In a few patients, the hemiballism may be severe and long-lasting. In such cases, as it is well known from the experimental literature in the 40´and 50´s, a subsequent pallidotomy will eliminate the hemiballism without loosing the antiparkinsonian benefit. Such patients, who are literally deprived of basal ganglia output in one hemisphere appear to perform remarkably well.. On the other hand, bilateral surgery of the basal ganglia is usually associated with important side effects. In addition, striatal dopamine depletion has to surpass over 90%(in the MPTP intracarotid injection model) in order to produce parkinsonian symptoms but much milder (i.e. 50%) bilateral depletion causes clinically relevant motor symptoms in PD. I conclude by suggesting that unilateral disruption of the basal ganglia is tolerated very well by the primate brain. This may be understood as a result of the distributive and bilateral distribution of the motor system, which does not depend upon unilateral BG output activity to perform motor routines indicating the importance of the BG-frontal cortex loops in guiding movement and behavior. From Basic Neuroscience to clinical practice 27A2 The role of progesterone and related neurosteroids in the treatment of traumatic brain injury and stroke Donald G. Stein Emory University, Dept. Emergency Medicine, Atlanta, Georgia 30322, USA We are now examining the role of progesterone‟s precursors and metabolites to determine their‟ specific mechanisms of action in the damaged central nervous system. We are also testing patients in an NIH sponsored, Phase II (a), single-center trial for safety and efficacy. The functional, physiological and genomic mechanisms underlying progesterone‟s beneficial effects and still being discovered and some of the newer findings will be described as a part of the presentation. There is now increasing, experimental evidence that this neurosteroid can play a role in reducing immune inflammatory disorders of the brain as well as providing benefits to the victims of stroke. We are currently examining these injury models in both laboratory rats and mice. In laboratory animals, females with traumatic brain injury have better functional and morphological outcomes than males with the same extent of injury. Naturally occurring levels of progesterone in females appear to mediate these beneficial effects. Treatment with exogenous progesterone in both adult males and females will lead to better outcomes after traumatic brain injury. The beneficial effects of progesterone treatment are related to its ability to reduce post-injury cerebral edema caused by the cytotoxic cascade caused by the trauma. Progesterone and its constituents act by reducing immune- inflammatory reactions, membrane lipid peroxidation, apoptosis and necrosis. Progesterone and it‟s metabolite, allopregnanolone, stimulate remelination of damaged axons and enhance regeneration. Phase IIa trial with progesterone sponsored by the U.S. National Institutes of Health is currently being conducted. 27A3 The growth of the Hebb Synapse: Evidence from the hippocampus Aryeh Routtenberg Northwestern University, USA Since the time of Cajal it has been thought that learning leads to an input-dependent neuronal growth process. The extent of growth of new synaptic connections has been speculated to be directly related to the long-lasting nature of the memory for that learning experience. Here we test this hypothesis by focusing on one particular synaptic junction, the mossy fiber –CA3 pyramidal cell synapse in the stratum lucidum of the hippocampus, which is known to process information that is critical for long-term memory. Initial evidence from this and other laboratories indicates that new growth has occurred such that ectopic mossy fibers are present in the stratum oriens. But this growth only occurs with overtraining. Why does new growth require overtraining, not simply training, to propel the apparent formation of new synapses formed consequent to spatial learning? A general framework for a specific answer may be in the formation of duplicate traces as initially proposed by Hebb. According to this view, the long-lasting nature of the memory trace depends on the formation of multiple representations of that trace. This implies that the mossy fiber system could be part of the network that represents the memory, or more accurately, a facet of the attributes of memory. A provisional working hypothesis is that learning begins the process of mossy fiber growth and that such growth provides the development of new circuits that overtraining activate, which in turn allow for reduplication of traces, involving mossy fibers in part, which are necessary for the long-term storage of information. Thus, available evidence on mossy fiber growth in rats makes it attractive to think that enhanced learning after overtraining may be both a consequence and a cause of the growth of mossy fibers. One over-arching long-term goal of this research is to specify the molecular determinants of this learning-induced growth. The readily identifiable characteristic features of the presynaptic and postsynaptic elements make them ideal for studying the role of growth proteins and their regulatory kinases. By using this tractable model, the proposed research provides the infrastructure to determine whether training-induced mossy fiber growth represents a specific instance of a more general event that occurs after learning in key memory storage locations throughout the brain. 27A4 The 'emotive brain', the noradrenergic system and functional plastic ity Susan J. Sara University of Paris 6, Paris, France Motivation and attention can have a profound influence on perception, learning and memory. Neuromodulatory systems, especially the noradrenergic (NE) system, covary with psychological states to modulate cortical arousal, influence sensory processing and promote synaptic plasticity. There is even some suggestion that the NE system might facilitate functional recovery after brain damage. Post-synaptic effects of NE in its ubiquitous projection regions have been well-studied, but factors controlling activation of NE neurons are less known.The pontine nucleus Locus Coeruleus (LC) contains the entire population of NE neurons projecting to the forebrain and all cortical and thalamic regions receive NE input. Using single unit recording in freely moving rats, we have been studying neuroanatomical circuits, along with sensory stimuli within their cognitive contexts that control LC firing. Rats are implanted with movable microelecrodes to record activity during a variety of behavioral situations: exploration of novelty in a hole-board, response to tones or odors that predict reward or absence of reward, extinction or reversal of stimulus-reward association. We find that LC-NE neurons respond to novel or salient stimuli, habituate rapidly to respond anew when the stimulus is associated with reward (CS+), particularly in the early stage of learning. Recent experiments suggest that these responses are more related to reward expectancy than to the CS+. Importantly, there is robust LC response to any change in the predictive value of the stimulus, i.e. when new learning must occur. NE released by LC activation will promote the underlying synaptic plasticity. 27A5 Neuroplasticity and depressiv e disorders. Efficacy of tianeptine. Clara Lucia Abreu de la Torre, Jorge Bergado Rosado, Eduardo Alvarez González, Carlos Suárez Monteagudo, Rene Macias Betancourt, Roidel Alessandrini González, Rolando Palmero Camejo, Centro Internacional de Restauración Neurológica (CIREN), La Habana, Cuba Introduction. Depressive disorders have a prevalence of 15-20% in the general population. The rate of depression in cerebro-vascular disease (CVD) increase to 30 and 50% Recovery of affected functions depend mostly on neuroplastic mechanisms which can be enhanced by therapeutic interventions. Recent evidence has indicated that neural plasticity depends on affective factors, which modulate its strength and duration. It is therefore important to correct depressive disorders in patients under rehabilitation treatment. Objective. To evaluate the efficacy of different antidepressive in CVD patients under treatment in our clinic. Method. The severity of depression was evaluated using the Hamilton Scale for Depression before and after conclusion of the therapeutic program. Antidepressive therapy with tianeptine (25 mg, average dose) was introduced in a group of 30 patients, which were previously without medication. Other patients under antidepressive treatment continue using the same drugs and dose. Results: Tianeptine revealed to be the most effective drug considering the improvement in their affective condition, the better results in rehabilitation and the reduced side effects. 27A6 Redefining the self after neurological insult Robert D. Voogt Robert Voogt & Associates, Inc., Virginia Beach, Virginia, USA For almost 10,000 years, the medical community has been involved in the understanding of the human nervous system. The most devastating aspect of neurological insult is the historical loss of who the individual was. Whether it is an alteration in how one ambulates or the ability to interact and be a part of the community, these changes require a redefinition of the self. Throughout the ages, literature and the arts have portrayed the progression from ancient medicine and healing to modern scientific technology. Seeking cures through medicine and potions was seen as early as 2100 B.C. Our success at controlling nature has created a world of disabilities because of much higher survival rates. We struggle every day to defy mortality and end up failing and living with people who are handicapped. They remain handicapped because the environment and community around them have failed to integrate them. In fact, the community often seeks to shut them out and reject them as less than able. Both, the community of abled and those disabled, lose.The goal of 21st century medicine must be more than the desire to control nature. It must unite the healer with those in need of healing and mend the relationship between patient, healer and the community. This presentation takes a historical look at the healing process and healing profession in an attempt to define the absolute goal in neurological rehabilitation. Institutional and social aspects of neurological restoration 27A7 Cognitive and behavioral rehabilitation of children and adolescents with traumatic brain injury Mark Ylvisaker College of Saint Rose, Albany, New York, USA Cognitive impairments and associated problems with communication, behavioral self-regulation, and academic performance are among the most common consequences of traumatic brain injury in children and adolescents. For families and teachers, the behavioral consequences of TBI tend to be most problematic. Attempts to restore isolated cognitive functions with discrete trial cognitive training exercises have yielded disappointing results in both children and adults with TBI. Similarly, attempts to improve behavioral regulation with traditional contingency management behavior modification strategies have yielded disappointing results with this population. I will briefly review alternative approaches to cognitive rehabilitation and behavior management, and describe a context-sensitive and support-oriented approach that is consistent with the neuropsychological profiles of many children and adolescents with TBI. Study Purpose: to test the effectiveness of a combined cognitive, behavioral, and executive function intervention, delivered within school settings and the academic curriculum; The intervention highlighted context supports (e.g., supportive interactive style of education staff) as well as compensatory strategies and general executive function routines for the child. Study Methods: single subject experimental methodology was used to test the intervention with young children and adolescents. Study Results: In each case, the intervention resulted in a reduction of negative behaviors and an increase in school work completed. Furthermore, the intervention was judged to be easily delivered within the context of everyday school routines. 27A8 Cognitive Rehabilitation Outcomes for Traumatic Brain Injury – Evidence Report Update Nancy Carneya, Hugo du Coudraya,b a Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA, b Department of Psychology, Portland Sate University, Portland, Oregon, USA In 1998 the Evidence-Based Practice Center (EPC) of Oregon Health & Science University (OHSU) conducted a systematic review of the scientific literature about the effectiveness of cognitive rehabilitation for the treatment of traumatic brain injury (TBI) in adults. In 2002 we updated that report. We conducted an electronic search of MEDLINE, PsychINFO, CINAHL, and the Cochrane Controlled Trials Register to capture literature from 1998 to 2002. We sought randomized controlled trials, non-randomized comparative trials, and systematic reviews. Publications were excluded in which samples included non-trauma brain injury and did not distinguish data for those patients from data for patients with TBI. Of 1,904 abstracts, and 24 additional references provided by peers, 9 publications met the inclusion criteria and were abstracted for evidence. In this presentation we will discuss the findings from the update, and will compare the quality of the literature generated between 1998 and 2002 with that of the previous evidence report. 27A9 The Brain Injury Day Treatment Program (BIDTP) Virginia Balbona a, John Sassb a Department of Rehabilitaion Medicine, Emory University, Atlanta, Georgia, USA, b Restore Neurobehavioral Center, Roswell, Georgia, U.S.A. Patients who have suffered traumatic brain injury (TBI) are participating in an intense program that considers their cognitive, social/emotional, and vocational rehabilitation. This innovative program based on the work of Yehuda Ben-Yishay, Ph.D. consists of an Initial Comprehensive Evaluation during which the patient undergoes a neuropsychological assessment. The evaluation reveals what cognitive deficits the patient may have as a result of their TBI and which skills have remained intact. The First Phase of the program (The Intensive Remedial Treatment) involves daily Orientation, Interpersonal Communication Skills, Cognitive Remedial Training, and Community Meeting Classes. Weekly Multiple Family Group sessions are attended by all the patient‟s significant others and the staff. The patient and family/significant others also receive counseling on a weekly basis. Twice during the program, the patient prepares, writes and rehearses a presentation given before an audience of guests and significant others. The presentations are videotaped and used as a tool to learn communication skills. The Second Phase of the program (The Guided Work Trials) transfers what the patient has learned in the remedial phase to a less structured environment. The goal is to discover the patients‟ potential for returning to work. Patients receive personal and/or small-group counseling. They receive guidance in areas that encourage independent living and performing activities of daily living. The Third Phase of the program (Post-Discharge, Maintenance/Follow-up Therapy) aims at helping the patient find work in the community and following their progress. 27A10 Cross-cultural analysis of predic tors of outcome from traumatic brain injury: an Argentina/United States collaboration Nancy Carney Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA In 1998 researchers from Oregon Health & Science University (OHSU) initiated a prospective observational study of traumatic brain injury (TBI). They established a system to collect data about patients with TBI spanning field transport, emergency department, intensive care unit, and hospital ward, and extending to post-discharge and long-term functional outcome measures. The objective was to compare outcomes for patients who received rehabilitation with those who did not. The investigators developed complex acute care measures of severity to improve their ability to associate severity with outcome, in order to control for the influence of this variable on outcome. In 2000 this group formed a collaboration with physicians from the Neurocritical Care Group of Sociodad de Argentina Terapia Intensiva (SATI) to initiate a similar study in Argentina, where rehabilitation for TBI is rare. There are 105 patients in the Oregon dataset and 278 in the Argentine dataset. In this conference we will present initial findings from these studies. We will compare treatment and outcomes for TBI patients between the two samples, and will present results of our analysis of predictors of outcome within and between both populations. 27A11 Latin-American Brain Injury Consortium. A brief presentation Caridad Soler Morejón, Cuban Section of Neurointensivism. National Council of Scientific Societies, Cuba The Latin-American Brain Injury consortium is a free association of Latin-American professionals, dedicated to the attention of brain damaged patients. This non lucrative organization was founded last month in Rosario, Argentina, and up to now, it joins medical doctors from 11 Latin-American countries, including Cuba. The main objectives are the following: 1) To promote the training of professionals who assist patients with brain injury, (courses, and meetings). 2)To promote and address researches for the improvement of the outcome of adult and pediatric patients suffering acute brain injury. 3) To establish close collaboration between centers and researchers in Latin America, for the management of brain trauma and other acute brain diseases. 4) To negotiate and participate with the sponsors of the researches to assure the excellence in design, conduction, analysis, and publication of essays and researches. 5) To act as a supervisor in theoretical and practical aspects related with the different studies. 6) To promote the diffusion of Guidelines for the management of different brain acute diseases. 7) To promote the cooperation with other consortiums or Brain Injury Groups from our region and other countries. Finally, our purpose is to present the goals and possibilities for the integrative and collaborative work that this organization could mean to our countries in order to achieve the better prognosis for our patients. Scientific researches and training are the most important tasks focused in this program. Posters 27P1 Strategy for communication and integral attention in the service to the neurologic patient. CIREN’s experience Rosa María Medina, Víctor Manuel González, María del Pilar Vilá, Farah María Paredes, Juan Miguel Avellanet International Center for Neurological Restoration (CIREN), Havana, Cuba A patient, who decides to receive most adequate medical and rehabilitation services in another country, needs to find well-structured programs with communicative actions and an integral attention to fill the gap for his/her habitual environment. CIREN‟s staff - inspired in the characteristics of the Cuban health and social systems - offer love and human warmth to contribute to the fulfillment of objectives for the patient‟s Neurological Restoration Program, for a safer and more pleasurable stay. This facilitates his/her recovery – which can also become a means of promotion. This issue is verified through different and systematic tools to know the patient‟s own satisfaction and to perfect the quality of offered services. Some results were: between 85% to 93% valued as suitable and pleasant the following communication actions as: reception and welcoming, transfer, information, attention, invoicing, visas, and other services pertaining to International Relations. An internal investigation of its staff on optimum communicational capacity showed 80%. More than 60% of incomes are the result of recommendations from relatives, friends, neurologists and others who know about this original and successful therapeutic experience. More than 35% are re-entering, and an 83% formulate notable differences as compared to other institutions; between a 98% and a 100% consider excellent the quality of diagnosis, the physician‟s work, as well as efficacy of physical therapy and nursing personnel. More than a 95% express their desire to come back and to recommended CIREN to others “because the attention and medical service are the best we have ever received”. 27P2 Process for Quality Certific ation of Work Groups as an Strategy of CIREN’s management System C Vázquez, B Castro, M Peña, E Cabrera International Center for Neurological Restoration, Havana, Cuba Quality is to achieve the user‟s satisfaction. Quality Management is an institutional organization that influences all technical and non-technical activities that take place within the institution. Since l994, CIREN has a Quality System where each group, department or clinic, uses a Manual of Norms and Procedures, along with a Plan for Quality Protection. This strategy has permitted us, for two years, to achieve a documentary organization within the quality process, and since 2002, we started to work on the design and implementation of the Quality Management System according to established requisites at NC ISO 9001:2000 “Requisites of the Quality Management System”. In order to guarantee all this process, we have designed a Quality Certification Procedure for all work groups, whose objectives are: to establish the methodology for Evaluation and Certification of the Quality in the integral work of all groups, and consequently, to achieve greater efficacy and quality in the services offered to the patients. This descriptive study is based on data of variables, obtained through Inspections for Certifications of Work Groups, and more comprehensive Integral Inspections expressing the quantitative and qualitative results. 27P3 Use of informatics as a strategy for communication in the relation w ith the neurological patients: website María del Pilar Vilá Cienfuegos, Mayra Llanes Govín, Víctor Manuel González Albear, Juan Miguel Morales Oliva, Emilio Villa Acosta, Elías Valdés Llanes, Martha Cristófol Corominas International Center for Neurological Restoration (CIREN); Havana, Cuba We performed a revision on the Theory of Information and its relation with the sciences of Social Communication, strategies and objectives. This issue is a link to work strategies at a health institution where services offered to neurological patients. The three types of necessary information for this type of patient as to most important moments for him-her to pass through in relation to the institution are as follows: search for updated information to request medical attention, establishing a communication link with the institution while he-she receives attention there, and maintenance of a communicative link with the attention center for the patient to know about scientific advances and the introduction of new technologies that may take place at any moment in relation to his-her needs. All the above mentioned is linked to the established design for the center‟s website in order to take at advantage of its capacity for diffusion of the type of informatics tool in the satisfaction of relation that the center may have with all neurological patients interested in this type of attention. After a necessary analysis and the discussion on the contents of our work, we got to conclusions as to its usefulness and therefore recommendations are made as to its importance for professionals linked to this issue. 27P4 Community-Based Cognitive Rehabilitation of TBI patients Bringas M.L., Pedroso I. International Center for Neurological Restoration, Havana, Cuba This program intends to provide long-term cognitive rehabilitation services to patients with TBI after discharge of the hospital which final goal were the employment or social insertion of them. Cognitive rehabilitation is a set of therapies used to help improve damaged intellectual, perceptual, psychomotor and behavioral skills and usually is offered only at the hospital environment. The program has three phases: 1st relaxation or general preparation (are stimulated activities to reduce stress and tension, relaxation, artistic skills, games, hydrotherapy, music and physical exercises). 2nd stimulation of cognitive functions (Exercises of Attention, Memory, Thinking and Calculus are structured on four levels of complexity). 3rd stabilization of the cognitive outcomes (consolidation of intellectual strategies, independence, self-esteem to prepare the social insertion). Transition between phases is individual and the objectives of the program are adapted to patient needs after an extensive neuropsychological and psychopathological evaluation. We designed this program using one relative or retired teachers as provider of the services, who received training for delivering the tasks, management of the frustration and to know how obtain the results and register the data. We showed results of this program with a sample of 5 TBI patients who followed this program after their discharge of the Clinic for Cuban Patients of CIREN. All of them improved their initial neuropsychological scores and are doing social activities now. The most important variables influencing the outcomes were severity of brain damage, age, evolution, pre-morbid personality, family support and marital status. 27P5 The Institutionalization and its Relation w ith Mental Problems and Conduct Disorder Luciana Mara C. Andrioti , Marcos Tomanik Mercadante Master Program in Development Disturbances, Mackenzie Presbyterian University, Brazil The inexistence of public health control in infants‟ psychiatry compromises the development of great part of the Brazilian population. Researches made in some institutions reveal 49,2% psychiatric disorder rates(and it represents 14,3% of the controls). The most common disorder is depression (28,6%) (Abreu 2000). In the Southeast of Brazil was identified the prevalence of 12,5% of one or more disorders, and if it is projected in the nation it suggests 3,4 million people with these problems (Bilyk, 2002). The aim of this research has been to identify the prevalence of mental problems and conduct disorder in children and teenagers between 4 and 17 years old who live with their family and go to school, throughout the role of interviews called Development and Well-Being Assessment, DAWBA. Not only the definition of these children‟s profile, but also the determination of parameters in the interventions that could be re-evaluated, they will contribute to decrease the number of disorders and the impact they cause on these people, as well as their family and the community. 27P6 Nursing care and neuro-rehabilitation for patients with Parkinson’s syndrome Miyares Paz Luanda, Morgado Teresa, Rojas Morales Juana M. International Center for Neurological Restoration (CIREN) Havana, Cuba The nurse is an important link within the team involved in neurorehabilitation carrying out multiple functions and achieving improvements in abilities as well as language and rehabilitation and treatment of patients with Parkinson‟s syndrome because of this we felt motivated to conduct a descriptive, retrospective and transversal study involving twelve patients admitted to CIREN‟s Clinic Movement Disorders and Degenerative Diseases during the period from march 2002 to July, 2003. The results obtained from the majority of these patients showed great improvement in physical mobility by combining the pharmacological adjustment with the neurorehabilitation, achieving improvements in mastication and absorption of food. Almost all patients achieved adequate elimination through an education in healthy habits in diet, the taking of medication, etc. They were also able to regulate their sleep patterns and better able to utilize mechanisms of problem solving to deal with family issues. 27P7 Risks in chronic neurological patients. Experience at the International Center of Neurological Restoration (CIREN) Lissette Miranda Lara, Maria Ángeles Peña Figueredo, Maria Isabel Garrote Lee International Center for Neurological Restoration, Habana, Cuba At the International Center of Neurological Restoration we attend patients with several neurological and neurosurgical diseases. They are exposed to many risks that can create additional complications. We made a review, in a retrospective study, using the reports to the Program for Prevention and Control of Accidents in use at CIREN. We include all reports made during year 2002. The mayor risk was falling down (21 cases) and infections (72) from the total of 1039 patients hospitalized during that year. The greatest incidence was found at the Clinic for Spinal Lesions, followed by the Clinic for Adult Static Lesions. This analysis lead to the introduction of strategies applied in our institution, by a team of nurses to decrease the risks of the patient based on the application of the Nurse Attention Process. 27P8 Evaluation of quality of life in Parkinson’s disease Leisa Díaz, Lázaro Álvarez, A Martínez, David Castañeda International Center for Neurological Restoration (CIREN), Havana, Cuba The present tendency to examine the impact of treatment on the quality of life of persons with Parkinson‟s disease includes the development of specific instruments of measurement (PDQ-39). Recently, Martinez and his collaborators have adapted the English version of this instrument into Spanish, using 37 items, validating them appropriately, demonstrating a strong correlation between the clinical variables and the well- being of Parkinson‟s patients. It is highly sensitive and specific. Between January 2003 and August 2003 we developed a protocol to evaluate this Spanish version for our work. For this purpose, we have applied the Spanish version of the PDQ scale to 30 patients with Parkinson‟s disease, 10 who only received a pharmacological treatment, 10 who were treated with a multidiscipline approach, and 10 were operated using the technique of stereotactic surgery. We observed a high correlation with the sub sections of daily activities and motor condition on the Unified Scale for the evaluation of Parkinson‟s PDQ. We obtain a reduction of 40% of the PDQ scale before treatment in operated group, and strong correlation whit UPDRS scale (Spearman R 0,515). We also noted the sensitivity of the PDQ in its ability to measure the patient‟s ability to distinguish between ON and OFF and to note the usefulness of the above treatments. We can conclude that the Spanish version of PDQ is a useful instrument for the evaluation of the effects of any treatment on Parkinson‟s and is well designed to examine the utility of any clinical treatment. 27P9 Appraisal of the development and growth in childen with cerebral palsy. Nursing care to these patients Norbert Sosa García, Luis Hernández Ramos, Mónica Hernández Díaz, Mirna Álvaro- Díaz Arredondo CIREN,Habana, Cuba We performed a retrospective and descriptive study for the evaluation of 103 patients bearers of cerebral palsy, hospitalized at CIREN's Neurology Clinic for Children during January 2000 to December 2002. This issue aims at demonstrating the existence of nutritional deterioration in these children, to relate them with a psychomotor commitment and to establish specific nursing cares for their neurological rehabilitation. We selected a group of pediatric patients with ages ranging from 1 to 15 years of age. We defined the absolute frequency and percentage according to sex and applied gross motor function scale for their psychomotor assessment and clinical diagnosis, as to the type of cerebral palsy and its distribution. The evaluation of their nutritional status in relation to weight and height (according to Jordan‟s Scale) was performed and we determined it predominates in the psychomotor affectation in males and in those patients with a greater compromise We evidenced in these children important nutritional affectations –where 26 patients were in the percentile range from O to 25, which means a 25 % of the total of evaluated cases. Our team kept in mind, that for the sake of nursing, fundamentally educative work with the parents as to their children‟s nutrition and its immediate importance during the course of their neurological restoration was necessary. 27P10 An experience in the treatment of Autism at CIREN’S Neurology Clinic for Children Idelys Sarduy , M. Eugenia García, Carlos Maragoto Internacional Center for Neurologic Restoracion (CIREN), Havana, Cuba Introduction: Autism is a relative mental impairment that typically appears during the first three years of life and it is the result of a neurobiological disorder that affects brain functioning. Main characteristics of this disease are: qualitative hindrance in the social interaction and in the development of language and communication, as well as a restricted range of activities and interests with the use of repeated and stereotyped patterns. Objective: To present our experience and results of the work with 5 cases diagnosed with Autistic Specter Disorder assisted at CIREN‟S Neurology Clinic for Children. Patients and Methods: A retrospective study was performed on 5 cases, starting from the revision of defectologic records where we collected data related with treatment and responses by the patients to this treatment and to initial and final neuropsychological evaluations. Results: In all the cases favorable changes are observed as to social, intellectual and conduct relations. Conclusions: The results achieved can be considered significant by keeping in mind, time of treatment and severeness of the disorder. 27P11 Nurse management to patients w ith temporal and extra temporal epilepsy Miriam Esther Guevara Pérez, Mercedes Frontela Hernández, Digna Pérez Madrigal, Lilia Morales Chacón Centro Internacional de Restauración Neurológica (CIREN), La Habana, Cuba Introduction: One important goal of the nurse‟s action in a Telemetry Unit is to identify the type of epileptic seizures of patients under long-term follow up with video-EEG. Objectives: To describe the differential handling of patients with temporal or extra temporal epilepsy. Material and Method: Twelve patients were studied, from them 6 were previously classified as temporal and 6 as extra temporal epilepsy. The clinical, motor, automatic and autonomic signs, as well as the presence of aura, response degree and memory of events during the crisis were evaluated. Results: All patients with temporal epilepsy showed automatic movements during the ictus. The most prominent pattern at the beginning is locked gaze (90%) and aura (90%). Extra temporal crisis showed tonic-clonic generalized crisis (83.3%). None showed automatic behavior and none of them recall aura. Conclusions: In the handling of the epileptic patients with temporal seizures, it is important to keep a constant observation and verbal communication with the patient in order to detect behavioral alterations and to recognize automatic patterns (oro-facial gesture, feeding-like behavior, walking without a purpose) to allow an early detection of the crisis and to prevent trauma. Extra temporal seizures require extreme security measures, because in most cases the patients suffer loss of consciousness, along with body convulsion and rapid, uncontrolled movements. The nurse must, in every case; act to prevent self inflicted injuries, falling dawn and other potentiality noxious consequences. 25P12 Intervention strategy for the training of the hemiplegic patient’s family Tania Francia González, A. Vernis González International Center for Neurological Restoration (CIREN) Havana,Cuba In this study we propose an intervention strategy, which centers its attention in training and on the basis of orientation through the occupational therapist, to those persons in charge of caring for patients who suffer the results of stroke. It is indispensable for there to be instructed on the knowledge of the disease‟s characteristics, the techniques for the handling them and how to help patients in the acquisition of abilities for the development of daily life activities as important as: getting dressed, self-validism, and feeding. The method used in this investigation was the experimental one for which a sample of 30 patients was used and divided into two groups: one control group and an experimental one, each one with a total of 15 patients. Barthel`s index was used to measure self-validism level in the selected population. We arrived to the conclusion that with this type of combined therapy among specialists, family and patient the experimental group improved considerably because they were able to establish and to automate in a short period of time, the daily abilities of feeding, self-validism and dressing. It facilitated the patient‟s independence and it increased the level of the relatives' knowledge in the correct handling of the patients. 27P13 Integral Handling of Sialorrhea on patients with Cerebral Palsy Nayoy Rodríguez Verde, Giselle Núñez González, Edgar Ney Galarraga International Center for Neurological Restoration, Havana, Cuba Introduction. Sialorrhea may have a significant negative effect in the quality of life, of patients suffering from cerebral palsy, hindering their adequate social interactions. This disease is an impairment of saliva flux. Objective. Our purpose is to contribute to the control of sialorrhea through the application of different therapeutic procedures. Materials and methods. We presented a sample of 18 children, ranging from 2-10 years of age hospitalized at the Clinic of Neuropediatrics for a 28 days stay during years 2001-2003. We used therapy of different kinds for approximately 15 minutes, and evaluated the patients at the beginning and end of the rehabilitation cycle. The applied techniques for treatment were: intra-buccal massage, crymotherapy (in such cases where orolingual muscles were hypotonic), lemon drops and mechanical stimulation of facial points with the use of a point vibrator. Results. We obtained a great increase in the mobility of orolingual structures that intervene in saliva swallowing. Most favored categories: labial, velar and lingual praxis, where we obtained 83,3 %, 100% and 59,3 % of improvement, respectively. Conclusions. The application of different procedures to favor the control of sialorrhea on pediatric patients with cerebral palsy is considered effective in speech therapy. 27P14 Disphagia in the neurological dysfunctions of communication Mayda Nelia López Hernández, Mª del Carmen Padín Hernández, Ernesto Bennett Rodríguez International Center for Neurological Restoration, Havana, Cuba Dysphagia is a symptom present in alterations of neurological origin, and with certain frequency, overlaps with dysfunctions of communication. The objectives of the investigation were: to establish the relationship between the pathology of the communication and dysphagia and to validate an intervention strategy. The study included 170 patients assisted at CIREN that were explored integrally in the service of language therapy. The clinical records were reviewed to obtain the pertinent neurological information, with the purpose of establishing the correspondence among neurological pathology, of the language disturbances and deglutition. 59 were subjected to study and, from them, therapy was applied at 29 to check effects. They reached 74 with dysphagia, which was statistically significant as tendency (47.4) and prediction (7.3). The study was made by neurological pathology and for pathology of the language, what is of interest for the diagnosis and rehabilitation prediction. In correspondence with the characteristics of the dysphagia a Plan of Language Therapy that improves the quality of life of the patient and it facilitates a better communication was applied. As a result of the application of the program a positive evolution was evidenced. Coincidence between pathology of the language and dysphagia was statistically significant. The application of the language therapy evidenced a positive result. 27P15 Logopedic suggestions for the physical rehabilitation in neuropediatrics A. Aguiar Rodríguez, M. López Hernández, A. Rodríguez Aldama International Center for Neurologic Restoration. Havana, Cuba Most of the children who receive multifactorial attention in our center show speech disorders like dysarthria or oral retardation. For a better prognosis, an early stimulation of all areas of minor development is required. A close relationship of all the specialists is necessary to reach a positive result. For instance, we suggest a series of activities that the physical therapist can perform to improve communication and language development. Objective: To study the development in the patient communication and language skills acquisition during physical rehabilitation, guiding the physical therapist in the fulfillment of the logopedic objectives. Material and Methods: Suggestions were made to the physical therapist so that, during the physical rehabilitation logopedic objectives would also be accomplished. The sample was composed by 67 patients in prelinguistic stage of development. Patients took part in a three days a week, one-month rehabilitation cycle. Results: The children showed a good response the combined physical therapy. Conclusions: The physical therapist can become a language-stimulating agent during the therapy. 27P16 Contribution of nursing to improve the communication of patients with dysarthria or aphasia Nancy Mustelier Carbonell, Juana María Rojas Morales, Susana Martínez Segón, Ismilet Varela Rosell, Luz Marina Lombillo, Tania Paredes Polo Clinic of Adult Static Encephalic Lesions, International Center for Neurological Restoration, Havana Cuba. Language sequels were studied in 96 adult patients of both sexes from different countries with cerebrovascular affections: 68 Encephalic Vascular Accidents, 23 Cranioencephalic Traumas and 5 Children‟s Cerebral Palsy, assisted at International Center of Neurological Restoration Havana Cuba, Clinic of Encephalic Static Lesions from 2001-2002. By means of descriptive prospective studies, of which their demurrage lapsed approximately 3 cycles and an average of 21 years of age for (Encephalic Trauma and Children‟s Cerebral Palsy (CCP), 58 years for Encephalic Vascular Accidents (EVA), with the purpose of applying nursing actions to improve communication, thus relating rules to be followed for their effectiveness, specifying the family role and therefore, evaluating the fulfillment of objectives. This was carried out with the participation of the nursing personnel, from the different houses at night schedules from 7:00-9:00 pm, from 5 minutes up to 1 hour when logopedic tasks are completed. We consulted specialists in logopedics at our center and different bibliographies were revised that approach the topic, which makes our study coincide with these issues. The nursing staff filled out the forms for data collection with qualitative and quantitative variables. By means of an interview, the nurse formulated his/her evaluative criteria as to the entrance, at the end of each cycle and discharge from hospital. The results are expressed in charts and graphics through percentages. Aphasia turned out to be the more impacting sequel, and repetition the most frequent action, and good results were obtained. 27P17 Effects of Early Stimulation Program on Spastic Cerebral Palsy outcome. A retrospectiv e study Idelys Sarduy, Maria E. Garcia NeuroPediatric Rehabilitation Service, International Center for Neurological Rehabilitation (CIREN) Cubanacan, Playa, La Habana, Cuba Cerebral palsy in the earliest childhood leads to retard or to stop the psychomotor development according to the biological age. The early identifications and diagnosis of spastic cerebral palsy (SCP) facility to the inclusion of patients to multifactorial rehabilitation program one them is the well-known Susana Matas‟s early stimulation program (ESP) in which the psychomotor condition is classified according to different fields or areas for better diagnosis and training as well as regarding to age ranks. A retrospective study was carried out in patients with diagnosis of spastic cerebral palsy (sample: 20; 0-5 years old) in order to appraise the incidence/impact of the Occupational Therapy specialty in this kind of patients as well as to evaluate the improvement of the psychomotor condition after early stimulation treatment (1-3 months). Evaluations al the beginning/end of training included: self-validity, cognition, social behavior and fine movements. Other concerns of the rehabilitation program were assumed by other specialties. Those mentally retard children submitted to the ESP showed a general amelioration of the above-cited conditions, particularly in the execution of movement tasks. Other functions such as those associated with cognition exhibited relevant improvement too. As conclusive comment it is important to point out that several factor affects the outcome of children with SCP i.e. age, time of evolution, temporal course between diagnosis and submission to the ESP, treatment period, etc. Obviously, the functional recovery observed after ESP is very heterogeneous but always it will have a positive balance for patients. 27P18 Neuropsychological evaluation in a sample of children between fiv e to twelve years w ith bilingual school instruction Francisco Javier Galarza del Angel, Luis Alfredo Padilla López, Julieta Bonilla, Gilberto Manuel Galindo Aldana, Connie Payán Domínguez, Belén Elena Preciado Yánez Universidad Autonoma de Baja California, Mexico As a part of a wider study, 176 children were evaluated through a neuropsychological battery. Children were 5 to 12 year-old (both sex), they were in medium socio-economic level and they were in a bilingual school. Children were divided by sex, and by age group (5-6, 7-8, 9-10 and 11-12 year-old). Neuropsychological battery included the Boston Naming Test, Token Test, Superimposed Figures (Poppelreuter type), a Verbal Fluency Test (FAS Test) and a Sequencial Verbal Memory Test. No differences were found between sex in any of the applied tests. There was a significant difference among age groups for all the tests that were applied. Results are compared with some other reported (Ardila & Rosselli, 1994). This study will continue in evaluation of another socio-economic levels and school education. 27P19 Psychosocial Factors associated to the Confrontation Process Vivian Blanco, Ileana Trevín, Caridad Valladares, Gabriel Olazarra, Lisette Blanco Servicio de Psiquiatría, Hospital Clínico Quirúrgico 10 de Octubre, Ciudad Habana, Cuba A research was carried out making a cuali-quantitative study of 40 patients belonging to the Intervention Crisis Unity in a Cuban General Hospital, during the last four months of 2001 and the three first months 2002. The main objectives of the present work were to evaluate the significance conceded to the vital events, the type of control employed and the kind of confrontation showed by the subjects included in the study. In addition, it was studied the relationship among these variables. In relation to the vital events significance, the category “very important” was exhibited by the majority of patients (62.5%). Simultaneously, these patients had “internal control” (55%) and they used a “central confrontation” in the problem (75%). It was found a strong correlation (r>65%) between the significance “very important” for the vital events and the central confrontation in the problem as kind of confrontation. In addition, the patients which exhibited a “complex confrontation with tendency to the problem” (7.5%) and “complex confrontation with tendency to the emotion” (2.5%); also conceded a “very important” or “important” significance to their vital events. In connection with the relationship between kind of control and kind of confrontation, a great number of patients showed “central confrontation in the problem” had “internal control” (45%) whereas only a 30% exhibited “external controls”. The present work evidenced that the very important strategies to solve the problems in relation to the mental health in the population studied were: 1. to establish the new concept about his disease, 2. to found new ways in order to develop a better confrontation of their problems and 3. to locate the people in the center of the problem. Restoration of sensory functions 27B1 Specific ity and plasticity in human neurocognitive development Helen Neville Psychology Department, University of Oregon, Eugene, Oregon, USA I will review ERP and fMRI results of visual and auditory and processing in normal adults and in those who have had different sensory and/or language experience. Taken together these studies suggest that within vision and audition different neural systems display considerable variability in the degree to which they are modified by early experience. Within vision, early auditory deprivation has most marked effects on the organization of systems important in processing motion information. Within the visual and auditory systems sensory deprivation has more effects on the representation of the peripheral than of the central fields. In addition, different subsystems within language display varying degrees of modifiability by experience. These results converge with other lines of evidence that suggest it is important to distinguish these different aspects of language, and they raise hypotheses about the initial development of these different language systems. Parallel studies of normal infants, children, and adults and studies of those with abnormal development provide further evidence for the roles of genetic factors and experience in human neurobehavioral development. The results of these several different types of experiments provide evidence that some systems within the human brain retain the ability to change, adapt, and learn throughout life, while other aspects of human neural and behavioral development display multiple, specific and different critical periods. 27B2 Children w ith cochlear implants; effects of age at implantation on speech and language development Robert V. Harrison, Richard J. Mount, Blake Papsin Auditory Science Laboratory, Department of Otolaryngology, the Hospital for Sick Children and the University of Toronto, Canada Cochlear implantation is a standard intervention for restoring hearing in children with severe to profound deafness. With congenital hearing loss, early intervention is universally accepted as being beneficial, but is not always possible because of late detection, socio-economic constraints, etc. An important practical question is whether there is a critical period or cut-off age of implantation after which hearing outcomes are significantly reduced. To date we have followed more than 200 pre- lingually deaf children (mostly congenital) implanted at ages ranging from 1-17 years. Each child was tested with auditory and speech understanding tests before, and at intervals up to 5 years post- implantation. Closed-set speech perception tests included TAC and WIPI; open-set tests included PBK and GASP. We have compared the rate of improvement in performance of speech understanding tests in younger implanted children compared with those implanted at a later age. To compare these groups we have split the data arbitrarily at an age of implant of 6 years. We have also used a binary partitioning algorithm to divide the data systematically at all ages at implant to determine the optimum split, i.e. to determine the age at implant which best separates performance of early implanted versus later implanted children. Using simple closed set tests, this age at implantation was found to be 4.4 years. For more difficult open set tests, the age ranged from 5.6 to 8.4 years. In any case we do observe age cut-off (some might say "critical period") for cochlear implantation in the congenitally deaf child. 27B3 Electroaudiometry: Advances and new clinical applications Pérez-Abalo M.C. Cuban Neuroscience Center. Havana, Cuba Over the last decade important advances have occurred within the field of electroaudiometry (use of auditory evoked responses for objective hearing assessment). As a result new technologies have become available for early detection and characterization of hearing losses. The present paper will focus on one of such methodologies, based on the recording of the fast rate (80-110 Hz) auditory steady state evoked responses (ASSR) elicited by multiple AM tones. With this technique several frequency specific thresholds (between 0.5 and 4 KHz) can be simultaneously evaluated, with the consequent reduction in testing time. Also the responses (represented as distinct spectral peaks) can be easily identified by different statistical indexes, thus allowing automatic threshold detection. Here we summarize the main findings obtained in the clinical validation of the technique in three different groups: normal and hearing-impaired adults, 2) well babies 3) high-risk babies. In the adults results indicate that the MSSR can reliable predict the behavioral pure tone thresholds (at 0.5, 1, 2 and 4KHz). Mean differences between response and behavioral thresholds ranged between 7- to15 dB in the normal hearing adults, and between 5 to 9 dB in the hearing impaired. Also the MSSR can accurately estimate different audiometric configurations in mild, moderate and severe hearing impairments. In the well babies (between 0 and 12 month of age) different maturational changes were evidenced for the low and high frequency MSSR. Finally within the context of a targeted screening protocol the role of MSSR was investigated by means of a long term follow up study of 513 high-risk babies. Results showed that the technique provided valuable information for the diagnosis and management of infants with hearing losses, and further developed, might become useful as a frequency specific screening procedure. 27B4 Objects, Attention and Brain Dysfunction Mitchell Valdes-Sosa Cuban Center for Neuroscience, Havana, Cuba Substantial progress has been made in the last decade in understanding the neural mechanisms underlying visuo-spatial attention, and in how these mechanisms are affected by brain lesions. However, traditional experimental paradigms focussing on spatial selection of visual information are blind to important strategies employed by observers when processing complex real-life scenes. Here we describe new developments using a paradigm dubbed 'rapid serial object-transformation', which provides new insights into the neural mechanisms of object-based visual attention. Moreover, we argue how this method can contribute to the understanding of attentional dysfunction in several diseases and present data about deficient attentional strategies in autism and subsequent to brain plasticity induced by sensory deprivation. 27B5 Impact of Visual Field Defects on Activities of Daily Living Jennifer Ullrich, Erich Kasten, Bernhard Sabel Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany There are about 550,000 patients suffering from brain lesions in Germany every year (Kasten, 2002), many of them result in visual deficits. The most frequent kind of visual impairment are visual field defects (VFD). Patients with VFD report various difficulties in activities of everyday life (ADL). We have designed a questionnaire for the self-assessment of these restrictions due to VFD. In this questionnaire the patient is asked to estimate the degree of the impact of his/her VFD on ADL. At the moment the questionnaire is used in a prae-post design for the purposes of a study testing the Visual Restitution Training (VRT) developed at our Institute. VRT is a computer- assisted training for patients suffering from VFD stimulating the transition zone between the intact and the blind area of the visual field. So far, 17 patients and 12 relatives of the patients have filled in the questionnaire before starting the VRT. Two main areas of impairment could be indentified - driving a vehicle and reading. E. g. 11 patients (64.7%) reported that they have given up driving a car due to their VFD, 10 of these patients (58.8%) said that their doctor advised them to do so; 82.4% reported that their reading was very slow sometimes, often or very often. On the base of these data a computer-assisted test containing photos of everyday life scenes in which subjects have to search for certain objects has been developed and is being evaluated at the moment. 27B6 fMRI of the human sensorimotor cortex before and after subsensory whole-hand afferent electric al stimulation V. Gonzáleza , S.M. Golaszewskib , W. Struhalc, C.M. Siedentopfd , F. Koppelstaetterd , M. Veriusd , F.M. Mottaghye, S.R. Felberd , F. Gerstenbrandf, M.R. Dimitrijevic g a Department of Neurology, Heinrich Heine University Düsseldorf, Germany b Department of Neurology, University Hospital of Graz, Austria cDepartment of Neurology, Kaiser Franz Josef Hospital, Vienna, d Department of Neuroradiology, University Hospital of Innsbruck, Austria, e Department of Nuclear Medicine, Research Center Jülich, Germany, f Ludwig Boltzmann Institute for Restorative Neurology and Neuromodulation, Otto Wagner Hospital Vienna, Austria, gDivision of Restorative Neurology and Human Neurobiology, Baylor College of Medicine, Houston, Texas, USA Introduction: Stimulation of propriozeptive pathways using whole-hand electrical stimulation with a mesh-glove has been shown to improve motor performances of stroke patients with chronic neurological deficits. The aim of the study was to elaborate, whether changes in the motor cortex activation pattern can be demonstrated after electrical stimulation of the hand in volunteers. Materials and Methods: All experiments were performed on a 1.5Tesla MR-scanner in 10 healthy subjects. The motor-paradigm was self-paced finger-to-thumb-tapping of the left hand. Firstly, a baseline fMRI-examination and secondly subthreshold electrical stimulation with 0.9mA was applied for 20 minutes outside the magnet to the left hand using a mesh-glove. Thirdly, an identical fMRI run to the baseline and the second run 12 hours post stimulation was performed. Post processing was done with SPM99. Results: Group-analysis of fMRI-data showed: 1. Baseline fMRI-examinations revealed brain activation of the primary and secondary sensorimotor cortex as previously described. 2. After electrical stimulation of the left hand, there was an increase of activated pixels in these areas. 3. In addition, there was activation of regions not visible on the baseline studies. These involved the ipsilateral inferior parietal lobule, the pre- and postcentral gyrus and the superior parietal lobule. 4. These changes disappeared twelve hours post stimulation. Conclusions: fMRI reflects an increased BOLD-response due to an increase of local-field-potentials within the sensorimotor cortex due to electrical stimulation. Thus, local-field-potentials can be successfully influenced by subsensory stimulation of afferent pathways. This holds promise for the application of fMRI in the planning of neurorehabilitation strategies. 27B7 Perispinal TNF-alpha inhibition for discogenic pain Tobinick, E. L. and S. Britschgi-Davoodifar Institute Research Associates, A Medical Group, Inc., Los Angeles, California 90095, USA. OBJECTIVE: To examine the potential of etanercept, a biological inhibitor of tumour necrosis factor-alpha (TNF), delivered by perispinal administration, for the treatment of pain associated with intervertebral disc disease. METHODS: Charts from 20 selected patients treated at our private clinic by perispinal delivery of etanercept 25 mg for severe, chronic, treatment-resistant discogenic pain were reviewed. Therapeutic benefit was assessed clinically and was documented by changes in a validated pain instrument, the Oswestry Disability Index. The patients were treated off-label with etanercept as part of our usual practice of medicine. Five detailed case reports are presented, including three additional patients. RESULTS: Rapid, substantial and sustained clinical pain reduction was documented in this selected group of patients. The cohort of 20 patients had a mean age of 56.5 and mean duration of pain of 116 months. Nine of the patients had undergone previous spinal surgery; 17 had received an epidural steroid injection or injections (mean 3.2). This group of patients received a mean of 1.8 doses (range 1-5, median 1.0) of etanercept during the observation period. The mean length of follow-up was 230 days. Clinical improvement was confirmed by a decrease in the calculated Oswestry Disability Index from a mean of 54.85 +/- 12.5 at baseline, improving to 17.2 +/- 15.3 (p <0.003) at 24 days and ending at 9.8 +/- 13 (p <0.003) at 230 days. CONCLUSIONS: TNF inhibition by etanercept delivered by perispinal administration may offer clinical benefit for patients with chronic, treatment-resistant discogenic pain. Further study of this new treatment modality is warranted. Challenging views of AD therapy I 27B8 Present and Future of cholinesterase inhibitors in the treatment of AD Ezio Giacobini Department .of Geriatrics and Rehabilitation , University of Geneva , Medical School Geneva, Switzerland Eighteen years after the first report of Summers, several million Alzheimer Disease (AD) patients, have been treated with cholinesterase inhibitors (ChEI).Approximately 50% of these patients have shown evidence of improvement (NICE, 2002 ) ,clinical stabilization up to one year in 20 % , up to two years in 10 % .There is no sharp distiction between responders vs non-responders and 50 % non-responders to ChEI–A will respond to ChEI-B or -C.Single dose ChEI produces f-NMR signs of activation of memory tasks in most patients (Rombouts et al. 2002 ) . CSF-ChE inhibition correlates to changes in most treated patients ( Giacobini 2002 ).This suggests that the number of non-responders is probably smaller than 50% particularly since AChE inhibition in brain at therapeutic doses reaches only 27-40% (PET). The recent discovery of the role of butyrylcholinesterase in brain points to this enzyme a as a new target for AD treatment in advanced AD cases. Based on the functional role of the cholinergic system indication for ChEI treatment should be extended to those diseases or syndromes showing a cholinergic deficit such as Lewy Body Disease, Vascular Dementia, Parkinson Dementia, Delirium , Brain injury etc. Most interesting is the possibility of applying ChEI therapy to MCI subjects ( Minimal Cognitive Impairment ) or to potentiate beta-amyloid reducing therapies such as immunization. 27B9 Executive function and cholinesterase inhibitors Roger Bullock, Anna Marriott Kingshill Research Centre, VictoriaHospital, Swindon, UK The cholinergic system has been implicated in the pathophysiology of Alzheimer‟s disease (AD) and new treatments have been developed around restoration of cholinergic function. Because AD is predominantly a memory disorder, cognitive measurements of efficacy have primarily concentrated on episodic and semantic memory, with little regard to working memory or executive function. The latter have been more frequently associated with vascular dementia (VaD). However attention, a useful indicator of executive function, declines over time in a predictable fashion and increased rates of this decline may herald more noticeable clinical deficits. The objective of the first study presented is to demonstrate executive dysfunction in AD, from memory clinic patient assessments in Swindon. This found that all tests on information processing in the test battery were as bad for AD as VaD. A review of data from studies on cholinesterase inhibitors, which included measures of executive function, will demonstrate that the cholinergic system is involved in attention and that deficits may respond to cholinergic enhancement. Differential effects between cholinesterase inhibitors will then be discussed using randomised data from a one year comparison of donepezil and galantamine. This showed similar improvements in simple reaction time, but a significant improvement of galantamine beyond any improvement achieved by donepezil in choice reaction time. As choice reaction time involves dopaminergic relays as well, this may be the first clinical demonstration of the reported nicotinic modulation by galantamine of the cholinergic system in a human population. Posters 27P20 Self-dependence and identity of symptoms of myofacial pain syndrome (MPS) and fibromyalgia (F) A.Y. Filyuk Moscow State Medico-Stomatological University, Moscow, Russia MPS may be occurred in 30-85 % of population (Han S.C., Harrison P., 1997), F in 2-6% (Wolfe F. et al., 1995).Number of investigators proposes MPS and F to be the one pathology. We suggest this problem to be discussing in the base of literature review, our clinical experience and the materials of our investigation work.Similarity: MPS and F are chronical conditions with pain symptoms in 100% cases. Infiltrative zones in muscles called muscular trigger points (MTPs) have place both in MPS and F. Main part of patients with MPS and F suffers from psychological disturbances. Thermal procedures in alterative muscles are used to treat both these pathologies. Difference: F is characterized by generalized muscle pain, in MPS case the pain is local. According to our clinical experience in 33 F patients and 350 patients with MPS we find out the level of psychological disturbances prevalent in F-group. Pain threshold is significantly reduced in F-group compared with MPS-group. Cerebral disturbances in electroencephalographic investigation prevalent in F-group too.Peripheral changes are expressed in MPS-group: synopsis transmission is highly affected; muscle damages are more expressed. Changes of electrical qualities in MTPs usually have place in case of MPS. 27P21 Myofacial pain syndrome’s prosopalgia w ith oral pathology on the background. Patients’ rehabilitation A.Y. Filyuk, S.A. Filyuk Moscow State Medico-Stomatological University, Moscow, Russia We examine 290 volunteers with loss of occlusal support. 62 of them are diagnosed to suffer from prosopalgia as a result of myofacial pain syndrome (MPS) of the masticatory system. The patients are divided into two groups (31 individuals each). Both groups get cold-agents on myofacial trigger points (MTPs), lidocaine-nicotine blockades on MTPs, antidepressants, tranquilizers, myorelaxants, laser therapy of MTPs, non-steroid analgesics, prosthetic occlusal correction. Temporomandibular joint normalization is performed in the 1st group by the post isometric relaxation (PIR) gymnastics complex for masticatory muscles. Then we teach these patients to do the gymnastics by themselves for prophylaxes. Duration of our investigation is 2-5 years. All of the patients are delivered from pain. Pain release is attained in 10,2 days in the 1st group and in 15,5 days in the 2nd group. 20 individuals from the 2nd group and 2 ones from the 1st group are found out to have season worsening of MPS lasted 7-20 days and 3-15 days consequently. 2 of 4 patients from the 1st group with season worsening don‟t practice the gymnastics. 11 patients from the 2nd group and 1 patient from the 1st one repeat worsening without any season dependence. Thus, in case the rehabilitation measures are included in MPS treatment the number of recovers increases as well as the duration of the disease decreases significantly. Regular gymnastics exercises let to prevent MPS worsening. 27P22 The consequence of rehabilitation in myofacial pain syndrome (MPS) patients A.Y. Filyuk, S.A. Filyuk Moscow State Medico-Stomatological University, Moscow, Russia. As a result of our longitudinal observation of 350 MPS patients we can formulate 3 periods of the rehabilitation. The period of decreasing MPS symptoms. It includes: maximal myorelaxation (first 3-4 days); kinetic therapy; psychotherapy; manual therapy; laser therapy; using of some medicines and subsidiary methods. The period of identification and liquidation of MPS reasons: a consultation of different medical specialists and a treatment of common pathology; the examination of spinal cord (in the static and dynamic positions); an investigation of vitamins and minerals deficit. The period of MPS prophylaxis: working out of the correct moving stereotypes; a prophylaxis of common diseases; a trauma prophylaxis; the nutrition hygiene; a prophylaxis of psychological disturbances; teaching of a patients to the post isometric relaxation gymnastic complex. This consequence of rehabilitation helps practitioners to get good results in the rehabilitation of their patients. 27P23 The blood concentration of tyrosine hydroxylase enzyme (TH) in myofacial pain syndrome (MPS) patients for the assessment of their adaptation A.Y. Filyuk, S.A. Filyuk Moscow State Medico-Stomatological University, Moscow, Russia Statement of problem: Tyrosine hydroxylase (TH) is a special enzyme that regulates catecholamine synthesis. There are four isoenzymes of TH: TH1, TH2, TH3, TH4. TH is usually determined in liquor. At the same time leukocytes were found to contain TH. In our literature review we have no information on any clinical investigations of the blood concentration of TH in MPD patients. Purpose: The aim of our study was to investigate the blood concentration of TH in MPD patients for the assessment of their adaptation. Methods: We examined the blood of 30 volunteers 15-55 aged with different symptoms of MPD in analyzing device FP-901 “Labsistems” (Finland) with spectrofotometrical method. Results: Thus in patients with MPD we revealed the prevalence of TH3 and TH4. The increased concentration of TH3 and TH4 pointed to stress, distress and breakdown of adaptation mechanisms. 27P24 Targeted etanercept for discogenic neck pain: uncontrolled, open-label results in two adults Tobinick EL. Institute Research Associates, A Medical Group, Inc., Los Angeles, California 90095, USA BACKGROUND: Etanercept, a recombinant biologic anti-tumor necrosis factor (TNF)-alpha therapeutic, is approved for the treatment of certain autoimmune arthritides by subcutaneous (SC) injection. TNF-alpha has been suggested to play a central role in neuropathic pain and neuronal damage associated with intervertebral disc herniation. Directed local administration of etanercept, in anatomic proximity to the site of disc and neuronal abnormality, may result in an enhanced therapeutic response. OBJECTIVE: This study reviews findings from 2 patients with chronic, severe, discogenic cervical pain who were treated with a targeted cervical injection of etanercept with the objective of obtaining relief from their treatment-resistant pain. METHODS: In this uncontrolled, open-label study, the case histories of 2 patients (1 woman and 1 man) presenting with a history of chronic neck pain refractory to various treatments are reviewed. Both patients were treated with etanercept 25 mg by SC injection to the cervical region (case 1) or the posterior neck overlying the spine (case 2). RESULTS: Both patients experienced almost complete pain relief as assessed subjectively. In case 1, the Oswestry score decreased from 58 before treatment to 6 one day following treatment. In addition, 1 day after treatment the patient reported a subjective assessment of 98% pain improvement, 100% sensory improvement, and 100% weakness improvement. She has remained asymptomatic for >1 year. In case 2, the Oswestry score decreased from 44 before treatment to 4 two months after treatment. The patient reported 100% pain relief and 90% sensory improvement 1 day after treatment. At 8-month follow-up, pain improvement continued to be 100% and sensory improvements was 75%. CONCLUSIONS: Etanercept, delivered by targeted SC injection, may be of benefit for selected patients with resistant pain associated with cervical disc disease. Further study of this new treatment modality is warranted. 27P25 Targeted Etanercept for Treatment-Refractory Pain Due to Bone Metastasis: Two Case Reports Edward Lewis Tobinick Institute for Neurological Research, Los Angeles, California Background: Parallel bodies of research suggest both a central role for osteoclasts in tumor-induced destruction of bone and the ability of biologic tumor necrosis factor–alpha (TNF-alpha) antagonists to attenuate the osteoclastmediated bone destruction that accompanies a variety of nonmalignant disorders. Additional studies have implicated TNF-alpha in the promotion of osteoclastmediated malignant osteolysis and the pathogenesis of neuropathic pain. TNFalpha antagonists have the potential to interfere in both processes. Objective: This article reviews the cases of 2 patients with treatment-refractory pain due to cancer metastases to bone who were given targeted injections of the biologic anti-TNF agent etanercept based on its potential to interfere directly with both malignant activation of osteoclasts and neuropathic pain. Methods: One patient had a diagnosis of non–small cell lung cancer and the other had a diagnosis of breast cancer. Both presented with treatment- refractory pain due to bone metastases. The 2 patients received etanercept 25 mg by targeted SC injection in anatomic proximity to the site of spinal metastasis for relief of their treatment-refractory pain. Results: Both patients experienced rapid, substantial, and sustained relief of chronic refractory pain at the treatment site after targeted administration of etanercept. Symptomatic improvement was correlated with objective measures of improvement, including weight gain in 1 patient and decreased uptake of radioactive tracer at the targeted site on positron emission tomography in the other. Conclusions: Etanercept delivered by targeted SC injection may be of clinical benefit in selected patients with treatment-refractory pain caused by bone metastases. Clinical trials are needed to define the potential benefit of biologic TNFalpha antagonists in the treatment and prevention of malignant osteolysis. 27P26 Visual search for images in Alternative Communication System in girls w ith Rett syndrome Patricia M. Baptista, Elizeu C. Macedo and José S. Schwartzman Master Program in Development Disturbances, Mackenzie Presbyterian University, Brazil Rett Syndrome is a disorder that in its typical form affects mainly girls. It is characterised by neuro- behavioural regression, loss of manual skills and severe psychomotor and language retardation. These children show significant handicap in their communication capacity and may benefit from using Alternative and Augmentative Communication (AAC). The purpose of this work was to verify the possibility of choice through visual search patterns of images of an AAC system shown on a computer monitor. Visual search patterns were analysed on two girls with Rett Syndrome, aged eight and nine, who were both in stage three of the syndrome. The computer used was a Pentium III PC with eye-tracking Eyegaze®, which consists of a camera that registers the movement of the pupil, calibrated accordingly to the user‟s profile. The images were shown using Trace software, which enables visual search patterns on the screen to be registered and recovered. The girls had to look at an image similar to the model, look at an image chosen by the examiner, or even, look at the image they liked the most. The results showed a systematic and correct, visual search pattern when using simple tasks in the two children. These preliminary results point to the possibility of using the direction in which they look as a way of establishing communication through computerised communication systems. Furthermore, it seems that they show a preserved capacity in understanding simple orders. 27P27 Regeneration of the sciatic nerve in rats after transplantation of bone-marrow cells Victor T. Ribeiro-Resende; Pedro M. Pimentel-Coelho; Raquel M.B. Mendez e Rosália Mendez- Otero Instituto de Biofísica Carlos Chagas Filho and Millennium Institute for Tissue Bioengineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. Transection of the sciatic nerve in adult animal's results in incomplete regeneration and often results in loss of function. We investigated whether bone-marrow cells inserted into the lesion site improve and facilitate axonal regeneration after nerve transection. Adult Lister male rats were anaesthetized and had their right sciatic nerves exposed, transected and the two nerve stumps were connected inside a polyethylene tube. In one group of animals, the tube was filled with Matrigel and a suspension of 108 bone-marrow cells (mononuclear fraction) previously labeled with DAPI. The control group received only Matrigel. After 7, 21 and 42, the animals were perfused with 4% paraformaldehyde. Sciatic nerves, dorsal root ganglia (DRG) and spinal cord were removed, sectioned using a cryostat and processed for histochemistry or imunohistochemistry for S100, NF200 and NOSn. Results showed that in the proximal stump, axonal growth in the experimental animals was more than five times higher than in the control group 7 and 21 days after transplantation (7days: exp:1,2mm n=6; control: 0,2mm n=4; p>0,01 ANOVA; 21 days: exp: 1,7mm, n=6; control: 0,3mm, n=4; p>0,001 ANOVA). 42 days after transplantation the regenerating axons were observed growing into the distal stump in the experimental group but not in the control. In addition, the number of surviving neurons in the DRGs of the experimental animals was 20% higher than in the control. Our conclusion is that transplantation of bone-marrow cells improves the regeneration of sciatic nerve axons and also improves the survival rate of DRG neurons after transection. 27P28 Effects of an induced deafness in the spiral ganglion cells’ density: a morphometric study Sandra Rodrígueza, Tania Valdésa, Yahima Harveya, Odelsa Ancheta a, Rosa Ma Coroc, Valia Rodríguezb a Electron Microscopy Department, Biotechnology Division, National Center of Scientific Research, Havana, Cuba. bCognitive Neuroscience Department, Cuban Neuroscience Center, Havana, Cuba. c Pathology Department, Institute of Neurology and Neurosurgery, Havana, Cuba Although most of the sensorineural hearing losses are caused by damage to the hair cells, the resulting sensory deprivation induces important degenerative changes at different levels of the auditory pathway, including loss of spiral-ganglion cells (the first relay in the pathway). However these studies have been mainly carried out in neonatal animals but needs further replications in adults. The aim of the present study was to explore the temporal dynamic of spiral ganglion degeneration in adult rats after an induced deafness. Thirty Wister rats were used in this study. The animals were divided into five treatment groups. Animals in three of these of groups were deafened using a co-administration of Kanamycin and Frusemide. These groups were sacrificed two, four and sixteen weeks after the induction and cochleas were removed for histopathological analysis. The other two groups were used as non-treated controls (GN1, GN2), sacrificing the animals for cochlear harvesting at the beginning (GN1) and at the end (GN2) of the study. The functional integrity of the auditory pathway was confirmed with electrophysiological techniques (Auditory Brainstem responses) at the beginning of the study for all animals and one week after the hearing loss in the treated groups. For histopathology, cochleas were embedded in Spurr resin and serial semi-thin slices were obtained. Cell density (cells/mm3) was calculated from Rosenthal‟s canal at the cochlear upper medial turn. The results showed that ototoxicity in adult rats produced a substantial reduction in the spiral ganglion cell density that significantly increased from the second to the sixteenth week. Besides proving the efficacy of the selected deafening model, the standardization of the used techniques and the degenerative changes observed constitute the necessary basis to conduct further studies on the required conditions to preserve the auditory system function despite sensory deprivation. 27P29 Effect of the duration of deafness and neural survival on the response of the auditory system in deafened guinea pigs Pavel Prado-Guitierreza,d , Leonie M. Fewstera, John M. Heasmanb , Colette M. McKaya, Robert K. Shepherda,c a Department of Otolaryngology, The University of Melbourne, Australia. bCochlear Ltd, Australia. c The Bionic Ear Institute, Australia, dCuban Neuroscience Centre, Havana, Cuba Eighteen guinea pigs were deafened by co-administration of kanamycin and frusemide. Each animal was implanted with an 8-electrode array at 1, 4 or 12 weeks following deafening. EABR input/output functions were recorded in response to biphasic current pulses. We measured the current change required to equalize EABR amplitude when pulse duration was doubled from 104 to 208µs per phase or interphase gap increased from 8 to 58µs. Following the completion of each experiment the animal was euthanased and the cochleae examined for auditory nerve survival. There was a reduction in the effect of changing pulse duration and interphase gap with increasing duration of deafness. However, this trend was not significant (one-way ANOVA), perhaps due to the large variance in the group of long-term deafened animals. There was a significant decrease in the effect of interphase gap between the 1- and 4-week deafened groups (t-test). It is possible that the large variance in the data for guinea pigs of equal duration of deafness may be due to variations in neural survival. Then, the effect of both, pulse duration and interface gap, on the EABR of deafened individuals would be correlated with of the neural survival more than the duration of deafness. These results, when applied to cochlear implantees, may provide a tool for investigating the role of neural survival in variations in performance with the implant. Support for this research was provided by the Garnett Passe and Rodney Williams Memorial Foundation, the National Health & Medical Research Council of Australia and the National Institutes of Health (NO1-DC-0-2109 27P30 Critical revision of induced modific ation by acupuncture in the Central Nervous System Tahimí Cardoso Suárez , Carlos M. Méndez Alonso, Irene Jiménez Ortiz Holistic Medicine Department, International Center of Neurological Restoration. Havana, Cuba. Acupuncture has been used to treat different affections as: zosterian disease, sacrolumbar pain of diverse etiologies and other diseases that commit the CNS in an important way. How can acupuncture induce a therapeutic response has not yet been revealed, but there is an accumulated experience as to its action, which is still unsystematic and thus, scarcely accessible for its integration. The aim of this work was to analyze some of the action and changes provoked by acupuncture in the CNS reviewed in different articles. 35 papers published between 1985 and 2003 were revised. An analysis was performed on published data, in relation to the changes provoked by acupuncture in the CNS, so much on animal basic (12 papers) as on human clinical investigation (23 papers). The modulation of the expression of neurotrophic factors, and the variation of cellular sub-populations in the CNS areas were found in diverse paper. Also studied were the regulation by the liberation of neurotransmitter, the modification of cerebral blood flow and variation in the excitability of determined neuronal groups. Acupuncture seems induce changes in different areas and functions of CNS, a fact likely related to the therapeutic response observed in different studies. 27P31 Transcraneal magnetotherapy as therapeutic alternative in the psycho-physiologic insomnia. A preliminary report Coralina Martínez Hidalgoa , Trinidad Virues Alba b , Roidel Alessandrinia , Armando Sentmanat Belisóna , Anairis Rodrígueza , Jorge Torres Hernándeza. a International Center of Neurological Restoration(CIREN). b CubanNeuroscience Center. Havana, Cuba The present investigation was worked out between the groups of Physiotherapy from the International Center of Neurological Restoration (CIREN) and the Clinic of Sleep Disorders from the Cuban Neurosciences Center (CNC). Objective: To corroborate the possible therapeutic effect of transcranial magneto therapy on patients suffering from psycho-physiological insomnia (PI) in the improvement of sleep quality. Material and Methods: The leading study included 5 patients with psycho-physiological insomnia treated with transcranial magneto therapy in 20 sessions of a 30– minute duration with an intensity of 30 gauss, pulsating, sinusoidal wave on a CM-1750-01 Magnetic-stimulation bed. The patients were evaluated before and after treatment with surveys and psychological tests, besides being submitted to a polysomnographic study in the lab for sleep disorders at CNC-CIREN. In this test, the following variables were assessed: latency as the beginning of total sleep and REM, amount of awakenings and total sleep time. The data were processed with application of non-parametric tests (Wilcoxon, for paired series, Kruskall-Wallis and Spearman´s correlation by multiple ranges). Results: Preliminary results show that the effects of magneto therapy have an incidence on the increase of effectiveness during sleep, sleep soundness and in the number of cycles that become similar to those of healthy subjects. These results also show a diminishing in vigil states and their duration, as well as, Arousal‟s Index. They all show a tendency to the recovery of sleep structures, an issue that indicates that this technique of treatment can activate those centers involved with sleep generators. Conclusions: In a preliminary way, it can be appreciated that transcranial magneto therapy can constitute a therapeutic alternative in this pathology. 27P32 Integration of orthopedic structural manipulation techniques with acupuncture in the handling of lumbar pain Carlos M. Méndez Alonso, Tahimí Cardoso Suárez, Irene Jiménez Ortiz Holistic Medicine Department, International Center for Neurological Restoration. Havana, Cuba. Lumbar pain is a frequent health problem. In some patients, the conventional therapy does not release pain and collateral events appear because of medication. This works aims to integrate two common therapeutic procedures from holistic therapies and to describe the outcome of the lumbar chronic pain treated with orthopedic structural technique (OST) and Acupuncture (AC). 25 patients with chronic lumbar pain (more than three weeks evolution) with or without sciatica, were treated in our department, nine women and sixteen men, between 24-83 years old. According to clinical features and imagenologic test, patients were distributed in 3 groups: 1- facetary cause- ten patient (there is not clinically or imagenologic evidence of discal pathology); 2-protusion of the intervertebral disc- seven patient; 3- extrusion of the disc –eight patients (extruded hernia). It was applied a cycle of 8 to 16 sessions according to the individual requirements: pain‟s outcome was evaluated by subjective pain scale: 10- the most intensive pain at the beginning, and 0- no pain. In the group 1, the release was in 2 weeks. In the group 2, in 5 weeks. Both groups finished without medication. The group 3 had a poor evolution, needing other procedures. In the chronic lumbar pain non-responsive to the habitual medication, the first two groups had a positive outcome with the integration of the therapeutic procedures. The OST acts more deeply in the etiology of pain, but is insufficient in the treatment of pain due to extrusion of the disc. 27P33 Auditory evoked responses in temporal lobe epileptic patients and definite multiple sclerosis patients M.M.Báez Martín, I.Cabrera Abreu, L.Morales Chacón, E.Infante International Centre for Neurological Restoration. Havana, Cuba. There are controversial reports about the characteristics of auditory evoked responses in epileptic patients depends on epilepsy classification, the chronicity of the illness, the response to antiepileptic drugs, and the generators of the different components. On the other hand, studies in patients with multiple sclerosis (MS) have reported an improvement in the diagnostic sensibility of auditory evoked potentials with the use of the middle-latency evoked response, but there is no consensus. Auditory brainstem response (ABR) and middle-latency auditory evoked response (MLR) were studied in ten patients with temporal lobe epilepsy, and an equivalent number of healthy subjects. ABR and MLR of thirteen MS patients with positive MRI were compared with the normative data of our Lab, according to sex and gender. Epileptic patients showed a significant increase of I-III and I-V interpeak intervals duration with decrement of III wave amplitude, prolonged latency of all MLR components, and increased Pa-Pb interpeak interval respect to control group with reduction of Na component amplitude. Eight of the MS patients (61.5%) showed abnormalities of the MLR, but only five showed anomalies of the ABR. Considering ABR and MLR together the sensibility of the tests increased until 76.9%. Our results confirm the compromise of auditory pathway structures at different levels in temporal lobe epileptic patients. MLR improved the diagnostic sensibility of auditory tests in MS patients. 27P34 Somatosensory cortical evoked potentials to laser stimulation Ana Fernández Nina , Marta Brown Martineza, Aymee Hernández Hernándeza, Rebeca Hernández Toranzob , Ramón Cabalb , Luis Marti Lopezb a Hospital Universitario Dr. Carlos J. Finlay, La Habana, Cuba. b Centro de Neurociencias de Cuba, La Habana, Cuba Somatosensory cortical evoked potentials were elicited stimulating A-delta and C nerve fibers of the skin by means of a laser stimulation device (Estimula-2). These fibers convey information about temperature and pain to the central nervous system. The objective exploration of these pathways can be very helpful to diagnose many neurological diseases. The present study reports the first experiences on this field in our country. Forty-five adult healthy volunteers were studied to construct a normative group, and 8 patients with thermal and pain dissociation caused by different illness were also explored. The Estimulas-2 was used to generate CO2 –laser pulses synchronized with a Neuronica 02 EP recording machine. The stimulation sites were the backs of hands and foots, as well as, the elbows and knees. Ten pulses were given in every site and after every stimulus an 800 ms EEG segment was recorded from the scalp. Single trials were averaged to obtain replicable responses. Latency, amplitude and conduction velocities were calculated for every response. The 8 patients exhibited cortical responses with longer latencies, lower amplitude and slowed conduction velocity compared to controls. The topography of the alterations varied according to the localization of the affected areas, but there was a high correlation between clinical and electrophysiological variables. It was concluded that the presented methodology is safe, reliable and of great help to neurological diagnosis. 27P35 Humoral intrathecal immunity, in the diagnosis exclusion of dementia. Cytokines and antioxidant activity interaction in AD Maria de los A Robinson-Agramonte, Maria E Gonzáles Fraguela, Martha Nápoles , Teresa Serrano Sanchez, Bertha Willson. Centro Internacional de Restauración Neurológica. Ave 25. No 15805 e/ 158 y 160, Playa. CP 11300. Ciudad de la Habana. Cuba Beside the utility of intrathecal immunity as a tool for the diagnosis exclusion of dementia, Inflammation and oxidative stress are refereed as biological markers from different fluids in AD looking for evidences helping to the following of disease progression. Nevertheless, no less important markers from peripheral fluids add information on the pathological events of the disease. We show an integral result of the immune-inflammatory response and oxidative stress in AD and others type of dementia. The analysis included the evaluation of intrathecal immune response using Reibergram program in different type of dementia and the quantitative estimation of pro- inflammatory cytokines (IL 1b, TNFa) following ELISA method as well as the quantitative estimation of antioxidant enzyme from serum in AD patients. The probable interaction between all these parameters was analyzed too. A Reibergram differential pattern was observed to each type of dementia. AD patients showed a significant difference to TNF a (p<0.05) as well as a significant interaction level to this variable with CAT antioxidant activity (p<0.05). The results underline the inflammatory mechanism in AD and tag the reactive oxygen species as cellular messenger instead a simple pathogenic agents to the disease, in add to the potential value of these markers to evaluate disease progression. 27P36 Prevalence, risk factors and predictiv e models of demential syndrome and Alzheimer’s disease in the Municipality of Marianao J.J. Llibre Rodríguez, H. Herrera Domínguez, H. Bayarre Vea, Héctor; T. Laucerique Pardo, M.A. Guerra Hernández, J.A. Samper Noa, C. Moreno Carbonell, G. Lluis Ramos, S. Sosa Pérez Saily; J.C. Medical University of Havana, Havana City, Cuba The risk predictive models of dementia syndrome and AD allowed us to determine from individual risk the probability that an old person develops these diseases. Aims of the investigation: To know the prevalence of the dementia syndrome in the population over 60 years from Marianao Municipality in Havana City and the relation of some biosocial factors that are associated with its prediction. Methodology: A transversal cutting descriptive study was done in which 779 old adults were evaluated in theirs home. The dementia syndrome diagnosis was based on the DSM-IIIr criteria as well as the criteria established for the different sub-types. A predictive model of the dementia syndrome and the Alzheimer‟s disease (AD) was elaborated and validated in efficiency terms. Conclusions: The prevalence rates founded are as follow: dementia syndrome was 8,22%, the prevalence of Alzheimer‟s disease was 5,13% and vascular dementia was 1,93%. Age, female sex, family history of dementia, hypertension, antecedent of depression, and the low school level were the factors that mostly influenced on the appearance of probable AD in the population that was investigated. 27P37 BM88 a cell-intrinsic determinant that regulates initiation of pan-neuronal and subtype-specific differentiation of spinal cord neurons Politis P.a, Geissen M.b , Rohrer H.b , Matsas R.a a Department of Biochemistry, Hellenic Pasteur Institute, Vas. Sofias 127, 11521, Athens. bMax- Planck-Institute for Brain Research, Deutschordenstr. 46, 60528 Frankfurt/Main, Germany Identification of molecules that control neurogenesis is of paramount importance for designing therapies for nervous system lesions and abnormalities. We have identified BM88 as a neuron- specific protein that drives neural precursors towards commitment to specific differentiation pathways in vivo. Specifically, gain-of-function experiments by which BM88 was expressed in the neuroepithilium of the developing chick spinal cord, by means of retroviral infection and in ovo electroporation of the neural tube, demonstrated a dramatic phenotypic effect in the developing CNS. In particular, BM88 over-expression caused a substantial decrease in BrdU incorporation indicating that forced expression of BM88 drives progenitors to prematurely become post-mitotic neurons. Consistently, BM88 led to a significant reduction in the size of the electroporated side of spinal cord compared to the GFP electroporated. Interestingly enough, BM88 over-expression was sufficient to produce ectopic neurons in the ventricular zone of spinal cord, manifested by down- regulation of Notch, and up-regulation of the pan-neuronal markers ß-III-Tubulin, SCG10 and NF160. The effect was more pronounced in the ventral spinal cord where over-expression of BM88 was sufficient to initiate a programme of motor neuron differentiation characterized by ectopic expression of the transcription factor Islet1 and of the cholinergic transmitter phenotype. Moreover, a significant reduction in the pool of spinal motor neurons was evident, possibly due to a premature depletion of motor neuron precursors and/or an effect in motor neuron migration. These results suggest that BM88 regulates qualitative and quantitative aspects of neurogenesis driving neuronal precursors to terminally differentiated neurons with a correct functional phenotype. 27P38 Magnetic resonance spectroscopy as a diagnosis aid in early Alz heimer disease Martina W.S. Nasruna; Patricia Widjaya b . a Department of Psychiatry, Faculty of Medicine University of Indonesia, Jakarta, Indonesia, b Department of Radiology, Husada Hospital, Jakarta, Indonesia. Diagnostic procedures in Alzheimer Disease (AD) are mainly based on clinical assessment and a series of neuro-psychological tests. There is a need to develop a technique in detecting early stage of Alzheimer Disease which can be used as a standard diagnostic procedure accurately. The tools should be practice, not expensive and not invasive. One of the possibilities is Magnetic Resonance Spectroscopy (MRS). This is a preliminary study to find out in which region of the brain showing prompt bio-metabolite decreased that correlate with AD pathogenesis (N-Acetyl Aspartate decreased and Myo-Inositol elevated) in people with early dementia Alzheimer type. The correlation of NAA, MI and its clinical presentation (including neuropsychological test) was examined. There was sixth subjects with early AD examined by MRS and a set of psychometric (MMSE, CDR, GDS and Verbal Fluency). Result of MRS examination showed that posterior parietal lobe was the region with the most marked NAA decreased, while MII elevated not specified yet. Clinical presentation and neuropsychological tests seems in line with brain bio-metabolite decreased detected by MRS. 27P39 Perineuronal Nets : A possible neuroprotective structure against oxidative stress in human brain Markus Morawski, Martina K. Brückner, Gert Brückner and Thomas Arendt Paul-Flechsig-Institute for Brain Research, University of Leipzig, Jahnallee 59, D-04109 Leipzig, Germany Perineuronal nets are lattice-like aggregations of extracellular matrix components, originally described by GOLGI and RAMON Y CAJAL as a reticular structure covering cell bodies and proximal dendrites of certain neurons. These matrix components mainly consist of large aggregating chondroitin sulphate proteoglycans connected to hyaluronan. PNs are associated with different types of neurons in region dependent patterns in the brain of many vertebrate species including man. In the human cerebral cortex, PNs surround several types of interneurons as well as subpopulations of pyramidal cells, which are most frequently found in motor and primary sensory cortical areas. Due to their glycosaminoglycan components, the perineuronal nets form highly negative charged structures in the immediate microenvironment of neurons and might be involved in local ion homeostasis. Perineuronal nets might also potentially be able to scavenge and bind redox-active iron, and to reduce the local oxidative potential in the neuronal microenviroment, thus providing some neuroprotection to net- associated neurons. Here, we show that neurons enwrapped by a perineuronal net in the human cerebral cortex are less frequently affected by lipofuscin accumulation than neurons devoid of a net both in normal aged brain and Alzheimer´s disease. As lipofuscin is an intralysosomal pigment mainly composed of cross-linked proteins and lipids generated through iron-catalyzed oxidative processes, this study proposes a possible neuroprotective effect of perineuronal nets against oxidative stress potentially involved in the pathomechanism of Alzheimer´s disease and related disorders. 27P40 Association of Multiple Sclerosis (MS), diabetic autonomic neuropathy (DAN) and Stroke Dimitrios Kountouris Center For Neurological Diagnosis, Athens, Greece. The co-existence of MS and diabetes is well known . However, it is also known that the DAN appears as well as to diabetes patient very often. In 3 MS patients with DAN in a period of exacerbation appeared symptoms of stroke. We evaluated the relationship between MS-DAN and stroke in 3 patients (2 female and 1 male) having used neurophysiological (evoked potential) and neuroradiological (MRI, SPECT, CTS) examinations. Simultaneously, we recorded the results of the clinical parameters of different stroke factor as hypertension, diastolic blood pressure, cholesterol level and smoking. In the period of the follow up in the 3 patient we attempted an intense recording of all examination and therapeutic parameters.2 of the patients showed deterioration of their clinical condition and they suffered 3 episodes of strokes which they appeared in the cerebral computer tomography. The man while showing a general improvement he subsequently had a stroke after which he had a slight deterioration. The results showed that the appearance of DAN in MS patients could be due to genetic predisposition. They also indicate therapeutic resistance and bad prognoses. 27P41 Medial Temporal and Parietal N-acetylaspartate Reduction in Elderly Adults Mild Cognitive Impairment Linda Chaoa, Norbert Schuffa, Diana Sacreya, Helena Chuib , Bruce Millera, William Jagustc, Michael Weinerd a Univeristy of California, San Francisco, b University of Southern California, cUniversity of California, Berkeley, USA, dSan Francisco Veterans Affairs Medical Center, USA There has been growing interest in elderly adults who suffer from cognitive impairment greater than that which accompanies normal aging because these subjects have higher rates (12-15% per year) of developing Alzheimer's disease (AD) than elderly subjects who are cognitively normal (1-2% per year). It is likely that cognitively impaired elderly adults have pathologic brain changes that correspond to an early phase of AD. The current study used magnetic resonance spectroscopic imaging to examine N-acetylaspartate (NAA) concentrations in different regions of the brain. NAA is a neuronal marker; therefore a decrease in its concentration suggests neuronal loss or dysfunction. We also investigated the relationship between NAA concentration and performance on the Memory Assessment Scales word list learning test because memory impairment is a cardinal feature of AD. Twenty-four AD patients, 21 cognitive impaired but not demented (CIND) subjects, and 24 age- matched cognitively normal subjects were studied. Relative to controls, CIND and AD and subjects both had lower NAA concentrations in parietal (p=0.01) and medial temporal lobe gray matter (p=0.001). Moreover, there were no significant differences in NAA concentrations between AD and CIND subjects in these brain regions. This suggests that CIND subjects have AD-like pathology in brain regions predominately impacted by the disease. In CIND subjects, medial temporal lobe NAA concentration correlated positively (r=0.44, p<0.05) with performance on delayed list recall. This finding underscores the functional significance of reduced NAA in the brains of CIND subjects. 27P42 Calcium is the unifying molecule in neurodegenerative dis orders András Palotás, Botond Penke, Lajos Kemény, Zoltán Janka, János Kálmán University of Szeged, Szeged, Hungary Efforts to elucidate the pathomechanism of Alzheimer‟s disease and other neurodegenerative disorders have yielded an increasing pile of hypotheses. When analyzing thousands of scientific papers, the involvement of the central secondary messenger, calcium, becomes apparent. We demonstrate that disturbed calcium homeostasis might be a common underlying factor in brain pathologies. By targeting calcium, this new information promises to broaden our understanding of health and illness and the approaches we take to treating disease. 27P43 Complications of the Pharmacological manipulations in aged people w ith paraly tical sequels of chronic al brain-vascular diseases submitted to Neurological Restauration Programs. Five years of experience René Macias Betancourt, Reinaldo Galvizu Sánchez, Yamilka Velazco Acosta, Judith Pla Moret Centro Internacional de Restauración Neurológica (CIREN), Havana, Cuba A retrospective study was done in aged people with paralytic sequels of chronic brain-vascular diseases that were submitted to Neurological Restoration Programs (4 weeks) in the CIREN in the last 5 years (118 patients), to know the main complications of the pharmacological manipulations in relation to the control of risk factors, sequels and self-complications of this type of affection, to determine the poly-pharmacy level in the studied sample and its possible relationships with adverse effects. It is found a real poly-pharmacy prevalence in the studied sample (25.75 of the cases had indicated 6 or more medicaments daily). The main adverse manifestations related to the medication were: gastric troubles, ortosthatic hipotension, constipation, somnolence and delirium. The main groups of medicaments involved in adverse reactions in order of frequency were: the benzodiazepines, tricyclic antidepressives, homorreologics, beta-blockers and anti-aggregants. It calls the attention the low incidence of secondary effects in the aspirin use. It is shown a high incidence in the adverse effects related to the quantity of used medicaments (57.1 % of the cases consumed 6 or more medicaments). The age also represented an easy condition for the appearance of adverse reactions (47.8% of the patients of 70 years or more presented some negative effect related with the therapy). Then, it is necessary a more rational and individualized use of the doses of the medicaments in aged poly-medicated people, paying special attention to tolerance. Parkinson‟s disease 27C1 Bilateral subthalamic nucleus lesion reverses levodopa-induced motor fluctuations and facilitates dyskinetic movements in an experimental model of parkinsonism Concepció Marin, Anna Jiménez, Mercè Bonastre, Eduardo Tolosa Laboratori de Neurologia Experimental, Fundació Clínic-Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain Glutamatergic overactivity might be involved in levodopa-induced motor complications since glutamate antagonists reverse and prevent levodopa-induced a shortening in motor response duration in 6-hydroxydopamine-lesioned (6-OHDA) rats and improve levodopa induced dyskinesias in parkinsonian monkeys and in patients with Parkinson‟s disease (PD). An increase in the subthalamic nucleus (STN) glutamatergic activity is believed to contribute to the pathophysiology of PD. However, the role of STN activity in levodopa-induced motor complications is not clear. In this study, the effect of STN lesions on levodopa-induced motor response complications has been investigated in rats with a nigrostriatal pathway lesion induced by 6-OHDA. Animals were injected with 6-OHDA in the medial forebrain bundle and treated with levodopa or saline for 22 days. On day 16, animals were randomly distributed in groups that were under surgery in the STN ipsilateral or contralateral to 6-OHDA lesion, or bilateral. Rotational behavior was measured on days 1, 15 and 22. Attenuation of STN activity by contralateral and bilateral, but not ipsilateral, STN lesion reversed the shortening in motor response duration induced by levodopa (p<0.01). Levodopa administration, but not saline, induced prominent dyskinesias in 6- OHDA-lesioned rats with additional bilateral STN lesions (p<0.05). The results indicate that bilateral lesions of STN potentiate the duration of levodopa-induced motor response and facilitate chronic levodopa-induced abnormal involuntary movements in 6-OHDA-lesioned rats. 27C2 Epidemiological assessment of levodopa use in cuba, 1993-1998 G Lara Fernándeza, EM Esteban Hernándeza, S Luis Gonzaleza , JI Cuadrado-Gamarra b , J de Pedro- Cuestab,c, S Giménez-Roldand , M. Estrada Suáreze a Instituto Nacional de Neurología y Neurocirugía, La Habana, Cuba, bNational Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain, c Division of Neurology, NEUROTEC, Karolinska Institute, Stockholm, Sweden, dDepartment of Neurology, Hospital Gregorio Marañon, Madrid, Spain, e Hospital Militar Luis Díaz Soto, Habana, Cuba OBJECTIVE: To assess the use of levodopa in Cuba in the period 1993-1998. METHODS: We obtained data on annual number of packages, units and strength of plain and combined, levodopa delivered from the central state own laboratory to fifteen provincial distributors to hospital and community pharmacies. An internationally established drug classification system and a reported method for epidemiological assessment of levodopa sales were applied. The reference population was Sweden in 1994. RESULTS: National crude rates of levodopa use remained basically stable since 1994, being in 1998 0.11 DDD per 1000 inh /day, approximately fifteen times lower than the corresponding figure in the reference population. Provincial annual use of levodopa showed considerable geographical variation with lowest rates in Guantánamo, Santiago de Cuba and La Habana, highest in Ciudad de La Habana, and increasing trends in Ciudad de La Habana and Camagüey. Adjustment for age reduced approximately 50% such differences. CONCLUSIONS: Despite some methodological limitations, the results show that levodopa use in Cuba is low and consistent with reported low prevalence of PD diagnoses. If PD prevalence in Cuba is within the range described worldwide, results suggest that there is a wide space for improvement of PD diagnosis and treatment in Cuba. 27C3 Clinical and genetic features of Parkinson's dis ease in Cuba José Luis Giroud Beníteza ,Aída María Bertolíb,c , Vincenzo Bonifatic ,e , Eduardo Alvarez Gonzálezd , Luis Herederob , Peter Heutink f. a University hospital" Dr. Carlos J. Finlay., Service of Neurology, Cuba. b National Center of Medical Genetics ISCM-Havana, Cuba. cDpto. of Clinical Genetics of the University of Erasmus, Rotterdam, Holland. d International Center of Neurological Restoration, Cuba. eUniversity The Sapienza, Rome, Italy. fSection Medical Genomics, University of Vrije, Ámsterdam, Holland Introduction. The etiology of Parkinson's disease is unknown yet; there are many factors that increase the risk to suffer it, as genetic factors are. Objectives. To expose the clinical-genetic characteristics of this entity in our country. Methods. We were carried out a genetic clinical study of series of cases in 200 consecutive patient with Parkinson's disease, from January of the 1999 to December of the 2002, in the Hospital" Dr. Carlos J. Finlay". In the patients that it was possible we was carried out a simple segregation analysis, and in the detected families it was carried out a molecular study according to the established protocols, the samples of DNA were made a will with markers for well-known loci. Results. 31.3% of the cases had family history. The autosomal recessive inheritance was observed in 3 families one of them with a heterozygotic new parkin mutation and another with a mutation of the DJ-1 gene. Autosomal dominant. Linkage and haplotype analysis allowed us to exclude the Park1 (alpha-synuclein gene), Park2 (parkin gene, 6q25-27), Park3 (2p13), Park 5, and UCH-L1 gene (4p14-15). No mutations were found by direct sequencing of Park1. A whole genome search is almost completed. We found linkage to chromosome 19q13.3-12p. Conclusions. The inheritance is an outstanding factor in the Parkinson's disease, the genetic and allelic heterogeneity of this entity it is characteristic of the genetically complex illnesses. 27C4 Neuropsychiatric disorders in Parkinson’s disease. A study of 111 patients Enrique Michel Esteban Hernandeza,Gloria Esther Lara Fernandeza, Nayibe Curi Mendozab a Clinica de Trastornos del Movimiento Instituto de Neurologia y Neurocirugia, La Habana,Cuba. b Policlínico “Elpidio Berovides” Municipio la Lisa, La Habana, Cuba Objective: To describe the presence and features of some Neuropsychiatric disorders (NPD) in a group of 111 patients with Parkinson‟s disease (PD). Background: NPD are commonly described among the non-motor expressions of PD and frequently they could be even more disabling than motor dysfunction itself. Methods: We studied one hundred eleven patients (56% male, non demented, ages from 30 to 80 years old) who fulfilled the clinical criteria for primary PD, in different stages of the disease (Hoehn &Yahr modified). The assessment scales used in the study were the UPDRS score for motor disability, Activities of the daily life score (Schwab-England), Cumming Neuropsychiatric Inventory, Diagnostic criteria of mood disorders (DSM IV), Beck depression inventory and Minimental State Examination (MMSE). Results: 65,7% of the patients had at least one NPD. The disorders more frequently found were: depression (45,9%); Anxiety (35,1%); Irritability (23,4%) and Hallucinations (12,6%). The presence of NPD did not correlated nor with gender neither with age, but it did significantly correlated with the duration of the disease. Conclusions: According to our data, depression is the most common NSD in PD patients and it has a higher incidence in patients with a worse motor control. 27C5 Functional MRI and other images in Parkinson’s disease Rafael Rodríguez-Rojasa, Rolando Palmerob , Lazaro Alvarezc, Mario Alvarezc, Raul Macíasc, Maylen Carballoa. a Brain Images Processing Group, bStatic Lesions Clinic, cMotor Disorders Clinic, International Center for Neurological Restoration, Havana, Cuba BACKGROUND: Recent developments in high-resolution functional magnetic resonance imaging (fMRI) provide a powerful tool to map the cortical activation in healthy and parkinsonian subjects. In this research we study the cortical activation maps in patients with Parkinson‟s Disease (PD) and we compare them with a group of normal subjects. The effect of DOPA medication and the correlation with clinical motor improvement were also tested. METHODS: fMRI data were acquired in 12 patients with PD and 4 normal subjects performing a motor task, consisting in finger opposition sequential movement followed of repetitive flexion- extension movements of the hand. Statistical Parametric Mapping (SPM) package was used to detect differences in the cortical activity of patients when is compared with both normal pattern and after DOPA supply. Clinical improvement was evaluated through UPDRS motor scale and correlation with changes in fMRI signal was tested. RESULTS: Patients with PD show abnormal activation intensities in Primary Motor cortex (M1), Pre-motor cortex (PM), Supplementary Motor Area (SMA), inferior orbitofrontal cortex and associative parietal areas. DOPA medication induced a greater activation in motor cortical areas. Improvement in clinical outcome correlated with increase in fMRI signal in SMA, M1 and PM. Changes in SMA are particularly correlated with improvement of hypokinesia in UPDRS motor scores. CONCLUSIONS: The study indicates that fMRI enables quantitative evaluation of abnormal activation pattern in PD and the effect of therapeutic intervention. PD patterns are partially normalized in ON medication state. 27C6 Ablative procedures for Parkinson’s dis ease treatment Macías R., Alvarez L., López G., Teijeiro J., Carballo M., Rodríguez R., Pavón N., Alvarez E., Maragoto C., Rodríguez Oroz MC., Guridi J., Obeso JA. International Center for Neurological Restoration (CIREN) Havana, Cuba Ablative procedures for Parkinson´s disease (PD) have been used for many years. Different targets have been selected for these treatments: VIM thalamus (VIM), Medial Globus palidum (GPm) and Subthalamic nucleus (STN). We had treated more than 347 patients with different movement disorders meanly PD with more than 415 surgical procedures. Patient selection is crucial for functional neurosurgery and the correct target choice to treat according with the clinical characteristic of each patient. According to our experience (82 VIM thalamotomies, 205 Palidotomies and 126 subthalamotomies): VIM thalamotomy must be very carefully chosen for those patients with advanced age and invalidating tremor as a main sign. GPm lesion could be decided for patient with very intense LDOPA induced dyskinesia. STN lesion has the most powerful effect over parkinsonian symptoms, signs, and permit maximal reductions in drug dosage. Bilateral lesions in VIM and GPm are hazardous but bilateral STN lesions do not produce speech or neuropsychological impairments. The efficacy of the procedures are higher than 90% (with reduction in UPDRS motor score between 40 and 80%), morbidity is less than 8% and mortality less than 1%. 27C7 Motor response to levodopa and oscillatory activ ity in the subthalamic nucleus in parksinson´s disease (PD) MC.Rodriguez-Oroza , F.Alonso-Frecha, I.Zamarbide a, M.Valencia a , M.Alegrea, M Rodriguez Diazb J.Artiedaa, JAObesoa a Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra, Pamplona. Spain. bSchool of Medicine, La Laguna, Tenerife, Spain The study of oscillatory activity in the basal ganglia and motor cortex in the physiology of motor control and pathophysiology of PD may help to understand some unexplained issues of the classical model of the basal ganglia. We studied 7 PD patients treated with electrodes for chronic stimulation. Local field potentials (LFP) from the subthalamic nucleus (STN) were recorded with the implanted macroelectrode (Medtronic). All patients were continuously recorded during the “off” to a fully “on” (following levodopa) medication state. The power spectrum of the dominant frequency of LFP activity in several frequency bands (5-10Hz, 10-20Hz, 20-30Hz, 30-40Hz, >60Hz) along the “OFF-ON” cycle were analyzed.All patients exhibited the same patron of LFP activity changing from a dominant 10-30 Hz oscillations in the “off” motor state to a higher activity (60-80 Hz) in the “on” motor state. Frequencies in the range of 5–10 Hz may have two different evolutions: A consistent peak during “off” was observed with a 4-6 Hz resting tremor (46%). Patients with coreic dyskinetic movements during the “on” showed a 5-10 Hz peak coinciding with the movements. Patients with alternating movements of the legs (“diphasic dyskinesias”) exhibited a drastic drop in all frequencies. Basal ganglia oscillatory activity is dependent on dopamine deficiency. The “off” and “on” motor states in PD are not only related to hyper/hypo activity of the STN but also to changes in oscillatory patterns, that may be included in a more precise revision of the pathophysiological model of the basal ganglia. 27C8 Surgery for Parkinson´s disease: Lesion or stimulation? Marwan Hariz Institute of Neurology, Queen Square, London, UK Purpose: To analyze the evolution of lesional and deep brain stimulation (DBS) surgery in Parkinson´s disease (PD), with respect to effects and side-effects, and to examine the rational for using either method in thalamus, pallidum and subthalamic nucleus (STN). Methods: Review of the author´s own experience as well as the literature on DBS and on thalamotomy, pallidotomy and subthalamotomy was conducted. Emphasis was put on analysing trends in choice of surgical targets and procedures as well as the reported clinical results and side-effects. Results: There is only one randomised study comparing lesion with DBS: it compares thalamotomy and thalamic DBS for tremor showing less side-effects for the latter. For all other targets and procedures, only historical information is available, and shows that DBS has re-emerged and seems to be preferred to lesions. The reasons for increased popularity of DBS may be the possibility for safe bilateral and adjustable surgery, the alledged lower frequency of adverse events, the potential offered by DBS as a research tool for mapping basal ganglia, the enthusiasm of many neurologists for non-ablative procedures, the decreased experience of many neurosurgeons in performing proper stereotactic lesions, and the promoting role of companies involved in DBS. Conclusions: Although DBS is increasingly popular, it is not accessible to all PD patients in need of surgery. Lesional surgery, especially in pallidum and possibly in STN, still has a role in surgical treatment of PD, provided judicious selection of patients by neurologists, and proper neurosurgical skills in performance of stereotactic lesions. 27C9 Rehabilitation in Parkinson's Disease: A Rational Approach Lazaro Alvarez Gonzalez Movement Disorders Clinic. CIREN, Havana, Cuba Before the introduction of L-Dopa in the late 60's,physical therapy was widely consider to be an option in the treatment of Parkinson's Disease but the development of more efficient drugs or surgical strategies in the last 40 years led to decrease interest in alternative therapies. Now is well know that the efficacy of drugs does not last indefinitely and surgery is only indicated in less than 10 % of the patients so in addition to the standard drug regimen ,physical therapy is often prescribed to help in the management of the disease. In recent years, there have been an increase in reports of physical therapy combined with various techniques (sensory cues, treadmill training with body weight support, instructional sets and others) with promising results who are consistent with our own experiences using rehab techniques in PD. Since 1988 to date we have been explored the efficacy and indications of the most recognized alternative methods alone or combined with standards treatment. In this review we summarized the evidence obtained from our experience and from the literature, in regarding to clinical efficacy and potential therapeutic mechanisms and propose and integral rehabilitation program to improve PD patients. Posters 27P44 Chiropractic intervention on parkinson's rehab treatment program Raul Carrillo Rodrigueza , Raul Alvarez Valerob a Northwestern College of Chiropractic, USA, bChristus Muguerza Hospital, Saltillo Coahuila Mexico. Parkinsonism, described in 1867 by Dr. James Parkinson, is recognized worldwide among the movement disorders, the symptoms experienced are: resting tremor, bradikinesia, simioid posture, frozen shoulder, seborrhoea, sialorrhea, dementia, visua l dyspraxia, orthostatic hipotension, disphagia, esophageal dismotility, constipation, etc. Patient classification has been done considering their motor, neuropsychological and cognitive capabilities. Through this observations, the motor dysfunction is considered as one of the base line symptoms to treat for the Parkinson‟s patient, thus chiropractic treatment plays a significant role on the restoration of proper biomechanics of the patient, through the chiropractic adjustment for the subluxation complexes presented by the patients due to the muscle tone imbalance that Parkinson‟s patients develop through mechanoreceptor activity and adaptation secondary to simioid posture and tremors present. The rehab program should involve an integral model in order to maintain muscle and biomechanical balance, in order to achieve improvements in balance, speed, coordination, dexterity and posture. The chiropractic adjustment in particular, functions to re-establish function at the motion unit involved (joint) and also the physiological effects that come along with the mechanical dysfunction of the sublimation complex. Adjustments are performed previous detection of the specific vertebral subluxation complexes or dysfunctional joints, through ortho-neurologic, radiological, dermathermography, bone density scans, bone scans, motion palpation, x-ray, MRI, all to trying to make the best and most accurate diagnosis. At integral health center, diverse specialist in different areas like orthopaedics, neurosurgery, neurology, chiropractic, physical medicine and rehab, radiologist, etc. 27P45 Influence of attention and motor planning in the activ ity of primary motor cortex Magdalena Sabaté a, Belén Gonzáleza a Ramón Muñiz c, and Manuel Rodríguezb a Department of Physical Medicine and Pharmacology, b Department of Physiology and Faculty of Medicine, University of La Laguna; cIMETISA, Canary University Hospital, Tenerife, Canary Islands, Spain. The primary motor cortex (M1) is the main cortical output for the executive motor orders coming from cortical and subcortical pre-motor centres. The objective of this work was to study with functional magnetic resonance imaging the possible pre-motor activity of M1 in relation to its motor functions. Data show that the dimension of the M1 area activated and the intensity of response were higher during activities that need pre-motor planning (phasic movements of the forefinger, motor imagery that consisted of imagining the performance of phasic movements of the forefinger but without real movements) than during motor activities (tonic flexion of the forefinger) that practically do not need of pre-motor planning. Distracting concurrent task (numeric calculus) that did not disturb the finger movements decreased the activation of M1 induced by the phasic movements of the forefinger. There was a mosaic-like distribution for pre-motor M1 functions, with the movement of individual fingers being controlled from several M1 loci. Attention induced a fast functional reconfiguration of M1, adding M1-subsets to motor programming but excluding others. Taken together, present study show that human M1 is involved in motor activities but also in the pre-motor planning of movements. 27P46 Nursing Attention Process to Parkinsonian patients candidates to selectiv e pallidotomy Antonio D. Villa Juárez and Janett Benavides Barbosa Neurosurgery Service, International Center of Neurologic Restoration Center, CIREN, Havana, Cuba. The Parkinsonian Syndrome is a degenerative disease of the CNS, characterized by abnormal involuntary movements. At the present moment this disease is treated surgically at different targets including the internal pallidum. The use of a personalized nursing attention process allows to achieve a superior attention care in the parkinsonian patient. The objective of this paper was to evaluate the impact of the nursing diagnosis and planned personalized attention on patients that will receive surgical treatment. For this issue, 22 patients with dyskinesia, submitted to selective pallidotomy, of which 16 were males and 6 females respectively, ranging from 35 to 65 years of age, were studied. The application of the nursing attention process allowed us to detect in those patients a 100% impairment of the hystic integrity, a 100% deficit for self-care, a 75% alteration in verbal communication, a 100% anxiety and a 100% risk of lesion. The role of nursing is fundamental in the evolution of these patients for their fast return to society. 27P47 Subthalamotomy in Parkinson´s Disease(PD): Effect on L-Dopa induced dyskinesias E.Alvarezª; L.Alvarezª; R.Maciasª; N.Pavonª; M.C.Rodriguezb ; J.Guridib ; J.A.Obesob a International Center For Neurological Restoration,Havana;Cuba; bClinica Universitaria de Navarra.Pamplona, Spain Dyskinesias are a common complication of advanced PD due to both long term L-dopa treatment and disease progression. Lesion of the subthalamic nucleus (STN) in humans is associated with hemichorea-ballism. In parkinsonian monkeys STN cytotoxic or thermolytic lesions were associated with mild dyskinesia or HCB. More recently, studies using deep brain stimulation (DBS) of the STN reports low ocurrence of HCB but improvement on previously existing L-Dopa induced dyskinesias(LID). In order to better define the relationship between dyskinesias and lesion of the STN in PD we conducted an open study during the last 5 years in 17 PD patiens submitted to bilateral lesion of STN (Staged or Simultaneous) using the UPDRS and the Dyskinesias Scale. We observe a transitory increase in Peak Dose Dyskinesias , a reduction of 50 % of diphasic diskinesias and an arrest of dystonic dyskinesias coinciding with the frecuent presence of spontaneous off dyskinesias related to the surgery, at short term follow up. At one, two and three years follow up global rating of LID decreased by 50%,with more marked effect on dystonic dyskinesias and a significant improvement in both, disphasic and peak dose dyskinesias. We can conclude that subthalamotomy reduce LIDs at long therm follow up. Whether or not this only related to the reduction in the total daily dose of L-Dopa is open to discussion. 27P48 Subthalamotomy in Parkinson¢s Disease: The CIREN experience L.Alvareza ,R.Maciasa and JA Obesob (on behalf of the CIREN subthalamotomy study group). a International Center for Neurological Restoration, Havana, Cuba. bUniversidad de Navarra, Spain Surgery for Parkinson's disease is not a new concept. Ever since scientists discovered that many of the symptoms of the disease can be traced to chemical imbalances deep in the brain, there has been theoretical support for the idea of restoring a balance by removing or disabling certain overactive areas.Palidotomy is accepted as a typical example but destroying areas implicated in Parkinson's disease may has been effectively bypassed by improvements in drugs and technologies such as deep brain stimulation (DBS). In the last few years, however, the lesion of the Subthalamic nucleus (STN) has emerged as a new alternative for special circumstances. In our first study, published in the Movement Disorders Journal (2001) , we were able to demonstrate that unilateral lesion of the STN can be performed safely and improve motor function without major complications. The next goal was to assess the safety and efficacy of bilateral subthalamtomy , which was done by performing staged surgery(at least one year apart) in 7 patients. This also resulted in marked symptomatic relief without noticeable side-effects. Recently, we have assessed the effect of bilateral, simultaneous subthalamotomy in 11 patients, followed for 36 months after surgery. As a group those patients were still scoring well over 50 percent better on movement tests than they had before surgery. Significant improvement was seen on other tests and the average daily L-dopa dose had been reduced by 70%, greatly reducing some of the side-effects of the drug. Up to now we have performed subthalamotomy in 90 patients (a third bilaterally) with similar good results. In fact, experience and refinement of the technique have led to shortening the intraoperatory time and more reliable clinical results. 27P49 Bilateral dorsal subthalamotomy in Parkinson’s disease: initial response and long-term evolution Alvarez La, Macias Ra, Lopez Ga , Alvarez Ea, Pavon Na, Rodriguez-Oroz MCb , Juncos Jc, Maragoto Ca , Guridi Jb ,Litvan Id , Tolosa ESe, Koller Wf,Vitek Jc, DeLong MRc, Obeso JAb . a Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica(CIREN), La Habana, Cuba. b Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra, Pamplona,Spain. cDepartment of Neurology, Emory University School of Medicine, Atlanta, USA. e Department of Neurology, University Hospital, Barcelona, Spain. f Parkinson’s Disease Research Center, University of Miami Medical School, Miami,USA. We conducted an open, pilot study of the effect of bilateral stereotactic subthalamotomy in 18 patients with advanced Parkinson‟s disease (PD) uncontrolled with the available pharmacological means. In 7 patients, the first subthalamotomy antedated the second by 12-24 months (“Staged surgery”). A second group of 11 patients received bilateral subthalamotomy on the same day (“Simultaneous surgery”). Patients were assessed according with the CAPIT (Core Assessment Program for Intracerebral Transplantation) and a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the “off” and “on” states before surgery (base line) and at 3, 6, 12, 18, 24 and 36 months postoperatively. Compared with baseline, bilateral subthalamotomy induced a significant (p<0.001) reduction of 50,8 % in the “off” and 33 % in the “on” UPDRS motor scores at the last assessment. Blind rating of videotapes showing the motor status in the “off” and “on” medication states pre and at 2 years postoperatively also revealed a significant improvement. All cardinal features of PD were significantly ameliorated and Activities of Daily Living (ADL) significantly (p<0.01) improved. The mean daily levodopa dose was reduced by 48 % (p<0.0001) at 3 years after surgery. Five patients stopped taking levodopa. Dyskinesias occurred intraoperatively in 14 patients (72%) but were mild and short lasting in all but 3 of the patients from the simultaneous surgery group. These patients developed severe generalized chorea associated with fairly large lesions of the subthalamic region. The generalized chorea improved spontaneously after some 3-6 months in these 3 patients. For the whole group, levodopa- induced dyskinesias were reduced by 50 %(p<0.01) .No permanent cognitive defect or speech deterioration was detected except in three patients who exhibited dysarthria. The motor benefit has maintained after 3 years. Bilateral subthalamotomy may induce a significant and long-lasting improvement of patients with severe PD but the clinical outcome is not homogeneous. Further refinement of the procedure is mandatory before establishing it as a part of the surgical option for PD. 27P50 Actions of Nursing in the neurorehabilitation of patients w ith Parkinson’s dis ease Leisa Díaz Gálvez, Deimi Reconde, Yusimí Serra Valdez, Teresa Morgado, Amneris Figueras International Center for Neurological Restoration (CIREN), Havana, Cuba The team of nursery plays an important role in the neurorehabilitation of patients with Parkinson‟s disease (PD). The keys of our approach are the principles of neural plasticity of the Nervous System and our concept of multifactorial neurorehabilitation. The nurse‟s work its not the simple prolongation of physical therapy or occupational therapy which create the automation to adequate pattern of walk, stand, language and manipulative abilities; all the which are decreased in PD. The nurse‟s contribution is to make the learned abilities integrated in every aspect of daily life and self care. The nurse‟s actions search also to improve the integration of the new behavior patterns to his family and to appreciate the better quality of life. 27P51 Post-surgic al rehabilitation of Parkinsonian patients Roberto Díaz Márquez, Mario Carballosa Coré, Lázaro Álvarez Gonzálezª International Center for Neurological Restoration (CIREN), Havana City, Cuba The work was carried out at International Center of Neurological Restoration (CIREN. A sample of 60 Parkinsonian operated patients was selected, with the objective of evaluating the results of their physical rehabilitation. A random retrospective study was carried out from 1993 to 2002. It conformed a control and an experimental group of 30 patients respectively, by using 12 standard tests. Measures were taken before and after treatment in the Integral Psychomotor Evaluation Laboratory. The patients of the experimental group received a post-surgical rehabilitation for a month. The results were statistically processed to check the differences at the beginning and at the end of the rehabilitation, to compare the results with operated on patients that did not receive physical therapy. Patients who were rehabilitated after surgery, improved their initial results by increasing their mobility, ba lance and coordination. In both groups of patients significant differences were obtained, and the experimental group had better results in functional tests, which indicates that post-surgical physical rehabilitation contributes to a better recovery of patients. 27P52 The Parkinson¢s Disease Gait Disorders Scale .Version 3.1(Spanish Version by Martinez et al,2000): Introduction and Validation. Preliminar report Morgado T.,Reconde D.,Figueras A.,Enamorado I.,Alvarez L.,Martinez.P. Movement Disorders and Degenerative Disease Clinic,CIREN,Havana,Cuba Gait disturbance is a main problem in advanced PD. Short steps, difficulties to turn, start hesitation, motor blocks and freezing induce important impairtments and falls. Some of them are refractary to drug treatment and partially responsive to surgery or trainning.To better define the overall impact of these disorders some methods and rating systems has already been developed. An integral score to assess gait in PD has been contructed and validated by Martinez et al in Spain. This instrument has strong consistence, reability and sensitivity to cuantificate the impairment to walk. From Jan 03 to June 03 we were conducting an open pilot study to introduce and validate the score in our clinic.The results show high correlation with the related items of the motor section of the UPDRS and appears as a very sensitive method to evaluate the impact of diferent therapeutical techniques on gait disturbances, better than the Tinetti score. In consecuence, we recomended the inclusion of this rating score in the follow-up of Clinical Trails in PD and to follow the response to treatment during inpatient care. 27P53 The physical exercise in patients with amyotrophic lateral sclerosis Alexander Echemendia del Valle, Reinaldo Gómez Pérez, Jorge Luis Torres, Gilda Martínez Aching, Carlos Fernández International Center of Neurological Restoration, Havana, Cuba Introduction: The use of the physical exercise with therapeutic and health purposes is known from the antiquity but only in the last years it has begun to establish their authentic physiologic and preventive repercussion. Among the illnesses that have been benefited by the contribution of the physical exercise is the amyotrophic lateral sclerosis. This is a degenerative disease of unknown etiology that affects the superior and inferior neurons, and is characterized by the weakness, muscle atrophy, hyperreflexia, and spasticity. Onset can occur at any moment after maturity. Objective: To analyze the effect of the physical exercise on the vital capacity, the muscular force and in the functionality of the patients with amyotrophic lateral sclerosis treated at the CIREN. Material and Methods:We used a sample of 6 patients diagnosed with amyotrophic lateral sclerosis with an age 55 year-old average and an evolution time of 2 years. All patients were evaluated in tests of: spirometry, hand dynamometry and back, application of ALS Functional Rating Scale, before beginning the treatment. The program of physical exercises was performed during 28 days. All tests were repeated after finishing the therapy. Results: A significant improvement was obtained in the vital capacity and in the functionality of the patients, while the muscular force remained almost unalterable. Conclusion: It is inferred that the properly dosed physical exercise can attenuate the effects of illness. 27P54 Progresive Supranuclear Palsy (PSP):A Descriptive Study and implications for Treatment Álvarez E., Maragoto C., Arteche ME., Carballo M., Álvarez L. Centro Internacional de Restauración Neurológica (CIREN). Habana. Cuba PSP is an uncommon ad sporadic degenerative disease, usually observed after 50 years as a parkinsonian syndrome with refractory response to L-Dopa. Main features include axial Parkinsonism and dystonia, supranuclear oftamoplegia, pseudo bulbar palsy, dementia and imbalance with frequent falls. First described by Steel, Richardson and Olzewski at early 60` shows no or minimal response to L-Dopa, a rapid course and marked impairment due to the falls and dysphagia. The better comprehension of the semiologic and pathofisiology of cardinal manifestations allow us to design more efficient treatment approach. Based on this premises, we has been conducted a descriptive clinical and epidemiological study in 18 patients who fully complete the NINDS-SPSP Operative Diagnostic Criteria. An exhaustive clinical evaluation using the Golbe Score and a battery of complementary studies were performed and results were summarized to characterize the common picture and to analyze its pathophysiological basis in order to obtain suggestion for further approach. The average age to start was 58.6 ± 8.2 years; the mean evolution time at diagnosis was 4.39 ± 2.3 years. Gait disorders, falls and slowness were the predominant features at early stages and dysphagia and dementia were late. None of them respond to dopaminergic stimulation but some of them partially respond to cholinergic and NMDA antagonist drugs. Validism were conserved by 4 years in the 75% of the patients and ambulation and communication promotes the disability, falls and imbalance improve after rehabilitation speech not. Some pathophysiologic and therapeutic considerations can be defined in consequence. 27P55 Nursing contribution to reduce the surgical time during stereotactic and functional neurosurgery for movement disorders Ángel L. Aquino Ávila, M. Cristina Grandal López Surgical Department, International Center for Neurologic Restoration, Havana, Cuba The surgical time is a main factor increasing infection risks, patient‟s psychological stress, and economic costs. Stereotactic and functional neurosurgery for movement disorders has several procedures that require a long time in the operating room. This paper describes the nursing contribution to reduce this time, and describes the time evolution between years 1996 to 2003. Actions carried out by the nurses are simultaneous to the surgical planning made by the neurosurgeon, or during the surgical act: That helps the physician to reduce general time of the surgical procedure. Time of surgeries made before and after the use of these nurse actions, is compared here. It is known that other factors also have influence on this variable, but a reduction of surgical time was reached with the nursing contribution. This experience has also been transmitted to other surgical teams, which have received training for stereotactic and functional neurosurgery at our center. 27P56 Conscious sedation in generalised dystonia surgery Alexei Villegas Achón, Juan Piedra García, Gerardo López Flores, Carlos Maragoto, Lázaro Álvarez. International Centre for Neurological Restoration, Havana, Cuba In the surgical treatment of patients suffering from generalized dystonia, the patient must be still and conscious in order to allow an ongoing assessment of their state throughout the surgery. We employ the method of conscious sedation in order to ensure the mentioned surgical procedure as required, using Diprivan as the agent of sedation. We proposed, via this research, to demonstrate the use of this method in addition to defining the correct dosage of the agent employed, corroborating the level of cerebral hypnosis via the bispectral index. In the ten patients studied a favorable state was obtained for the surgical procedure by defining the range of dosage of Diprivan as between 0.8 y 1.2mcg/ml to acquire a state of tranquility and a safe level of consciousness, corresponding with a Bispectral index of 82-98. The results achieved in this study are unprecedented. 27P57 Current situation of Parkinson Disease in Habana Vieja municipality 2000 -2001 G Lara Fernándeza, EM Esteban Hernándeza, M. Estrada Suárezb , S Luis Gonzaleza , A. Hernández Péreza, J. Mena Pedrosob , M. Blanco Pegoc a Instituto Nacional de Neurología y Neurocirugía, La Habana, Cuba, b Hospital Militar Luis Díaz Soto, La Habana, Cuba, c Municipio de Salud Habana Vieja OBJECTIVE: Evaluation of Current situation of Parkinson Disease in an urban municipality of Cuba. METHODS: At this municipality, the population of 105650 inhabitants and 18% of them with more than 60 years old, which is distributed into five areas of health and 162 doctor and nurse offices; a research was developed in two phases 1) recording of all patients with Parkinson Disease diagnosis made by those doctor´s offices and 2) evaluation of all patients made by a special team of the Institute of Neurology and Neurosurgery of Cuba for a diagnosis confirmation. RESULTS: The diagnosis for 28 patients was confirmed, predominating the group of 60 to 69 years with 25% of pathological familiar antecedents of first and second degree for the disease; 92,86% of good answer to levodopa and motor complications after 3 years of treatment cycle. The 30% of patients presented parkinsonisms by medicines. CONCLUSIONS: It was detected a low disease prevalence, with a 41.6% of over diagnosis. The hand tremor was the most frequent initial symptom and the presence of motor fluctuations was more related with long exposures to levodopa than diskynesias. The diagnosis capacity of the medical personal of primary attention must be raised. 27P58 Functional magnetic resonance imaging in Parkinson´s disease before and after levodopa Mario Álvarez, Lázaro Álvarez, Rolando Palmero International center for Neurological Restoration (CIREN) Havana, Cuba Functional Magnetic Resonance (fMRI) was used to study blood oxygen level dependent cortical signal changes associated with volitional limb movements with and without levodopa in Parkinson‟s disease. Twelve patients with early stage akinetic Parkinson‟s disease and four volunteers underwent functional imaging while performing movements of the hand. We repeated the scanning procedure in the Parkinson‟s disease patients when akinesia improved after oral levodopa. Compared with the control group, patients both off and on levodopa showed movement related impaired activation in the rostral supplementary motor area, primary motor cortex and cerebellum, and increased activation in parietal cortex. We conclude that levodopa improves impaired motor initiation in the supplementary motor area and decreases hyperfunction of lateral premotor associated with Parkinson´s disease during simple volitional movements. The cortical areas cited above are not primary damaged in Parkinson‟s disease thus could be the target for further new rehabilitation programs. ABSTRACTS Sponsored by: Centro Internacional de Restauración Neurológica Ave. 25 # 15805, Cubanacán 11300 Playa, Ciudad de La Habana CUBA