H. Tankisi

Magnetic resonance neurography and diffusion tensor imaging of the peripheral nerves in patients with Charcot‐Marie‐Tooth Type 1A

Investigation of peripheral neuropathies by magnetic resonance neurography (MRN) may provide increased diagnostic accuracy when performed in combination with diffusion tensor imaging (DTI). This study seeks to evaluate DTI in the detection of neuropathic abnormalities in Charcot‐Marie‐Tooth type 1A (CMT1A).

Risk-Factor Trajectories Preceding Diabetic Polyneuropathy: ADDITION-Denmark

OBJECTIVE To study cardiometabolic risk-factor trajectories (in terms of levels and changes over time) preceding diabetic polyneuropathy (DPN) 13 years after a screen-detected diagnosis of type 2 diabetes. RESEARCH DESIGN AND METHODS We clinically diagnosed DPN in a nested case-control study of 452 people in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION). By linear regression models, we estimated preceding risk-factor trajectories during 13 years. Risk of DPN was estimated by multivariate logistic regression models of each individual’s risk-factor trajectory intercept and slope adjusting for sex, age, diabetes duration, height, and trial randomization group. RESULTS Higher baseline levels of HbA1c (odds ratio [OR] 1.76 [95% CI 1.37; 2.27] and OR 1.68 [95% CI 1.33; 2.12] per 1% and 10 mmol/mol, respectively) and steeper increases in HbA1c over time (OR 1.66 [95% CI 1.21; 2.28] and OR 1.59 [95% CI 1.19; 2.12] per 1% and 10 mmol/mol increase during 10 years, respectively) were associated with DPN. Higher baseline levels of weight, waist circumference, and BMI were associated with DPN (OR 1.20 [95% CI 1.10; 1.31] per 5 kg, OR 1.27 [95% CI 1.13; 1.43] per 5 cm, and OR 1.24 [95% CI 1.12; 1.38] per 2 kg/m2, respectively). CONCLUSIONS Both higher levels and slopes of HbA1c trajectories were associated with DPN after 13 years. Our findings indicate that the rate of HbA1c increase affects the development of DPN over and above the effect of the HbA1c level. Furthermore, this study supports obesity as a risk factor for DPN.

Chronic Pain and Neuropathy Following Adjuvant Chemotherapy

ObjectivenTo determine symptoms and characteristics of chronic sensory neuropathy in patients treated with oxaliplatin and docetaxel, including patterns of somatosensory abnormalities, pain descriptors, and psychological functioning.nnnDesignnA retrospective cross-sectional study.nnnSettingnA chronic pain research center.nnnSubjectsnThirty-eight patients with chronic peripheral pain and/or dysesthesia following chemotherapy.nnnMethodsnSensory profiles, psychological functioning, and quality of life were assessed using standardized questionnaires. In addition, standardized quantitative sensory testing and nerve conduction studies were carried out.nnnResultsnThe sensory profiles and clinical symptoms were very similar in the two groups. Pricking, numbness, and burning were common descriptors in both groups, and the predominant finding was sensory loss to A beta-mediated sensory modalities with decreased mechanical and vibration detection thresholds. A high frequency of abnormalities in thermal sensory limen and the presence of paradoxical heat sensation seem to be sensitive markers of small fiber loss. Both groups had mainly sensory, axonal large fiber or mixed fiber polyneuropathy, which tended to be most severe in the oxaliplatin group.nnnConclusionsnBoth oxaliplatin-induced and docetaxel-induced polyneuropathies represent a significant problem that affects the daily life of the patients. Our results, defining the somatosensory phenotype, can improve the understanding of the pathophysiological mechanisms useful for future studies in the tailored treatment of prevention of chemotherapy-induced peripheral neuropathy and pain.

Response to Comment on Andersen et al. Risk-Factor Trajectories Preceding Diabetic Polyneuropathy: ADDITION-Denmark. Diabetes Care 2018;41:1955–1962

We thank Rigalleau et al. (1) for their interest in our study (2) on risk-factor trajectories preceding a clinical diagnosis of diabetic polyneuropathy (DPN) 13 years after a diagnosis of type 2 diabetes by screening. Rigalleau et al. showed that in patients with long-standing diabetes, retrospectively analyzed strong declines in HbA1c levels over 6 years were associated with higher indices of DPN (vibration perception thresholds and skin autofluorescence) (1). Strong decline was defined as the quintile of patients experiencing the greatest decline in HbA1c in the 6 years preceding DPN assessments. Associations were studied in linear regression models adjusted for sex, age, diabetes duration, BMI, blood lipids, and arterial hypertension.nnIn our study (2), we hypothesized that the velocity of risk-factor changes during the course of diabetes might reflect distinct pathophysiological mechanisms and that the effect …

Chronic neuropathic pain following oxaliplatin and docetaxel: A 5-year follow-up questionnaire study

Abstract Background Adjuvant chemotherapy with docetaxel and oxaliplatin increases survival in patients with high-risk breast and colorectal cancer, respectively, but may induce acute and chronic neurotoxicity. This study is a 5-year follow-up of chronic chemotherapy-induced peripheral neuropathy (CIPN). Methods In 2011–2012, 74 patients with high-risk colorectal cancer and 100 patients with high-risk breast cancer answered a questionnaire before, during and one year after receiving adjuvant chemotherapy with oxaliplatin and docetaxel, respectively. In 2016, a 5-year follow-up with the same questionnaire was performed in survivors. Results Fifty-two (36.5% women) of 74 patients (91%) treated with oxaliplatin and 80 (100% women) of 100 patients (85%) treated with docetaxel answered the questionnaire. The most common symptoms of CIPN were tingling in the hands (44.2% in the oxaliplatin (CI 95% 30.5; 58.7) and 36.3% in the docetaxel group (CI 95% 25.8; 47.8)) and feet (52.0% in the oxaliplatin (CI 95% 37.6; 66.0) and 37.5% (CI 95% 29.9; 49.0) in the docetaxel group) and numbness in the feet (34.6% in the oxaliplatin (CI 95% 22.0; 49.1) and 17.5% (CI 95% 9.9; 27.6) in the docetaxel group). Pain was present in the hands or feet in 28.9% of patients treated with oxaliplatin (CI 95% 17.12; 43.0) and 31.3% of patients treated with docetaxel (CI 95% 21.3; 42.6). Conclusions The results showed no major change in symptoms of neuropathy or pain from 1 to 5 years after chemotherapy. Symptoms of neuropathy were more common in patients treated with oxaliplatin.

P258 Detection of early motor involvement in diabetic polyneuropathy using a novel MUNE method-MScanFit MUNE

Hospital Aim To examine whether a novel MUNE method so called MScanFit MUNE (MScan) can detect early motor involvement in diabetic polyneuropathy (DPN). Methods In this study, 100 patients with diabetes mellitus type II will be prospectively included as a part of International Diabetic Neuropathy Consortium (IDNC) project. Preliminary results of 24 patients (18 males, 6 females, mean age: 63, range: (44–74) will be presented here. Nerve conduction studies (NCS) of three motor (median, peroneal, tibial) and three sensory (bilateral sural and median) nerves and MScan in abductor pollicis brevis (APB) muscle were done in all patients.NCS results were compared to laboratory controls. MScan results were compared to 20 age-matched healthy subjects. Results From NCSs, DPN was classified by Dyck’s criteria. Six of 24 patients (25%) had DPN while 18 patients had normal NCS. None of the 24 patients had decreased CMAP amplitude of median nerve. MScan was abnormal in eight of 24 patients (33%). Of these eight, two patients had DPN and six had normal NCS. Discussion Normal MScan in patients with DPN may be due to length dependent feature of DPN, thereby unaffected upper extremities as these patients had slight sensory neuropathy. However, MScan could detect abnormality in nerves with normal CMAP amplitude and normal NCS. Conclusion MScan may improve electrodiagnosis of DPN by detection of early motor involvement and motor unit loss. Significance MScan is a promising novel method which may be useful in quantifying motor unit loss in different neuromuscular disorders including DPN.

P968: Motor unit number estimation in diabetes mellitus patients with and without polyneuropathy

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S305 117, range 65–182) were significantly lower than control MUNIX (mean 215, range 131–391) and MPS (mean 329, range 165–503) (p<0.01). Similarly in CIDP patients both MUNIX (mean 64, range 19–139) and MPS (mean 98, range 15–223) were lower than controls (p<0.01). In CIDP patients MUSIX (mean 90, range 61–136) and sMUP (mean 50, range 29–69) were significantly higher than control MUSIX (mean 58, range: 40–89) and sMUP (mean 35, range 22–61) (p<0.05). In contrast, no significant difference was found for MUSIX (mean 65, range 48–104) and sMUP (mean 40, range 18–58) in AIDP patients compared to controls (p>0.05). When AIDP and CIDP groups were combined a sensitivity of 84.62% for MPS and 69.23% for MUNIX were estimated. Conclusions: Decreased MPS and MUNIX suggest presence of axonal loss both in AIDP and CIDP. Increased motor unit size in CIDP patients indicates compensatory reinnervation. Moreover, MPS is shown to be a more sensitive MUNE method than MUNIX in inflammatory demyelinating neuropathies. P967 Two novel HSJ1 mutations in a cohort of distal hereditary motor neuropathy patients B. Gess1, A. Schirmacher1, M. Auer-Grumbach2, J. Senderek3, P. Young1 1University Hospital Muenster, Sleep Medicine and Neuromuscular Disorders, Muenster, Germany; 2University Hospital Vienna, Neurology, Vienna, Austria; 3Friedrich-Baur-Institute, Munich, Germany Distal hereditary motor neuropathies (dHMN) form a rare group of hereditary neuropathies characterized by distal motor symptoms. HSJ1 was recently found as the causative gene of a recessive dHMN in a Moroccan Jewish kindred. In this study, we undertook genetic testing for mutations in the HSJ1 gene in a cohort of dHMN patients from Germany and Austria. We found four patients, two each in two families, with HSJ1 mutations. Both HSJ1 mutations were novel and homozygous. One mutation was a splice-site-, the other a missense-mutation. The splice-site mutation was shown to lead to inclusion of an intron into the transcript, causing reduced expression of HSJ1 protein in patient fibroblast cultures. Patients showed distal-symmetric pareses of the legs and the hands. Nerve conduction studies showed axonal neuropathy with signs of acute and chronic denervation in electromyography. In one family, there was mild sensory involvement in clinical and electrophysiological testing. Taken together, we show a low frequency of HSJ1 mutations and present two novel mutations in our cohort of dHMN patients. P968 Motor unit number estimation in diabetes mellitus patients with and without polyneuropathy M.-M. Kallestrup1,2, S. Paramanathan1, H. Andersen2, A. Fuglsang-Frederiksen1, H. Tankisi1 1Aarhus University Hospital, Dept. of Clinical Neurophysiology, Aarhus, Denmark; 2Aarhus University Hospital, Dept. of Neurology, Aarhus, Denmark Question: What is the utility of Motor Unit Number Estimation (MUNE) methods in quantifying the degree of axonal loss in Diabetes Mellitus patients with and without polyneuropathy? Methods: Twenty-two Type I and Type II diabetic patients were prospectively included. Patients were divided into neuropathic (10) (mean age: 66, range: 47-78) and non-neuropathic group (12) (mean age: 64, range: 41-78), based on clinical examination and nerve conduction studies in dominant median motor and sensory, bilateral peroneal and tibial motor and bilateral sural nerves. Multipoint Stimulation MUNE (MPS) and Motor Unit Number Index (MUNIX) examinations on Abductor Pollicis Brevis by stimulating the median nerve were conducted. Motor unit size was calculated as surface motor unit potential (sMUP) and Motor unit size index (Musix). The results were compared with twenty untrained healthy control subjects (mean age: 46.7, range: 23-67). Results: In neuropathic patients MUNIX (mean: 122, range: 34-308) and MPS were (mean: 100, range: 63-262) significantly lower than control MUNIX (mean: 215, range: 131-391) and MPS (mean: 329, range: 162-503) (p<0.05). Similarly, in non-neuropathic diabetic patients, MUNIX (mean: 147, range: 65-306) and MPS (mean: 147, range: 61-304) were lower than controls (p<0.01). sMUP was significantly higher both in neuropathic (mean: 71, range: 38-120) and non-neuropathic (mean: 64, range: 39-130) patients than controls (mean: 35, range: 22-61) (p<0.05). In contrast, there was no difference in Musix between controls (mean: 58, range: 40-89) and neuropathic (mean: 67, range: 34-122) or non-neuropathic (mean: 65, range: 43-112) diabetic patients (p>0.05). Conclusions: Decreased MPS and Munix values together with increased sMUP suggest presence of axonal loss not only in neuropathic but also in non-neuropathic diabetic patients which probably could not be determined by routine NCSs due to compensatory reinnervation. However, further studies should be conducted with larger patient groups and older control subjects. P969 New evidence suggesting high fasting glycemia as a cause of peripheral neuropathy in non-diabetic subjects B.I. Tiftikcioglu1, T. Duksal1, S. Bilgin1, S. Kose2, Y. Zorlu1 1Tepecik Research and Education Hospital, Neurology, Izmir, Turkey; 2Tepecik Research and Education Hospital, Infectious Diseases and Clinical Microbiology, Izmir, Turkey Question: Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) have been referred to as “pre-diabetes” and represent an increased risk for diabetes. Although several groups have mentioned the necessity of evaluation of patients with IGT for neuropathy, IFG patients have not been studied yet. Microvascular inflammation is one of the major pathogenetic mechanisms in diabetic peripheral neuropathy (DPN). However, the relationship between inflammation and nerve conduction studies (NCS) abnormalities has not been studied extensively. We aimed to investigate the associations between the serum biomarkers of inflammation and endothelial dysfunction and the most distal sensory NCSs in the very early phases of diabetes, namely IFG and IGT. Methods: NCSs including sural, medial dorsal cutaneous (MDC), dorsal sural (DS) and medial plantar (MP) sensory nerves, were performed on 44 controls, 25 IFG and 25 IGT patients. Symptoms and examination were scored using Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS). Serum vWF and sE-selectin levels were analyzed for endothelial dysfunction, inflammation was assessed through an IL-6 assay. Results: Compared with controls, IL-6 levels were higher in IFG and IGT; vWF and sE-selectin levels were higher in IGT (p<0.001). Compared with IFG patients, levels of all biomarkers were higher in IGT (p<0.05). Increase in IL-6 levels was related to increase in NSS and NDS. Both IFG and IGT patients showed significant abnormalities in MDC, DS and MP sensory NCSs, even in patients with preserved sural NCSs. Increase in biomarkers of inflammation and endothelial dysfunction were correlated with various NCS abnormalities in MDC, DS, and MP sensory NCSs (p<0.05). Conclusions: Our results indicate that neuropathy might begin in individuals as early as IFG stage. This is confirmed by both clinically, through increased NSS and NDS, and electrophysiologically, through impaired NCSs of the most distal sensory nerves. Besides, the marked elevation in IL-6 indicates the on-going inflammation process in IFG patients. Abnormalities in the most distal sensory NCSs were associated with biomarkers of inflammation and endothelial dysfunction. Our findings highlight the importance of evaluating individuals with IFG, as well as IGT, in terms of peripheral neuropathy. P970 Distinctive patterns of sonographic nerve enlargement in CharcotMarie-Tooth type 1A and hereditary neuropathy with pressure palsies S. Goedee, G. Brekelmans, L. van den Berg, L. Visser UMC Utrecht, Neurology, Utrecht, Netherlands Objective: We systematically investigated main arm and leg nerves in CMT-1A and HNPP patients to determine whether nerve sonography is able to discriminate between HNPP and CMT-1A. Background: Sonographic detection of morphologic abnormalities in polyneuropathies is a relatively new research area. The most prominently encountered pathological features are nerve enlargement, increased fascicle size, hypo-echogenicity and intraneural vascularization. There are only a few case reports and case series, mentioning nerve enlargement in CMT and HNPP patients. However, no systematic investigation has been performed yet. Methods: We recruited 9 patients fulfilling the international criteria on CMT-1A and 9 with DNA proven HNPP. Medical Research Council sumscore was determined. A standardized sonographic protocol was applied.

P236: Neurophysiological changes in CIDP patients treated with subcutaneous immunoglobulin

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S111 Methods: We report the clinical and neurophysiological findings in three patients with CMT and neprhopathy and a follow-up of ten years. Results: The probands, a 29 year old woman and her brother, aged 27, reported gait imbalance and feet deformities since infancy. Both had developed end-stage renal disease, steppage gait, severe atrophy of distal muscles of the forearm and legs and areflexia. Nerve conduction studies (NCS) revealed absent sensory nerve action potentials (SNAPs), absent motor potentials in lower limbs and intermediate motor nerve conduction velocities (MNCV) in upper limbs. The brother died of sepsis at age 39. His elder son, evaluated at age 6, had frequent falls and NCS revealed slight reduction of SNAPs amplitudes and conduction velocities. After ten years, he developed feet deformities, steppage gait and renal failure. Kidney biopsy revealed diffuse glomerular sclerosis. All SNAPS were absent and MNCV was reduced to intermediate range. No mutations were found in PMP22, MPZ, EGR2 or GJB1. Conclusions: The mechanisms underlying neurological and renal disease in CMT/FSGS are currently unknown, although both diseases seem to progress together in an inexorable way to end-stage renal failure and severe neurological compromise. P235 Cervical myelopathy masked by sensorymotor polyneuropathy S. Kostic Dedic, T. Smiljkovic, R. Sujic, V. Cvijanovic, V. Nikolic, D. Jovanovic, J. Malovic, A. Gavrilovic chc zvezdara, Neurology, belgrade, Serbia Background: Peripheral nerve disorders due to polyneuropathy can alter the signs of myelopathy. Methods: This study is a case description and analysis of 4 consecutive cases with the diagnosis of cervical myelopathy coexisting peripheral nerve disorder identified during the sixth years. Results: All our 4 cases had compressive cervical myelopathy due to disc herniation C4-5 in assotiation with sensorymotor polyneuropathy, in three cases with diabetes melltus and in one case with hypothireoidism. There were three man and one woman, average age of 59 year. They suffered from weakness and numbness legs during one or two years. Previously present data for diabetes mellitus and hypothyroidism. Neurological examination revealed hipotrophy of legs, enhanced one or both PR while AR were reduced. Extensor plantar response in three patients but asymmetrical and flexor in one patient. Electrophysiologic fundings showed markedly reduced amplitude of the distal sensory and motor evoked response of both peroneus and tibialis nerves with reduced motor and sensitive conduction velocity, without signs of denervation (EMNG) and reduced amplitude with prolonged distal latency of N9 and asymmetricaly dicrease amplitude of N13 (SSEP n medianus). Cervical spine MRI showed herniates disc C4-5 and signs of myelopathia with stenosis of spinal canal. Conclusion: It is important to continually question whether the working diagnosis of peripheral nerve disorder explains the clinical findings. Electrodiagnostic tests and neuroimaging methods can identified myelopathy whose adequate treatment offers a better outcome. P236 Neurophysiological changes in CIDP patients treated with subcutaneous immunoglobulin M. Otto1, H. Tankisi1, L. Markvardsen2, A. Fuglsang-Frederiksen1 1Aarhus University Hospital, Dept. of Clinical Neurophysiology, Aarhus, Denmark; 2Aarhus University Hospital, Dept. of Neurology, Aarhus, Denmark Question: Do electroneurographic parameters and Motor Unit Number and Size Index (MUNIX, MUSIX) change during treatment with subcutaneous immunoglobulin (SCIG) in patients with chronic inflammatory demyelinating polyneuropathy (CIDP)? Methods: We analyzed neurophysiologic data from a randomized, placebocontrolled, double-blind parallel-group trial, testing SCIG in 30 patients with CIDP (Markvardsen et. al 2013). This trial had showed an improvement in isokinetic muscle strength in the SCIG group. Neurophysiological evaluation was performed before and after the 12 weeks treatment period. We assessed the distal motor latency (DML), motor conduction velocity (mCV), amplitude and duration of the compound muscle action potential (CMAP) as well as F-wave minimum latency in one peroneal, median and ulnar nerve. MUNIX and MUSIX were assessed in the abductor pollicis brevis muscle. Results: Data from 23 patients could be analyzed. Changes in MUNIX were greater in the SCIG treated group compared to placebo (p<0.05), with higher MUNIX values in the end of the treatment period. We found no change in MUSIX neither during SCIG or placebo. There was a trend towards an increase in CMAP amplitudes during SCIG treatment (p=0.05). On the other hand, DML, mCV and F-wave latencies remained unchanged. Conclusion: MUNIX values increased during treatment with SCIG. This might be due to an increase in CMAP amplitudes. There were no changes in DML, mCV or F-wave latencies during treatment with SCIG. P237 Neuropathic complications in patients after unilateral varicectomy – comparing the yield in neurography, clinical sensory tests and subjective symptoms L. Puksa1, J. Lieberg2, S. Jaeaeskelaeinen2,3, S. Laaksonen3 1Tartu University of Tartu, Department of neurology, Tartu, Estonia; 2Tartu University Hospital, department of vascular surgey, Tartu, Finland; 3Turku University Hospital, Department Of Neurophysiology, Turku, Finland Question: The aim of the study was to investigate occurrence and risk factors of sensory nerve injuries and neuropathic pain in patients undergoing varicectomy, and to evaluate the diagnostic sensitivity of sensory neurography and clinical sensory tests in detecting the neuropathic complications. Methods: All 38 patients (33 women) were prospectively studied before and within 30 days after varicectomy. The patients who showed neuropathic symptoms or signs were further investigated after 3 and 6 months. Symptoms were evaluated using a symptom chart drawing and Visual Analogue Scale (0-100) for pain. Clinical sensory tests included warm/cold discrimination using thermal rolls (Somedic) and tactile as well as mechanical pain detection thresholds measured with Semmes-Weinstein monofilaments and method of limits. Pain wind-up was tested with the monofilament giving the first slight sensation of pricking pain. Sensory neurography of the sural, saphenous, and superficial peroneal nerves was done bilaterally with standardized protocol. Results: Five of the 38 patients (13.2%) reported postoperative neuropathic symptoms: neuropathic pain and altered sensibility: two patients within saphenous, one within superficial peroneal and saphenous, and two patients in all 3 studied nerve distributions. In 4 patients, sensory alterations and pain symptoms disappeared by 6 months after surgery. In one patient (2.6%), neuropathic pain persisted after severe partial axonal saphenous nerve lesion. Neurography findings were in line with subjective symptoms and confirmed all nerve injuries (demyelinating), severity of the lesion was moderate/severe), while clinical sensory tests were able to detect 3 out of 7 injured nerves. Conclusion: Varicectomymay cause neuropathic complications but it rather infrequently gives rise to persistent neuropathic pain. Subjective sensory symptoms should be verified with neurophysiologic recordings as clinical sensory testing may remain falsely negative in these iatrogenic injuries. Poster session 14. Neurorehabilitation P238 Does cross-training balance strength asymmetry in healthy subjects? A proof-of-concept trial A. Manca1, E. Ortu1,2, F. Ginatempo1,2, F. Pisanu1, E. Tolu1, F. Deriu1 1University of Sassari, Department of Biomedical Sciences, Sassari, Italy; 2National Health Institute-S.S.N. ASL 1 Sassari, Neurology, Ozieri, Italy Question: We investigated whether a unilateral, maximal isokinetic strength training of the stronger leg may balance strength asymmetry between sides, inducing in the contralateral untrained side a worthy strength-transfer, i.e. a cross-training effect (CT) as well as cortico-spinal adaptations. Methods: Ten healthy volunteers (25.2±4.3yrs) underwent: i) bilateral measurements of the tibialis anterior (TA) strength with isokinetic dynamometry; ii) assessment of both cortical and spinal drives to the untrained TA, through recordings of central motor conduction time, input-output curve, short-interval intracortical inhibition, intracortical facilitation, shortinterval intracortical facilitation, cortical silent period (cSP), short-latency afferent inhibition, H-reflex, V-wave and M-wave. Dynanometric and neu-

Poster session 49. Free topicsP875: Pelvic floor electrophysiology in spinal cord injury

There exists a way of invading physically the area of game in football stadium. We can modify his acoustic field. The pretension is to study the stimuli generated by the principal sources of the sound: the supporters from the terraces. The exhibition to these sonorous stimuli well could unleash feelings euphoria, lessen the physical weariness, to free from inhibitions, improve the skill ambidextrous, modify the relation temporary space, alter the perception or diminish the time of response. Another application may be to reduce the recovery time of injuries, allowing to reduce the perception of effort and pain if not relevant. Similarly, the music has been used to reduce the length of stay in hospital care units. Along the investigation have been registered the sonorous environments of six matches. Also there have been processed some other sonorous stimuli of equal duration and claimed emotional load but without any relation with the sport. Finally fans have been exposed to these stimuli in order to value, by means of the response format named SELF ASSESSMENT MANIKIN. We answer about arousal, valence and other variables. Also, we used Electrodermal Group Activity (EDAg) for study lateral answer of brain and compare with previously qualitative results. This measurement technique is possible with machine named Sociograph®. Of this form we will be able to discriminate against the variable of belonging or not to the sports activity as fundamental characteristic of the stimulus to study the consequences in the brain.

P831: Laser evoked cutaneous silent periods in patients with chemotherapy induced polyneuropathy

Question: Short-term habituation (STH) is known as a fundamental component of attention since it represents a cortical “bottom-up” filter for salient stimuli. Our aim was to verify if STH is still preserved in patients with different levels of Disorder of Consciousness (DOC), namely vegetative (VS) versus minimally conscious state (MCS). Methods: We selected 40 DOC patients assessed with a standardized neurobehavioral examination (Coma Recovery Scale-Revised). We performed a multimodal neurophysiological evaluation that included EEG, somatosensory evoked potentials, oddball protocol and STH paradigm. The STH protocol provides for the delivery of trains of three stimuli (S1-S2-S3): S1 and S2 always belongs to the same sensory modality (auditory or somatosensory) whereas S3 can belong either to the same modality or to the alternative modality. S1/S2/S3-related N1-P2 amplitudes were compared in order to detect any STH. Results: STH was detected in each emerging and MCS patient, whereas it was found absent only in the VS group (10 out of 19): until now, none of these 10 patients has regained consciousness. Among the 9 VS patients showing STH, 4 have subsequently become MCS. Conclusions: STH could represent a new potential diagnostic/prognostic neurophysiological tool in DOC. The STH protocol may be able to pick-up preserved elementary information processing in DOC patients since we found a STH in every patient with a preserved level of consciousness (emerging and MCS groups). It remains to be determined whether the presence/absence of STH in an early DOC stage can have a prognostic value and whether the absence of STH in chronic VS can assume the significance of a diagnostic confirmation.