29th International Congress of Clinical Neurophysiology S253

Method: Focusing on corticospinal tract, the time course of FA in posteriorlimb of the internal capsule (FA/PIC) was analyzed in group of normalcontrol and of neurotrauma (A; shaken baby syndrome and infant acutesubdural heamtoma, B; neonatal intracranial bleeding, C; congenitalhydrocephalus, D; other). Using 1.5T MRI (GE Signa), DTI image wasobtained with pulse sequence EPI, b value 1000, Matric 128×128, slicedepth 4 mm, MPG 15 axis. On FA map, FA of PIC was mesured by manualROI on both sides.Result: (1) FA/PIC was reliabe, independent of examiner. (2) In earlyinfancy, FA/PIC showed steep increase in first 20 weeks and gradualafterward. (3) In Gp. A and D, the decrease of FA/PIC correlated withlater motor development delay and spasticity.Conclusion: To evaluate the effect of neurotrauma on infant moterdevelopment, analysis FA/PIC was one handy method to detect and toprospect future developmental delay. DTI provide marked information ofwhite matter damage which other modality could not, and futher casestudies are required.

P25-12Is pain quality associated with specific physiopathological mechanismsin migraine of adolescents? A neurophysiological and psychologicalstudy

C. Vollono1, S. Tarantino1, C. De Ranieri2, F. Galli3, M. De Luca1,G. Biondi2, F. Vigevano1, V. Guidetti4, M. Valeriani11Headache Center, Neurology Division, Paediatric Hospital BambinoGesu IRCCS, Rome, Italy, 2Paediatric Psychology, Paediatric HospitalBambino Gesu IRCCS, Rome, Italy, 3Faculty of Psychology, La SapienzaUniversity, Rome, Italy, 4Dipartimento di Neurologia, Psichiatriae Riabilitazione della Infanzia e della Adolescenza, La SapienzaUniversity, Rome, Italy

Objective: Some studies showed a different physiopathological mech-anism working in migrainous imploding pain (IP) or exploding pain (EP).Aims of this study were to investigate whether the level of somatosensorysystem excitability in adolescent migraineurs with EP or IP is different,and whether this may interact with some psychological features.Methods: We studied 18 patients with migraine without aura. They weredivided in 2 groups on the base of their type of pain: 11 patientshad a prevalent EP and 7 patients referred IP. The somatosensoryevoked potential (SEP) recovery cycle was used to compare 2 groups.We calculated the modifications of the latency and amplitude of theSEP components after paired electrical stimuli at 5 ms, 20 ms and40 ms interstimulus intervals (ISIs), comparing these data with a singlestimulus condition assumed as the baseline. Psychological assessmentwas performed by means of the State Trait Anger Expression Inventory(STAXI), a measure of the components of anger.Results: As for the frontal N30 SEP component recovery cycle, therewas a significant interaction between the ISI and the group of patients.Correlation analysis showed that: (1) in EP patients there was a positivecorrelation between the N30 amplitude change at 5 ms ISI and the levelof anger directed inward (Anger-In), and (2) in IP patients there was anegative correlation between the N30 amplitude change at 5 ms ISI andthe trait anger (T-Anger).Conclusions: Our results suggest that the inhibitory mechanisms withinthe somatosensory cortex are more impaired in IP than in EP patients.Moreover, while the N30 amplitude modifications in the double stimuluscondition show a positive correlation with anger in EP patients, thiscorrelation is negative in IP patients. The hypothesis can be made that thetype of migraineuos pain is associated with different physiopathologicalmechanisms.

P25-13Spinal cord injury at birth as a consequence of a postulatedprenatal anterior spinal artery ischemic infarct: The value ofelectromyographic studies

I. Goirigolzarri1, M. Pitt2, A. Molyneux2, C. De Pablos1, A. Garcia1

1Department of Clinical Neurophysiology, University Hospital Marques deValdecilla, Santander, Spain, 2Department of Clinical Neurophysiology,Great Ormond Street Hospital for Children, London, UK

Objective: To evaluate the use of electrodiagnostic studies (nerve con-duction studies and needle EMG) in the diagnosis of a possible intrauterineanterior spinal artery ischemic infarct evident soon after birth.Method: A case series review of the clinical and electromyographicfindings in 4 neonates with bilateral and symmetrical flaccid upper limb

weakness at birth. Clinically lower limbs and facial/bulbar muscles werenormal. In case 4 there was additional respiratory weakness requiringventilation from birth. All patients were initially suspected to havesuffered a brachial plexus injury.Results: Sensory nerve action potentials from the upper limbs werenormal in all cases. Compound motor action potentials from the abductorpollicis brevis and first dorsal interosseous in all cases showed severereduction or absence of response. Electromyography (EMG) showedchanges of chronic denervation in myotomes between C5-C7/C8 in allpatients. In case 4, the patient with ventilator dependence, the EMGshowed additional chronic denervation in the T8 intercostal but normaldiaphragmatic EMG. MRI in this case showed significant thinning of thecord from C7-T7 with appearances of patchy myelomalacia extending2 levels above the start of the thinning. Also no signs of nerve rootavulsion were present radiologically. The MRI changes were consistentwith a vascular insult to the cord not localizable to a specific territorydue to the image quality. Imaging was not available in the other cases.Conclusion: In a newborn infant with symptoms of bilateral flaccidarms with or without respiratory difficulty, electrophysiological studies(electromyography, sensory and motor nerve conduction studies) arerecommended as they allow distinction between brachial plexus palsy andcervico-thoracic myelopathy. We postulate that the common aetiology inthese cases is an ischaemic event in the distribution of the anterior spinalartery during the prenatal period.

P25-14Autonomic tone, autonomic reactivity and autonomic maintenanceof activity features in older school age children with type I diabetesmellitus

A.V. Nalbat1, E.Z. Yakupov1

1The Neurology, Neurosurgery and Medical Genetics Department, KazanState Medical University, Kazan, Russian Federation

Objective: To evaluate the features of autonomic tone and the dynamicsof time and spectral indices during the active orthostatic test (AOT) inolder school age children with type I diabetes mellitus (DM).Methods: By time and spectral analysis of the structure of heart ratevariability during the background test and the AOT 32 children aged12 17 years with type I DM were examined. The comparison groupconsisted of 30 healthy children of comparable age and sex.Results: The autonomic tone in children with type I DM was characterizedby a reduction of sympathetic influences, was reflected in the reliabledecline in LF (low frequency component) and the LF/HF-ratio (p < 0.05).The contribution of VLF (very low frequency component) (humoral-metabolic effect) was also reduced. In spite of this the values oftotal spectral power (TP) were within the conventional standards byincreasing of parasympathetic influences (high frequency component,HF). The overall reactivity of the autonomic nervous system (ANS) andthe reactivity of its parasympathetic division were assessed during theAOT. Significant decrease in parasympathetic reactivity (the coefficient‘30/15’<1.2) was detected in 31% of measured cases. Reduced response ofANS as a whole to the AOT was observed while in 62.5% of measured cases,indicating a decrease not only parasympathetic but also sympatheticreactivity in patients of the examined group. Autonomic maintenance ofactivity during the AOT was characterized by halve-reduction of spectralpower in all investigated ranges compared with the norm.Conclusions: The functional state of ANS in older school age childrenwith type I DM is characterized by the reduction in the contribution ofsympathetic and humoral-metabolic effects on the background of theredundancy of parasympathetic influences in rest and by the lack of totalinput from both divisions of ANS during the AOT.

P25-15Reflex seizures triggered by tooth-brushing: Report of a severelydisabled girl

T. Kumada1, R. Nishii2, T. Higashi2, T. Miyajima1, T. Kusunoki1, N. Oda1,H. Shimomura1, K. Saito1, N. Mito1, T. Fujii11Department of Pediatrics, Shiga Medical Center for Children, Shiga,Japan, 2PET Unit, Shiga Medical Center Research Institute, Shiga,Japan

Objective: Tooth-brushing epilepsy is rare reflex epilepsy triggered bybrushing the teeth. The somatosensory cortex is speculated to beresponsible for this reflex epilepsy. Only eight cases have been reported inthe literature, none of whom had psychomotor delay, and all developed