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Herbrecht E, Kievit E, Spiegel R, Dima D, Goth K, Schmeck K. Become Related: FIAS, an Intensive Early Intervention for Young Children with Autism Spectrum Disorders. Psychopathology 2015; 48:162-72. [PMID: 25832916 DOI: 10.1159/000375504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 01/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND In autism spectrum disorders (ASDs), impairments in fundamental social abilities and a lack of interest in social stimuli become apparent early in life. These impairments are thought to negatively affect further brain and behavioural development. Early intensive interventions can help to attenuate social-development and other risk factors and, thus, to ameliorate the deficits associated with ASDs. We present FIAS, an intensive early intervention approach for young children with ASD, which aims at developing children's social motivation. During 18 days, therapists work continuously for 6 h a day with the affected child, involving the whole family in a day care setting. Follow-up care at home over 1 year as well as fresh-up interventions and inclusion in kindergarten or a play group should stabilise the effects and help to respond to further challenges. MATERIAL AND METHODS Here, we present observations from the first 12 patients (25-48 months of age) treated according to the FIAS approach. We evaluated changes in core autistic symptoms and level of functioning after the 18 days of intensive intervention. Beyond standardised assessment, two innovative video-based instruments (Autism Behaviour Coding System and Evaluationsfragebogen) have been developed to assess autistic symptoms and interaction parameters during intervention. RESULTS Improvements were noted in most core autistic symptom domains, with the highest effect sizes in domains like eye contact, communication, repetitive behaviour, imitation, motivation and reciprocity. In addition, the level of functioning significantly improved. CONCLUSIONS The first evaluation of the FIAS approach shows promising results, as the FIAS intervention appears to improve core autistic symptom domains as well as the level of everyday functioning. Limitations of this study are the small sample size and the lack of a control group. A more comprehensive and longitudinal evaluation is in progress; this will focus on the stability of the observed effects and will attempt to identify potential predictors of treatment response. © 2015 S. Karger AG, Basel.
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Elfring G, Reha A, Spiegel R, Peltz S, McDonald C. G.P.106. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kerem E, Wilschanski M, Sermet-Gaudelus I, De Boeck K, Accurso F, Konstan M, Rowe S, Elfring G, Spiegel R, Peltz S, Barth J, Ajayi T. 94 The effect of Pseudomonas aeruginosa infection on pulmonary function outcome in a cohort of patients with nonsense mutation cystic fibrosis. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60230-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Reha A, Spiegel R, Elfring G, Barth J, Husain M, Peltz S. S1 Development of a confirmatory phase 3, multicentre, randomized, double-blind, placebo-controlled study of ataluren in patients with nonsense mutation Duchenne muscular dystrophy. Neuromuscul Disord 2014. [DOI: 10.1016/s0960-8966(14)70095-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spiegel R, Nawroth PP, Kasperk C. The effect of zoledronic acid on the fracture risk in men with osteoporosis. J Endocrinol Invest 2014; 37:229-32. [PMID: 24474679 DOI: 10.1007/s40618-013-0038-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prospective, placebo-controlled, double-blind, randomized studies on osteoporosis treatment with bisphosphonates in men are rare. This review focuses on a recent trial and compares the results with other studies. METHODS This review provides a summary of recent literature on fracture risk in men following treatment with zoledronic acid. According to a recent clinical study with 1,199 men, zoledronic acid was linked to a lower risk of vertebral fractures. In this manuscript, a re-analysis of the presented statistical data will be demonstrated by performing a Bonferroni-correction to adjust for type 1 error accumulation in multiple statistical tests. RESULTS It will be shown that the provided evidence linking zoledronic acid to a lower fracture risk in male osteoporosis is true, but less pronounced than originally assumed. CONCLUSION Comparative clinical studies are recommended, where the benefits of different bisphosphonates are compared to each other under the same experimental conditions.
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Berres M, Kukull WA, Miserez AR, Monsch AU, Monsell SE, Spiegel R. A Novel Study Paradigm for Long-term Prevention Trials in Alzheimer Disease: The Placebo Group Simulation Approach (PGSA): Application to MCI data from the NACC database. J Prev Alzheimers Dis 2014; 1:99-109. [PMID: 25530953 PMCID: PMC4268776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The PGSA (Placebo Group Simulation Approach) aims at avoiding problems of sample representativeness and ethical issues typical of placebo-controlled secondary prevention trials with MCI patients. The PGSA uses mathematical modeling to forecast the distribution of quantified outcomes of MCI patient groups based on their own baseline data established at the outset of clinical trials. These forecasted distributions are then compared with the distribution of actual outcomes observed on candidate treatments, thus substituting for a concomitant placebo group. Here we investigate whether a PGSA algorithm that was developed from the MCI population of ADNI 1*, can reliably simulate the distribution of composite neuropsychological outcomes from a larger, independently selected MCI subject sample. METHODS Data available from the National Alzheimer's Coordinating Center (NACC) were used. We included 1523 patients with single or multiple domain amnestic mild cognitive impairment (aMCI) and at least two follow-ups after baseline. In order to strengthen the analysis and to verify whether there was a drift over time in the neuropsychological outcomes, the NACC subject sample was split into 3 subsamples of similar size. The previously described PGSA algorithm for the trajectory of a composite neuropsychological test battery (NTB) score was adapted to the test battery used in NACC. Nine demographic, clinical, biological and neuropsychological candidate predictors were included in a mixed model; this model and its error terms were used to simulate trajectories of the adapted NTB. RESULTS The distributions of empirically observed and simulated data after 1, 2 and 3 years were very similar, with some over-estimation of decline in all 3 subgroups. The by far most important predictor of the NTB trajectories is the baseline NTB score. Other significant predictors are the MMSE baseline score and the interactions of time with ApoE4 and FAQ (functional abilities). These are essentially the same predictors as determined for the original NTB score. CONCLUSION An algorithm comprising a small number of baseline variables, notably cognitive performance at baseline, forecasts the group trajectory of cognitive decline in subsequent years with high accuracy. The current analysis of 3 independent subgroups of aMCI patients from the NACC database supports the validity of the PGSA longitudinal algorithm for a NTB. Use of the PGSA in long-term secondary AD prevention trials deserves consideration.
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McDonald C, Henricson E, Abresch R, Florence J, Eagle M, Gappmaier E, Glanzman A, Spiegel R, Barth J, Elfring G, Reha A, Peltz S, P.T.C. Study Group. P.2.8 The 6-min walk test and clinical endpoints in Duchenne MD: Reliability, validity, and clinically-important differences. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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McDonald C, Henricson E, Abresch R, Florence J, Eagle M, Gappmaier E, Glanzman A, Spiegel R, Barth J, Elfring G, Reha A, Peltz S. P.2.9 The 6-min walk test and other endpoints in Duchenne MD: Multi center longitudinal natural history observations over 48weeks. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Miron D, Kawar B, Lumelsky D, Spiegel R, Horovitz Y. Encysted peritoneal hydatidosis in a child — the effectiveness of pre-operative therapy with a combination of praziquantel and albendazole. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 99:577-82. [PMID: 16156971 DOI: 10.1179/136485905x51445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A child with encysted peritoneal hydatidosis was found to be completely cured after 3 months of combined therapy with praziquantel and albendazole followed by resection of a huge peritoneal cyst and the removal of numerous, dead, daughter cysts.
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Spiegel R, Doody RS, Hendrix S, Kahle-Wrobleski K. Modeling the course of Alzheimer's disease to improve clinical trials: symposium report. Alzheimers Res Ther 2013; 5:29. [PMID: 23767782 PMCID: PMC3706927 DOI: 10.1186/alzrt183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
In a symposium held at the Clinical Trials in Alzheimer's Disease conference in Monte Carlo, Monaco (29 to 31 October 2012) three different, not mutually exclusive approaches to improve and facilitate clinical trials with anti-dementia drugs were presented and discussed. All three approaches are summarized in this manuscript. Core suggestions are: stratification of trial participants at the outset of studies, using cognitive and disease-course characteristics available at baseline; creating new composite cognitive scores for optimizing responsiveness to decline in early and very early Alzheimer's disease; and replacing some of the conventional long-term placebo-controlled trials in advanced stages of drug development, using the placebo group simulation approach. Future efforts should focus on incorporating, where appropriate, the suggestions provided at the symposium into clinical trials now being planned.
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Ajayi T, Konstan M, Accurso F, De Boeck K, Kerem E, Rowe S, Sermet-Gaudelus I, Wilschanski M, Brody A, Miller N, Elfring G, Spiegel R, Peltz S, Barth J. 63 The use of high resolution computerized tomography of the chest in evaluating the effect of ataluren in nonsense mutation cystic fibrosis (nmCF) lung disease. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60205-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kerem E, Wilschanski M, Sermet-Gaudelus I, De Boeck K, Accurso F, Konstan M, Rowe S, Miller N, Elfring G, Spiegel R, Peltz S, Barth J, Ajayi T. WS7.5 Interim results of the phase 3 open-label study of ataluren in nonsense mutation cystic fibrosis (nmCF). J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60044-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Claaßen J, Kalla R, Stephan T, Flanagin V, Spiegel R, Strupp M, Jahn K. Dependance of supraspinal locomotor control on speed and gait pattern - an fMRI study. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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DiMauro S, Spiegel R. Progress and problems in muscle glycogenoses. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2011; 30:96-102. [PMID: 22106711 PMCID: PMC3235878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In this selective review, we consider a number of unsolved questions regarding the glycogen storage diseases (GSD). Thus, the pathogenesis of Pompe disease (GSD II) is not simply explained by excessive intralysosomal glycogen storage and may relate to a more general dysfunction of autophagy. It is not clear why debrancher deficiency (GSD III) causes fixed myopathy rather than exercise intolerance, unless this is due to the frequent accompanying neuropathy. The infantile neuromuscular presentation of branching enzyme deficiency (GSD IV) is underdiagnosed and is finally getting the attention it deserves. On the other hand, the late-onset variant of GSD IV (adult polyglucosan body disease APBD) is one of several polyglucosan disorders (including Lafora disease) due to different etiologies. We still do not understand the clinical heterogeneity of McArdle disease (GSD V) or the molecular basis of the rare fatal infantile form. Similarly, the multisystemic infantile presentation of phosphofructokinase deficiency (GSD VII) is a conundrum. We observed an interesting association between phosphoglycerate kinase deficiency (GSD IX) and juvenile Parkinsonism, which is probably causal rather than casual. Also unexplained is the frequent and apparently specific association of phosphoglycerate mutase deficiency (GSD X) and tubular aggregates. By paying more attention to problems than to progress, we aimed to look to the future rather than to the past.
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Strupp M, Kalla R, Claassen J, Adrion C, Mansmann U, Klopstock T, Freilinger T, Neugebauer H, Spiegel R, Dichgans M, Lehmann-Horn F, Jurkat-Rott K, Brandt T, Jen JC, Jahn K. A randomized trial of 4-aminopyridine in EA2 and related familial episodic ataxias. Neurology 2011; 77:269-75. [PMID: 21734179 DOI: 10.1212/wnl.0b013e318225ab07] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The therapeutic effects of 4-aminopyridine (4AP) were investigated in a randomized, double-blind, crossover trial in 10 subjects with familial episodic ataxia with nystagmus. METHODS After randomization, placebo or 4AP (5 mg 3 times daily) was administered for 2 3-month-long treatment periods separated by a 1-month-long washout period. The primary outcome measure was the number of ataxia attacks per month; the secondary outcome measures were the attack duration and patient-reported quality of life (Vestibular Disorders Activities of Daily Living Scale [VDADL]). Nonparametric tests and a random-effects model were used for statistical analysis. RESULTS The diagnosis of episodic ataxia type 2 (EA2) was genetically confirmed in 7 subjects. Patients receiving placebo had a median monthly attack frequency of 6.50, whereas patients taking 4AP had a frequency of 1.65 (p = 0.03). Median monthly attack duration decreased from 13.65 hours with placebo to 4.45 hours with 4AP (p = 0.08). The VDADL score decreased from 6.00 to 1.50 (p = 0.02). 4AP was well-tolerated. CONCLUSIONS This controlled trial on EA2 and familial episodic ataxia with nystagmus demonstrated that 4AP decreases attack frequency and improves quality of life. LEVEL OF EVIDENCE This crossover study provides Class II evidence that 4AP decreases attack frequency and improves the patient-reported quality of life in patients with episodic ataxia and related familial ataxias.
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Spiegel R, Berres M, Miserez AR, Monsch AU. For debate: substituting placebo controls in long-term Alzheimer's prevention trials. ALZHEIMERS RESEARCH & THERAPY 2011; 3:9. [PMID: 21418632 PMCID: PMC3226271 DOI: 10.1186/alzrt68] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 01/02/2011] [Accepted: 03/21/2011] [Indexed: 12/26/2022]
Abstract
Introduction Novel compounds with potential to attenuate or stop the progression of Alzheimer's disease (AD) from its presymptomatic stage to dementia are being tested in man. The study design commonly used is the long-term randomized, placebo-controlled trial (RPCT), meaning that many patients will receive placebo for 18 months or longer. It is ethically problematic to expose presymptomatic AD patients, who by definition are at risk of developing dementia, to prolonged placebo treatment. As an alternative to long-term RPCTs we propose a novel clinical study design, termed the placebo group simulation approach (PGSA), using mathematical models to forecast outcomes of presymptomatic AD patients from their own baseline data. Forecasted outcomes are compared with outcomes observed on candidate drugs, thus replacing a concomitant placebo group. Methods First models were constructed using mild cognitive impairment (MCI) data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. One outcome is the Alzheimer Disease Assessment Scale - cognitive subscale (ADAScog) score after 24 months, predicted in a linear regression model; the other is the trajectory over 36 months of a composite neuropsychological test score (Neuro-Psychological Battery (NP-Batt)), using a mixed model. Demographics and clinical, biological and neuropsychological baseline values were tested as potential predictors in both models. Results ADAScog scores after 24 months are predicted from gender, obesity, Functional Assessment Questionnaire (FAQ) and baseline scores of Mini-Mental State Examination, ADAScog and NP-Batt with an R2 of 0.63 and a residual standard deviation of 0.67, allowing reasonably precise estimates of sample means. The model of the NP-Batt trajectory has random intercepts and slopes and fixed effects for body mass index, time, apolipoprotein E4, age, FAQ, baseline scores of ADAScog and NP-Batt, and four interaction terms. Estimates of the residual standard deviation range from 0.3 to 0.5 on a standard normal scale. If novel drug candidates are expected to diminish the negative slope of scores with time, a change of 0.04 per year could be detected in samples of 400 with a power of about 80%. Conclusions First PGSA models derived from ADNI MCI data allow prediction of cognitive endpoints and trajectories that correspond well with real observed values. Corroboration of these models with data from other observational studies is ongoing. It is suggested that the PGSA may complement RPCT designs in forthcoming long-term drug studies with presymptomatic AD individuals.
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Claaßen J, Bardins S, Schneider E, Kalla R, Spiegel R, Strupp M, Jahn K. The influence of dual task on gait during galvanic vestibular or visual motion stimulation. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Claaßen J, Bardins S, Spiegel R, Schneider E, Kalla R, Strupp M. Body position and direction of a moving object influence visual motion perception. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Spiegel R, Kalla R, Rettinger N, Schneider E, Straumann D, Marti S, Glasauer S, Brandt T, Strupp M. Head position during resting modifies spontaneous daytime decrease of downbeat nystagmus. Neurology 2011; 75:1928-32. [PMID: 21098408 DOI: 10.1212/wnl.0b013e3181feb22f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The intensity of downbeat nystagmus (DBN) decreases during the daytime when the head is in upright position. OBJECTIVE This prospective study investigated whether resting in different head positions (upright, supine, prone) modulates the intensity of DBN after resting. METHODS Eye movements of 9 patients with DBN due to cerebellar (n = 2) or unknown etiology (n = 7) were recorded with video-oculography. Mean slow-phase velocities (SPV) of DBN were determined in the upright position before resting at 9 am and then after 2 hours (11 am) and after 4 hours (1 pm) of resting. Whole-body positions during resting were upright, supine, or prone. The effects of all 3 resting positions were assessed on 3 separate days in each patient. RESULTS Before resting (9 am), the average SPV ranged from 3.05 °/s to 3.6 °/s on the separate days of measurement. After resting in an upright position, the average SPV at 11 am and 1 pm was 0.65 °/sec, which was less (p < 0.05) than after resting in supine (2.1 °/sec) or prone (2.22 °/sec) positions. CONCLUSION DBN measured during the daytime in an upright position becomes minimal after the patient has rested upright. The spontaneous decrease of DBN is less pronounced when patients lie down to rest. This indicates a modulation by otolithic input. We recommend that patients with DBN rest in an upright position during the daytime. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with DBN 2 hours of rest in the upright position decreases nystagmus more than 2 hours of rest in the supine or prone positions (relative improvement 79% upright, 33% supine, and 38% prone: p < 0.05).
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Spiegel R, Khayat M, Shalev SA, Horovitz Y, Mandel H, Hershkovitz E, Barghuti F, Shaag A, Saada A, Korman SH, Elpeleg O, Yatsiv I. TMEM70 mutations are a common cause of nuclear encoded ATP synthase assembly defect: further delineation of a new syndrome. J Med Genet 2010; 48:177-82. [DOI: 10.1136/jmg.2010.084608] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spiegel R, Kalla R, Muggleton N, Bueti D, Claassen J, Walsh V, Bronstein A. Adaptive mechanisms in visual motion processing and a possible link to evolution. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Spiegel R, Kalla R, Rettinger N, Schneider E, Straumann D, Claassen J, Glasauer S, Marti S, Brandt T, Strupp M. The influence of resting in light or darkness on the spontaneous decrease of downbeat nystagmus. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Spiegel R, Kalla R, Rettinger N, Schneider E, Straumann D, Marti S, Claassen J, Glasauer S, Brandt T, Strupp M. The influence of positional effects on the spontaneous decrease of downbeat nystagmus in the course of the day. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Oser N, Penner I, Huber M, Opwis K, Spiegel R, Mäder M, Wilhelm F. PO31-FR-07 Novel linear and nonlinear measures of heart rate variability in remitting patients with severe brain injury: a preliminary report. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)71225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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