32^nd European Neurology Congress July 22-24, 2019 London, UK

Zao C. Xu is a Professor in Indiana University School of Medicine, USA. He has more than 30 years of experience in Neuroscience research using electrophysiological, morphological and molecular biological approaches. The major research projects in his laboratory are the mechanisms underlying the neuronal injury/survival after cerebral ischemia and traumatic brain injury and the mechanisms of seizure/epilepsy following acute neurological disorders such as stroke and traumatic brain injury.

Seizures are the most common neurological sequelae following brain injury such as stroke and traumatic brain injury (TBI). The mechanisms of seizure/epilepsy in these acute neurological disorders remain unclear. Recent studies indicated that epilepsy could be mediated by energy metabolism related proteins such as Sestrin3 (SESN3). The present study attempted to reveal the contribution of SESN3 to seizure generation in cerebral ischemia in diabetic condition and TBI. Transient global ischemia was produced in adult rats and mice. Diabetes was induced by i.p. injection of 50 mg/kg streptozotocin (STZ). TBI was induced in mice using the control cortical impact method. The seizure activity was defined by the Racine scale III-V. The neuronal death in the brain was determined by hematoxy lineosin staining. The expression levels of SESN3 were analyzed by western blotting and immunohistochemistry. The neuronal excitability was recorded using electrophysiological approaches. The blood glucose levels was >300 mg/ dL in animals one week after STZ injection. Th e seizure rate was significantly increased after 15 min ischemia. No obvious neuronal damage was observed in hippocampus and cerebral cortex. SESN3 expression in hippocampus was signifi cantly increased in diabetic animals with post-ischemia seizures. The potassium channel expression and currents in hippocampal neurons were decreased and neuronal excitability increased in these animals. The seizure rate was signifi cantly decreased from 60% of wild type mice to 15% of SESN3 knockout mice after 15 min ischemia. In mice with TBI, the seizure was induced by GABAA receptor blocker Pentyleneletrazole (PTZ, 40 mg/Kg, i.p.). One week after TBI, the latency of seizure onset was reduced in SESN3 KO mice; the input resistance of hippocampal neurons decreased and the rheobase increased in these KO animals. These data suggest that SESN3 involved in seizure generation aft er brain injury by affecting neuronal excitability.

Lingling Zhu has completed her PhD at Jichi Medical University, Japan and Postdoctoral studies from Academy of Military Medical Sciences, Beijing, China. She is the Director of Department of Cognitive Sciences of the Institute of Military Cognition and Brain Science. As the first author or corresponding author, she has published more than 25 papers in reputed journals and was invited to write English chapters.

FG-4592, an inhibitor of prolyl hydroxylase (PHD), stabilizes HIF-1α and has been used in Phase III trials for the treatment of anemia patients with chronic kidney disease (CKD). Chronic Unpredictable Mild Stress (CUMS), an animal model recapitulating the core symptoms of human depression, showed an atrophy of dendritic spines and a decrease in neurogenesis on hippocampus. In the current study, we investigated whether FG-4592 exhibits anti-depressant effect in rat CUMS model and its possible molecular mechanisms. We found that FG-4592 not only reversed the depressive behaviors, but also reversed impaired learning and spatial memory in the rat CUMS model. Moreover, FG-4592 increased hippocampal neurogenesis and synaptic plasticity including the density and the length of dendritic spines. At the molecular level, FG-4592 increased HIF-1α expression and activation, hence increase its target genes expression of EPO and BDNF (and other HIF target genes). Taken together, our findings demonstrated that FG-4592 has a therapeutic potential similar to an antidepressant in animal models of depression and could be developed as a treatment therapeutic option against this pathophysiological state.

Manoj Malhotra received his medical degree from Wayne State University in Detroit, Michigan. He completed his Neurology residency and two fellowships at The Cleveland Clinic in Cleveland, Ohio. Manoj is Vice President, Head of Medical Affairs, for the Neurology Business Group at Eisai Inc. He is responsible for Medical Affairs activities for the Americas and is Global Medical Lead for Epilepsy. He holds 6 neurology board certifications (neurology, epilepsy, sleep medicine, clinical neurophysiology, vascular neurology and electrodiagnostic medicine) and has extensive experience in neurodegenerative diseases, rare diseases and epilepsy. Manoj’s industry experience includes working at Novartis, Takeda and Mallinckrodt.

Perampanel is a once-daily oral anti-seizure drug for partial-onset seizures (POS) and primary generalised tonicclonic seizures. We report second interim results for adolescent patients from the multicentre, non interventional, Phase IV retrospective Study 506 (NCT03208660), to assess retention rate, safety and dosing experience of perampanel administered to patients with epilepsy during routine clinical care. Data were obtained from medical records of patients initiating perampanel aft er 1 January 2014. Primary endpoint is retention rate (proportion of patients in Safety Analysis Set [SAS] remaining on perampanel). Safety, efficacy and dosing experience are secondary objectives. Interim SAS comprised 605 patients; 101 were aged 12-<18 years (mean age [standard deviation (SD)], 14.6 [1.8] years; 50.5% female). Seizure types included: complex partial, n=51 (50.5%); POS with secondary generalisation, n=31 (30.7%); generalised tonic-clonic, n=46 (45.5%). Th e mean (SD) perampanel dose was 5.7 (2.3) mg, and the mean (SD) maximum perampanel dose was 6.6 (3.4) mg. At data cut-off (5 March 2018), 52 (51.5%) adolescent patients remained on perampanel and 49 (48.5%) had discontinued, mainly due to adverse event (AE; n=30 [29.7%]) and inadequate therapeutic effect (n=16 [15.8%]). Retention rates at 3, 6, 12, 18 and 24 months were 77.2% (n=78/101), 69.0 (n=69/100), 55.6% (n=50/90), 49.3% (n=35/71) and 52.9% (n=27/51), respectively. Treatment-emergent AEs occurred in 48.5% of patients, including aggression (8.9%), somnolence (7.9%) and irritability (5.9%). This subgroup analysis suggests daily oral doses of adjunctive perampanel are generally well tolerated, with favourable retention rates for ≤2 years in adolescent patients (aged 12-<18 years) with epilepsy.

Leock Y. Ngo has a PhD in Pharmaceutical Sciences from the University of Alberta, Canada and was a Postdoctoral Research Fellow at the University of Washington in Seattle, Washington. Stella is Director in Clinical Research at Eisai Inc., responsible for the development of new anti-epilepsy drugs. She is the International Project Lead for Fycompa® and Inovelon®, and the Clinical Lead for new chemical entities in early development for epilepsy treatment. Before joining Eisai, Stella gained 19+ years’ experience in clinical pharmacology and clinical trials across various therapeutic areas, including neurology (Alzheimer’s disease and peripheral neuropathy), oncology, pulmonology and autoimmune/inflammatory disorders.

Study 311 (NCT02849626) assessed safety, tolerability, pharmacokinetics and efficacy of once-daily adjunctive perampanel oral suspension in patients aged 4 to <12 years with POS (with/without secondarily generalised seizures [SGS]) or PGTCS. Here, we report core study safety and efficacy data stratified by age (Cohort 1: 4 to <7 years; Cohort 2: 7 to <12 years). Th e core study included 4-week pre-treatment, 23-week treatment and 4-week follow-up periods. Primary endpoints were safety and tolerability. Secondary endpoints included median percent change in seizure frequency per 28 days from baseline, and 50% responder and seizure-freedom rates during maintenance. In total, 180 patients received ≥1 perampanel dose (Cohort 1: n=46; Cohort 2: n=134). Treatment emergent adverse events were reported by 45 (97.8%; Cohort 1) and 115 (85.8%; Cohort 2) patients; most common were somnolence, nasopharyngitis, dizziness and irritability. Full analysis set, cohort 1 vs., 2: POS, n=40 vs 108; SGS, n=17 vs 37; PGTCS, n=3 vs 19, respectively. Median percent reduction in seizure frequency per 28 days from baseline for POS, PGTCS and SGS, Cohort 1 vs 2: 42.7%, 56.5%, 56.3% vs 40.1%, 81.9%, 60.6%, respectively. 50% responder rates were similar between cohorts for POS, PGTCS and SGS (Cohort 1: 45.0%, 66.7%, 70.6% vs., cohort 2: 47.2%, 63.2%, 62.2%, respectively). Seizure-freedom rates for POS, PGTCS and SGS, Cohort 1 vs., 2: 7.5%, 66.7%, 17.6% vs., 13.0%, 52.6%, 18.9%, respectively. Adjunctive perampanel was generally well tolerated and effi cacious in patients 4 to <7 and 7 to <12 years with POS, PGTCS or SGS.

Nilgun Cinar graduated from the Cumhuriyet University School of Medicine. She worked as practician doctor in Sinop and Ankara between 1996 and 2001. She completed her residency in Neurology in Eskisehir Osmangazi University School of Medicine. She worked in different instituitons, including Sanlıurfa Siverek State Hospital and Aksaray Training and Research Hospital Neurology Services between 2006-2008. She became Assistant Professor in 2009 and associate Professor in 2013 at Maltepe University School of Medicine. She published many articles to both national and international journals. Dr. Cinar generally works in multidisciplinary areas, including cognitive neurology, stroke, headache, electrophysiology and movement disorders. She is an active member of cognitive neurology and quality of life working study group of Turkish Neurological Society. She currently works as Assoociate Proffessor of Neurology in Maltepe University, Department of Neurology.

Background: Late mild cognitive impairment (LMCI) is described as performance of 1.5 standard deviation below the normative mean of cognitive tests. Late MCI has highest risk of transformation to Alzheimer's disease. It is well known that APO-ε4 is an important risk factor for developing AD. We aimed to evaluate the eff ect of APOE-ε4 status in cognition and brain volume in LMCI. Method: Change from baseline to month 24 in hippocampus volume and AD Assessment Scale (ADAS)-13 score were evaluated according to APOE-ε4 status in LMCI from Alzheimer’s Disease Neuroimaging Initiative (ADNI) data. Cases were divided into two groups as non-carriers (NC) and carriers (C) (homozygot and heterozygot) according to APOE-ε4 phenotype. Results: Total 180 LMCI cases (male/female: 128/52, APOE-ε4 carriers: %60) enrolled to the study. Mean age, baseline ADAS-13 score, hippocampal volume of NC and C were 75±8, 74±6 years, 18±5.5, 19±5.7, 6537±1228mm³, 6238±1056mm³, respectively. No statistical differences were detected between the groups. ADAS-13 score and hippocampal volume after 24 months of NC and C were 20±7.5, 25±9, 6312±1417mm³, 5980±1036mm³. ADAS- 13 score were found signifi cantly different between the groups. No gender difference was found between groups in evaluation of baseline and 24 months aft er. Conclusion: Our results showed that although there was no significant change in hippocampus volume, there was a detoriation in cognition after 24 months in APOE-ε4 carrying LMCI cases. Therefore, evaluating APOE-ε4 and neurocognitive tests may provide earlier findings from neuroradiological assessments.

Abdulrahman Alharbi is currently working as an Assistant Professor of Neurology & Consultant Stroke Neurologist in the College of Medicine at Majmaah University.

Background and Objectives: The association of micro vascular complications (diabetic nephropathy) with the stroke is limited because it will require huge sample size of diabetic population with nephropathy and long follow-up period to see the association or development incidence of stroke among these patients. So, we conducted out this meta-analysis of the existing studies to find out the incidence/ risk of stroke among diabetic nephropathy patients and, explore the association between stroke and proteinuria in a diabetic nephropathy population and to describe Does Degree of Proteinuria a Clinical Matter!! ? Methods & Materials: We searched the existing databases from the year 1995 to August 2018 by using the MeSH terms. All cohorts, cross sectional studies were searched for, fulfilling the inclusion criteria and as per operational definitions. Study Result: Seven studies were found to be eligible for inclusion in the meta- analysis. The hazards or risk of stroke development among diabetic patients was 3.25 times higher in patients with nephropathy as compared to patients without nephropathy. The pooled hazards ratio of 1.46 (95% CI=0.81-2.60) and of 1.65 (95% CI=0.53-5.11) among diabetic patients with micro albuminuria and macro albuminuria respectively. Conclusion: This is the first meta-analysis which has included studies from January 1995 to August 2018 to the best of our knowledge which has tried to compare the risk/ hazard of stroke among diabetic patients with and without nephropathy and sub- group analysis for micro- and macro albuminuria. Diabetic nephropathy patients have a higher incidence and risk of stroke compared to diabetic patients without nephropathy.

Fu-Jen Cheng graduated from Chang Gung University College of Medicine on 2004. He is an Attending Physician in Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, since 2009. He has published more than 10 papers in reputed journals.

Background: Causes of headache range from benign to life-threatening. Subarachnoid hemorrhage (SAH) is one of the most serious diagnoses. Ottawa subarachnoid hemorrhage (OSAH) rule is a clinical decision rule, which identifies patients with acute nontraumatic headache who require further investigation. OSAH rule had high sensitivity for SAH. Purpose: The present study had two purposes they are to validate the OSAH rule to assess its classification performance in ED headache patients; to evaluate the impact of OSAH rule for ICH and other intracranial hemorrhage (ICH) and intracranial pathology (ICP). Methods: We conducted a retrospective cohort study from January 2016 to March 2017. Patients with acute headache, defined as those with a primary complaint of headache onset within 14 days before ED visit, were included. We excluded patients who had sustained direct head trauma in the previous 7 days, and those with new onset abnormal neurologic findings, or patients with changes in levels of consciousness. Per the OSAH rule, patients with any of the following predictors require further investigation: age 40 years or older, neck pain, stiffness or limited flexion, loss of consciousness, onset during exertion or thunderclap. Results: During the study period, 913 patients were included. Of them, 15 patients were diagnosed as SAH. The OSAH Rule had sensitivity for SAH: 100% (95% CI, 78.2%-100%), specificity 37.0% (95% CI, 33.8-40.2%-10.6%). Total 22 cases diagnosed as SAH or ICH, when applied with OSAH rule, 100% sensitivity (95% CI, 84.6%-100%), 37.3% (95% CI, 34.1%-40.5%) specificity were noted. When we applied OSAH rule to non-hemorrhagic ICP, the sensitivity decreased to 75.0% (95% CI, 53.3%-90.2%), and negative predictive value (NPV) decreased to 98.2% (95% CI, 96.1%-99.3%). Conclusions: In our cohort, OSAH rule had 100% sensitivity and NPV for SAH and ICH, with acute headache. The sensitivity and specificity were lower for non-hemorrhagic ICP. These data suggest that applying the rule might be an effective tool to exclude acute ICH and SAH in our setting.

Amal Yousef Kentab has completed her MMBS from King Saud University and ABP and KSU fellowship in Pediatrics in 1996, MRCP at UK - London in 1998; Fellowship in Pediatric Neurology at King Fasial Specialist Hospital and Research Center in Riyadh in 2001. She is an Associate Professor, Consultant Pediatric Neurologist and the Deputy Director of Pediatric Residency Program at King Saud University, Riyadh, Saudi Arabia. She has published more than 35 papers in reputed journals and has been serving as a Reviewer in multiple journals and presented in multiple international conferences.

Background: Vici syndrome (OMIM: 242840) is a rare autosomal recessive congenital multisystem disorder characterized by oculocutaneous hypopigmentation, agenesis of corpus callosum, cataract, combined immunodeficiency, hypertrophic cardiomyopathy and psychomotor retardation. It is caused by mutations in the EPG5 gene (18q12.3). Approximately 30 patients have been reported in the world. Reports of patients from the Arabian Peninsula are rare due to lack of awareness among physicians. Method: A retrospective chart review of seven children diagnosed with Vici syndrome at a University Hospital, in Riyadh. Results: There was female sex preponderance (71.4%). All patients were failing to thrive (85.7%) except for one. Developmental delay and hypotonia were found in all, while seizure disorder was found in 3(42.9%). Ocular albinism was detected in 2(28.6%). Facial dysmorphism was found in all (high arched palate and micrognathia) 5(71.4%) patients had optic atrophy and 4(57%) patients had retinal hypoplasia while only one had cataract. Brain MRI revealed hypoplasia of corpus callosum in 5(71.4%) patients while agenesis of corpus callosum was found in one. Hypoplasia of cerebellar hemisphere was found in all while of the vermis was found in all except one. All had delayed myelination of white matter and only 4(57%) had gyral abnormalities. Muscle biopsy was done in 3(42.9%) patients and showed myopathy. One patient had cardiac hypertrophy, 2(28.6%) patients had kidney abnormalities, and lymphopenia with lymophocytes subsets abnormalities were detected in 3(42.9%) patients. Conclusion: Vici syndrome should be suspected in children presented with developmental delay, hypotonia and abnormalities of corpus callosum or cerebellum. Awareness may help in improving the quality of life and survival of these patients.

Kyung Chul Noh has expertise in stroke evaluation and passion in improving the health in Korea. He is in the first year of stroke fellowship in Asan Medical Center, Seoul, South Korea and majoring in stroke. He is interested in personalized treatment in Neurology field, adjusting antiplatelet or anticoagulation therapy in each stroke patient.

Treatment failure of stroke is commonly attributed to multiple causes, including vascular factors causing increased platelet activation or failure to uncover the true cause or mechanism of stroke. Clinicians are faced with options of switching to a new antiplatelet medication or using a combination of antiplatelet medications in the acute setting and for long-term secondary stroke prevention, balancing future protective benefit and risks. We have consecutively enrolled patients with ischemic stroke classified as LAA and under the use of aspirin. Ischemic stroke was classified according to the location of atherosclerosis, ischemic lesion pattern and mechanism of stroke. Aspirin resistance unit (ARU) was measured at the day of admission ARU>550 was regarded as resistant to aspirin. ARU and proportion of patients with aspirin resistance was compared among different groups. ARU was higher in those with extracranial than intracranial atherosclerosis (492.9 vs., 461.8; respectively, p=0.007). Aspirin resistance was more frequently observed from extracranial atherosclerosis (28.8% vs., 10.3%; P=0.001). By mechanism ARU was low in those with local branch occlusion than other mechanisms (p=0.037). Aspirin resistance was less frequent in those with local branch occlusion (20.2% vs., 3.4%; p=0.029) Similarly, ARU was most low in those with subcortical infarction pattern (p=-0.001). ARU in Ischemic stroke due to LAA differs according to the mechanism of stroke. Ischemic stroke occurring under aspirin due to extracranial atherosclerosis and artery-to-artery embolism is associated with aspirin resistance, whereas the role of platelet inhibition is limited in ischemic stroke due to local branch occlusion in intracranial atherosclerosis.

Khalid Hundallah is a Consultant Pediatric Neurologist. He is the head of Pediatric Neurology, Prince Sultan Military Medical City. He is an Assistant Professor, Colleague of Medicine, Al-Imam `Mohd Ibn Saud University. He has completed his fellowship in McMaster University. He has published more than 18 papers in reputed journals and has been serving as an Associate Editor in the Neuroscience Journal (KSA).

Background: De novo loss or gain of function mutations in KCNA2 gene have been described in individuals with epileptic encephalopathy, ataxia or intellectual disability. Seizures are usually refractory to antiepileptic medications. Aim: Access the effect of acetazolamide on patients with early onset epileptic encephalopathy caused by KCNA2 gene mutation both clinically and electro-physiologically. Methods: We report a cohort of 11 patients with severe early onset epileptic encephalopathy carrying KCNA2 mutations. All had refractory seizures resistant to multiple antiepileptic drugs, significant developmental delay and slowing of EEG background. We started them on acetazolamide after antiepileptic medications failed. Pre and post therapy seizures burden and electroencephalography (EEG) studies were evaluated. Results: 9 of the 11 children (81%) showed a significant improvement both clinically and electro-physiologically and Acetazolamide is a potentially eff ective therapy in patients with early onset epileptic encephalopathy carrying KCNA2 mutations.

Ming-Ta Tsai has completed his Graduation from China Medical University College of Medicine in 2010. He is an attending physician in Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, since 2016.

Objectives & Aim:Vertigo/dizziness is some of the commonest reasons where adults seek medical advice during emergency department (ED) visits. It is a challenge for emergency physicians (EPs) to identify few patients with dizziness/vertigo caused by life threatening central nervous system (CNS) disorders among the overwhelming majority of patients with benign dizziness/vertigo. Th is study aimed to evaluate the association between physician seniority and head computed tomography (CT) use and ED length of stay (LOS) in ED patients with isolated dizziness/vertigo. Methods: This retrospective cohort study included adult patients with non-traumatic isolated dizziness/vertigo examined in the ED. The EPs were categorized into three groups based on seniority: junior (≤6 years of work experience), intermediate (7–12 years), and senior (≥12 years) groups. Results: Of the 2291 patients with isolated dizziness/vertigo, 421(18.4%) received brain CTs; 44(1.9%) patients received a fi nal diagnosis of CNS disorder. Compared with senior EPs, junior and intermediate EPs were more likely to order CT examinations [odds ratio (OR) =1.355, 95% confi dence interval (CI): 1.007–1.829 and OR=1.577, 95% CI: 1.197–2.092]. Conversely, shorter ED LOS were noted for patients treated by junior and intermediate EPs (OR=- 0.280, 95% CI: -0.771–0.211 and OR=-0.478, 95% CI: -0936 to -0.019). Conclusions: This study identifi ed different decision-making strategies among senior, intermediate, and junior EPs. Senior EPs had the lowest rate of CT use for patients with isolated vertigo/dizziness and was accompanied by a slightly longer LOS.

Haroon Hamid is a Graduate from University of Liverpool. Currently, she is working as a doctor on the Isle of Man, with an interest in research. Research from time during work at the Walton Centre, Aintree Hospital during completion of a Masters in Research.

Introduction: NASH (National Audit of Seizure Management in Hospitals) is a comprehensive audit surveying those who had attended ED due to seizure. This could be patients with known epilepsy, known epilepsy with blackouts or no known epilepsy. 4544 patients were audited, across over 150 national trusts. We analysed data relevant to the question being posed are women of a childbearing age being treated appropriately and managed according to guidelines. These state sodium valproate (VPA) to be highly teratogenic, either as a monotherapy or polytherapy. The audit allowed us to see the proportions of women of a childbearing age currently on VPA. Methods: Data was collected using a simple web based answering scheme. Th is allowed for multiple trusts to be involved in the audit and allowed a large population to be asked various key points about their management and treatment. We focused on results from questions relevant to the usage of VPA such as monotherapy, polytherapy, care plans, specialist referrals etc. From these analyses we have made observations and drawn conclusions for future work/amendments in clinical practice that need to be made. Results: 4544 patients recruited, 43% female, 25% of these were of a childbearing age (1117/4544). Of these only 14% of women 15-49 were on VPA. Alarmingly, 60% were on VPA and polytherapy with only 20% not taking any AED prior to attending ED. Th ere were lower figures for those on polytherapy as opposed to monotherapy for women of this age group (37% polytherapy and 42% monotherapy). In the ED senior reviews were common for all patients over 15- approximately 57% of patients had a senior review. Furthermore, Neurologists were the most sought after specialists for advice; however, only 20% of women on VPA were seen by the Neurologist during their admission, with only approximately 1/3rd of these patients having a care plan in place. Rates of GP referrals were signifi cantly higher for those 15-49-48% in comparison to 33% for those over 49. In regards to investigations whilst in ED, those over 49 were much more likely to have more investigations (Plantars, ECG, EEG and CT) than those 15-49. Conclusions: Good patient care for women 15-49 is evident. Guidelines are specific and thorough when it comes to how to treat women of a childbearing age with regards to their Epilepsy. Vital to know the patients plans for the future and to have pre-conception counselling. Seizure freedom and as lower AED usage as possible is desirable. Certain AED’s and AED combinations need to be avoided- eg. VPA throughout the pregnancy, and various combinations (VPA and Lamotrigine is highly teratogenic). The results found show clinicians have been treating women of a childbearing age according to the guidelines; however, more can be done to avoid polytherapy, more specialist input into their care in the ED whilst more should have a care plan in place. Importantly these results are not necessarily reflective of the overall general Epilepsy population as these are values of just those attending ED with seizures- i.e. those whose Epileptic control is not necessarily as stable as others.

Ayelet Siman-Tov completed her PhD from Bar Ilan University and was awarded the Rector's prize for excellent research students for her distinction in her doctoral studies. Her main research interests: autism parenting and family. She also received a certificate of merit as an excellent lecturer from the Kibbutzim College of Education. From 2014-2017- Coordinator of faculty researchers, Department of Special Education at Kibbutzim College of Education, Israel; 2006-2018- Researcher and Lecturer, Department of Special Education at Kibbutzim College of Education, Israel; 2009-2018-Researcher, Lecturer, Mentor and Academic Coordinator in a Training program for Therapists, School of Social Work, Bar Ilan University, Israel; Researcher and Lecturer, Department of Human Development and Education, School of Education, Tel Aviv University, Israel.

Backgrounds: The purpose of the current study is the construction and validation of a model for the mental health and quality of marriage of parents and a child with autism. The model comprises four elements: parental stress, parental resources, parental mental health and quality of marriage and the child's autism symptoms. Our main hypothesis is that the resources (sense of coherence, locus of control and social support), will be negatively correlated with parental stress. The more social support parents have and greater their sense of coherence and internal locus of control, the less pressure they will report in parenting their autistic child. The intensity of the stress will be also negatively correlated with parental mental health and quality of marriage. Consequently, parental mental health and quality of marriage will be positively correlated with the child improvement. Methods: 176 parents of children aged between 6 to 16 diagnosed with ASD answered several questionnaires measuring parental stress, personal resources, mental health and marriage quality and the child's autism symptoms. Results: Path analysis showed that sense of coherence, internal locus of control, social support and quality of marriage increase the ability to cope with the stress of parenting an autistic child. Conclusions: It seems that the explanations of the results of this research emphasize the concept of control. A strong sense of control may facilitate use of active coping and support seeking methods encourage persistence and promote domain-specifi c satisfaction and affect.