1
|
Masanneck L, Pawlitzki MG, Meuth SG. [Digital medicine in neurological research-Between hype and evidence]. DER NERVENARZT 2024; 95:230-235. [PMID: 38095660 DOI: 10.1007/s00115-023-01581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND The rapid advancement of digital medicine and health technologies in neurology offers both significant potential and challenges. This article outlines fundamental aspects of digital medicine related to neurological research and highlights application examples of digital technologies in neurological research. AIM To provide a comprehensive overview of current digital developments in neurology and their impact on neurological research. MATERIAL AND METHODS In this narrative review articles from various sources and references related to digital medicine and health technologies in neurology were compiled and analyzed. RESULTS AND DISCUSSION The data presented indicate that digital health technologies and digital therapeutics have the potential to decisively shape neurological care and research; however, it is emphasized that a critical evaluation and evidence-based approach to these technologies are essential to determine their actual value in neurology.
Collapse
Affiliation(s)
- Lars Masanneck
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
- Hasso-Plattner-Institut, Potsdam, Deutschland.
| | - Marc G Pawlitzki
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Sven G Meuth
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
| |
Collapse
|
2
|
Poser PL, Sajid GS, Beyer L, Hieke A, Schumacher A, Horstkemper L, Karl A, Grüter T, Sgodzai M, Pitarokoili K, Gerwert K, Gold R, Fisse AL, Gisevius B, Motte J. Serum neurofilament light chain does not detect self-reported treatment-related fluctuations in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16023. [PMID: 37539836 PMCID: PMC11235597 DOI: 10.1111/ene.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Serum neurofilament light chain (sNfL) is a marker for axonal degeneration. Patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) often report a fluctuation of symptoms throughout one treatment cycle with intravenous immunoglobulins (IVIG). The aim of this study was to determine whether sNfL is suitable to quantify patient-reported symptom fluctuations. METHODS Twenty-nine patients with the diagnosis of CIDP or a CIDP-variant under treatment with IVIG were recruited in this study and underwent examination before IVIG infusion, in the middle of the treatment interval, and before their next IVIG infusion. Patients were surveyed regarding symptom fluctuations at the last visit and divided into two groups: those with and without fluctuations of symptoms. At the first visit, sociodemographic and disease-specific data were collected. Clinical scores were assessed at every examination. sNfL values were compared between both groups at the different time points after conversion into Z-scores-adjusted for age and body mass index. RESULTS Patients with CIDP show elevated sNfL Z-scores (median at baseline: 2.14, IQR: 1.0). There was no significant change in sNfL Z-scores or questionnaire scores within the treatment cycle in either group. There was no significant difference in sNfL levels between the patients with and without symptom fluctuations. CONCLUSIONS CIDP patients show elevated sNfL levels. However, sNfL is not suitable to reflect patient-reported fluctuations of symptoms. This indicates that symptom fluctuations during treatment with IVIG in patients with CIDP are not caused by a neuroaxonal injury. Furthermore, repeated sNfL measurements within one treatment cycle with IVIG seem to have no benefit for symptom monitoring.
Collapse
Affiliation(s)
| | | | - Léon Beyer
- Department of Biophysics, Faculty of Biology and BiophysicsRuhr‐University BochumBochumGermany
- Center for Protein Diagnostics (Prodi)Ruhr‐University BochumBochumGermany
| | - Alina Hieke
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| | - Aurelian Schumacher
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| | - Lea Horstkemper
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| | - Anna‐Sophia Karl
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
| | - Thomas Grüter
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| | - Klaus Gerwert
- Department of Biophysics, Faculty of Biology and BiophysicsRuhr‐University BochumBochumGermany
- Center for Protein Diagnostics (Prodi)Ruhr‐University BochumBochumGermany
| | - Ralf Gold
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| | - Barbara Gisevius
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
| | - Jeremias Motte
- Department of Neurology, St. Josef‐HospitalRuhr‐University BochumBochumGermany
- Immunmediated Neuropathies Biobank (INHIBIT)Ruhr‐University BochumBochumGermany
| |
Collapse
|
3
|
Masanneck L, Voth J, Huntemann N, Öztürk M, Schroeter CB, Ruck T, Meuth SG, Pawlitzki M. Introducing electronic monitoring of disease activity in patients with chronic inflammatory demyelinating polyneuropathy (EMDA CIDP): trial protocol of a proof of concept study. Neurol Res Pract 2023; 5:39. [PMID: 37612774 PMCID: PMC10464162 DOI: 10.1186/s42466-023-00267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/07/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Chronic inflammatory demyelinating polyneuropathy (CIDP) is one of the most common immune neuropathies leading to severe impairments in daily life. Current treatment options include intravenous immunoglobulins (IVIG), which are administered at intervals of 4-12 weeks. Determination of individual treatment intervals is challenging since existing clinical scores lack sensitivity to objectify small, partially fluctuating deficits in patients. End-of-dose phenomena described by patients, manifested by increased fatigue and worsening of (motor) symptoms, are currently difficult to detect. From a medical and socio-economic point of view, it is necessary to identify and validate new, more sensitive outcome measures for accurate mapping of disease progression and, thus, for interval finding. Digital health technologies such as wearables may be particularly useful for this purpose, as they record real-life data and consequently, in contrast to classic clinical 'snapshots', can continuously depict the disease course. METHODS In this prospective, observational, non-interventional, single-center, investigator-initiated study, CIDP patients treated with IVIG will be continuously monitored over a period of 6 months. Clinical scores and blood analyses will be assessed and collected during three visits (V1, V2, V3). Additionally, activity, sleep, and cardiac parameters will be recorded over the entire period using a wearable device. Further, patients' subjective disease development and quality of life will be recorded at various visits (read-outs). The usability of the smartwatch will be assessed at the end of the study. PERSPECTIVE The study aims to evaluate different digital measurements obtained with the smartwatch and blood-based analyses for monitoring disease activity and progress in CIDP patients. In conjunction, both means of monitoring might offer detailed insights into behavioral and biological patterns associated with treatment-related fluctuations such as end-of-dose phenomena. TRIAL REGISTRATION The study protocol was registered at ClinicalTrials.gov. Identifier: NCT05723848. Initially, the protocol was submitted prospectively on January 10, 2023. The trial was publicly released after formal improvements on February 13, 2023, after first patients were included according to the original protocol.
Collapse
Affiliation(s)
- Lars Masanneck
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Hasso Plattner Institute, University of Potsdam, 14482, Potsdam, Germany
| | - Jan Voth
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Menekse Öztürk
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christina B Schroeter
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| |
Collapse
|