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Resumption of oral anticoagulation after spontaneous intracerebral hemorrhage
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Jochen A. Sembill , Joji B. Kuramatsu , Stefan Schwab , Hagen B. Huttner
Yıl :
2019
Neurological Research and Practice
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Abstract Background Given an ageing population the incidence of both patients suffering from intracerebral hemorrhage (ICH) and those requiring oral anticoagulation will increase. Up to now there are no results from randomized trials available whether or not, and when, ICH survivors should resume OAC. This review summarizes the most important observational studies, and initiated ongoing trials, to help guiding physicians in daily routine decision making. Findings Several large observational studies and meta-analyses verified that OAC resumption was associated with a significant reduction of thromboembolic complications and mortality without leading to increased rates of recurrent ICH. OAC resumption seemed further associated with improved functional recovery and favorable long-term outcome. Given the general bleeding risk reduction in patients using Non–vitamin K antagonist oral anticoagulants (NOAC) compared to Vitamin-K-antagonist (VKA), NOAC use should also be preferred after ICH, although specific comparative studies are pending. Patients with lobar ICH need special attention as these patients showed increased ICH recurrence rates, why decision making should include extended diagnostic work-up evaluating cerebral microbleed burden, cortical subarachnoid hemorrhage and superficial siderosis. Further, patients with mechanical heart valves need specific consideration as restarting VKA may be unsafe until two weeks, whereas optimal balancing of hemorrhagic with thromboembolic complications may allow earlier re-initiation one week after ICH. In patients with atrial fibrillation, resumption generally should take place between 4 and 8 weeks after ICH depending on a patient’s individual risk profile. Left atrial appendage occlusion (LAAO) might represent an alternative strategy in high-risk patients. Ongoing clinical trials will clarify whether OAC resumption versus LAAO versus no antithrombotic therapy may represent the best possible secondary stroke prevention in ICH survivors with atrial fibrillation. Conclusions According to observational data OAC resumption after ICH seems beneficial and safe. Ongoing clinical trials will create evidence regarding treatment effects of pharmaceutical resumption and interventional alternatives. Yet, individual decision making weighing the patient’s individual thromboembolic versus hemorrhagic risks remains essential.
DOI : 10.1186/s42466-019-0018-0
Anahtar Kelimeler : Intracerebral hemorrhage, Oral anticoagulation, Resumption, Stroke prevention, Secondary prophylaxis, Intracranial hemorrhage
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 10
2
Recovery from stroke: current concepts and future perspectives
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Christian Grefkes , Gereon R. Fink
Yıl :
2020
Neurological Research and Practice
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Abstract Stroke is a leading cause of acquired, permanent disability worldwide. Although the treatment of acute stroke has been improved considerably, the majority of patients to date are left disabled with a considerable impact on functional independence and quality of life. As the absolute number of stroke survivors is likely to further increase due to the demographic changes in our aging societies, new strategies are needed in order to improve neurorehabilitation. The most critical driver of functional recovery post-stroke is neural reorganization. For developing novel, neurobiologically informed strategies to promote recovery of function, an improved understanding of the mechanisms enabling plasticity and recovery is mandatory. This review provides a comprehensive survey of recent developments in the field of stroke recovery using neuroimaging and non-invasive brain stimulation. We discuss current concepts of how the brain reorganizes its functional architecture to overcome stroke-induced deficits, and also present evidence for maladaptive effects interfering with recovery. We demonstrate that the combination of neuroimaging and neurostimulation techniques allows a better understanding of how brain plasticity can be modulated to promote the reorganization of neural networks. Finally, neurotechnology-based treatment strategies allowing patient-tailored interventions to achieve enhanced treatment responses are discussed. The review also highlights important limitations of current models, and finally closes with possible solutions and future directions.
DOI : 10.1186/s42466-020-00060-6
Anahtar Kelimeler : Neurorehabilitation, Neuroimaging, Brain stimulation, Motor
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 10
Sınıflandırma :
3
Pallidal neurostimulation versus botulinum toxin injections in the treatment of cervical dystonia: protocol of a randomized, sham-controlled trial (StimTox-CD)
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Thorsten M. Odorfer , Uwe Malzahn , Cordula Matthies , Peter U. Heuschmann , Jens Volkmann
Yıl :
2019
Neurological Research and Practice
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Abstract Background Selective peripheral denervation via botulinum neurotoxin injections into dystonic muscles is the first-line treatment for cervical dystonia. Pallidal neurostimulation is a potent alternative, but currently restricted to patients failing on neurotoxin therapy. As botulinum neurotoxin is partially effective but often unsatisfactory in a relevant proportion of patients, earlier neurostimulation might be advantageous in providing stable symptom control and preventing disability. This trial intends to demonstrate, that pallidal neurostimulation is superior to neurotoxin injections in best clinical practice for controlling the symptoms of cervical dystonia and that it is safe in patients with a partial therapy response to peripheral denervation. We hypothesize a better outcome in everyday functioning and health-related quality of life of neurostimulated patients. Methods We aim to recruit 66 cervical dystonia patients into a double-blind comparison of pallidal neurostimulation versus botulinum neurotoxin type A. Eligible patients need ≥25% motor symptom reduction 4 weeks after a neurotoxin test injection, but are willing to undergo DBS surgery due to unsatisfactory symptom control. All participants will be implanted with a DBS system, and randomized into 2 groups: First group will receive effective neurostimulation and saline injections into dystonic muscles. Second group is treated with regular neurotoxin injections and undergoes a sham-stimulation. Primary outcome is the change in TWSTRS total score between baseline and 6 months of therapy. Secondary outcome parameters are corresponding changes in TWSTRS motor score, Tsui score, CDQ-24 and SF-36. Safety will be assessed by frequency and severity of reported adverse events. Statistical analysis includes intention-to-treat and per protocol populations, analysis based on imputation of missing values and analysis adjusting for differences in baseline TWSTRS. After 6 months of blinded treatment all patients will receive open-label neurostimulation and neurotoxin treatment as needed, and are followed up 48 weeks after randomization. Perspective We will assess if pallidal neurostimulation is a safe and effective alternative to selective peripheral denervation by botulinum toxin injections in cervical dystonia, which may be offered earlier in the course of disease based on patient preference. A positive study outcome would influence future treatment guidelines of cervical dystonia. Trial registration EudraCT registration number: 2016–001378-13
DOI : 10.1186/s42466-019-0007-3
Anahtar Kelimeler : Cervical dystonia (CD), Pallidal neurostimulation, Deep brain stimulation (DBS), Botulinum neurotoxin type a (BoNT a), Motor symptom control, TWSTRS (Toronto Western spasmodic torticollis rating scale)
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 8
Sınıflandırma :
4
Historical review: a short history of German neurology – from its origins to the 1940s
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
A. Karenberg , H. Fangerau , H. Steinmetz , P. Berlit , M. Grond
Yıl :
2019
Neurological Research and Practice
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Abstract This paper aims at reconstructing the development and role of German neurology between 1840 and 1940. Therefore a couple of original sources as well as selected material form the scattered secondary literature were assessed and reviewed. Since the middle of the nineteenth century, an intricate process of separation from internal medicine and psychiatry gradually led to forming a self-conscious community of German neurologists. While Moritz Heinrich Romberg had constructed a cognitive basis for neurology, scientific founders such as Wilhelm Erb, Carl Wernicke, Alois Alzheimer, Hermann Oppenheim, Max Nonne, and many others established the new discipline within modern medicine. In 1891, the first generation of “pure” neurologists succeeded in founding the German Journal for Neurology (Deutsche Zeitschrift für Nervenheilkunde) followed by an autonomous professional organisation, the Society of German Neurologists (Gesellschaft Deutscher Nervenärzte) in 1907. A variety of external factors, however, hampered the institutional evolution and thus the implementation of chairs and departments remained quite modest. In 1935, only 2 years after the National Socialists had seized power, the regulatory merger with the psychiatristsʼ society caused the cautious attempts of German neurologists for autonomy to end in complete failure. The imprisonment, murder and expulsion of neuroscientists declared as Jewish or non-Aryan caused profound changes in neurology, medicine, academic life, and health care in general. Further historical research is needed to reconstruct in detail the involvement of German neurologists in racial-hygienic and eugenic research as well as the institutional and scientific development of German neurology after World War II.
DOI : 10.1186/s42466-019-0019-z
Anahtar Kelimeler : Neurology/history, Specialization/history, Germany, National socialism/history
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 6
Sınıflandırma :
5
Anodal tDCS over left parietal cortex expedites recovery from stroke-induced apraxic imitation deficits: a pilot study
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Jana M. Ant , Eva Niessen , Elisabeth I. S. Achilles , Jochen Saliger , Hans Karbe , Peter H. Weiss , Gereon R. Fink
Yıl :
2019
Neurological Research and Practice
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Abstract Background To date, specific therapeutic approaches to expedite recovery from apraxic deficits after left hemisphere (LH) stroke remain sparse. Thus, in this pilot study we evaluated the effect of anodal transcranial direct current stimulation (tDCS) in addition to a standardized motor training on apraxic imitation deficits. Methods In a rehabilitation hospital, we assessed apraxic, aphasic, and motor deficits in 30 LH stroke patients before and after a five-day standard programme of motor training combined with either anodal (10 min, 2 mA; n = 14) or sham (10 min, 0 mA, n = 16) tDCS applied in a double-blind fashion over left posterior parietal cortex (PPC). Where appropriate, data were analyzed with either t-test, Fisher’s exact test, or univariate/ repeated measures ANOVA. Results Compared to sham tDCS, five sessions of anodal tDCS expedited recovery from apraxic imitation deficits (p < 0.05): Already after 5 days, the anodal tDCS group showed levels of imitation performance that were achieved in the sham tDCS group after 3 months. However, the primary outcome of the study (i.e., anodal tDCS induced improvement of the total apraxia score) failed significance, and there was no significant tDCS effect on apraxia after 3 months. Anodal tDCS improved grip force (of the contra-lesional, i.e., right hand), but had no effect on aphasia. Conclusions Data from this pilot study show that repetitive, anodal tDCS over left PPC combined with a standardized motor training expedites recovery from imitation deficits in LH stroke patients with apraxia (relative to sham stimulation). Results suggest that in patients suffering from apraxic imitation deficits a randomized controlled trial (RCT) is warranted that investigates the effects of tDCS applied over PPC in addition to a standardized motor training.
DOI : 10.1186/s42466-019-0042-0
Anahtar Kelimeler : Apraxia, Neuromodulation, Stroke, Neurorehabilitation, Transcranial direct current stimulation (tDCS), Motor cognition
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 10
6
Outcome evaluation by patient reported outcome measures in stroke clinical practice (EPOS) protocol for a prospective observation and implementation study
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
D. Leander Rimmele , Lisa Lebherz , Marc Frese , Hannes Appelbohm , Hans-Jürgen Bartz , Levente Kriston , Christian Gerloff , Martin Härter , Götz Thomalla
Yıl :
2019
Neurological Research and Practice
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Abstract Introduction The impact of stroke-related impairment on activities of daily living may vary between patients, and can only be estimated by applying patient-reported outcome measures. The International Consortium for Health Outcome Measurement has developed a standard set of instruments that combine clinical and longitudinal patient-reported outcome measures for stroke. The present study was designed (1) to implement and evaluate the feasibility of the use of it as a consistent outcome measure in clinical routine at the stroke center of a German university hospital, (2) to characterize impairment in everyday life caused by stroke, and (3) to identify predictive factors associated with patient-relevant outcomes. Methods We plan to enroll 1040 consecutive patients with the diagnosis of acute ischemic stroke, transient ischemic attack, or intracerebral hemorrhage in a prospective observational study. Demographics, cardiovascular risk factors, and living situation are assessed at inpatient surveillance. At 90 days and 12 months after inclusion, follow-up assessments take place including the Patient-reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10), the Patient- Health Questionnaire-4, and the simplified modified Ranking Scale questionnaire. The acceptance and feasibility (1) will be assessed by a process evaluation through qualitative semi-structured interviews with clinical staff and patients and quantitative analyses of the data quality evaluating practicability, acceptance, adoption, and fidelity to protocol. The primary outcome of objective 2 and 3 is health-related quality of life measured with the PROMIS-10. Additional outcomes are depressive and anxiety symptoms and patient participation in their social roles. Patient-reported outcomes will be assessed in their longitudinal course using (generalized) mixed regressions. Exploratory descriptive and inference statistical analyses will be used to find patterns of patient characteristics and predictive factors of the outcome domains. Perspective The results will describe and further establish the evaluation of stroke patients of a stroke center by standardized PROMs in everyday life. Trial registration The trial is registered at ClinicalTrials.gov (NCT03795948). Approval of the local ethics committee (Ethik-Kommission der Ärztekammer Hamburg) has been obtained.
DOI : 10.1186/s42466-019-0034-0
Anahtar Kelimeler : Stroke care, Patient-reported outcome measures, Patient-relevant care, Long term assessment, Health-related quality of life, Process evaluation
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 7
Sınıflandırma :
7
Emerging and re-emerging viruses affecting the nervous system
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Uta Meyding-Lamadé , Eva Craemer , Paul Schnitzler
Yıl :
2019
Neurological Research and Practice
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Abstract Emerging and re-emerging viruses may cause meningitis, encephalitis, meningoencephalomyelitis, encephalitis, Guillian-Barré-like-syndromes as well as strokes. Most important viruses belong to the family of Adenoviridae, Arbovirus, Arenaviridae, Herpesviridae, Picornaviridae, Paramyxoviridae as well as Togaviridae. Clinical presentation usually consists of a biphasic presentation. Non-specific febrile illnesses may be accompanied by rash, headache, arthralgia and myalgia. Thereafter focal neurological signs may evolve. Diagnostic strategies for the detection of emerging and re-emerging viruses may be difficult due to the short viraemic period. Pitfalls in serology may be due to antibody crossreactivity. Arboviruses are transmitted by arthropods. Aedes mosquitos are one of the vectors for arboviruses like Chikungunya-virus, Dengue-virus, Japanese-Encephalitis-B-virus and West-Nile-virus. Since the last centuries Aedes mosquitos have spread from their naturally habitat in Africa to America as well as Europe. The arboviruses risk profile depend essentially on the occurrence, the activity of the respective vector, this may be the key to fight the disease and its spread. Due to global shifts in the ecological balance but also as a result of more or less successful control measures, some diseases have become rarer, others are more common. The viruses persist in the respective vector months to years; in ticks they may persist for years and in mosquitoes 1 to 4 months. In order to survive bad climatic conditions unscathed, the viruses partially overwinter in arthropods.
DOI : 10.1186/s42466-019-0020-6
Anahtar Kelimeler : Emerging viruses, Dengue-virus, Japanese-encephalitis-B-virus, Meningoencephalitis, Neuroinfectious disease, Nipahvirusencephalitis
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 9
Sınıflandırma :
8
SOP: First-ever epileptic seizure in adult patients
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Julian Bösel
Yıl :
2019
Neurological Research and Practice
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Abstract Background About 5% of all adults will have at least one epileptic seizure in their life. The incidence of all unprovoked seizures ranges from approximately 50 to 70 /100,000. The very first epileptic seizure in an adult can be a very decisive event and demands a great deal of responsibility on the part of the treating clinician. Optimal clinical work-up and systematic decision-making are necessary to ensure adequate treatment as well as to avoid unnecessary treatment, such as life-long application of anticonvulsants that may not be indicated. Aim To present a pragmatic standard operating procedure (SOP) for approaching the first seizure in adults. Method Based on current recommendations and personal suggestions, an SOP in the form of a flow chart accompanied with topical explanations and tables was created. Results Approaching the first seizure should start with obtaining bystander information on the seizure and its clinical features. Then, differential diagnoses should be considered. The diagnostic work-up hast to contain a neurological and physical examination, emergency blood tests and cerebral imaging. This should allow to differentiate an unprovoked from an acute symptomatic seizure, i.e. triggered by current specific and identifiable structural or metabolic cause that should be eliminated if possible. In the case of an unprovoked seizure, estimation of seizure recurrence is necessary for the decision to start treatment with antiepileptic drugs. Conclusion The challenge of diagnostic work-up and treatment decisions after a first epileptic seizure in adults may be facilitated by a systematic, SOP-based approach.
DOI : 10.1186/s42466-019-0006-4
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 6
Sınıflandırma :
9
Symptoms and probabilistic anatomical mapping of lacunar infarcts
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Ewgenia Barow , Hans Pinnschmidt , Florent Boutitie , Alina Königsberg , Martin Ebinger , Matthias Endres , Jochen B. Fiebach , Jens Fiehler , Vincent Thijs , Robin Lemmens , Keith W. Muir , Norbert Nighoghossian , Salvador Pedraza , Claus Z. Simonsen , Christian Gerloff , Götz Thomalla , Bastian Cheng , on behalf of the WAKE-UP investigators
Yıl :
2020
Neurological Research and Practice
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Abstract Background The anatomical distribution of acute lacunar infarcts has mainly been studied for supratentorial lesions. In addition, little is known about the association with distinct stroke symptoms, not summarized as classical lacunar syndromes. We aimed to describe the spatial lesion distribution of acute supra- and infratentorial lacunar infarcts and their association with stroke symptoms in patients eligible for thrombolysis. Methods All patients enrolled in the WAKE-UP trial (efficacy and safety of magnetic resonance imaging [MRI]-based thrombolysis in wake-up stroke) were screened for lacunar infarcts on diffusion-weighted imaging (DWI). The relationship between the anatomical distribution of supra- and infratentorial lacunar infarcts, their demographic characteristics and acute stroke symptoms, defined by the National Institutes of Health Stroke Scale (NIHSS) score, were correlated and compared. Results Maps of lesion distribution from 224 lacunar infarct patients (76 [33.9%] females, mean age [standard deviation] of 63.4 [11.5] years) were generated using computational image mapping methods. Median infarct volume was 0.73 ml (interquartile range [IQR] 0.37–1.15 ml). Median NIHSS sum score on hospital arrival was 4 (IQR 3–6). 165 (73.7%) patients had lacunar infarcts in the supratentorial deep white or grey matter, while 59 (26.3%) patients had infratentorial lacunar infarcts. Patients with supratentorial lacunar infarcts presented with a significantly lower occurrence of deficits in the NIHSS items gaze (p < 0.001) and dysarthria (p = 0.008), but had more often a paresis of the left arm (p = 0.009) and left leg (p = 0.068) compared to patients with infratentorial infarcts. Conclusions The anatomical lesion distribution of lacunar infarcts reveals a distinct pattern and supports an association of localization with different stroke symptoms. Trial registration NCT01525290 .
DOI : 10.1186/s42466-020-00068-y
Anahtar Kelimeler : Lacunar infarct, Magnetic resonance imaging, Lesion distribution, Probabilistic atlas, WAKE-UP
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 7
Sınıflandırma :
10
Cerebral involvement in systemic vasculitides
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Peter Berlit , Markus Krämer , for the Consensus Group
Yıl :
2019
Neurological Research and Practice
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Abstract Cerebral vasculitis is a rare disorder but plays a major role in the differential diagnosis of stroke, encephalopathy and headache. This guideline was developed in order to support clinicians in the diagnosis and treatment of cerebral manifestations of systemic vasculitides and rheumatic diseases. It is based on a medline research and was developed in a modified Delphi process and approved by the involved societies. This article is an abridged and translated version of the guideline published in DGNeurologie: Berlit, P. & Krämer, M. DGNeurologie (2018) 1: 17. https://doi.org/10.1007/s42451-018-0001-y
DOI : 10.1186/s42466-019-0016-2
Anahtar Kelimeler : Cerebral vasculitis, Giant cell Arteriitis (GCA), Takayasu arteritis (TA), Polyarteritis nodosa (PAN), ANCA-associated Vasculitides (AAV), Granulomatosis with polyangiitis (GPA)
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 16
11
SOP: antibody-associated autoimmune encephalitis
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Rosa Rössling , Harald Prüss
Yıl :
2020
Neurological Research and Practice
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Abstract Background Antibody-mediated and paraneoplastic autoimmune encephalitides (AE) present with a broad spectrum of clinical symptoms. They often lead to progressing inflammatory changes of the central nervous system with subacute onset and can cause persistent brain damage. Thus, to promptly start the appropriate and AE-specific therapy, recognition of symptoms, initiation of relevant antibody diagnostics and confirmation of the clinical diagnosis are crucial, in particular as the diseases are relatively rare. Aim This standard operating procedure (SOP) should draw attention to the clinical presentation of AE, support the diagnostic approach to patients with suspected AE and guide through the necessary steps including therapeutic decisions, tumour screening and exclusion of differential diagnoses. Method Based on existing diagnostic algorithms, treatment recommendations and personal experiences, this SOP gives an overview of clinical presentation, diagnostic procedures and therapy in AE. Additional information is provided within an accompanying text and a table describing the most important autoantibodies and their characteristics. Results The initial steps of the AE flow chart are based on clinical symptoms and the patient’s history. Assignment to paraneoplastic or antibody-mediated AE is sometimes clinically possible. Diagnostics should include MRI, EEG and CSF analysis with antibody panel diagnostic. Definite AE can be diagnosed if the underlying antibody is compatible with the clinical presentation. Classification of probable AE may be possible even with negative anti-neuronal autoantibodies if the clinical presentation and laboratory abnormalities are highly suggestive of AE. The confirmed AE diagnosis requires immediate initiation of immunotherapy. Conclusion The SOP facilitates the recognition of patients with AE and presents the necessary diagnostic and therapeutic steps.
DOI : 10.1186/s42466-019-0048-7
Anahtar Kelimeler : Autoimmune, Encephalitis, Limbic encephalitis, Antibody, Paraneoplastic, NMDAR
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 7
Sınıflandırma :
12
Diagnosis of peripheral neuropathy
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Helmar C. Lehmann , Gilbert Wunderlich , Gereon R. Fink , Claudia Sommer
Yıl :
2020
Neurological Research and Practice
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Abstract Introduction Peripheral neuropathy represents a spectrum of diseases with different etiologies. The most common causes are diabetes, exposure to toxic substances including alcohol and chemotherapeutics, immune-mediated conditions, and gene mutations. A thorough workup including clinical history and examination, nerve conduction studies, and comprehensive laboratory tests is warranted to identify treatable causes. First steps The variability of symptoms allows distinguishing characteristic clinical phenotypes of peripheral neuropathy that should be recognized in order to stratify the diagnostic workup accordingly. Nerve conduction studies are essential to determine the phenotype (axonal versus demyelinating) and severity. Laboratory tests, including genetic testing, CSF examination, nerve imaging, and nerve biopsy, represent additional clinical tests that can be useful in specific clinical scenarios. Comments We propose a flow chart based on five common basic clinical patterns of peripheral neuropathy. Based on these five clinical phenotypes, we suggest differential diagnostic pathways in order to establish the underlying cause. Conclusions The recognition of characteristic clinical phenotypes combined with nerve conduction studies allows pursuing subsequent diagnostic pathways that incorporate nerve conduction studies and additional diagnostic tests. This two-tiered approach promises higher yield and better cost-effectiveness in the diagnostic workup in patients with peripheral neuropathy.
DOI : 10.1186/s42466-020-00064-2
Anahtar Kelimeler : Peripheral neuropathy, Diagnosis, Nerve conduction studies, Hereditary amyloid transthyretin (ATTRv) amyloidosis
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 7
Sınıflandırma :
13
Neuro-Sweet syndrome - a rare differential diagnosis in aseptic meningoencephalitis
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Elgin Hoffmann , Christian Boßelmann , Stephan Forchhammer , Holger Lerche , Tobias Freilinger
Yıl :
2019
Neurological Research and Practice
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Abstract Acute febrile neutrophilic dermatosis (Sweet‘s syndrome) is a dermatological entity, which may be associated with malignancies, drugs, and infections and which is characterized by high fever, elevated neutrophils, and tender erythematous skin lesions. Involvement of the nervous system – Neuro-Sweet syndrome (NSS) - is rare, manifesting most commonly with an encephalitic syndrome in addition to fever and dermal lesions. Here, we report an unusual case of NSS in a Caucasian male patient in the setting of B-cell-lymphocytosis, with encephalitis preceding dermal lesions. Symptoms resolved completely in response to corticoids. NSS is a rare, but important differential diagnosis in the work-up of febrile aseptic meningoencephalitis unresponsive to anti-infectious treatment. Due to its rarity and clinical variability, diagnosis of NSS might be challenging. Knowledge of this entity may facilitate proper diagnosis and differentiation from conditions with similar clinical presentation, especially Neuro-Behçet‘s disease. It may further lead to early detection of a potentially underlying malignancy and help in initiating adequate therapy.
DOI : 10.1186/s42466-019-0041-1
Anahtar Kelimeler : Differential diagnosis to meningoencephalitis, Neuro-sweet syndrome, Neuro-Behçet disease, Paraneoplastic syndromes
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 3
Sınıflandırma :
14
Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Andreas Hug , Christian Schuld , Bettina Mürle , Markus Böttinger , EMSCI study group , Norbert Weidner , Rüdiger Rupp
Yıl :
2019
Neurological Research and Practice
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Abstract Background Accurate predictors of neurological recovery after cervical spinal cord injury are needed. Particularly, to tailor adequate rehabilitation plans. However, objective and quantifiable predictors are sparse. Methods Within the prospective European Multicenter Study about Spinal Cord Injury (EMSCI) registry, cervical spinal cord injury patients are monitored at fixed follow up visits (2, 4, 12, 24, and 48 weeks after injury) clinically and with ulnar nerve electroneurography. Associations of ulnar nerve compound muscle action potential amplitudes (CMAP) with American Spinal Cord Injury Association (ASIA) impairment scale (AIS) grades over time were analyzed using linear mixed modeling. Applying logistic regression, the prognostic value of within 4-week ulnar nerve CMAP for 1-year AIS was analyzed. To account for missing data, (1) last observation carried forward and (2) multiple imputation methods were applied. For model derivation, our centers’ cohort (EMSCI-HD) was analyzed. For model validation the cohort of other centers (EMSCI-nonHD) was used. Results In the EMSCI-HD cohort, the median age (interquartile range (IQR)) was 52 (34–67) years. 58% were male. The initial AIS distribution was: A = 31%, B = 17%, C = 30%, and D = 22%). In the EMSCI-nonHD cohort, the median age was 49 (32–65) years. Compared to the EMSCI-HD cohort more patients were male (79%, p = 0.0034). The AIS distribution was: A = 33%, B = 13%, C = 21%, and D = 33%). In complete-case mixed model analyses (EMSCI-HD: n = 114; EMSCI-nonHD: n = 508) higher ulnar nerve CMAP were associated with better AIS grades over the entire follow up period. In complete-case logistic regression (EMSCI-HD: n = 90; EMSCI-nonHD: n = 444) higher ulnar nerve CMAP was an independent predictor of better AIS grades. The odds ratio for within 4-week ulnar nerve CMAP to predict 1-year AIS grade D versus A-C in the EMSCI-HD cohort was 1.24 per millivolt (confidence interval 1.07–1.44). The model was validated in an independent cervical spinal cord injury (EMSCI-nonHD) cohort (odds ratio 1.09, confidence interval 1.03–1.17). Conclusions In cervical spinal cord injury, the consideration of early ulnar nerve CMAP improves prognostic accuracy, which is of particular importance in patients with clinical grading uncertainties.
DOI : 10.1186/s42466-019-0017-1
Anahtar Kelimeler : Spinal cord injury, Electroneurography, Ulnar nerve, Prognosis, Outcome
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 8
Sınıflandırma :
15
Inter-rater and test-retest reliability of the “standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients”
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Tobias Warnecke , Paul Muhle , Inga Claus , Jens B. Schröder , Bendix Labeit , Sriramya Lapa , Sonja Suntrup-Krueger , Rainer Dziewas
Yıl :
2020
Neurological Research and Practice
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Abstract Background Removal of a tracheostomy tube in critically ill neurologic patients is a difficult issue, particularly due to the high incidence of oropharyngeal dysphagia. For an objective evaluation of decannulation readiness the “Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) – a stepwise evaluation of ‘secretion management’, ‘spontaneous swallows’ and ‘laryngeal sensibility/cough’ – has been introduced. With the recent study detailed data on inter-rater and test-retest reliability are presented. Methods To obtain inter-rater reliability levels both in a group of raters with at least 5 years of experience (‘experts’) and in a group of raters with no or only minor experience using the SESETD (‘non-experts’), for each single item of the protocol and the sum score α-, respectively κ-levels were determined. The ‘experts’ assessed the same videos after a four-week interval to determine test-retest reliability. Ten videos from tracheostomized neurological patients completely weaned from mechanical ventilation were assessed independently by six ‘experts’. 27 ‘non-experts’ applied the SESETD on 5 videos from the same patient population after introduction to the protocol in a one-hour workshop. Results For the items ‘secretion management’ and ‘spontaneous swallows’ α-levels were identified at > 0.800 both in the group of ‘experts’ and ‘non-experts’. With regard to the item ‘laryngeal sensibility/cough’ in both groups, the α-level was ≥0.667. With κ-levels of 1.0 for ‘secretion management’, 0.93 for ‘spontaneous swallows’ and 0.76 for ‘laryngeal sensibility/cough’ test-retest reliability showed at least substantial agreement for each item. Intraclass correlation coefficient for the sum score was excellent in both groups (α ≥ 0.90). Conclusions The SESETD demonstrates good to excellent agreement for each single item included as well as the sum score in experienced and unexperienced raters supporting its usefulness for implementation in daily clinical routine and as an outcome measure for clinical trials.
DOI : 10.1186/s42466-020-00055-3
Anahtar Kelimeler : Tracheostomy, Decannulation, Intensive care, Swallowing, Dysphagia
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 7
Sınıflandırma :
16
Socioeconomic decline and advancement within and between generations and the risk of stroke - a case-control study
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Armin J. Grau , Annette Aigner , Christian Urbanek , Frederik Palm , Florian Buggle , Anton Safer , Heiko Becher
Yıl :
2019
Neurological Research and Practice
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Abstract Background Disadvantageous socioeconomic conditions (SEC) in both childhood and adulthood increase the risk of stroke. We investigated whether intergenerational and lifetime social advancement decreases and/or social descent increases stroke risk. Methods In a case-control study with 466 patients with first-ever ischemic stroke and 807 controls randomly selected from the general population, we compared paternal profession to subjects’ professional education in adolescence and their last profession in adulthood. Furthermore, we constructed a socioeconomic risk score for childhood (based on paternal and maternal profession and occupation, familial, living and material conditions), adolescence (based on highest school degree and professional education), and adulthood (based on last profession, periods of unemployment, and marital status), and compared subjects´ positions at different life stages. Odds ratios were derived based on conditional logistic regression conditioning on age and sex only, after adjustment for medical and lifestyle risk factors, and after additional adjustment for socioeconomic risk score values. Results Intergenerational upward mobility between paternal profession and subject’s professional education was associated with lower ischemic stroke risk independent of medical and lifestyle risk factors (odds ratio (OR) 0.58; 95% confidence interval (CI) 0.41–0.81) and after additional adjustment for socioeconomic conditions in all three life stages (OR 0.67; 95% CI 0.45–0.99). Advancement between fathers´ profession and subject’s last profession was associated with reduced odds of stroke after adjustment for risk factors (OR 0.65; 95% CI 0.47–0.89), but not significantly after additional adjustment for SEC (OR 0.77; 95% CI 0.52–1.13). Social descent between adolescence and adulthood indicated by the transition into a more disadvantageous tertile of socioeconomic risk score was associated with increased odds of stroke after adjustment for all risk factor (OR 2.93; 95% CI 1.21–7.13). Analyses by sex revealed mostly similar results in men and women with only few potential differences. Conclusions Our study results indicate that aspects of social downward mobility during adulthood may be associated with increased risk of stroke, whereas intergenerational upward mobility may be linked to a lower stroke risk. If confirmed by future studies, such results may help to focus stroke prevention measures at high risk populations.
DOI : 10.1186/s42466-019-0012-6
Anahtar Kelimeler : Socioeconomic conditions, Risk factor, Ischemic stroke
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 6
Sınıflandırma :
17
Functional stroke outcomes after mobile stroke unit deployment – the revised protocol for the Berlin Prehospital Or Usual Delivery of acute stroke care (B_PROUD) part 2 study
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Peter Harmel , Martin Ebinger , Erik Freitag , Ulrike Grittner , Irina Lorenz-Meyer , Ira Napierkowski , Christian H. Nolte , Bob Siegerink , Heinrich J. Audebert
Yıl :
2019
Neurological Research and Practice
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Abstract Background Studies investigating the Mobile Stroke Unit (MSU) concept have shown increased thrombolysis rates, reduced alarm-to-treatment times and improved prehospital triage. Yet, so far, there is no definite scientific proof of better functional outcome after MSU deployment compared to regular ambulances. Methods We provide a revised protocol for the second part of the B_PROUD trial as organization of the MSU dispatch did not meet the anticipated standards in the first part. B_PROUD is a pragmatic, prospective study comparing functional outcomes of treatment candidates with or without MSU care. Treatment candidates are defined as patients with a final diagnosis of ischemic stroke or transient ischemic attack, onset-to-dispatch-times ≤4 h, disabling symptoms not resolved at time of ambulance arrival, and the ability to ambulate prior to the qualifying event. These patients are included if their emergency call prompted a stroke alarm at the dispatch center during MSU operation hours (7 am–11 pm, Monday-Sunday) and if the emergency is located within the MSU operation area in Berlin, Germany. The intervention group consists of patients who are cared for by the MSU. When the MSU is already in operation for another emergency, MSU dispatches are handled by regular ambulances (about 45%). These dispatches create the control group. Blinded stroke physicians assess the modified Rankin Scale (mRS) score in recorded structured interviews 3 months after stroke. The primary outcome is the degree of disability and death over the full range of the mRS. As a change to the previously published protocol and only pertinent in case of more than 9% lost-to-follow-up, a co-primary outcome was introduced consisting of the proportions of death, new institutional care or severe disability in patients with additional use of information from registration offices. Perspective The results will inform parties involved in acute stroke care organization on the effectiveness of the MSU concept. Trial registration The protocol is registered in (NCT03931616) and has been approved by the ethical review committee of the Charité – University Medicine Berlin (EA4/109/15) on September 2, 2015. The study protocol of B_PROUD part 1 had been published in the International Journal of Stroke as “Berlin Prehospital Or Usual Delivery of acute stroke care (B_PROUD) – study protocol” (doi: https://doi.org/10.1177/1747493017700152) on March 22, 2017 [1] previous to first patient’s registration.
DOI : 10.1186/s42466-019-0022-4
Anahtar Kelimeler : Stroke, Prehospital, Mobile stroke unit, Thrombolysis, Endovascular thrombectomy, Functional outcome
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 5
Sınıflandırma :
18
HDMTX-based induction therapy followed by consolidation with conventional systemic chemotherapy and intraventricular therapy (modified Bonn protocol) in primary CNS lymphoma: a monocentric retrospective analysis
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Sabine Seidel , Agnieszka Korfel , Thomas Kowalski , Michelle Margold , Fatme Ismail , Roland Schroers , Alexander Baraniskin , Hendrik Pels , Peter Martus , Uwe Schlegel
Yıl :
2019
Neurological Research and Practice
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Abstract Background To evaluate outcome and toxicity of High-dose methotrexate (HDMTX)-based induction therapy followed by consolidation with conventional systemic chemotherapy and facultative intraventricular therapy (modified Bonn protocol) in patients with primary CNS lymphoma (PCNSL). Methods Between 01/2005 and 12/2013 113 patients with newly diagnosed PCNSL presented at our center; 98 of those qualified for HDMTX based chemotherapy, received a modified Bonn protocol and were included in the analysis. The treatment regimen was based on the “Bonn protocol”, but modified by omission of systemic drugs not able to cross the intact blood brain barrier. Intraventricular therapy was postponed until completion of three induction chemotherapy cycles or was replaced by intrathecal liposomal AraC and rituximab was added to induction from 2010 onwards. Results Median patient age was 67 years (range 38–83). Complete response/complete response unconfirmed (CR/CRu) was achieved in 59/98 patients (60%), partial response (PR) in 9/98 patients (9%). Twenty-four patients (23%) had progressive disease (PD), 6 (6%) died on therapy. Median progression-free survival (PFS) for all patients was 11.4 months, median overall survival (OS) 29.1 months. A trend to better outcome for intraventricular therapy versus intrathecal liposomal AraC was found in patients < 65 years (HR 0.53 [0.19–1.47] for OS and 0.46 [0.21–1.02] for PFS. Ommaya reservoir infection occurred in 3/33 patients (9%). Conclusions The data of this single center experience suggest that the outcome with a modified Bonn protocol was comparable to that of the previous regimen, showed fewer Ommaya reservoir infections and may have a trend for better outcome with intraventricular therapy.
DOI : 10.1186/s42466-019-0024-2
Anahtar Kelimeler : PCNSL, Methotrexate, Consolidation chemotherapy, Intraventricular therapy, Bonn protocol
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 9
19
Computer-aided imaging analysis in acute ischemic stroke – background and clinical applications
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Yahia Mokli , Johannes Pfaff , Daniel Pinto dos Santos , Christian Herweh , Simon Nagel
Yıl :
2019
Neurological Research and Practice
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Kaydet Alıntıla
Abstract Tools for medical image analysis have been developed to reduce the time needed to detect abnormalities and to provide more accurate results. Particularly, tools based on artificial intelligence and machine learning techniques have led to significant improvements in medical imaging interpretation in the last decade. Automatic evaluation of acute ischemic stroke in medical imaging is one of the fields that witnessed a major development. Commercially available products so far aim to identify (and quantify) the ischemic core, the ischemic penumbra, the site of arterial occlusion and the collateral flow but they are not (yet) intended as standalone diagnostic tools. Their use can be complementary; they are intended to support physicians’ interpretation of medical images and hence standardise selection of patients for acute treatment. This review provides an introduction into the field of computer-aided diagnosis and focuses on the automatic analysis of non-contrast-enhanced computed tomography, computed tomography angiography and perfusion imaging. Future studies are necessary that allow the evaluation and comparison of different imaging strategies and post-processing algorithms during the diagnosis process in patients with suspected acute ischemic stroke; which may further facilitate the standardisation of treatment and stroke management.
DOI : 10.1186/s42466-019-0028-y
Anahtar Kelimeler : Acute ischemic stroke, Imaging, Computer aided diagnosis, Artificial intelligence
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 13
Sınıflandırma :
20
Remarkable improvement of primary orthostatic tremor using perampanel
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Marcus Grobe-Einsler , Oliver Kaut
Yıl :
2020
Neurological Research and Practice
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Abstract Management of primary orthostatic tremor (POT) remains challenging, and medication is often ineffective. We report the case of a 53-year-old female with orthostatic tremor for 6 years who was refractory to gabapentin, clonazepam, primidone and propranolol. After treatment with 4 mg/day perampanel, she reported almost complete resolution of tremor. The diagnosis of POT was confirmed by tremor analysis using surface electromyography. Our report shows the potential use of the novel AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor antagonist perampanel for the treatment of POT. To date, only two similar patients, one refractory to treatment and the other previously treated with clonazepam only, have been reported. We would like to note that our patient was refractory to all previous therapy and responded to a low dose of perampanel without side effects. The striking clinical improvement suggests a putative role of glutamate in the pathophysiology of orthostatic tremor.
DOI : 10.1186/s42466-020-0050-0
Anahtar Kelimeler : Orthostatic tremor, Tremor, Perampanel
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 3
Sınıflandırma :
21
Signatures of immune reprogramming in anti-CD52 therapy of MS: markers for risk stratification and treatment response
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Laura Bierhansl , Tobias Ruck , Steffen Pfeuffer , Catharina C. Gross , Heinz Wiendl , Sven G. Meuth
Yıl :
2019
Neurological Research and Practice
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Abstract Background Multiple sclerosis is one of the most prevalent neurological diseases in young adults affecting over 2 million people worldwide. Alemtuzumab is a highly effective therapy in relapsing remitting MS. Alemtuzumab is a monoclonal CD52 antibody that proved its efficacy against an active comparator (interferon [IFN]-β1a) in a phase II trial and two phase III trials regarding clinical and MRI outcomes. Nevertheless, the exact mode of action is still unknown. Alemtuzumab is commonly associated with secondary autoimmune disorders significantly affecting the risk-benefit ratio. Therefore, new biomarkers predicting treatment response and adverse events are urgently needed. This study aims to further elucidate the mechanism of action of the neuroprotective potential of alemtuzumab in relapsing-remitting multiple sclerosis (RRMS). Methods/Design This is a 3-year multicentre, explorative study including overall 150 patients comprising three different groups: (i) de novo patients prior and after alemtuzumab treatment initiation, (ii) patients under alemtuzumab treatment and (iii) patients requiring more than two alemtuzumab infusions. Peripheral blood and serum samples will be collected semi-annually for several in vitro/ex vivo assays to detect and characterize immune cells including their functional activity. Furthermore, data of MRI scans and disease-related impairment (using EDSS and MSFC), as well as the number and time of relapses, will be assessed. The clinical study is registered at clinicaltrials.gov (NCT04082260). Perspective Our study will provide deep insights into the underlying immunological changes in a longitudinal analysis of alemtuzumab treated RRMS patients. By combining clinical, radiological and functional immune-phenotype data, we will be able to identify biomarkers and/or immune signatures predicting treatment response and adverse events. Thereby, the understanding of the mechanisms of action of alemtuzumab will improve its efficacy and safety for present and future patients.
DOI : 10.1186/s42466-019-0045-x
Anahtar Kelimeler : Relapse-remitting multiple sclerosis, Alemtuzumab, Biomarker, mechanism of action, secondary autoimmune disease, Disease-modifying therapy, risk stratification
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 9
Sınıflandırma :
22
GCS 15: when mild TBI isn’t so mild
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Latha Ganti , Tej Stead , Yasamin Daneshvar , Aakash N. Bodhit , Christa Pulvino , Sarah W. Ayala , Keith R. Peters
Yıl :
2019
Neurological Research and Practice
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Kaydet Alıntıla
Abstract Objective The present study characterizes patients with the mildest of mild traumatic brain injury (TBI), as defined by a Glasgow coma score (GCS) of 15. Methods This is an IRB approved observational cohort study of adult patients who presented to the emergency department of a Level-1 trauma center, with the primary diagnosis of TBI and a GCS score of 15 on arrival. Data collected included demographic variables such as age, gender, race, mechanisms of injury, signs and symptoms including associated vomiting, seizures, loss of consciousness (LOC), alteration of consciousness (AOC), and post-traumatic amnesia (PTA).Pre- hospital GCS, Emergency Department (ED) GCS, and results of brain CT scans were also collected as well as patient centered outcomes including hospital or intensive care unit (ICU) admission, neurosurgical intervention, and in hospital death. Data were stored in REDCap (Research Electronic Data Capture), a secure, web- based application. Descriptive and inferential analysis was done using JMP 14.0 for the Mac. Results Univariate predictors of hospital admission included LOC, AOC, and PTA, all p < 0.0001. Patients admitted to ICU were significantly more likely to be on an antiplatelet or anticoagulant (P < 0.0001), have experienced PTA (p = 0.0025), LOC (p < 0.0001), or have an abnormal brain CT (p < 0.0001). Patients who died in the hospital were significantly more likely to be on an antiplatelet or anticoagulant (P = 0.0005. All who died in the hospital had intracranial hemorrhage on ED head CT, despite having presented to the ED with GCS of 15. Patients were also significantly more likely to have had vomiting (p < 0.0001). Patients who underwent neurosurgical intervention were significantly more likely to be male (P = 0.0203), to be on an antiplatelet or anticoagulant (P = < 0.0001) likely to have suffered their TBI from a fall (P = 0.0349), and experienced vomiting afterwards (P = 0.0193). Conclusions This study underscores: 1) the importance of neuroimaging in all patients with TBI, including those with a GCS 15. Fully 10% of our cohort was not imaged. Extrapolating, these would represent 2.5% bleeds, and 1.47% fractures. 2) The limitations of GCS in classifying TBI, as patients with even the mildest of mild TBI have a high frequency of gross CT abnormalities.
DOI : 10.1186/s42466-018-0001-1
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 8
23
Letter to the editor: risk comorbidities of COVID-19 in Parkinson’s disease patients in Germany
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Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Daniel Richter , Dirk Bartig , Christos Krogias , Lars Tönges
Yıl :
2020
Neurological Research and Practice
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DOI : 10.1186/s42466-020-00069-x
Anahtar Kelimeler : COVID-19, Parkinsonu2019s disease, Infection risk
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 3
Sınıflandırma :
24
New alternative splicing variants of the ATXN2 transcript
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Isabel Lastres-Becker , David Nonis , Joachim Nowock , Georg Auburger
Yıl :
2019
Neurological Research and Practice
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Kaydet Alıntıla
Abstract Background Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant disorder with progressive degeneration of cerebellar Purkinje cells and selective loss of neurons in the brainstem. This neurodegenerative disorder is caused by the expansion of a polyglutamine domain in ataxin-2. Ataxin-2 is composed of 1312 amino acids, has a predicted molecular weight of 150-kDa and is widely expressed in neuronal and non-neuronal tissues. To date, the putative functions of ataxin-2 on mRNA translation and endocytosis remain ill-defined. Differential splicing with a lack of exons 10 and 21 was described in humans, and additional splicing of exon 11 in mice. In this study, we observed that the molecular size of transfected full-length wild-type ataxin-2 (22 glutamines) is different from endogenous ataxin-2 and that this variation could not be explained by the previously published splice variants alone. Methods Quantitative immunoblots and qualitative reverse-transcriptase polymerase-chain-reaction (RT-PCR) were used to characterize isoform variants, before sequencing was employed for validation. Results We report the characterization of further splice variants of ataxin-2 in different human cell lines and in mouse and human brain. Using RT-PCR from cell lines HeLa, HEK293 and COS-7 throughout the open reading frame of ataxin-2 together with PCR-sequencing, we found novel splice variants lacking exon 12 and exon 24. These findings were corroborated in murine and human brain. The splice variants were also found in human skin fibroblasts from SCA2 patients and controls, indicating that the polyglutamine expansion does not abolish the splicing. Conclusions Given that Ataxin-2 interacts with crucial splice modulators such as TDP-43 and modulates the risk of Amyotrophic Lateral Sclerosis, its own splice isoforms may become relevant in brain tissue to monitor the RNA processing during disease progression and neuroprotective therapy.
DOI : 10.1186/s42466-019-0025-1
Anahtar Kelimeler : ATXN2, Alternative splicing, Spinocerebellar Ataxia type 2, PolyQ expansion
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 9
Sınıflandırma :
25
How to use and assess qualitative research methods
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Loraine Busetto , Wolfgang Wick , Christoph Gumbinger
Yıl :
2020
Neurological Research and Practice
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Kaydet Alıntıla
Abstract This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions, and focussing on intervention improvement. The most common methods of data collection are document study, (non-) participant observations, semi-structured interviews and focus groups. For data analysis, field-notes and audio-recordings are transcribed into protocols and transcripts, and coded using qualitative data management software. Criteria such as checklists, reflexivity, sampling strategies, piloting, co-coding, member-checking and stakeholder involvement can be used to enhance and assess the quality of the research conducted. Using qualitative in addition to quantitative designs will equip us with better tools to address a greater range of research problems, and to fill in blind spots in current neurological research and practice.
DOI : 10.1186/s42466-020-00059-z
Anahtar Kelimeler : Qualitative research, Mixed methods, Quality assessment
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 10
Sınıflandırma :
26
Changed functional connectivity at rest in functional illiterates after extensive literacy training
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Bahram Mohammadi , Thomas F. Münte , David M. Cole , Amir Sami , Melanie Boltzmann , Jascha Rüsseler
Yıl :
2020
Neurological Research and Practice
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Kaydet Alıntıla
Abstract Background About 6.2 million adults in Germany cannot read and write properly despite attending school for several years. They are considered to be functional illiterates (FI). Since the ability to read and write is crucial for being employed and socially accepted, we developed a special literacy training to overcome these deficits. Methods In this study, we investigate training-related changes in intrinsic functional connectivity (iFC) at rest in a group of 20 FI and 20 adult normal readers using resting state functional magnetic resonance imaging (rsfMRI). We used independent component analysis (ICA) to define different networks. Results Before training, the between group analysis showed increased iFC in FI in a left-fronto-parietal network (LFPN; anterior insula, medial frontal cortex, lateral and frontal parietal regions) and in the Basal Ganglia network (BGN: thalamus, caudate, putamen, pallidum, amygdala, supplementary motor cortex and cingulate gyrus). Furthermore, the Visual Network-1 (VN1; temporal occipital fusiform gyrus, lateral occipital cortex, occipital pole, lingual gyrus, thalamus) showed decreased iFC in FI. After training the FI group showed reversal of the “hyperconnectivity” in middle frontal gyrus and in the frontal orbital cortex and between supramarginal gyrus and the BGN. Furthermore, functional connectivity increased in FI VN1 (lateral occipital cortex, insular cortex). These changes in connectivity correlated with gains in reading speed and spelling accuracy. Conclusions These findings show that poor reading and writing abilities are associated with abnormalities in iFC in several brain areas subserving cognitive processes important for reading. Intensive literacy training induces changes in the functional connectivity between and within neural networks important for literacy skills.
DOI : 10.1186/s42466-020-00058-0
Anahtar Kelimeler : Functional connectivity, Functional illiteracy, Independent component analysis, Training intervention
ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 15
Sınıflandırma :
27
Molecular mechanisms of proteinopathies across neurodegenerative disease: a review
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Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Alexander P. Marsh
Yıl :
2019
Neurological Research and Practice
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Kaydet Alıntıla
Abstract Background Although there is a range of different symptoms across neurodegenerative diseases, they have been noted to have common pathogenic features. An archetypal feature shared between these diseases is protein misfolding; however, the mechanism behind the proteins abnormalities is still under investigation. There is an emerging hypothesis in the literature that the mechanisms that lead to protein misfolding may be shared across neurodegenerative processes, suggesting a common underlying pathology. Main body This review discusses the literature to date of the shared features of protein misfolding, failures in proteostasis, and potential propagation pathways across the main neurodegenerative disorders. Conclusion The current data suggests, despite overarching processes being shared, that the molecular events implicated in protein pathology are distinct across common neurodegenerative disorders.
DOI : 10.1186/s42466-019-0039-8
Anahtar Kelimeler : Neurodegeneration, Protein folding
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 7
Sınıflandırma :
Biyotıp %100
Nörokimya %21
28
Genotypes and phenotypes of patients with Lafora disease living in Germany
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
David Brenner , Tobias Baumgartner , Sarah von Spiczak , Jan Lewerenz , Roger Weis , Anja Grimmer , Petra Gaspirova , Claudia D. Wurster , Wolfram S. Kunz , Jan Wagner , Berge A. Minassian , Christian E. Elger , Albert C. Ludolph , Saskia Biskup , Dennis Döcker
Yıl :
2019
Neurological Research and Practice
Yayıncı Web Sitesi
 Piri Tam Metin Bulucu
Kaydet Alıntıla
Abstract Background Lafora progressive myoclonus epilepsy (Lafora disease) is a rare, usually childhood-onset, fatal neurodegenerative disease caused by biallelic mutations in EPM2A (Laforin) or EPM2B (NHLRC1; Malin). The epidemiology of Lafora disease in Germany is largely unknown. The objective of this retrospective case series is to characterize the genotypes and phenotypes of patients with Lafora disease living in Germany. Methods The patients described in this case series initially had the suspected clinical diagnosis of Lafora disease, or unclassified progressive myoclonus epilepsy. Molecular genetic diagnostics including next generation sequencing-based diagnostic panel analysis or whole exome sequencing was performed. Results The parents of four out of the 11 patients are nonconsanguineous and of German origin while the other patients had consanguineous parents. Various variants were found in EPM2A (six patients) and in EPM2B (five patients). Eight variants have not been reported in the literature so far. The patients bearing novel variants had typical disease onset during adolescence and show classical disease courses. Conclusions This is the first larger case series of Lafora patients in Germany. Our data enable an approximation of the prevalence of manifest Lafora disease in Germany to 1,69 per 10 million people. Broader application of gene panel or whole-exome diagnostics helps clarifying unclassified progressive myoclonus epilepsy and establish an early diagnosis, which will be even more important as causal therapy approaches have been developed and are soon to be tested in a phase I study.
DOI : 10.1186/s42466-019-0040-2
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 5
Sınıflandırma :
29
Distribution and evolution of acute interventional ischemic stroke treatment in Germany from 2010 to 2016
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Ralph Weber , Jens Eyding , Martin Kitzrow , Dirk Bartig , Christian Weimar , Werner Hacke , Christos Krogias
Yıl :
2019
Neurological Research and Practice
Yayıncı Web Sitesi
 Piri Tam Metin Bulucu
Kaydet Alıntıla
Abstract Background Mechanical thrombectomy (MT) is a new evidence-based treatment option for large vessel occlusion in the anterior brain circulation. Using comprehensive administrative data from Germany, we analysed the nationwide development of intravenous thrombolysis (IVT) and MT in Germany between 2010 and 2016. Methods We considered all documented cases (n = 1,515,634) with a main diagnosis of the ICD-10-GM code I63 (ischemic stroke) and identified specific stroke recanalization therapy by using the corresponding Operating and Procedure Key for systemic thrombolysis and mechanical thrombectomy out of the DRG statistics. Regional analyses are based on data from the 413 German administrative districts and cities and the obligatory quality reports of all hospitals. We distinguished between rates of MT related to place of residence of patients and place of treatment. Results Coded ischemic strokes increased by 10.2% from 2010 (n = 206.688) to 2016 (n = 227.687). The rate of IVT increased from 8.9% in 2010 to 14.9% in 2016 and the rate of MT increased from 0.8% in 2010 to 4.7% in 2016 with a strong increase in 2015 and 2016. There was a high regional variability of MT according to place of residence of patients between 0 and 11.2% in 2016 with significant lower treatment rates in rural compared to urban areas (3.8 vs 5.4%). Mean age of patients treated with MT increased from 67.8 years in 2010 to 73.3 years in 2016 and almost reached the mean age of IVT treated patients (74.4 years). The number of hospitals coding MT increased from 91 to 193 from 2010 to 2016, but 80% of all MT procedures were performed in neurointerventional centers with ≥50 procedures/year in 2016. Conclusions The rate of IVT in patients with acute ischemic stroke in Germany continues to rise and has reached 14.9% nationwide. The increase of MT is even more pronounced and was triggered by the evidence after publication of the MT randomized trials. There is still a high regional variability with significant lower MT rates in rural areas.
DOI : 10.1186/s42466-019-0010-8
Anahtar Kelimeler : Stroke, Thrombectomy, Thrombolysis, Health care structure
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 9
Sınıflandırma :
30
The use of a dedicated neurological triage system improves process times and resource utilization: a prospective observational study from an interdisciplinary emergency department
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Neurological Research and Practice
Yazar(lar) :
Carolin Hoyer , Patrick Stein , Hans-Werner Rausch , Angelika Alonso , Simon Nagel , Michael Platten , Kristina Szabo
Yıl :
2019
Neurological Research and Practice
Yayıncı Web Sitesi
 Piri Tam Metin Bulucu
Kaydet Alıntıla
Abstract Background Patients with neurological symptoms have been contributing to the increasing rates of emergency department (ED) utilization in recent years. Existing triage systems represent neurological symptoms rather crudely, neglecting subtler but relevant aspects like temporal evolution or associated symptoms. A designated neurological triage system could positively impact patient safety by identifying patients with urgent need for medical attention and prevent inadequate utilization of ED and hospital resources. Methods We compared basic demographic information, chief complaint/presenting symptom, door-to-doctor time and length of stay (LOS) as well as utilization of ED resources of patients presenting with neurological symptoms or complaints during a one-month period before as well as after the introduction of the Heidelberg Neurological Triage System (HEINTS) in our interdisciplinary ED. In a second step, we compared diagnostic and treatment processes for both time periods according to assigned acuity. Results During the two assessment periods, 299 and 300 patients were evaluated by a neurologist, respectively. While demographic features were similar for both groups, overall LOS (p < 0.001) was significantly shorter, while CT (p = 0.023), laboratory examinations (p = 0.006), ECG (p = 0.011) and consultations (p = 0.004) were performed significantly less often when assessing with HEINTS. When considering acuity, an epileptic seizure was less frequently evaluated as acute with HEINTS than in the pre-HEINTS phase (p = 0.002), while vertigo patients were significantly more often rated as acute with HEINTS (p < 0.001). In all cases rated as acute, door-to-doctor-time (DDT) decreased from 41.0 min to 17.7 min (p < 0.001), and treatment duration decreased from 304.3 min to 149.4 min (p < 0.001) after introduction of HEINTS triage. Conclusion A dedicated triage system for patients with neurological complaints reduces DDT, LOS and ED resource utilization, thereby improving ED diagnostic and treatment processes.
DOI : 10.1186/s42466-019-0036-y
Anahtar Kelimeler : Emergency department, Neurology, Triage
ISSN: 2524-3489
Cilt: 1
Sayı: 1
Sayfa: 1 - 10

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