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Peters N, Holtmannspötter M, Opherk C, Gschwendtner A, Herzog J, Sämann P, Dichgans M. Brain volume changes in CADASIL: A serial MRI study in pure subcortical ischemic vascular disease. Neurology 2006; 66:1517-22. [PMID: 16717211 DOI: 10.1212/01.wnl.0000216271.96364.50] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited small vessel disease causing stroke and subcortical vascular dementia. Recent studies in sporadic subcortical ischemic vascular disease have drawn attention to brain atrophy as a clinically important marker of disease progression. However, little is known about the role of brain atrophy and its clinical correlates in CADASIL. METHOD The authors determined the normalized brain volume (NBV) and percent brain volume change (PBVC) over 2 years in 76 CADASIL subjects (45.1 +/- 9.7 years) using the SIENA (structural image evaluation using normalization of atrophy) software and its adaptation for cross-sectional measurements (SIENAX). Baseline assessments included systolic blood pressure (SBP), homocysteine levels, BMI, and APOE genotyping. T2-lesion volumes and clinical scales were assessed at both time points. RESULTS The NBV significantly correlated with all clinical scores (Rankin, NIH Stroke Scale, Barthel, structured interview for the diagnosis of Alzheimer dementia and multi-infarct dementia, Mattis dementia rating scale) at both time points independently of age and sex. PBVC correlated with changes of all clinical scores (all p < 0.01) except for the Mattis dementia rating scale (p = 0.10). In a linear regression model, age (p < 0.001), male sex (p < 0.01), and SBP (p = 0.07) were the main risk factors for a lower NBV at baseline. Age (p < 0.001) and SBP (p = 0.01) were risk factors for brain volume loss during follow-up. Sample size estimates showed that the number of individuals needed to demonstrate a treatment effect in a trial can be reduced when PBVC is used as an endpoint. CONCLUSIONS This study identifies brain atrophy as an important aspect of the disease process in CADASIL and establishes significant correlations with multiple clinical aspects including cognition. Age and systolic blood pressure are risk factors for brain volume loss during follow-up. Percent brain volume change seems promising as an adjunct outcome measure in future interventional trials.
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Peters N, Holtmannspötter M, Opherk C, Gschwendtner A, Herzog J, Sämann P, Brückmann H, Dichgans M. Diffusion tensor imaging derived metrics and brain volume changes correlate with clinical progression in CADASIL: a serial MRI study in pure subcortical ischaemic vascular disease. AKTUELLE NEUROLOGIE 2006. [DOI: 10.1055/s-2006-953011] [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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Herzog J, Wailke S, Pinsker M, Wasner M, Steigerwald F, Deuschl G, Volkmann J. Stimulation of subthalamic fibre tracts reduces dyskinesias in STN-DBS. AKTUELLE NEUROLOGIE 2006. [DOI: 10.1055/s-2006-953230] [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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Herzog J, Weiss P, Assmus A, Wefer B, Seif C, Herzog H, Volkmann J, Deuschl G, Fink G. STN-DBS modulates cortical control of urinary bladder in Parkinson's disease. AKTUELLE NEUROLOGIE 2006. [DOI: 10.1055/s-2006-952979] [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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Bartsch T, Volkmann J, Pinsker M, Wasner M, Steigerwald F, Herzog J, Baron R, Mehdorn M, Deuschl G. Tiefe Hirnstimulation des posterioren Hypothalamus bei therapierefraktären chronischen Cluster Kopfschmerzen. AKTUELLE NEUROLOGIE 2006. [DOI: 10.1055/s-2006-953239] [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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Herzog J, Morsnowski A, Wodarg F, Pinsker M, Wasner M, Deuschl G, Volkmann J. Optimal stimulation site for Parkinson's disease within the MRI-defined subthalamic nucleus. AKTUELLE NEUROLOGIE 2006. [DOI: 10.1055/s-2006-953232] [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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Steigerwald F, Stangenberg P, Pötter M, Kopper F, Herzog J, Stiller R, Pinsker M, Mehdorn H, Deuschl G, Volkmann J. Discharge properties of human subthalamic nucleus neurons in Parkinson's disease. AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-919311] [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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Opherk C, Peters N, Bergmann T, Castro M, Herzog J, Dichgans M. Spectrum of mutations in biopsy-proven CADASIL: implications for diagnostic strategies. AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-919505] [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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Dichgans M, Herzog J, Freilinger T, Wilke M, Auer DP. 1H-MRS alterations in the cerebellum of patients with familial hemiplegic migraine type 1. Neurology 2005; 64:608-13. [PMID: 15728280 DOI: 10.1212/01.wnl.0000151855.98318.50] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND About 20% of patients with familial hemiplegic migraine (FHM) develop progressive cerebellar signs. Genetic studies have established an association with mutations in the CACNA1A gene. However, the mechanisms underlying cerebellar involvement are largely unknown. OBJECTIVE To use proton MR spectroscopy (1H-MRS) to investigate metabolic alterations in the cerebellum as well as cortical regions known to be involved in the propagation of migraine aura. METHODS Fifteen CACNA1A mutation carriers from three FHM families and 17 healthy control subjects were studied. Eleven patients had clinical signs of cerebellar involvement. LCModel fits were used to estimate absolute concentrations of N-acetyl aspartate (NAA), myo-inositol (mI), glutamate (Glu), choline-containing compounds, total creatine, and lactate in the superior cerebellar vermis (SCV), parietal cortex, and occipital cortex. To control for atrophy effects, automated image segmentation was performed using SPM99. The brain parenchyma fraction (BPF) was determined for all three regions. RESULTS Compared with controls, the brain parenchyma fraction (BPF), NAA, and Glu were significantly reduced and mI was significantly elevated in the SCV of patients with FHM. In contrast, no metabolite alterations were found in supratentorial regions. BPF and NAA in the SCV significantly correlated with cerebellar scores, in particular, gait ataxia. CONCLUSIONS The findings suggest that there is a regionally distinct neuronal impairment in the superior cerebellar vermis that exceeds macroscopic tissue loss. Correlations with clinical scores emphasize the functional relevance of localized atrophy (brain parenchyma fraction) and N-acetyl aspartate levels. These measures may be useful to monitor disease progression. The observed reduction in glutamate may in part reflect impaired glutamatergic neurotransmission.
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Steigerwald F, Hinz L, Pinsker MO, Herzog J, Stiller RU, Kopper F, Mehdorn HM, Deuschl G, Volkmann J. Effect of propofol anesthesia on pallidal neuronal discharges in generalized dystonia. Neurosci Lett 2005; 386:156-9. [PMID: 16024174 DOI: 10.1016/j.neulet.2005.06.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 05/27/2005] [Accepted: 06/01/2005] [Indexed: 11/23/2022]
Abstract
We present the results of continuous microelectrode recordings from individual pallidal neurons in patients with idiopathic torsion dystonia under different levels of propofol anesthesia. Neither the estimated plasma concentration of propofol nor the level of consciousness had a consistent effect on abnormally low neuronal firing rates. Our data support the pathophysiological model of a decreased basal ganglia output in dystonia and argue against a possible pharmacological artifact.
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Steigerwald F, Herzog J, Deuschl G, Mehdorn HM, Volkmann J. Microelectrode recordings from Patients with Parkinson-Disease. AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-916313] [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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Herzog J, Volkmann J, Deuschl G. Treatment guidelines of the Movement Disorder Society for deep brain stimulation for Parkinson's Disease. AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-916297] [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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Mehdorn HM, Pinsker MO, Volkmann J, Hamel W, Schrader B, Stiller U, Herzog J, Deuschl G. Deep brain stimulation for idiopathic or secondary movement disorders. ACTA NEUROCHIRURGICA. SUPPLEMENT 2005; 93:105-11. [PMID: 15986738 DOI: 10.1007/3-211-27577-0_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Deep brain stimulation has gained increasing interest in the treatment of movement disorders. Presenting our clinical series of 179 patients operated upon since 1999, the indications, risks and benefits for the patients are discussed in order to further improve the techniques and their applications.
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Manchot W, Herzog J. Untersuchungen über den Reaktionsmechanismus bei der Oxydation mit gasförmigem Sauerstoff. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/zaac.19010270141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jurkat-Rott K, Freilinger T, Dreier JP, Herzog J, Göbel H, Petzold GC, Montagna P, Gasser T, Lehmann-Horn F, Dichgans M. Variability of familial hemiplegic migraine with novel A1A2 Na+/K+-ATPase variants. Neurology 2004; 62:1857-61. [PMID: 15159495 DOI: 10.1212/01.wnl.0000127310.11526.fd] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A1A2 Na+/K+-ATPase mutations cause familial hemiplegic migraine type 2 (FHM2). The authors identified three putative A1A2 mutations (D718N, R763H, P979L) and three that await validation (P796R, E902K, X1021R). Ten to 20% of FHM cases may be FHM2. A1A2 mutations have a penetrance of about 87%. D718N causes frequent, long-lasting HM, and P979L may cause recurrent coma. D718N and P979L may predispose to seizures and mental retardation. A1A2 does not play a major role in sporadic HM; only one variant, R383H, occurred in 1 of 24 cases.
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Binder A, Remien P, Guballa C, Wasner G, Pohle S, Schattschneider J, Herzog J, Volkmann J, Deuschl G, Baron R. Beeinflusst die tiefe Hirnstimulation das somatosensible System beim Morbus Parkinson? AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pfeifer P, Schubert K, Liauw MA, Herzog J, Emig G, Messerschmitt T, Aigner A. Kinetische Untersuchungen zur selektiven Acetylierung vicinaler nucleophiler Gruppen in Mikrostrukturreaktoren mit integriertem Mikrostrukturmischer. CHEM-ING-TECH 2004. [DOI: 10.1002/cite.200490171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ludwig J, Guballa C, Remien P, Wasner G, Binder A, Pohle S, Schattschneider J, Herzog J, Volkmann J, Deuschl G, Baron R. Influence of Deep Brain Stimulation on the Autonomic Nervous System in Patients Suffering from Parkinson's Disease. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832082] [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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69
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Bahadini B, Herzog J, Somlo G, Frankel P, Sand S, MacDonald D, Blazer K, Weitzel JN. Prevalence of BRCA mutations in a cohort of young high-risk breast cancer patients. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Martinez SL, Herzog J, Weitzel JN. Loss of five amino acids in BRCA2 is associated with ovarian cancer. J Med Genet 2004; 41:e18. [PMID: 14757868 PMCID: PMC1735667 DOI: 10.1136/jmg.2003.010827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Herzog J, Hamel W, Wenzelburger R, Mehdorn HM, Deuschl G. Most effective stimulation site for severe intention tremor. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833139] [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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Freilinger T, Eckstein G, Herzog J, Lorenz-Depiereux B, Huber S, Strom T, Dichgans M. Kartierung eines dritten Genlocus für familiäre hemiplegische Migräne. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833361] [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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Opherk C, Herzog J, Luedtke R, Peters N, Dichgans M. Langzeitprognose und Todesursachen von CADASIL: Eine retrospektive Untersuchung an 411 Patienten. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-832955] [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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Peters N, Opherk C, Danek A, Ballard C, Herzog J, Dichgans M. The pattern of cognitive performance in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833403] [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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Herzog J, Peters N, Opherk C, Dichgans M. A two-year clinical follow-up study in 80 CADASIL subjects: progression patterns and implications for clinical trials. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833048] [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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