April 25, 2018April 10, 2018Free AccessOnabotulinum Toxin Serves as an Effective Treatment for Chronic Daily Headache in Patients with Hypermobility Spectrum Disorder (P4.139)Kelsey Riggs, Lauren Babcock, Vernon Rowe, John Hunter, Arlene O’Shea, Doug Schell, Dorsey Paul, and James BarnettAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement) Letters to the Editor

April 26, 2018April 10, 2018Free AccessSymptoms of Hypermobility Spectrum Disorder May Mimic Multiple Sclerosis (S44.003)Kelsey Riggs, Lauren Babcock, Vernon Rowe, John Hunter, Doug Schell, Arlene O’Shea, Dorsey Paul, Gloria Ortiz-Guerrero, and James BarnettAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement)https://doi.org/10.1212/WNL.90.15_supplement.S44.003 Letters to the Editor

April 22, 2018April 10, 2018Free AccessPolysomnography is Crucial to the Diagnosis of Sleep Disordered Breathing Syndromes in Patients with Hypermobility Spectrum Disorder (P1.099)Lauren Babcock, Kelsey Riggs, Vernon Rowe, John Hunter, Arlene O’Shea, Doug Schell, Dorsey Paul, Mark Varona, Shelia Miller, James Barnett, and Snehal KadiaAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement)https://doi.org/10.1212/WNL.90.15_supplement.P1.099 Letters to the Editor

Background: At sufficiently high doses, methotrexate (HDMTX) achieves substantial CNS penetration, whereas other tissues can be rescued from the effects of HDMTX by leucovorin rescue (LR), which does not penetrate the blood -brain barrier. Objectives: To report on the efficacy and safety of HDMTX with LR(HDMTX-LR), in the treatment of acute demyelinating inflammatory CNS syndromes refractory to conventional immunotherapy.Methods: We performed a retrospective chart review of 12 patients treated (6 multiple sclerosis [MS], 4 neuromyelitis optica [NMO], and 2 Sjogren's syndrome myelopathy [SSM]) with HDMTX-LR after failing to improve, or exhibiting worsening following conventional immunotherapy. 11 patients were followed for a total of 6 months following HDMTX-LR (one was lost to follow up after 1 month); and clinical findings were documented at 1 month, 3 months, and 6 months following HDMTX-LR therapy.Results: Ten patients demonstrated both clinical and radiologic evidence of near, if not complete, abolishment of disease activity, in conjunction with impressive reconstitution of neurologic function in the 6-month period following HDMTX-LR. Mean Kurtzke Expanded Disability Status Scale (EDSS) prior to HDMTX-LR was 8.1 (+/- 1.4). Following HDMTX-LR, mean EDSS was 6.6 (+/- 2.4) at 1 month, 5.8 (+/- 2.3) at 3 months, and 5.7 ( +/- 2.3) at 6 months.Conclusions: In this retrospective assessment of treatment-recalcitrant fulminant inflammatory CNS syndromes, HDMTX-LR was observed to be a safe and highly effective treatment, producing the rapid and near complete cessation of disease activity, in conjunction with an important corresponding and 'durable remission' in the majority of our small treatment cohort. (C) 2016 Published by Elsevier B.V.