Posters

P01 - Hyperhomocysteinemia. A Risk Factor of Stroke and Recurrent Stroke

Brander T, Christensen H, Gideon R, Truelsen T, Boysen G



Department of Neurology and Department of Clinical Biochemistry, Bispebjerg Hospital, Denmark



Objective: The levels of s-homocystein (s-hcy) were compared in patients with transient ischemic attachs (TIA), ischemic stroke and hemorrhagic stroke. We evaluated s-hcy measured the day after admission as a predictor of recurrent stroke within the following year.

Methods: 944 patients were admitted at the Department of Neurology, Bispebjerg Hospital with the diagnoses TIA (n=190), ischemic stroke (n=634) or hemorrhagic stroke (n=120). The patients` mean levels of s-hcy were compared in the three diagnoses, and in patients with recurrent stroke versus patients without recurrent stroke during the following year. Due to log normal distribution, data was analysed after log 10 transformation. A multivariate logistic regression model was set up after univariate analysis including variables at a significance level of 0.1.

Results: Patients with an ischemic event (TIA or ischemic stroke) (n=824) had a mean s-hcy of 11.99 mmol/l (CI 95%: 11.64-12.39), patients with hemorrhagic stroke had a mean s-hcy of 10.52 mmol/l (CI 95%: 9.73-11.38). The difference between the two groups was significant, p=0.003. After one year we could document recurrent stroke in 44 cases, these patients had mean s-hcy levels at the primary admission of 14.29 mmol/l (CI 95%: 11.51-17.70) whereas patients without recurrent stroke had mean levels of s-hcy of 11.69 mmol/l (CI 95%: 11.53-12.27), p=0.005. S-hcy reached significance in multivariate logistic regression model.

S-hcy+10mmol/l OR: 1,4(CI 95% 1.2-1.7) p=0.0028

Conclusion: Elevated s-hcy was independently associated with recurrent stroke within the first year after a cerebrovascular event. Our findings corroborate those of other investigators indicating that hyperhomocysteinemia was a risk factor for ischemic stroke. Ongoing intervention studies will clarify whether treating hyperhomocysteinemia can reduce the risk of stroke and recurrent stroke.



P02 - Correlation between early TNF-A levels and ischaemic stroke severity

Zaremba J1, Losy J1,2



1Department of Clinical Neuroimmunology,University School of Medicine, Poznan, Poland, 2Neuroimmunological Unit,Institute of Experimental and Clinical Medicine Polish Academy of Sciences, Poznan, Poland



Objectives: The study aimed to evaluate the levels of an important proinflammatory cytokine tumour necrosis factor-a (TNF-a) in cerebrospinal fluid and serum in acute stroke and to study the relation between those and the neurological stroke severity and functional disability.

Material and methods: The investigations comprised 23 ischaemic stroke patients. CSF and blood samples were obtained 24h after the onset of stroke, and stored until analysis. Patients were examined according to Scandinavian Stroke Scale (SSS) and to Barthel Index (BI).

Results: The patients displayed statistically significant high levels of TNF-a in CSF and sera within the first 24h of stroke. These correlated significantly with SSS and BI scores calculated within the same interval, and 1 and 2 weeks later.

Conclusion: The results suggest involvement of TNF-a in mechanisms of early stroke-induced inflammation and a predictive value of the initial TNF-a levels for the outcome of stroke.



P03 - Entacapone is of benefit in patients with early Parkinson's disease without motor fluctuations

Brooks D, Gordin A, Poewe W, Deuschl G, Leinonen M, Kultalahti E-R, Reinikainen K



Research Centre, Orion Pharma, Espoo, Finland



Objective: It has been shown that entacapone is effective and safe in advanced Parkinson's disease (PD). Entacapone has not earlier been studied in non-fluctuating patients. These patients can still be bradykinetic, and also have other symptoms of PD, irrespective of gaining relief with small doses of dopaminergic drugs.

The aim was to study whether patients with PD without motor fluctuations could benefit from combining entacapone with their current levodopa treatment.

Material and methods: A multicenter, placebo controlled, double-blind, randomised (2:1 entacapone vs. placebo) six months study was carried out in 29 clinics in the UK and republic of Ireland. The study included 300 PD patients, of whom 128 were classified as non-fluctuating. Entacapone, 200 mg (or placebo) was administered with each daily levodopa dose.

Results: The ADL score improved from 10.6 to 10.0 in the entacapone compared with a reduction of 0.1 in the placebo group (p<0.01). The scheduled levodopa dose remained practically unchanged in the entacapone group, and increased by 47 mg in the placebo group, the difference being statistically significant (p<0.01). The effect of entacapone was lost upon withdrawal. The ADL score worsened from the last visit value of 9.9 to a post-study value of 10.6.

Conclusion: Adjunct entacapone significantly improved the ADL score in patients without fluctuations. This demonstrates the beneficial effect of the use of entacapone before motor complications are emerging.



P04 - Changes in heart rate variability after stroke

Kristjánsson B, Hjaltason H, Stefánsson SB



Dept. of Neurology, Landspitali University Hospital, Reykjavík, Iceland.



Introduction: Heart rate variability (HRV) reflects sympathetic and parasympathetic modulation of the cardiac sinus node. The aim of the present study was to assess disruption of sympathetic/parasympathetic balance to the heart following stroke using HRV as a probe.

Material and methods: Twelve stroke patients admitted to Landspítali, University Hospital participated in the investigations. These were compared with a control group having similar age and sex distribution and without a history of neurological or cardiac disease. The patients were assessed by means of the National Institute of Health Stroke Scale. The electrocardiogram (ECG) was recorded digitally for ten minutes from all participants. The R waves of the ECG were located and time-series were constructed from consecutive R-R intervals. After calculating the mean R-R interval and its variance the latter was decomposed into 3 different frequency components by means of spectral analysis: VLF (very low frequency) < 0.05 Hz; LF between 0.05 - 0.15 representing sympathetic activity; HF between 0.15 and 0.5 Hz representing parasympathetic activity.

Results: Patients showed increased heart rate compared with controls (p<0.05). The LF component of HRV was increased in the patient group (p<0.05) but the HF component was similar in the two groups. In the patient group there was not a significant difference between the LF and the HF components whereas within the control group the HF component was stronger.

Conclusion: The results show evidence of disrupted sympathetic/ parasympathetic balance following stroke. HR and the LF component of HRV were increased in the patient indicating an increased sympathetic tone.



P05 - Microangiopathic dementia: A case report from singapore

Auchus AP, Chen CPLH, Wilder-Smith E, Yu GXE, Wong MC



Dept. of Neurology, Singapore General Hospital, Singapore



Objective: To describe a case of subcortical ischemic vascular dementia secondary to a non-CADASIL, small vessel vasculopathy.

Material and methods: A 46 year-old Chinese woman developed subacute dementia over 1.5 years. She had no chronic medical problems and no family history of similar illness. Examination revealed apathy, memory loss, pseudobulbar affect and gait apraxia. Head CT demonstrated moderate leukoaraiosis with no lacunes, hydrocephalus or cerebral atrophy. Brain MRI showed multifocal, confluent, white matter hyperintensities without areas of infarction. Biochemical analyses, syphilis and HIV serologies, and screens for collagen vascular disorders were normal. Cerebrospinal fluid was acellular and sterile, with normal protein content. Malignant cells, markers for neurotropic viruses, and oligoclonal bands were absent. P100 latencies were normal on VER, and EEG showed intermittent generalized slowing. Carotid and vertebral arteriography was normal. Vascular biopsy was performed on the palm. The biopsied material included skin and subcutaneous tissue, and was processed for light (LM) and electron (EM) microscopy using standard methods.

Results: LM revealed no evidence of perivascular inflammatory cell infiltrates, neoplasia, vessel hyalinization or fibrinoid necrosis. On EM, there was no granular osmophilic material (GOM) in smooth muscle cells as seen in CADASIL. Instead, we found hypertrophic and cuboidal endothelial cell changes producing luminal narrowing of capillaries and post-capillary venules. In addition, endothelial cells demonstrated abnormal vacuolization and villous-like invaginatons of their plasma membranes.

Conclusion: This middle-aged, Chinese woman developed progressive dementia from severe ischemic subcortical brain injury. Although large and medium-sized vessels were normal, ultrastructural studies revealed pathological changes in microvessels suggestive of an endothelial cell disorder.





P06 - Stroke is different in men and in women. The Copenhagen Stroke Study

Jørgensen HS, Mosegaard D, Houth JG



Dept. of Neurology, Gentofte Hospital, Copenhagen, Denmark

Purpose: Men and women differ in stroke incidence and possibly also regarding the functional anatomy of the brain. We compared risk factor distribution, CT findings, initial stroke severity, and outcome between sexes.

Methods: We prospectively included 1,197 unselected patients with acute stroke from the community-based Copenhagen Stroke Study. Data were analyzed in multiple regression models.

Results: Men were younger (70.8 vs 77.3 years, p<0.01), had more frequently a daily alcohol use (p<0.01), a previous myocardial infarct (p<0.01), diabetes (p=0.04), a previous stroke (p=0.04), and were smokers (p<0.01), but had less frequent hypertension (p=0.02). CT lesion size, side and regions were comparable between sexes, but women had more frequent a hemorrhage (11% vs 7%, p=0.02). Initial stroke severity was generally less severe in men (Scandinavian Stroke Scale score on acute admission was 37 vs 32 points, p<0.01). Mortality was in the univariate analysis comparable between sexes, but when differences in age, initial stroke severity, and risk factor distribution was considered, mortality was increased in men (relative risk 1.8, 95% CI 1.2 to 2.6, p<0.01).

Conclusion: Men and women differ in several aspects of stroke: in risk factor distribution, in initial stroke severity, in distribution of stroke subtype, and in outcome. We speculate that this difference may be explained by either differences in stroke pathology, and/or differences in functional anatomy or plasticity of the brain between sexes.



P07 - Quality of life after stroke in Estonia

Lembra E, Kõrv J, Roose M, Kaasik A-E



Department of Neurology and Neurosurgery, University of Tartu, Estonia



Objective: To study the quality of life of the patients who have suffered from acute stroke in Estonia.

Material and methods: All consecutive acute stroke patients admitted to the Department of Neurology, Tartu University Clinics, were registered in 1999. Six months and 1 year after the stroke the patients were sent a postal questionnaire including MOS SF-36. Additionally, the patients were contacted by investigators; those with the diagnoses of aphasia and/or dementia (<24 in MMSE) were excluded. The results of stroke patients were compared with age- and sex-matched controls drawn from the population registry of Estonia.

Results: At 6 months and 1 year after stroke 59 and 48 patients, respectively, were considered eligible for the study. The changes in MOS SF-36 during this period were nonsignificant. Comparison of the results of the patients and controls at 6 months revealed differences in most items of MOS SF-36, except for the domains of bodily pain and role limitations due to emotional health. No differences were found between the younger (< 70) and older (> 69) patients. At the same time the older controls were significantly poorer in the domain of physical functioning compared with younger controls. Differences between the younger patients and controls were found in all domains, except for the domains of bodily pain and role limitations due to emotional health. No differences were observed between the older patients and controls.

Conclusion: The quality of life of stroke patients showed no significant changes at 6 months and at 1 year after stroke. Stroke affects particularly the quality of life of the younger stroke patients.



P08 - Hemiballism in a patient with intracerebral hematoma

Haldre S, Kõrv J, Roose M



University of Tartu, Tartu, Estonia



Objective: Lesion of the subthalamic nucleus may cause contralateral hemiballistic syndrome. It may be preceded by sensory or motor complaints indicative of a vascular event involving the upper midbrain or diencephalon.

Material and methods: We describe a patient (84 y., male) who presented with the history of subjective rightsided weakness and uncontrolled movements in his right hand and leg that developed one day later.

Results: The patient had arterial hypertension for 10 years. On admission he was fully awake, there were ballistic movements in his right side, there was no obvious paresis. During sleep the symptoms were less prominent. CT scan disclosed in thalamus intracerebral hematoma with diameter of 1 cm. Haloperidol was used as symptomatic treatment. The movement disorder decreased to some extent. The patient became drowsy and disoriented. Finally he was transferred to the longterm treatment facility.

Conclusion: The reported patient with hemiballism had small hemorrhage in the basal part of the thalamus which is typical for such case. However, at our department there have been only few stroke patients who have presented with hemiballism. We have recorded the syndrome on the tape and would like to present video as an illustration to this case.



P09 - Intrathecal apolipoprotein E production is reduced in multiple sclerosis

Schwarz C, Bachner M, Schiefermeier M, Kollegger H



Department of Clinical Neurology, University of Vienna, Austria



Objective: To compare apolipoprotein E (ApoE) concentrations in cerebrospinal fluid (CSF) and plasma of patients with clincally definite, relapsing multiple sclerosis (MS) with those of age-matched controls, using the distribution of ApoE genotypes (e 3/3 vs e non3/3) and the presence or absence of relapses as grouping variables.

Material and methods: We investigated 24 MS patients (18 women, mean age 33.4 [7.2] years; 6 men, 34.3 [8.4] years; 14 patients with, 10 patients without relapses) and 28 (17 women, 11 men) age-matched headache sufferers without neurologial deficits and normal CSF findings (controls). Neurological evaluation and routine CSF examination were carried out and ApoE concentrations (CSF, plasma) were measured using an enzyme-linked immunosorbent assay. ApoE genotypes were determined by a restriction fragment length polymorphism method. For statistical analysis Mann-Whitney rank-sum tests were used.

Results: We found that the ApoE concentration in CSF (but not in plasma) of MS patients was lower than that of controls (0.31 [0.10] vs 0.40 [0.14] mg/dl; P=0.035) and that the distribution of ApoE genotypes had no influence on ApoE production. The ApoE concentration in CSF of patients with relapses was not different from that of patients without relapses (0.30 [0.09] vs 0.33 [0.12] mg/dl; P=0.585).

Conclusion: In conclusion, we demonstrate that intrathecal ApoE production in MS patients - irrespective of ApoE genotypes and the presence or absence of acute relapses - is reduced. The molecular mechanisms underlying this reduction of intrathecal ApoE production in MS patients are unknown but might provide valuable information on oligodendrocyte dysfunction and give clues how myelin repair could be promoted.



P10 - The ICAM1 K469E dimorphism is not associated with multiple sclerosis in Sweden

Masterman T, Zhang Z, Hellgren D, Anvret M, Hillert J



Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden

Intercellular adhesion molecule (ICAM)-1 is expressed on brain-vessel endothelial cells; through interaction with integrins on leucocytes, ICAM-1 mediates the migration of immune cells through the blood-brain barrier. ICAM-1 expression is increased on the CNS microvessels of multiple sclerosis (MS) patients, and administration of anti-ICAM-1 antibodies reduces the severity of signs and pathological changes in an MS-like animal model. The gene encoding ICAM-1 has been mapped to chromosome 19p13, a region whose possible involvement in MS is supported by the results of British and American whole-genome screens. An A-to-G transversion in exon 6 of the gene results in a glutamate-for-lysine substitution in codon 469 of the translated protein. Homozygosity for the K469E A allele was found to be more common in MS patients than in controls in Polish and Finnish datasets, but not in a Dutch dataset. We genotyped by pyrosequencing 644 Swedish MS patients and 662 Swedish controls for the ICAM1 exon 6 dimorphism; genotype frequencies did not differ significantly between patients and controls, even after patients were stratified according to carriage status for the MS-associated HLA class II specificity DR15.



P11 - Chronic reflex sympathetic dystrophy with dystonia (Complex Regional Pain Syndrome) developing months after cervical spinal cord injury

Guðmundsdóttir Þ, Daníelsdóttir G, Guðmundsdóttir V, Sveinbjörnsdóttir S



Dept. of Neurology, Landspítalinn University Hospital, Reykjavík, Iceland



RSD syndrome is characterised by variable disturbances of autonomic, sensory and motor systems following trauma to the head, spine or limbs.

We describe a case history of a 22 year old male, who in April 2000 sustained a blunt trauma to the back of his head and neck while skiing. Initial symptoms were left ptosis, paresthesia and pain in the left shoulder and arm and a slight power reduction in the left limbs. He had urinary retension in the first 24 hours after the injury which resolved temporarily. MRI´s of the cervical spinal cord and brain were normal. His symptoms remained stationary for three months after which he developed progressive spasticity with prominent dystonia and increasing pain in the left shoulder and upper limb. These symptoms progressed over the next 5 months, resulting in almost complete left sided paralysis with dystonic posturing of the limbs, a progressive pain and urinary retention. A repeat MRI of the cervical spine was normal. X-rays of the limbs showed patchy demineralization of the bones in the left leg. Isotope bone scan showed a reduced bone circulation in the left leg and hyperaemic soft tissues.

Treatment with intermittent local botulinum toxin A and physiotherapy improved the posture of his hand and leg, he was gradually able to walk with an aid but grip function in his left hand is minimal and the arm remains paralysed. His pain responds poorly to medical treatment and transcutanous nerve stimulation therapy.

Conclusion: RSD syndrome may be associated with dystoni and can develop months after the initial injury. Awareness of the characteristics and latency of these symptoms and early diagnosis with initiation of treatment may improve outcome. Spinal cord stimulation may produce pain relief in these cases.



P12 - Proctalgia and Parkinson´s disease

Örvar KB1, Sveinbjörnsdóttir S2



1Pelvic Floor Clinic St. Joseps´s, 2Department of Neurology, Landspítalinn - University Hospital



Pain in Parkinsons´s disease is frequently associated with muscle spasms or dystonia and often improves with adjustments in medical therapy. Proctalgia of various causes is a relatively common complaint in the female population. Frequently the etiology is unkonwn and treatment attempts unsuccessful. In this report we describe proctalgia in three patients with Parkinsons´s disease and one patient with Multiple System Atrophy (MSA). All had a normal gynecological examination, vaginal ultrasounds and endoscopic procedures. All patients had severe levator muscle tenderness.

Despite extensive diagnostic workup in a referral pelvic floor clinic no etiology was found for the significantly troublesome proctalgia in these patients. Adjustment in Parkinson´s therapy did not improve the symptoms.

Conclusion: Despite poor response to Parkinson´s therapy we propose that the proctalgia may have been caused by muscle spasms or pelvic dystonia associated with the underlying neurological disease.

P13 - Central extrapontine myelinolysis due to polydipsia causing basal ganglia dysfunction with Parkinsonism. A case report

Sveinbjörnsdóttir S, Daníelsdóttir G, Benediktsdóttir K



Depts. of neurology, rehabilitation and radiology, Landspítali University Hospital, Reykjavík, Iceland.



We descripe the case history of a 43 year old woman who in June 2000 developed severe parkinsonism with prominent rigidity, dystonia and somnolence. These symptoms occurred while she was an inpatient in a psychiatric ward because of a manic episode during which she had polydipsia. Prior medical history included several manic episodes in the last 15 years. MRI of the brain showed signal changes in bilateral basal ganglia, in particular in the lentiform nuclei without similar changes in the pons.

Her symptoms were initially considered as being side effects from chronic treatment with Lithium but serum sodium concentration was 123 mmol/l, indication myeliniolysis caused by hyponatermia. Sodium was slowly corrected and her extrapyramidal symptoms treated with clonazepam. Her symptoms slowly resolved, although minor residual extrapyramidal symptoms were still present at discharge seven months after the episode.

Conclusion: Polydipsia can be the underlying cause of myelinolysis in the cerebrum. Extrapontine myelinolysis is a rare complication but may occur without myelinolysis in the pons and may cause severe extrapyramidal symptoms.



P14 - Long-term efficacy and safety of entacapone as an adjunct to levodopa in patients with parkinson's disease and motor fluctuations

Larsen JP, Siden Å, Worm-Petersen J, Gordin A, Reinikainen K, Kultalahti E-R



Department of Neurology, University of Trondheim, Trondheim, Norway



Objective: The COMT inhibitor entacapone has been studied in a Nordic, randomised, placebo controlled, double-blind study over 6 months. We here report especially the safety results of its extension study; an open, uncontrolled 3-year trial were all patients were administered entacapone.

Material and methods: Of 152 patients completing the Nordic study, 132 continued in this study. All patients had Parkinson's disease (PD) with motor fluctuations. Entacapone, 200 mg, was administered with each daily levodopa dose. Efficacy was evaluated by the duration of effect of a single levodopa dose, the UPDRS, and levodopa dosing. Safety was evaluated by adverse events, BP, HR, ECG and laboratory safety analyses.

Results: Eighty-six patients (65%) completed the 3-year follow-up. The mean duration of benefit from a single levodopa dose remained prolonged after 3 years of treatment (without and with entacapone, p<0.001). There was no worsening of PD disability scores from baseline in the activities of daily living (ADL). Most patients had the proportion of daily OFF-time (UPDRS item 39) decreased or unchanged compared to baseline (p<0.001). The mean daily levodopa dose was reduced by 41 mg at the end of the study compared to baseline. Most of the AE's reported were dopaminergic, such as dyskinesias, nausea, and could be handled by reducing the levodopa dose. Diarrhoea was reported by 13%, but led to discontinuation in only 3% of the patients. No liver toxicity were recorded.

Conclusion: The efficacy and safety parameters indicate that the benefits of entacapone are maintained in long-term treatment.



P15 - Entacapone as an adjunct to controlled-release levodopa preparations

Gordin A, Poewe W, Deuschl G, Kultalahti E-R, Haapaniemi H, Leinonen M, Reinikainen K



Research Centre, Orion Pharma, Espoo, Finland



Objective: It has earlier been shown in several studies that entacapone, used as an adjunct to levodopa, is effective and safe in combination STD levodopa preparations. Entacapone has also been shown to be effective in short term studies with CR levodopa. The efficacy and safety of entacapone when used in combination with standard (STD) and/or controlled release (CR) levodopa preparations was studied in Parkinson's disease (PD).

Material and methods: A multicenter, double-blind, placebo controlled randomised (2:1 entacapone vs. placebo) study of six months duration was carried out in Germany and Austria. Entacapone 200 mg (or placebo) was administered with each daily levodopa dose. 301 patients with PD participated, most with motor fluctuations (260 patients). Of the 301 patients 136 received only STD levodopa and 20 only CR levodopa preparations. Of those using a combination of STD and CR levodopa preparations, 67 used only one CR tablet a day.

Results: The daily ON-time was increased both in the patients taking STD levodopa only (increase 1.6 hours) and in those taking more than one daily CR levodopa dose with entacapone (increase 1.7 hours) compared to placebo. Activities of daily living (ADL), was improved to a similar extent in both the entacapone compared to the placebo groups. When interactions between the groups were tested, this was independent of the type of the levodopa preparations used.

Conclusion: The beneficial effect of entacapone as an adjunct to either STD or CR levodopa is comparable in PD patients.



P16 - Electroretinographic and histologic assessment of retinal function in MICROPHTHALMIA mutant mice

Möller A1, Eysteinsson T1, Steingrímsson E2



Departments of 1Physiology and 2Molecular Biology, University of Iceland, Reykjavik, Iceland



Objective: To examine the effects of mutations in the mouse (Mus musculus) multi-allelic microphthalmia transcription factor (Mitf) gene on retinal function. Mitf mice are the only known mouse model for retinal degeneration that can be traced to a defect in the retinal pigment epithelium (RPE).

Material and methods: Electroretinography (ERG) was used to evaluate the functional state of the retina and to determine the role of the Mitf gene in visual function. Corneal ERGs were recorded with a steel wire in response to white flashes of light. Homozygous (MitfMi-wh/ MitfMi-wh, Mitfmi-sp/ Mitfmi-sp, Mitfmi-bws/ Mitfmi-bws), compound heterozygous (MitfMi-wh/Mitfmi-sp) mutants and homozygous wild-type mice (C57BL/6J) were studied at 16 weeks of age. Each animal was only tested once. Electroretinograms were correlated with histopathological findings in the same animals.

Results: The ERGs of both Mitfmi-sp/Mitfmi-sp and Mitfmi-bws/Mitfmi-bws mice appear normal but ERGs of MitfMi-wh/MitfMi-wh mice show they are probably blind. On the other hand, ERGs from MitfMi-wh/Mitfmi-sp mice were reduced in amplitude and delayed, indicating an RPE/photoreceptor defect.

Conclusions: At 16 weeks post partum, MitfMi-wh/Mitfmi-sp mutants show evidence of rod-cone dystrophy, possibly with a slow progression. Surprisingly, Mitfmi-bws/Mitfmi-bws mice, which have a similar phenotype as Mitfmi-vit mice, show normal ERGs.



P17 - Quantification of myosin is a valuable tool

Ansved T, Ahlbeck C, Eriksson LI, Fri Y



Dept. of Neurology, Karolinska Hospital, Stockholm, Sweden



Objective: To develop a clinically useful method for rapid diagnosis of critical illness myopathy.

Materials and methods: We studied ten critically ill patients (5 males and 5 females, aged 16-76 years) who had been diagnosed with critical illness myopathy based on clinical signs, neurophysiology and muscle biopsy findings.

The muscle biopsies were re-evaluated with regard to light microscopical and ultrastructural pathology and the myosin/actin ratio was quantified by densitometry following horizontal pore gradient SDS-polyacrylamide electrophoresis (SDS-PAGE).

Results: Histopathological changes at the light microscopical level included muscle fibre atrophy, degeneration, regeneration and loss of myofibrillar ATPase activity, often focally within fibres. Ultrastructurally, preferential loss of thick filaments were found to a varying degree in all biopsy specimens, foremost in core formations with loss of normal sarcomeric pattern. Vacuoles were seen, some of them enlarged and proliferated triads. In some patients, the changes were very mild and present only in parts of the biopsy.

The myosin/actin ratio was 0.37±0.17(SD), which was 73% lower than the corresponding mean value of 42 controls (18 males and 24 females, aged _-72 years), who had undergone muscle biopsy due to suspected or confirmed myopathies of different kinds (1.37±0.21; p<0.0002). There was no overlap between patients and controls.

Conclusion: Quantification of the myosin/actin quotient is an efficient and potent tool in the diagnosis of critical illness myopathy, also in cases where muscle biopsy only reveales mild changes. It is considerably less time-consuming than e.g. electron microscopy.



P18 - Categorical speech perception and experiments with ERP: relationship between voice onset time and N100 latency

Levy SRA1, Stefánsson SB2, Pind J1



1Department of Psychology, University of Iceland, 2Department of Neurology, Landspitali, University Hospital, Iceland



Objective: To determine the relationship between voice onset time (VOT) and the N100 latency of auditory event related potentials (ERP).

Material and methods: Two experiments were carried out with ten participants. In the first experiment the participants listened to 6 different sounds 200 ms in duration on a /ga-ka/ continuum. The only difference between the sounds was that the VOT varied between 10-60 ms. The sounds were presented through earphones. Interstimulus interval was 1000 ms. The ERP elicited by the stimuli was recorded from vertex. In the second experiment 6 disyllabic words, 460 ms in duration on a /gala-kala/ continuum were used. The beginning of these stimuli was exactly the same as in the first experiment with the same variation in VOT. The ending /-la/ was the same for all stimuli. The interstimulus interval was 2000 ms. The ERP was recorded in the same way. Before the experiments participants categorised the stimuli to ascertain that they heard the difference.

Results: In the first experiment sounds with longer VOT elicited N100 with later onset than those with short VOT. In the second experiment there was no correlation between N100 latency and VOT.

Conclusion: The difference in outcome in the first and the second experiment could possibly be due to the shorter interstimulus interval in the first experiment. Another possibility is that in the first experiment the N100 is elicited directly by meaningless stimuli whereas in the second experiment the N100 is strongly influenced by the cognitive content of the stimulus.



P19 - Prevalence of obstructive sleep apnea syndrome in patients with difficult headache

Bekkelund SI, Jensen R, Olsborg C, Torbergsen T, Salvesen R



Dept. of neurology, University Hospital of Tromsø, Norway



Objective: Obstructive sleep apnea syndrome (OSAS) is a common disorder in the general population. Although the mechanisms remain obscure, an association with headache has been reported. Most studies are cross-sectional in design with a limited number of patients. We aimed to assess the prevalence of OSAS in a population of patients with difficult headache referred to a neurological specialist consultation.

Material and methods: We included all patients referred to neurological specialists for headache in Northern Norway during a period of two years. Patients who reported heavy snoring and episodes of breathing pauses at night underwent a polysomnographic (PSG) examination. We regarded an apnea/hypopnea index of 5 or higher as abnormal.

Results: Of 903 patients with difficult headache, 75 reported heavy snoring and episodes of interrupted nocturnal breathing (8%). Among 43 patients examined with PSG, 14 (1.5% of the total study population) had an apnea/hypopnea index of 5 or higher. Eleven of the patients reported headache at wake-up in the morning.

Conclusion: The prevalence of OSAS in a sample of patients referred to specialist for difficult headache is not higher than what is reported for the general population. The relatively low prevalence of OSAS in this selected group of patients with difficult headache does not support the notion that OSAS brings about headache.







P20 - Do carpal canal stenosis predict outcome after surgical treatment for carpal tunnel syndrome?

Bekkelund Si, Pierre-Jerome C





Dept. of neurology, University Hospital of Tromsø, Norway



Objective: We investigated the role of carpal canal stenosis as a predictor of outcome in patients who underwent surgical treatment for carpal tunnel syndrome (CTS).

Material and methods: We performed magnetic resonance imaging (MRI) of the wrist in 31 patients with clinically and neurophysiologically confirmed CTS. With a computerised analyser we quantitatively calculated the focal narrowest point of the tunnel. Patient's assessment of CTS-related symptoms were obtained by using a visual analogue scale before, and 6 months after treatment.

Results: Seventeen (56%) patients improved in all symptoms after treatment. The focal narrowest point of the tunnel was identified at its distal third in all patients, at 8 mm from the outlet. The median area of the narrowest point in those who improved clinically (n=17) was 238.9 mm2 compared with 269.8 mm2 in others (n=14), p=0.046. Age and neurophysiological parameters were not associated with positive outcome in this group.

Conclusion: Identification of carpal canal stenosis may be important in selecting good candidates for treatment in symptomatic CTS.



P21 - Diagnostic disagreement in patients referred to a neurological outpatient clinic

Albretsen C, Bekkelund SI



Dept. of neurology, University Hospital of Tromsø, Norway



Objective: We aimed to study the diagnostic accuracy in patients referred to a neurological specialist centre from general practice.

Material and methods: Patients consecutively referred from general practice during 6 months were included in the study. The diagnoses from general practitioners (GP) were recorded from the referral letter while the final neurological diagnosis after specialist visit were obtained from the specialist´s notes.

Results: From a total of 1207 patients, 568 referred from primary health care were examined by a neurologist for the first time. The neurologists changed the diagnosis proposed by the general practitioner (GP) in 281 patients (49%). After clinical examination, 186 (33%) had one or more neurological deficit. The neurologist initiated some kind of treatment in 162 cases (29%). Among frequently referred groups of patients, especially tension type headache and mixed headache forms were underdiagnosed while the GP seemed to overestimate cervical radiculopathia. We found a significant tendency of diagnostic disagreement in those who had waited a longer time for an appointment (p=0.05).

Conclusion: Improved diagnostic work-up in patients with less serious conditions in primary practice may reduce the workload in secondary neurological care and thereby provide a better service for those who need it.



P22 - Prevalence of head trauma in patients with difficult headache

Bekkelund SI, Salvesen R





Dept. of neurology, University Hospital of Tromsø, Norway



Objective: To test whether chronic headache (>3 days/week) is more prevalent than episodic headache (< 3 days/week) in patients with a previous history of significant head trauma.

Material and Methods: We included 903 consecutive patients referred to a specialist centre for headache during a period of two years. As the main parameter, we selected self-reported history of previous significant head trauma defined as loss of consciousness or hospitalisation due to head trauma.

Results: 189 out of 903 patients with difficult headache referred to a neurologist had a previous history of head trauma (20%). We identified 297 patients with headache three days or more per week (33%). Of these patients with chronic headache, 68 (23%) reported previous significant head trauma, compared to 121/714 (17%) in other headache patients (p=0.18). Shorter length of education was associated with chronic headache; however, age, sex or specific headache syndromes such as migraine or tension headache were not related to chronicity.

Conclusion: Although the prevalence of previous head trauma was prevalent in this highly selected group of headache patients, such a history was not a predictor of chronicity.



P23 - Multidisciplinary group rehabilitation for patients with Parkinson's disease. A Pilot study

Bjarnadóttir Ó, Arnardóttir E, Benediktsdóttir S, Sigurðardóttir M, Gunnbjörnsdóttir H



Reykjalundur Rehabilitation Center, Mosfellsbaer, Iceland



Objective: To determine the effectiveness of a multidisciplinary inpatient group therapy program for individuals with Parkinson´s disease.

Methods: A total of thirty-four patients with idiopathic PD received a five week inpatient group therapy program. Mean age was 65 years (49-84). The patients were divided into two groups based on the Hoehn and Yahr disability scale (HY); HY 1-2 and HY 3-4. Treatment was multidisciplinary, specialised for individuals with Parkinson´s disease.

The degree of disability and neurologic status was assessed by these measurements: Unified Parkinson´s Disease Rating Scale (UPDRS); a 6 min. walking test (WT), balance (TUG), vocal intensity in sustained phonation and conversation (Sound Level Meter), finger dexterity (Purdue Pegboard (PP), Box and Block Test (BB)), hand strength in pounds (HS), Icelandic Quality of Life Scale (IQL). These measurements were determined pre-treatment and after 5 weeks of therapy. Twenty-five patients came for a follow-up 3 months post treatment, where the above measurements were repeated.

Results: In the whole group there were significant differences before and after treatment in UPDRS (p=<,0001), vocal intensity (p=<,0001), WT (p=<,0001), TUG (p=,0438), PP left hand (p=,0134), hand strength left (p=,0089) and right (p=,0151), IQL (p=, 0023). In the follow-up the UPDRS, vocal intensity, WT, HS right and IQL continued to be significant compaired with pre-treatment assessment.

Conclusion: The results demonstrate that multidisciplinary group rehabilitation has diverse benefits for individuals with Parkinson´s disease. The HY scale was found to be a satisfactory tool to insure homogenous groups, symptomwise, for group therapy.



P24 - The epidemiology of headache and irritable bowel syndrome in icelandic adults - is there an association?

Ólafsdóttir LB1, Sveinbjörnsdóttir S2, Jakobsson F3



1Pharmacologist, FutureMedTec, Reykjavík, 2Clinical Neurologist, Dept. Neurology, The National University Hospital, Reykjavík, Iceland



Objectives: A population based epidemiological study on various types of headache and irritable bowel syndrome (IBS) in Iceland to estimate the pevalence and association in adults.

Materials and methods: Based on the Total Method of Dillman, a self-report questionnaire was sent to a random sample of 2000 inhabitants age 18-75 years (1% of the total population). The questionnaire addressed 75 items of which 35 addressed the different symptoms of headache and 15 addressed gastrointestinal problems related to IBS. The Manning criteria was used to diagnose IBS. The others addressed past and present health, sociodemographic features and psychosomatic symptoms.

Results: Response rate was 65% (49% males, 51% females). Any type of headache was reported by 77% (66% males, 87% females). By using the IHS criteria modified for this questionnaire the prevalence of migraine within this population was 13% (7% male, 19% female). Migraine with aura was 6% and without aura 9,5%. The prevalence of tension type headache was 18% without significant difference between men and women. The criteria of IBS was met by 38% (30% male, 47% female) The prevalence of IBS in young people was 2 times higher than that of older subjets. Migraineurs with and without an aura was were diagnosed with IBS significantly more often than other subjects. Women had significant correlation between migraine and IBS. There was no difference between migraineurs with and without an aura. There was no significant difference in subjects with tension type headache diagnosed with IBS than other subjects.

Conclusion: Headache is common in Iceland. Migraine is not very common in Iceland. IBS is very common in Iceland, apparently more prevalent than reported elswhere. Migraine and IBS is more prevalent among younger subjects when tension type headache is most common among subjects in the age group 26-55 years. Migraine is frequently associated with female IBS induviduals. Tension type headache is not associated with IBS.



P25 - The epidemiology of migraine in Icelandic adults

Ólafsdóttir LB1, Sveinbjörnsdóttir S2, Jakobsson F3



1Pharmacologist, FutureMedTec, Reykjavík, 2Clinical Neurologist, Dept. Neurology, The National University Hospital, Reykjavík, Iceland



Objectives: A population based epidemiological study on migraine in Iceland to estimate the pevalence, duration and severity of migraine in adults.

Materials and methods: Based on the Total Method of Dillman, a self-report questionnaire was sent to a random sample of 2000 inhabitants age 18-75 years (1% of the total population). The questionnaire addressed 75 items of which 35 addressed the different symptoms of headache. The others addressed past and present health, sociodemographic features and psychosomatic symptoms.

Results: Response rate was 65% (49% males, 51% females). Any type of headache was reported by 77% (66% males, 87% females). Self reported migraine was 4% for men and 12% for women. By using the IHS criteria modified for this questionnaire the prevalence of migraine within this population was 13% (7% male, 19% female). Migraine with aura was 6% and without aura 9,5%. Women reported migraine with aura significantly more often than men (9% vs. 3%). Migraine without aura was also significantly more prevalent in women than men (14% vs. 5%). Migraine was more commomly present in the younger age groups. After the age of 55 the prevalence of migraine falls significantly in both men and women.

The duration of headache in migraineurs was reported 2-12 hours in 54%. One out of eight of these subjects had their headaches lasting less than 2 hours. 15% had their headache lasting 12-24 hours, 12% had their headache lasing 1-2 days and 7% reported continuing headache for three days or longer. One third of migraineurs reported headache every third month and quarter of migraineurs reported headache every month. The severity of the headache in the population with migraine was moderate-severe in the great majority of responders (96%).

Conclusion: Headache is common in Iceland. Migraine is not very common in Iceland. Migraine appers to be more common among women than men and more common among younger induviduals. The most common duration of migraine appers to be 2-12 hours and the migraine pain is moderate-severe. Most migraineurs experience headache every one to third month. Based on the results of this study the prevalence of migraine in Iceland is in the lower range of reported prevalence.



P26 - Maternal obstetric neuropathies in lower extremities: Frequency, localizations, etiology and prognosis

Hjaltason H, Vigfússon G, Hauksdóttir S, Steingrímsdóttir Þ, Ólafsson E



Landspítali University Hospital, Reykjavík, Iceland



Objectives: Determine the frequency, etiology and clinical features of maternal neuropathies in the lower extremities in a general obstetric population, presenting during childbirth.

Subjects and methood: The cases were identified by reviewing all neurological consultations from the department of Obstetrics and Gynecology in Iceland University Hospital during a 25 month period. A further analysis included a careful assessment of patient charts, and when necessary further information was obtained by an interview and physical examination. During the study period there were 5902 deliveries in this hospital, approximately 75% of all deliveries in the country.

Results: A total of 11 women with a peripheral neuropathy were identified or 1.8/1000 deliveries. Motor and sensory deficits were in 8/11 cases consistent with a unilateral L5 radiculopathy, in 4 cases combined with S1 symptomatology. The cause was determined as a compression of the lumbosacral plexus during labour in 4 cases, in 2 cases compression of other peripheral nerves, in 2 cases epidural/ spinal anesthesia, in 1 case a herniated intervertebral disc, and in 2 cases the cause was left undetermined. The most distinguishing symptoms of the 2 cases related to anesthesia were unpleasant paresthesia, in those cases the prognosis was worse. The causal frequency of neuropathies related to labour was thus 4/5902 (0.7/1000) and to anesthesia 2/2645 (0.8/1000).

Conclusion: Maternal neurological deficits in the lower extremities are uncommon but important complications of labour and delivery. Compression caused by labour and delivery seems to be the most common cause but there are difficulties, especially during prologned labour, in differentiating the significance of compression and a more direct trauma caused by spinal/epidural anesthesia.



P27 - The "Interferonal" - documentation and quality assurance. Documentation and quality assurance of nursing for patients with Multiple Sclerosis (MS) in interferon-beta treatment (IFN)

Bangsgaard L1, Eskildsen M2, Hansen A3, Krogh H4



1University Hospital Glostrup, 2Odense University Hospital, 3Copenhagen University Hospital, Rigshospitalet, 4Viborg/Kjellerup Hospital



Background: In connection with the introduction of IFN treatment in Denmark (1996) the ndividual nurse had a need for a working tool. The working tool had to be described to give the possibility for documentation of the tasks of the nurse.

Goal: Make the nursing visible

High professional standard

Efficient resource exploitation

Quality assurance

Method: Group projects

Education

Information retrieval

Questionnaire study

Conclusion: The working tool has now been implemented in own practise since January 1999. The visibility of the nursing has been made possible. The target for the quality development in nursing the MS patient in IFN treatment is to increase the specialised level of quality and aim at a high satisfaction among both patients and the professionals. The Interferonal is a good tool that works satisfactory according to the patients. Our goal for acquiring a high professional standard is hereby obtained. 95% of the patients who were asked found the information satisfactory. Through this tool we have documented and made the nursing visible and the patients have clearly expressed the importance of having a permanent contact nurse.

Future visions: In each clinic we will adjust practise from the results of the questionnaire study so the nursing is quality assured. We will also continue to work with the nursing to all other MS patients. We will, at the same way we have quality assured the nursing to patient in IFN treatment, continue to work with developing standards for new diagnosed MS patients.



P29 - Women's Experience of Multiple Sclerosis

Jónsdóttir H1, Sigurðardóttir GM2, Hafsteinsdóttir JE2, Björnsdóttir ÓE2



1Assoc. Professor Faculty of Nursing, University of Iceland, 2National University Hospital Reykjavik, Iceland



The purpose of this qualitative study was to describe women's experience of multiple sclerosis in order to increase insight of nurses and other health care staff into the daily life of women who suffer from this disease.

A convenience sample of three women, age 38-51 years who had lived with multiple sclerosis for a few years, was used. Each woman was interviewed twice and data analyzed into themes. Results revealed the following six themes, which are intertwined and ordered by importance: Diagnosis, a turning point in life, Various obstacles in daily life, "I'm not about to die soon, but I have to live with this", "More prone to gloomy thoughts", Building a support network and "I want to be treated with respect". The results show that multiple sclerosis greatly affected the participants in a number of ways. The disease caused a turmoil in the women's lives and changed their future plans.

The women felt incapable of attending to their families and their homes in the way they wanted to and the disease also affected their children's upbringing. The women greatly valued having a good support network, which primarily consisted of their families and female friends from the Multiple Sclerosis Association. It is concluded that nurses need to further emphasize supporting those who suffer from multiple sclerosis and their families, as well as providing them with more detailed information and counseling.

P30 - Quality assesment of nursing dokumentation

Hvid K, Fatum H



Frederiksberg Hospital H:S, Frederiksberg, Denmark



Objectives: The nursing documentation in the Stroke Clinic was not systematic making it very hard to perform audits, choice of nursing procedures was typically up to the individual person, the procedures did not guide the personnel properly. Objectives: To develop a documentation procedure enabling a systematic data collection / ongoing documentation audits the personnel to be guided in good nursing skills.

Method: The method we have used is the quality circel "Plan Do Check Act".

Step 1. Implementation of one´ printed clinical nursing plan.

Step 2. The implementation process.

Step 3. Making and implement a new complete nursing

documentation procedures.

Results/Conclusion:

1. The printed clinical nursing plan highly complied with the objectives made, but implementation was incomplete.

2. The personnel's level of knowledge both in relation to the special nursing and in relation to using the printed clinical nursing plan was of high importance. Equally, it was essential to have a co-ordinator. A Clinical nurse Educator has been employed as a facilitator and to educate the personnel both theoretically and bedside.

3. Making printed clinical nursing plans covering essential areas of the stroke patient nursing and implement them in the clinic. Making a number of clinical guidelines for each clinical nursing plan. To date the project has aschieved the following results: Implementation of seven printed clinical nursing plans (nutrition, urine excretion, faeces excretion, mobilisation, communication, cognitive state, personal hygiene). Preparation of matching clinical guidelines. Training of the personnel both theoretically and bedside.



P31 - Developing Patient Education of Patients with Parkinson's Disease in the Clinic of Neurology, Oulu University Hospital

Toljamo M1, Hentinen M1, Jämsä T2, RN, Heikkinen T2, Hiltunen A2, Järvimäki L2



1Department of Nursing and Health Administration1 and 2Department of Neurology, University of Oulu, Finland



Objective: During 1996-2001, we conducted a project to develop PD patients' education in the Clinic of Neurology at Oulu University Hospital. The main objective was to unify the educational practice in the clinic by gathering data from patients, updating the educational material, and finally, creating a new educational model.

Method: We applied a modified action research method. Our project arose from the nursing practice, then we conducted a research, and after that we moved back to the nursing practice to develop patient education.

Findings: The patients thought that their education was too medicine-oriented, and the nurses did not have enough time to discuss with them. The traditional education emphasized acute problems, pharmaceutical treatment and the care provided by different specialists. The goals of this education were to give information and to make the patients compliant. Based on these findings, we developed a model of empowerment-oriented education. Along with the developed model, nurses spend more time with every patient than before, discuss the patient's background, earlier knowledge about PD, well-being and social support network. The model has been planned to be an individual and comprehensive way to care for a patient. The goals are a good quality of life, to find a balance in everyday life with changing symptoms and to have a sense of control over the symptoms.

Conclusion: Empowerment-oriented education is suitable for the care of chronically ill patients. The strengths and weaknesses of the action research method will be discussed.



Key words: patient education, developing process, empowerment, Parkinson Disease



P32 - Implementation of new documentation procedures for the nursing in the Stroke Clinic of Frederiksberg Hospital. - An ongoing assesment projekt focusing on both the clinical quality as well as documentation

Hvid K, Fatum H



Frederiksberg Hospital H:S, Frederiksberg, Denmark



Objectives: The nursing documentation in the Stroke Clinic was not systematic making it very hard to perform audits, choice of nursing procedures was typically up to the individual person, the procedures did not guide the personnel properly. Objectives: To develop a documentation procedure enabling: A systematic data collection /ongoing documentation. Audits. The personnel to be guided in good nursing skills.

Method: The method we have used is the quality circel "Plan Do Check Act".

Step 1. Implementation of one´ printed clinical nursing plan.

Step 2. The implementation process.

Step 3. Making and implement a new complete nursing documentation procedures.

Results / Conclusion:

1. The printed clinical nursing plan highly complied with the objectives made, but implementation was incomplete.

2. The personnel's level of knowledge both in relation to the special nursing and in relation to using the printed clinical nursing plan was of high importance. Equally, it was essential to have a co-ordinator. A Clinical nurse Educator has been employed as a facilitator and to educate the personnel both theoretically and bedside.

3. Making printed clinical nursing plans covering essential areas of the stroke patient nursing and implement them in the clinic. Making a number of clinical guidelines for each clinical nursing plan. To date the project has aschieved the following results: Implementation of seven printed clinical nursing plans (nutrition, urine excretion, faeces excretion, mobilisation, communication, cognitive state, personal hygiene). Preparation of matching clinical guidelines. Training of the personnel both theoretically and bedside.



P33 - Quality of life before and after stroke. The Copenhagen Stroke Study

Mosegaard D, Houth JG, Jørgensen HS



Department of Neurology, Gentofte Hospital, Copenhagen, Denmark



Purpose: To assess quality of life (QoL) before and after stroke and to evaluate the impact of various socio-demographic and medical factor on QoL.

Methods: This study is part of the community-based Copenhagen Stroke Study, and prospectively included 401 patients with acute stroke. Assessment of QoL was done using the Frenchay Activity Index (FAI). It was performed within the first week of admission, and at the 6-month follow-up. The independent importance of variables on QoL was evaluated in a multiple linear regression model.

Results: The following factors were negatively related to QoL before stroke: Male gender (p<0.01), nursing home recidence (p=0.04), living single (p=0.02), diabetes (p=0.01), home help (p<0.01), smoking (p<0.01), previous stroke (p<0.01), other disabling disease (p=0.01), and increasing age (p<0.01). Working prior to stroke was the only positive factor for QoL before stroke (p=0.01). QoL after stroke was negatively related to increasing neurological deficit on the Scandinavian Stroke Scale (p<0.01) and disability in basic activities after stroke (Barthel Index, p=0.02), male gender (p<0.01), nursing home recidence (p<0.01), diabetes (p<0.01), home help (p<0.01), previous stroke (p<0.01), and age (p<0.01), and positively related to QoL before stroke (p<0.01).

Conclusion: A good social network is important to life quality. Due to differences in sex roles men performed poorer than women in FAI score. QoL was significantly lower in patients with diabetes both before and after stroke. Smoking was related to a poorer QoL before stroke. Neurological deficit and functional disability after stroke, nursing home recidence, previous stroke and diabetes were the most important negative factors for QoL after stroke. A good life quality before stroke was the most important factor for a good QoL after stroke. Improvement in QoL after stroke should focus on limiting the neurological deficits and basic functional disability after stroke.



P34 - Documentation of tacit knowledge. Improving MS nursing

Jota PA, Haugstad R, Kornerud U, Wehus R, Klingsheim B, Nortvedt MW



Central Hospital in Hedemark HF, Elverum, Norway



Background/objective: After the introduction of the interferon-beta therapy in multiple sclerosis (MS), nurses have been given new tasks in the treatment of MS-patients. This includes the development and organisation of information, training and follow-up of patients on treatment. We wish to evaluate how the patients manage their new treatment, and to find elements of our practice related to information, training and follow-up that might be improved.

Method: All patients beginning with interferon treatment (Avonex, Betaferon, Rebif) in four hospitals in Norway are consecutively asked to participate in the study and will be followed-up with individual consultations by MS nurses. The study will include 75 patients. The patients are given a questionnaire including a diary to be filled out during a period of three months. In a follow-up after one year the patients will be asked to fill out an equivalent questionnaire. The questionnaire includes questions regarding how the patient evaluates the information, training and the follow-up given by the nurse. It also includes questions regarding side effects and how these are managed. Additionally, a quality of life questionnaire (SF-36) is completed at baseline, month three and month 12.

Results: The collection of data started in October 2001 and 30 patients are included by the end of February 2002. All 75 patients are expected to be included before the end of 2002. The project has already had a positive effect on the member of the project group during the planning process. We have become more aware of the importance of documenting our clinical experience.

Conclusion: As nurses we ought to visualize the importance of what we do. Our challenge is to document our experience and tacit knowledge, and to show that appropriate nursing makes a positive difference for the patients.



P35 - Evidence-based nursing to stroke patients. Application of an evidence-based clinical guideline concerning the basic need: Nutrition

Zielke S, Christensen D, Muus I



H:S Bispebjerg Hospital Copenhagen University Hospital Denmark



The aim of the project was to evidence-base nursing care of stroke patients and to monitor the quality of nursing practice concerning the basic needs: nutrition

Methods: A clinical guideline has been developed.

Recommendations for good clinical practice:

Identifying the risk patient:

Assessment according to screening tool

- Drinking test (B)

- Nutritional state (C)

Nutritional therapy for the risk patient:

- Calculating the patient\'s need for energy, protein and fluid (C)

Choosing diet:

- Adjusting food consistency in relation to dysphagia (C)

- nasogastric tube feeding within 72 hrs by transient dysphagia

- percutaneous endoscopic gastrostomy tube feeding within 2-4 weeks by expected Persistent dysphagia (B)

Evaluating the patient\'s need for specific training

Monitoring:

Quality indicators:

- Daily assessment of energy, protein and fluid

- Weekly assessment of body weight

- Eating ability according to Barthel Index or other validated instrument

- Body Mass Index at admission, after 3 weeks, and at discharge

- Events of pneumonia treated with antibiotics during hospitalisation

Results/Conclusion: The clinical guideline has been implemented in stroke units at Bispebjerg University Hospital, Århus University Hospital and Esbønderup Hospital and results from the database will be present at the congress.



P36 - Does rehabilitation improve quality of life in individuals with Parkinson´s disease? Prospective pilot study

Gunnbjörnsdóttir H, Bjarnadóttir ÓH



Reykjalundur Rehabilitation Center, Mosfellsbær, Iceland



Objective: To determine if rehabilitation improves quality of life and secondly, if quality of life measurements can be used for locating hidden nursing problems.

Material and methods: Thirty-five individuals with Parkinson´s disease received a five week inpatient group rehabilitation program in small groups (4-6) from November 1999 - September 2001. Mean age was 65 years (49-84). Individuals were selected according to severity of symptoms, based on the Hoehn and Yahr scale, into homogenous groups. The program involved physiotherapy, occupational therapy, speech therapy, education regarding Parkinson´s disease and nursing diagnosis and intervention. The Icelandic Quality of Life scale (IQL) has twelve subscales with age norms. Reliability and validity have been established and the scale has been recommended for clinical use and research. IQL was administered before and after 5 weeks of treatment. Twenty-three individuals were also retested at a follow-up visit 3 months post treatment.

Results: Significant differences (p<,05) were found before and after treatment in six of the twelve subscales, i.e. general health, depression, social functioning, anxiety, general well-being and pain; and in overall health related quality of life (HRQL). This change was still observed at follow-up in general health, social functioning, depression, general well-being and HRQL.

Conclusion: The results show a general improvement in quality of life after rehabilitation. Some subscales of the IQL may be useful to locate hidden problems like depression and anxiety. Improvements in physical strength and endurance were not directly observed by the IQL, although objective differences were documented by use of other assessment tools and the patients reported improvements in those areas.



P37 - Benefits of rehabilitation after stroke.

Sigurðardóttir KR, Bjarnadóttir ÓH



Reykjalundur Rehabilitation Center, Mosfellsbær, Iceland



Objective: To determine the benefits of post-stroke rehabilitaton using the Barthel Index, and to see if treatment in excess of 3 months post-stroke further improves ADL function as measured by the Barthel Index.

Material and methods: From January 2000 to November 2001, 40 patients underwent rehabilitation in a rehabilitation center, after initial diagnosis and treatment in an acute hospital facility. Nine patients had been discharged to their homes a few days before rehabilitation commenced. The Barthel Index (BI) was filled out at admission and discharge. For the six individuals who where in the rehabilitation setting longer than 3 months post-stroke, the BI was filled out for the third time. The Barthel Index measures the individual´s performance on 10 Activity of Daily Living (ADL) functions. A total score of 100 indicates independence. Six patients dropped out; for four the Barthel had not been filled out, one had not been discharged, and one died.

Results: Mean age was 64 years (range 33-80). For 34 individuals the Barthel subclasses showed statistic differences (p<,05) from admission to disharge in: eating, personal hygiene, independent bathing, stair climbing, going to the toilet, dressing, "chair to bed" and walking.

Admission Discharge

BI (mean) (p=<,001) 78,14 (18-100) 93,06 (48-100)

Days post-stroke (median) 27,5 (12-92) 102 (42-193)



The six individuals who were still inpatients at 3 months post-stroke showed little or no further improvements as measured by the BI.

Conclusion: The results show distinctive improvements in 8 of 10 parameters in the BI in the first three months post-stroke. Rehabilitation after 3 months have lapsed post stroke appears to add little or no improvement in ADL.



P38 - The need for nursing care rehabilitation in patients with acute stroke. The copenhagen stroke study

Mosegaard D, Jørgensen HS



Department of Neurology, Gentofte Hospital, Copenhagen, Denmark



Purpose: Rehabilitation in specialized stroke units has proven effective. A large part of the rehabilitation is performed by the nursing staff focusing on disabilities in basic activities of daily living (ADL). We describe the need of nursing care in a community-based stroke population.

Methods: Included were 1197 unselected patients with acute stroke from the community-based Copenhagen Stroke Study. All patients had all their treatment and rehabilitation within the stroke unit. We used the Barthel Index to measure basic ADL at the time of acute admission and again at discharge after completed rehabilitation. Only items in the Barthel Index specifically related to nursing care rehabilitation are described.

Results: Mean age was 74.3 years (SD 11.1). 54% were women and 46% were men. The need for nursing care intervention in the rehabilitation of ADL was as follows: 65% of the patients needed training in transfers, 54% in feeding, 52% in grooming, 60% in toiletting, 65% in bathing, 63% in dressing, and 48% in training urinary continence. 72% needed rehabilitation of at least one of the mentioned activities. After completed rehabilitation, 35% were still dependent in transfers, 22% in feeding, 20% in grooming, 29% in toiletting, 37% in bathing, 35% in dressing, and 28% were urinary incontinent.

Conclusions: A large part of patients with acute stroke need rehabilitation in a number of basic ADL. The most of this rehabilitation is performed by the nursing staff. The organization of nursing care rehabilitation of ADL is probably important to the improved outcome of patients treated in a stroke unit. Currently, efforts to improve therapy is directed towards medical intervention, but should also focus on improving nursing care with seems to be an important part of the rehabilitation program.