Knowledge gaps in Parkinson’s disease and other movement disorders – Abstracts 1 Patients with Complex Regional Pain Syndrome type I and fixed posture of the hand disclose a normal motor cortex plasticity C. Terranova, A. Naro, M. Russo, V. Rizzo, G. Risitano, P. Girlanda, A. Quartarone, F. Morgante Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, Università di Messina, Messina, Italy Background: CRPS type I is a painful disorder typically following minor injury which may be associated with development of move- ment disorders such as fixed dystonia. Controversy surround the issue whether movement disorders in CRPS I have a psychogenic origin. Objective: To demonstrate that patients with Complex Regional Pain Syndrome (CRPS) type I, who have developed a fixed posture of the hand, do not show abnormalities of motor cortex plasticity, which is the neurophysiological hallmark of organic dystonia. Methods: Ten patients affected by CRPS type I (1 man, 9 women, age = 55.5 ± 9.3 years, disease duration of 1.1 ± 0.6 years) were enrolled for this study and matched with 10 healthy sub- jects (1 man, 9 women, age = 49.8 ± 4.5 years). Patients satisfied the IASP criteria for CRPS I and were tested in both hands. We evaluated by transcranial magnetic stimulation (TMS): intracorti- cal inhibition (ICI) and facilitation (ICF) and sensorimotor integra- tion through long-latency (LAI) afferent inhibition. Synaptic plasticity through paired associative stimulation (PAS) with assessment of topographical specificity was tested by recording from abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles. Results: The study of synaptic plasticity of the motor cortex, did not disclose any difference between patients and controls. ICI and LAI were significantly reduced and ICF was increased in the affected arm of CRPS I patients compared to normal subjects. Conclusions: Patients with CRPS I and a fixed posture of the hand show a normality of motor cortex plasticity, as we recently reported in psychogenic dystonia. Similarly to patients with psychogenic dys- tonia, the reduced inhibitory tone of the motor cortex contralateral to the limb affected by CRPS I is probably related to the maintenance of a fixed posture from the patients. On the other side, we found a altered sensory-motor integration possibly determined, at central level, from a continuous nociceptive input that modifies sensitive– motor inputs interactions. http://dx.doi.org/10.1016/j.baga.2012.04.002 2 Parkinson and parkinsonism: The role of transcranial B-mode sonography M. Ravagnani, K. Savio, R. Tarletti, D. Barbagli, M. Mongiovetti, G. Gusmaroli, R. Cantello Ospedale degli Infermi di Biella SC Neurologia, Clinica Neurologica, Università del Piemonte Orientale ‘‘A. Avogadro’’, Novara, Italy Background: The use of transcranial B-mode sonography (TCS) to assess brainstem has become an important tool for the diagnosis of movement disorders. Although substantia nigra (SN) hyperechog- enicity can be found in more than 90% of Idiopatic Parkinson’s dis- ease (IPD) patients, it is very rarely found in patients with atypical parkinsonism. Methods: The objective was to evaluate the effectiveness of TCS in diagnosis of IPD and parkinsonism. TCS was performed in a group of 51 patients (mean age: 69.3 years). Twenty-five patients (49%) had a clinical diagnosis of IPD; 21 patients (41%) had parkinsonism (12 multiple system atrophy (MSA), 2 progressive supranuclear palsy (PSP), 2 vascular parkinsonism and 3 iatrogenic parkinsonism). Five patients (10%) had essential tremor (ET). Cardiac 123 metaiodoben- zylguanidine (MIBG) scintigraphy was performed in 21 patients. Results: In 20 patients with IPD (80%), in 1 patient with MSA (8%), in 1 patient with PSP (33%), in 3 patients with iatrogenic parkinson- ism (100%) and in 5 patients with ET (100%) TCS showed an increased SN hyperechogenicity. Cardiac MIBG SPECT was positive in 8 patients with IPD; in 7 patients there was an overlap between the cardiac MIBG SPECT and TCS. Sensitivity of TCS was of 77% in IPD and 93% in MSA and PSP; specificity was 72% in IPD and 97% in MSA and PSP. Conclusions: Although the limitation due to the bone window, TCS represents a non invasive approach and it has wide availability. This makes it an useful tool on improving the clinical diagnosis for several movement disorders. http://dx.doi.org/10.1016/j.baga.2012.04.003 3 Creative thinking in patients with Parkinson’s disease and in healthy subjects: The professional artists make the difference? M. Canesi a , M.L. Rusconi b , E. Reali b , F. Moroni b , R. Cilia a , G. Pezzoli a a Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy, b Department of Human Science, Università degli Studi di Bergamo, Bergamo, Italy http://dx.doi.org/10.1016/j.baga.2012.04.001 Basal Ganglia 2 (2012) 257–265 Contents lists available at SciVerse ScienceDirect Basal Ganglia journal homepage: www.elsevier.com/locate/baga