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Hunt AP, Pagnussat AS, Lehn A, Moore D, Schweitzer D, Laakso EL, Hennig E, Morris ME, Kerr G, Stewart I. Evidence of heat sensitivity in people with Parkinson's disease. Int J Biometeorol 2024:10.1007/s00484-024-02658-w. [PMID: 38602550 DOI: 10.1007/s00484-024-02658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024]
Abstract
Examining how heat affects people with Parkinson's disease is essential for informing clinical decision-making, safety, well-being, and healthcare planning. While there is evidence that the neuropathology associated with Parkinson's disease affects thermoregulatory mechanisms, little attention has been given to the association of heat sensitivity to worsening symptoms and restricted daily activities in people with this progressive disease. Using a cross-sectional study design, we examined the experiences of people diagnosed with Parkinson's disease in the heat. Two-hundred and forty-seven people completed an online survey (age: 66.0 ± 9.2 years; sex: male = 102 (41.3%), female = 145 (58.7%)), of which 195 (78.9%) reported becoming more sensitive to heat with Parkinson's disease. Motor and nonmotor symptoms worsened with heat in 182 (73.7%) and 203 (82.2%) respondents, respectively. The most commonly reported symptoms to worsen included walking difficulties, balance impairment, stiffness, tremor, fatigue, sleep disturbances, excess sweating, difficulty concentrating, and light-headedness when standing. Concerningly, over half indicated an inability to work effectively in the heat, and nearly half reported that heat impacted their ability to perform household tasks and social activities. Overall, heat sensitivity was common in people with Parkinson's disease and had a significant impact on symptomology, day-to-day activities and quality of life.
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Affiliation(s)
- Andrew P Hunt
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, 4059, Australia.
| | - Aline Souza Pagnussat
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
- Department of Physical Therapy, Georgia State University, Atlanta, USA
| | - Alexander Lehn
- Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Daniel Moore
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Daniel Schweitzer
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Centre for Neurosciences, Mater Hospital, Brisbane, QLD, Australia
- Wesley Hospital, Brisbane, QLD, Australia
| | - E-Liisa Laakso
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Ewald Hennig
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, 4059, Australia
| | - Meg E Morris
- The Victorian Rehabilitation Centre and ARCH, La Trobe University, Bundoora, 3086, Australia
| | - Graham Kerr
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, 4059, Australia
| | - Ian Stewart
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, 4059, Australia
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White P, Abbey S, Angus B, Ball HA, Buchwald DS, Burness C, Carson AJ, Chalder T, Clauw DJ, Coebergh J, David AS, Dworetzky BA, Edwards MJ, Espay AJ, Etherington J, Fink P, Flottorp S, Garcin B, Garner P, Glasziou P, Hamilton W, Henningsen P, Hoeritzauer I, Husain M, Huys ACML, Knoop H, Kroenke K, Lehn A, Levenson JL, Little P, Lloyd A, Madan I, van der Meer JWM, Miller A, Murphy M, Nazareth I, Perez DL, Phillips W, Reuber M, Rief W, Santhouse A, Serranova T, Sharpe M, Stanton B, Stewart DE, Stone J, Tinazzi M, Wade DT, Wessely SC, Wyller V, Zeman A. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis. J Neurol Neurosurg Psychiatry 2023; 94:1056-1063. [PMID: 37434321 DOI: 10.1136/jnnp-2022-330463] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/03/2023] [Indexed: 07/13/2023]
Abstract
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive-behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which 'downgraded' the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.
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Affiliation(s)
- Peter White
- Wolfson Institute for Population Health, Queen Mary University Barts and The London School of Medicine and Dentistry, London, UK
| | - Susan Abbey
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brian Angus
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | | | - Alan J Carson
- Centre for Clinical Brain Sciences, Royal Infirmary, Edinburgh, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine and Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jan Coebergh
- Ashford St Peter's NHS Foundation Trust, Chertsey, St George's University Hospitals, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Barbara A Dworetzky
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark J Edwards
- Neuroscience Research Centre, St George's University, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Per Fink
- Research Clinic for Functional Disorders, Aarhus University, Aarhus, Denmark
| | - Signe Flottorp
- Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Béatrice Garcin
- Hopital Avicenne, Universite Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Willie Hamilton
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Peter Henningsen
- Psychosomatic Medicine, University Hospital, Technical University Munich, Munich, Germany
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mujtaba Husain
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Hans Knoop
- Department of Medical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander Lehn
- Brisbane Clinical Neuroscience Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Lloyd
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ira Madan
- Faculty of Occupational Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical College, Nijmegen, Netherlands
| | - Alastair Miller
- Department of Medicine, Cumberland Infirmary Carlisle, Carlisle, UK
| | - Maurice Murphy
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Irwin Nazareth
- Primary Care & Population Science, University College London, London, UK
| | - David L Perez
- Neurology and Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Markus Reuber
- Department of Neuroscience, The Medical School, University of Sheffield, Sheffield, UK
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy Clinic, University of Marburg, Marburg, Germany
| | - Alastair Santhouse
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tereza Serranova
- Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford, Oxford, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, London, UK
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Jon Stone
- Centre for Clinical Brain Sciences, Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Derick T Wade
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Simon C Wessely
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Vegard Wyller
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Adam Zeman
- Cognitve Neurology Research Group, University of Exeter Medical School, Exeter, UK
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Dissanayaka N, Pourzinal D, Byrne GJ, Yang J, McMahon KL, Pontone GM, O'Sullivan JD, Adam R, Littleford R, Chatfield M, Lehn A, Mari Z, Bakker A. Levetiracetam for the treatment of mild cognitive impairment in Parkinson's disease: a double-blind controlled proof-of-concept trial protocol. Pilot Feasibility Stud 2023; 9:189. [PMID: 37993889 PMCID: PMC10664284 DOI: 10.1186/s40814-023-01406-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Mild memory impairment, termed amnestic mild cognitive impairment (aMCI), is associated with rapid progression towards dementia in Parkinson's disease (PD). Studies have shown hyperactivation of hippocampal DG/CA3 subfields during an episodic memory task as a biomarker of aMCI related to Alzheimer's disease. This project investigates the feasibility of a trial to establish the efficacy of a repurposed antiepileptic drug, levetiracetam, in low doses as a putative treatment to target DG/CA3 hyperactivation and improve episodic memory deficits in aMCI in PD. Based on previous work, it is hypothesized that levetiracetam will normalize DG/CA3 overactivation in PD-aMCI participants and improve memory performance. METHODS Twenty-eight PD-aMCI participants, 28 PD participants without memory impairment (PD-nMI), and 28 healthy controls will be recruited. PD-aMCI participants will undertake a 12-week randomized, placebo-controlled, double-blind cross-over trial with a 14-day treatment of 125 mg levetiracetam or placebo twice daily, separated by a 4-week washout period. After each treatment period, participants will complete an episodic memory task designed to tax hippocampal subregion-specific function during high-resolution functional magnetic resonance imaging (fMRI). PD-nMI and healthy controls will undergo the fMRI protocol only, to compare baseline DG/CA3 subfield activity. RESULTS Episodic memory task performance and functional activation in the DG/CA3 subfield during the fMRI task will be primary outcome measures. Global cognition, PD severity, and adverse events will be measured as secondary outcomes. Recruitment, eligibility, and study completion rates will be explored as feasibility outcomes. CONCLUSIONS This study, the first of its kind, will establish hippocampal subregion functional impairment and proof of concept of levetiracetam as an early therapeutic option to reduce dementia risk in PD. TRIAL REGISTRATION ClinicalTrials.gov, NCT04643327 . Registered on 25 November 2020.
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Affiliation(s)
- Nadeeka Dissanayaka
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia.
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia.
| | - Dana Pourzinal
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Jihyun Yang
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gregory M Pontone
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, USA
| | - John D O'Sullivan
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Robert Adam
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Roberta Littleford
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Mark Chatfield
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
| | - Arnold Bakker
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, USA
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Petrie D, Lehn A, Barratt J, Hughes A, Roberts K, Fitzhenry S, Gane E. How is Functional Neurological Disorder managed in Australian Hospitals? A multi‐site study conducted on acute inpatient and inpatient rehabilitation wards. Mov Disord Clin Pract 2023; 10:774-782. [DOI: 10.1002/mdc3.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- Dharsha Petrie
- Physiotherapy Department Princess Alexandra Hospital Brisbane Australia
| | - Alexander Lehn
- Neurology Department Princess Alexandra Hospital Brisbane Australia
- School of Medicine University of Queensland Brisbane Australia
| | - Jessica Barratt
- Physiotherapy Department Bundaberg Base Hospital Bundaberg Australia
| | - Amy Hughes
- Physiotherapy Department Princess Alexandra Hospital Brisbane Australia
| | - Kathryn Roberts
- Physiotherapy Department Logan General Hospital Logan Australia
| | - Sarah Fitzhenry
- Physiotherapy Department Sunshine Coast University Hospital Sunshine Coast Australia
| | - Elise Gane
- Physiotherapy Department Princess Alexandra Hospital Brisbane Australia
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Australia
- Centre for Functioning and Health Research Metro South Health Brisbane Australia
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5
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de Liège A, Carle G, Hingray C, Lehn A, Autier L, Degos B, Garcin B. Functional Neurological Disorders in the medical education: An urgent need to fill the gaps. Rev Neurol (Paris) 2022; 178:788-795. [PMID: 35863918 DOI: 10.1016/j.neurol.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 03/03/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND FND is a disabling disease that accounts for 5 to 10% of the reason for consultation in neurology. However, young physicians often say they have little or no training in their management. AIM The aim of the present study was to assess whether French junior neurologists, psychiatrists and physical and rehabilitation medicine (PRM) specialists received teaching on FND during their medical studies, including the residency, and to evaluate their knowledge and perception of the disorder. METHODS The survey was distributed by the means of a Google form questionnaire to specialist registrars and young specialists with the help of resident's organizations. RESULTS 568 respondents from the 3 specialties were included in the study. Most respondents (72.4%) were specialists registrars. Almost half of the respondents (45.5%) answered they never received any teaching on FND, and only 20.5% of them knew the Hoover's sign, a positive sign specific of functional weakness. A large majority of respondents felt they were not sufficiently trained in FND (87.9%), and they did not have sufficient knowledge of these disorders (85.3%). DISCUSSION Better training would allow clinicians to make a diagnosis earlier, to better explain it to patients, and to limit the costs associated with diagnosis delays. A better training of clinicians about FND would also improve the prognosis of patients, as early diagnosis and good explanation is associated with a better prognosis. CONCLUSION This survey shows that there is a gap about FND in the training programs in the medical studies and during the specialization training of young doctors in France.
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Affiliation(s)
- A de Liège
- Service de Neurologie, AP-HP, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France
| | - G Carle
- Consultation-Liaison Psychiatry and Psychiatric Emergency Department, Toulouse University Hospital, Toulouse, France
| | - C Hingray
- Pole de psychiatrie universitaire du grand Nancy, Centre Psychothérapeutique de Nancy, Laxou, France
| | - A Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - L Autier
- ANAINF (Association Nationale des Assistants et Internes de Neurologie de France), France
| | - B Degos
- Service de Neurologie, AP-HP, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France; Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, College de France, CNRS UMR7241/INSERM U1050, Université PSL, 75005 Paris, France
| | - B Garcin
- Service de Neurologie, AP-HP, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France.
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Charmley AR, Kimber T, Mahant N, Lehn A. Driving restrictions following deep brain stimulation surgery. BMJ Neurol Open 2021; 3:e000210. [PMID: 34964044 PMCID: PMC8653775 DOI: 10.1136/bmjno-2021-000210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background There are currently no Australian guidelines to assist clinicians performing deep brain stimulation (DBS) procedures in setting postoperative driving restrictions. Purpose We aimed to provide recommendations for post-DBS driving restrictions to guide practice in Australia. Methods A review of current Australian and international driving guidelines, literature regarding the adverse effects of DBS and literature regarding the long-term effect of neurostimulation on driving was conducted using Elton B Stephens Company discovery service-linked databases. Australian neurologists and neurosurgeons who perform DBS were surveyed to gain insight into existing practice. Results No guidance on driving restrictions following DBS surgery was found, either in existing driving guidelines or in the literature. There was a wide difference seen in the rates of reported adverse effects from DBS surgery. The most serious adverse events (haemorrhage, seizure and neurological dysfunction) were uncommon. Longer term, there does not appear to be any adverse effect of DBS on driving ability. Survey of Australian practitioners revealed a universal acceptance of the need for and use of driving restrictions after DBS but significant heterogeneity in how return to driving is managed. Conclusion We propose a 6-week driving restriction for private licences and 6-month driving restriction for commercial licences in uncomplicated DBS. We also highlight some of the potential pitfalls and pearls to assist clinicians to modify these recommendations where needed. Ultimately, we hope this will stimulate further examination of this issue in research and by regulatory bodies to provide more robust direction for practitioners performing DBS implantation.
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Affiliation(s)
- Andrew Roy Charmley
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Thomas Kimber
- Central Adelaide Neurology Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Neil Mahant
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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Müller T, Demes M, Lehn A, Köllermann J, Vallo S, Wild PJ, Winkelmann R. The peri- and intratumoral immune cell infiltrate and PD-L1 status in invasive squamous cell carcinomas of the penis. Clin Transl Oncol 2021; 24:331-341. [PMID: 34449004 PMCID: PMC8794908 DOI: 10.1007/s12094-021-02694-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/08/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Penile carcinomas are rare tumors throughout Europe. Therefore, little attention is drawn to this disease. That makes it important to study tumor-associated key metrics and relate these to known data on penile neoplasias. MATERIALS AND METHODS A cohort of 60 well-defined penile invasive carcinomas with known human papillomavirus (HPV) infection status was investigated. Data on tumor type, grading and staging were recorded. Additionally, data on the peri- and intratumoral immune cell infiltrate in a semiquanititave manner applying an HE stain were assessed. RESULTS Our study showed a significant correlation of immune cell infiltrate and pT stage with overall survival. Therefore, in a subset of tumors, PD-L1 staining was applied. For tumor proportion score (TPS), 26 of 30 samples (87%) were scored >0%. For the immune cell score (IC), 28 of 30 samples (93%) were defined as >0% and for CPS, 29 of 30 samples (97%) scored >0. PD-L1 expression was not associated with overall survival. CONCLUSION PD-L1 is expressed in penile carcinomas, providing a rationale for targeted therapy with checkpoint inhibitors. We were able to show that immune reaction appears to be prognostically relevant. These data enhance the need for further studies on the immune cell infiltrate in penile neoplasias and show that PD-L1 expression is existent in our cohort, which may be a potential target for checkpoint inhibitor therapy.
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Affiliation(s)
- T Müller
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - M Demes
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Lehn
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | - J Köllermann
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - S Vallo
- Institute of Virology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P J Wild
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany.,Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany
| | - R Winkelmann
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany.
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Lehn A, Watson E, Ryan EG, Jones M, Cheah V, Dionisio S. Psychogenic nonepileptic seizures treated as epileptic seizures in the emergency department. Epilepsia 2021; 62:2416-2425. [PMID: 34396517 DOI: 10.1111/epi.17038] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to estimate the rate of psychogenic nonepileptic seizures (PNES) among patients presenting to an emergency department with presumed seizures. We also wanted to identify factors that can assist health care professionals in determining whether these events are likely to be epileptic or nonepileptic. METHODS We performed two retrospective audits on patients who were treated for seizures in the department of emergency medicine at the Princess Alexandra Hospital, Brisbane, Australia. Exploratory analyses and logistic regressions were conducted to investigate the characteristics of the presentations and the relationships between our variables of interest. RESULTS In the group of all presentations with presumed seizures over a 3-month period (n = 157), a total of 151 presentations (96.2%) presentations were given a primary diagnosis of epileptic seizures. Of these 151 presentations, only 84 (55.6%) presented with epileptic seizures and 40 (26.5%) actually presented with PNES. In the group of patients who presented with prolonged and/or multiple events (n = 213) over a 1-year period, 196 (92.0%) were treated as epileptic seizures. Of these 196 presentations, only 85 (43.4%) presented with epileptic seizures and 97 (49.5%) actually presented with PNES. Several factors were identified to help risk stratify between epileptic seizures and PNES: Duration of events and of the postictal phase, number of events, presence of a structural brain pathology, mental health history, lactate levels and presence of tongue bite, incontinence, and/or vomiting. SIGNIFICANCE A large proportion of people who present to emergency departments with events resembling epileptic seizures actually have PNES rather than epilepsy-particularly those patients who present with prolonged and/or multiple events. The rate of misdiagnosis was high. Efforts need to be made to recognize patients with psychogenic nonepileptic seizures earlier and diagnose them correctly to avoid unnecessary iatrogenic harm and to provide adequate treatment.
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Affiliation(s)
- Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Emily Watson
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth G Ryan
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.,Research and Statistical Support Service, Centre for Health Service Research, The University of Queensland, Brisbane, QLD, Australia
| | - Maryon Jones
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Vince Cheah
- Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Sasha Dionisio
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
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Bullock-Saxton J, Lehn A, Laakso EL. Exploring the Effect of Combined Transcranial and Intra-Oral Photobiomodulation Therapy Over a Four-Week Period on Physical and Cognitive Outcome Measures for People with Parkinson's Disease: A Randomized Double-Blind Placebo-Controlled Pilot Study. J Alzheimers Dis 2021; 83:1499-1512. [PMID: 34092640 DOI: 10.3233/jad-210170] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Neuroprotection against Parkinson's disease degeneration by photobiomodulation has been reported in animal models but no true placebo-controlled human studies have been published. OBJECTIVE To understand if photobiomodulation therapy can produce clinically significant differences in physical performance measures in people with Parkinson's disease; and what frequency of treatment is necessary to initiate clinical change. METHODS In a participant and assessor-blinded, randomized, placebo-controlled pilot study, 22 participants received either sham and/or active laser photobiomodulation (904 nm, 60 mW/diode, 50 Hz) for 33 s to each of 21 points at the cranium and intra-orally, on one, two or three times/week for 4 weeks. Two treatment phases were separated by a 4-week wash-out (Phase 2). Upper and lower limb physical outcome measures were assessed before and after each treatment phase. The Montreal Cognitive Assessment was evaluated prior to treatment Phase 1, and at the end of treatment Phase 3. RESULTS Montreal Cognitive Assessment remained stable between start and end of study. No measures demonstrated statistically significant changes. With regular treatment, the spiral (writing) test and the dynamic step test were most sensitive to change in a positive direction; and the 9-hole peg test demonstrated a minimum clinically important difference worthy of further investigation in a larger, adequately powered clinical trial. A placebo effect was noted. CONCLUSION The results support the notion that combined transcranial and intra-oral photobiomodulation therapy needs to be applied at least 2 to 3 times per week for at least four weeks before some improvement in outcome measures becomes evident. Longer courses of treatment may be required.
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Affiliation(s)
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland Princess Alexandra Hospital Clinical School, Queensland, Australia
| | - E-Liisa Laakso
- Mater Research Institute, Brisbane and Menzies Health Institute, Queensland, Australia
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10
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Navaratnam D, Harm K, Fenton A, Bullock-Saxton J, Griffin A, Lehn A. Implicit motor imagery using laterality recognition in functional movement disorders. J Clin Neurosci 2021; 89:139-143. [PMID: 34119257 DOI: 10.1016/j.jocn.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/25/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Functional movement disorder (FMD) presents as disabling motor symptoms that cannot be explained by organic processes. Despite the lack of lesion or known central nervous system dysfunction, distortion in sensorimotor processing in movement generation and execution is often observed. A person's capacity to judge laterality of a body part requires processing of sensorimotor information. This prospective observational study compared reaction time (RT) and accuracy (ACC) of hand laterality recognition between 30 people diagnosed with FMD and 30 age-matched healthy control participants. The association of RT and ACC with severity of FMD as measured by the Simplified Functional Movement Disorders Rating Scale (SFMDRS) was also explored. RT was on average 0.6 s slower (95% CI 0.4 - 0.8 s, p < 0.001) in patients with FMD (mean 2.2 s, standard deviation (SD) 0.5) than controls (mean 1.7 s, SD 0.3). ACC was on average 8.9% lower (95% CI -15.7 - -2.2, p = 0.01) in patients with FMD (mean 79.6%, SD 16.6) than controls (mean 88.5%, SD 8.1). When adjusted for SFMDRS using robust regression, RT was 0.3 s slower (95% CI 0.01 - 0.5, p = 0.04) in cases than in controls, but ACC was no longer different between groups. There was a moderate negative correlation between RT and ACC in FMD patients (ρ -0.58, p < 0.001 but not in controls (ρ -0.26, p = 0.17). People with FMD had significantly slower RT and lower ACC compared to the control group. These results provide new insights into underlying sensorimotor processing deficits in those with FMD.
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Affiliation(s)
- Dharsha Navaratnam
- Active Rehabilitation Physiotherapy, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia.
| | - Karl Harm
- Active Rehabilitation Physiotherapy, Brisbane, Australia
| | - Alison Fenton
- Active Rehabilitation Physiotherapy, Brisbane, Australia
| | | | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Alexander Lehn
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Mater Research, Brisbane, Australia
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11
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Grünewaldt A, Stützle S, Lehn A, Rohde G. [Dyspnoea and Comorbidity in Lung Cancer-Patients: The Therapy Starts with Taking the Patients History]. Pneumologie 2021; 75:353-359. [PMID: 33598900 DOI: 10.1055/a-1340-5609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Dyspnoea is a frequent and compromising symptom in patients with advanced and metastatic lung cancer. Exogenous as well as endogenous factors contribute to development of shortness of breath. Knowledge of these influences is essential for effective treatment of this important symptom. In our study, we evaluated the influence of cofactors and comorbidity on development of dyspnoea in lung cancer patients for the purpose of effective therapy of shortness of breath in this target group. METHODS In this prospective monocentric study, we registered severity of dyspnoea in advanced lung cancer patients using the modified Medical Research Council-Scale (mMRC-scale). Patients' history of COPD and cardiopulmonary comorbidity was recorded using a standardized questionnaire. Moreover, cofactors such as pain or cancer-induced mental stress were documented by visual rating scale. RESULTS 25 (48,1 %) of 52 recruited lung cancer-patients reported moderate or severe dyspnoea. In logistic regression analysis history of COPD or cardiopulmonary comorbidity, severe pain, airway obstruction or pleural effusion were associated with severe dyspnoea (mMRC-scale ≥ 3). Furthermore, in our study cohort lower cancer level III UICC and absence of metastasis correlated with severe dyspnoea. CONCLUSIONS Our findings confirm the relevance of dyspnoea in patients with advanced lung cancer. Probability of occurrence is influenced by comorbidity and cofactors. The knowledge of these factors contributes to better understanding of occurrence and treatment of dyspnoea.
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Affiliation(s)
- A Grünewaldt
- Schwerpunkt Pneumologie/Allergologie, Medizinische Klinik 1, Universitätsklinikum, Goethe-Universität Frankfurt am Main
| | - S Stützle
- Schwerpunkt Pneumologie/Allergologie, Medizinische Klinik 1, Universitätsklinikum, Goethe-Universität Frankfurt am Main
| | - A Lehn
- Institut für Biostatistik und Mathematische Modellierung, Fachbereich Medizin, Goethe-Universität Frankfurt am Main
| | - G Rohde
- Schwerpunkt Pneumologie/Allergologie, Medizinische Klinik 1, Universitätsklinikum, Goethe-Universität Frankfurt am Main
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12
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Pun P, Frater J, Broughton M, Dob R, Lehn A. Psychological Profiles and Clinical Clusters of Patients Diagnosed With Functional Neurological Disorder. Front Neurol 2020; 11:580267. [PMID: 33178122 PMCID: PMC7593396 DOI: 10.3389/fneur.2020.580267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/08/2020] [Indexed: 12/18/2022] Open
Abstract
Our understanding about underlying mechanisms leading to Functional Neurological Disorders (FND) has changed in recent years. While in the past these disorders were presumed to be solely due to psychological issues we know now that their development is dependent on complex interactions between biological, psychological and social factors. We present an analysis of clinical presentations and psychological profiles of patients who were seen in our FND outpatient clinic over 3 years. We aim to review the prevalence of common symptoms in the patients seen within our clinic, and to identify any common psychological or psychiatric profiles that differentiated these symptom groups. This may help to elucidate underlying mechanisms leading to the development of functional symptoms and identify the predisposing, triggering and perpetuation factors.
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Affiliation(s)
- Paul Pun
- Emotional Health Unit, Mater Misericordiae Health Services Brisbane Ltd, Brisbane, QLD, Australia
| | - Julanne Frater
- Emotional Health Unit, Mater Misericordiae Health Services Brisbane Ltd, Brisbane, QLD, Australia
| | - Megan Broughton
- Brisbane Clinical Neuroscience Centre, Brisbane, QLD, Australia
| | - Rian Dob
- Map and Mind Psychology, Brisbane, QLD, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,The University of Queensland Princess Alexandra Hospital Clinical School, Woolloongabba, QLD, Australia
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Asadi‐Pooya AA, Nicholson TR, Pick S, Baslet G, Benbadis SR, Beghi M, Brigo F, Buchhalter J, D'Alessio L, Dworetzky B, Gigineishvili D, Kanaan RA, Kozlowska K, LaFrance WC, Lehn A, Perez DL, Popkirov S, Pretorius C, Szaflarski JP, Tolchin B, Valente K, Stone J, Reuber M. Driving a motor vehicle and psychogenic nonepileptic seizures: ILAE Report by the Task Force on Psychogenic Nonepileptic Seizures. Epilepsia Open 2020; 5:371-385. [PMID: 32913946 PMCID: PMC7469780 DOI: 10.1002/epi4.12408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This International League Against Epilepsy (ILAE) Report: (a) summarizes the literature about "driving and psychogenic nonepileptic seizures (PNES)"; (b) presents the views of international experts; and (c) proposes an approach to assessing the ability of persons with PNES (PwPNES) to drive. METHODS Phase 1: Systematic literature review. Phase 2: Collection of international expert opinion using SurveyMonkey®. Experts included the members of the ILAE PNES Task Force and individuals with relevant publications since 2000. Phase 3: Joint analysis of the findings and refinement of conclusions by all participants using email. As an ILAE Report, the resulting text was reviewed by the Psychiatry Commission, the ILAE Task Force on Driving Guidelines, and Executive Committee. RESULTS Eight studies identified by the systematic review process failed to provide a firm evidence base for PNES-related driving regulations, but suggest that most health professionals think restrictions are appropriate. Twenty-six experts responded to the survey. Most held the view that decisions about driving privileges should consider individual patient and PNES characteristics and take account of whether permits are sought for private or commercial driving. Most felt that those with active PNES should not be allowed to drive unless certain criteria were met and that PNES should be thought of as "active" if the last psychogenic seizure had occurred within 6 months. SIGNIFICANCE Recommendations on whether PwPNES can drive should be made at the individual patient level. Until future research has determined the risk of accidents in PwPNES a proposed algorithm may guide decisions about driving advice.
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Affiliation(s)
- Ali A. Asadi‐Pooya
- Epilepsy Research CenterShiraz University of Medical SciencesShirazIran
- Department of NeurologyJefferson Comprehensive Epilepsy CenterThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Timothy R. Nicholson
- Section of Cognitive NeuropsychiatryInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Susannah Pick
- Section of Cognitive NeuropsychiatryInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Gaston Baslet
- Department of PsychiatryBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Selim R. Benbadis
- Comprehensive Epilepsy ProgramUniversity of South Florida and Tampa General HospitalTampaFLUSA
| | | | | | | | - Luciana D'Alessio
- Epilepsy Center Ramos Mejía y el Cruce HospitalsBuenos Aires UniversityCONICETBuenos AiresArgentina
| | - Barbara Dworetzky
- Department of NeurologyThe Bromfield Epilepsy CenterBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - David Gigineishvili
- Department of Neurology & NeurosurgeryTbilisi State UniversityTbilisiGeorgia
| | - Richard A. Kanaan
- Department of PsychiatryUniversity of MelbourneAustin HealthHeidelbergAustralia
| | - Kasia Kozlowska
- The Children's Hospital at WestmeadWestmead Institute of Medical ResearchUniversity of Sydney Medical SchoolSydneyNSWAustralia
| | | | | | - David L. Perez
- Functional Neurology Research GroupDepartments of Neurology and PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Stoyan Popkirov
- Department of NeurologyUniversity Hospital Knappschaftskrankenhaus BochumRuhr University BochumBochumGermany
| | - Chrisma Pretorius
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - Jerzy P. Szaflarski
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamALUSA
| | - Benjamin Tolchin
- Department of NeurologyYale Comprehensive Epilepsy CenterYale School of MedicineNew HavenCTUSA
| | - Kette Valente
- Laboratory of Clinical NeurophysiologyDepartment of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Jon Stone
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Markus Reuber
- Academic Department of NeurosciencesUniversity of SheffieldRoyal Hallamshire HospitalSheffieldUK
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14
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Lehn A, Navaratnam D, Broughton M, Cheah V, Fenton A, Harm K, Owen D, Pun P. Functional neurological disorders: effective teaching for health professionals. BMJ Neurol Open 2020; 2:e000065. [PMID: 33681789 PMCID: PMC7903179 DOI: 10.1136/bmjno-2020-000065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives To provide an outline for the delivery of an educational course or lecture about functional neurological disorders (FND) that is directed towards health professionals with varying clinical knowledge and to highlight the educational efficacy that can be derived from a well-designed educational platform. Method Through multidisciplinary collaboration, a course designed to develop the skills for diagnosis and management of FND was created. Elements essential to the delivery of education are: (A) knowledge creation; (B) facilitating multidisciplinary cross-pollination; (C) listening to patients’ experiences; (D) communication skills practice; (E) case studies; (F) discipline specific mentoring; (G) establishing and addressing participant learning goals and (H) developing collegial and referral networks. Changes in participants’ knowledge and clinical practice were assessed via anonymous questionnaires before and after the course. Results Dramatically improved knowledge and confidence in assessment and management of people with FND has been found both immediately following the course as well as on 6-month follow-up. Conclusion It is possible to make real change in the understanding and management of medical and allied health clinicians working with people with FND with a low-cost intervention. Also, the development of educational networks and multidisciplinary collaboration can lead to the creation of therapeutic platforms for the diagnosis, management and advocacy of this patient group.
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Affiliation(s)
- Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,The University of Queensland Princess Alexandra Hospital Clinical School, Woolloongabba, Queensland, Australia
| | | | - Megan Broughton
- Brisbane Clinical Neuroscience Centre, Brisbane, Queensland, Australia
| | - Vince Cheah
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Alison Fenton
- Active Rehabilitation, Brisbane, Queensland, Australia
| | - Karl Harm
- Active Rehabilitation, Brisbane, Queensland, Australia
| | - Diana Owen
- Mater Education Centre, Brisbane, Queensland, Australia
| | - Paul Pun
- Emotional Health Unit, Mater Misericordiae Health Services Brisbane Ltd, Brisbane, Queensland, Australia
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15
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Popkirov S, Nicholson TR, Bloem BR, Cock HR, Derry CP, Duncan R, Dworetzky BA, Edwards MJ, Espay AJ, Hallett M, Lang AE, Leach JP, Lehn A, McGonigal A, Morgante F, Perez DL, Reuber M, Richardson MP, Smith P, Stamelou M, Tijssen MAJ, Tinazzi M, Carson AJ, Stone J. Hiding in Plain Sight: Functional Neurological Disorders in the News. J Neuropsychiatry Clin Neurosci 2019; 31:361-367. [PMID: 31117907 PMCID: PMC7291360 DOI: 10.1176/appi.neuropsych.19010025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Functional movement and seizure disorders are still widely misunderstood and receive little public and academic attention. This is in stark contrast to their high prevalence and levels of associated disability. In an exploratory observational study, the authors examined whether the relative lack of media coverage of functional neurological disorders is in part due to misidentification in "human interest" news stories. METHODS Thirteen recent news stories from high-impact English-language media outlets that portrayed patients with complex symptoms either attributed to other diagnoses or presented as medical mysteries were identified using online keyword searches. All selected news stories contained video or still images displaying relevant symptoms. Cases were categorized into movement disorders or seizure disorders and were then independently assessed by 10 respective expert raters. For each category, one story of a patient whose symptoms were due to a well-recognized neurological disease was also included. Both the diagnostic category and the respective confidence level were reported by each rater for each case. The interrater agreement was calculated for each group of disorders. RESULTS The raters confirmed almost unanimously that all presented news stories except the negative control cases portrayed misidentified functional movement or seizure disorders. The interrater agreement and average diagnostic confidence were high. CONCLUSIONS Functional neurological disorders are often wrongly considered a rare medical curiosity of the past. However, these findings suggest that, while they are largely absent from public discourse, they often appear in the news incognito, hiding in plain sight.
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Affiliation(s)
- Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Timothy R. Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
| | - Bastiaan R. Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands
| | - Hannah R. Cock
- Institute of Medical and Biomedical Education, St. George’s University of London and Atkinson Morley Regional Neuroscience Centre, St. George’s University Hospitals NHS Foundation Trust, London
| | - Christopher P. Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom
| | - Roderick Duncan
- Department of Neurology, University of Otago, Christchurch, New Zealand
| | - Barbara A. Dworetzky
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Mark J. Edwards
- Institute of Molecular and Clinical Sciences, St. George’s University of London
| | - Alberto J. Espay
- Department of Neurology, Gardner Family Center for Parkinson Disease and Movement Disorders, University of Cincinnati
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md
| | - Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto
| | - John Paul Leach
- Queen Elizabeth University Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Alexander Lehn
- Mater Centre for Neurosciences and School of Medicine, University of Queensland, Brisbane, Australia
| | - Aileen McGonigal
- Institut de Neurosciences des Systèmes, INSERM, Aix-Marseille Université, Marseille, France,Department of Clinical Neurophysiology, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Francesca Morgante
- Institute of Molecular and Clinical Sciences, St. George’s University of London,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - David L. Perez
- Departments of Neurology and Psychiatry, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, United Kingdom
| | - Mark P. Richardson
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London
| | - Philip Smith
- Department of Neurology, Alan Richens Epilepsy Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Maria Stamelou
- HYGEIA Hospital, Athens, Greece,Neurology Clinic, Philipps University Marburg, Marburg, Germany,University of Athens, Greece
| | - Marina A. J. Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, University of Verona, Verona, Italy
| | - Alan J. Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Gillinder L, Lehn A, Brown H, Dionisio S. Treatment outcomes after the introduction of a new seizure management protocol. Intern Med J 2018; 48:810-816. [DOI: 10.1111/imj.13765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Lisa Gillinder
- Department of Neurology; Princess Alexandra Hospital; Brisbane Queensland Australia
- Mater Advanced Epilepsy Unit; Mater Hospital; Brisbane Queensland Australia
| | - Alexander Lehn
- Department of Neurology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Helen Brown
- Department of Neurology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Sasha Dionisio
- Department of Neurology; Princess Alexandra Hospital; Brisbane Queensland Australia
- Mater Advanced Epilepsy Unit; Mater Hospital; Brisbane Queensland Australia
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Lilley K, Swayne A, Watson E, Kee R, Wong D, Lehn A, Brown H, O’Gorman C, Sheikh N, Bird R, Prain K, Gillis D, Wong RC, Blum S. 058 ANTI-CASPR2-ANTIBODY associated encephalitis in a 63-year old male with chronic lymphocytic leukaemia. J Neurol Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionThis case from a tertiary neurology centre reports a novel association between the emerging clinical entity of anti-contactin associated protein-2 (CASPR-2) antibody encephalitis and chronic lymphocytic leukaemia (CLL).CaseWe describe a 63 year old Maori male truck-driver who presented with progressive altered personality, speech, cognition and perception over 9 months. The patient also developed choreiform movements, broad-based gait, incontinence, sleep apnoea with type 2 respiratory failure and episodic loss of consciousness. 12 months prior, he had been diagnosed with low-risk CLL, for which he remained untreated. MRI of the brain revealed mid-sagittal bilateral mid-temporal T2/FLAIR hyperintensities. Cerebrospinal fluid examination showed a mononuclear pleocytosis (WCC 270×10^6/L) with 15% of these CD5/CD19/CD23 positive and 92% CD3/CD5 positive CD 19 negative on flow cytometry, protein was also elevated at 2600 mg/L. The interplay between CLL and inflammation is uncertain. Anti-Caspr2-antibody was identified in CSF and serum. The patient was treated with a combination of fludarabine, cyclophosphamide, rituximab, dexamethasone and intravenous immunoglobulin (IVIG). Clinical status improved and antibody titre decreased from 580 to 241 pM in three weeks and to 55pM (negative <85 pM) at five months. Symptoms worsened when IVIG doses were missed. He returned home after inpatient rehabilitation, showed striking clinical improvement at 12 month follow-up and continues on maintenance IVIG therapy.ConclusionWhilst paraneoplastic VGKC encephalitis has been described associated with a number of malignancies, this is the first reported case of CASPR-2 antibody present in association with CLL.References. Van Sonderen A, Petit-Pedrol M, Dalmau J, Titulaer MJ. The value of LGI1, Caspr2 and voltage-gated potassium channel antibodies in encephalitis. Nature Reviews Neurology2017;13(5):290–301.. Nogai H, Israel-Willner H, Zschenderlein R, Pezzutto A. Improvement in Paraneoplastic Limbic Encephalitis after Systemic Treatment with Rituximab in a Patient with B-Cell Chronic Lymphocytic Leukaemia. Case Reports in Haematology2013;2013:Article ID958704.. Van Sonderen A, Ariño H, Petit-Pedrol M, et al. The Clinical Spectrum of Caspr2 antibody-associated disease. Neurology2016;87:521–528.. Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, et al. Paraneoplastic limbic encephalitis: Neurological symptoms, immunological findings and tumour association in 50 patients. Brain2000;123:1481–1494.
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Lehn A, Sowden D, Anstey C, Stephensen B, Newman H. Patients with Bacteraemia Discharged from the Department of Emergency Medicine: Distribution of Organisms and Associated Characteristics. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Although blood cultures are commonly used to investigate febrile patients presenting to an emergency department, treatment decisions usually have to be made before the results are available. Methods We performed a retrospective analysis of consecutive patients presenting with community-acquired bacteraemia at the emergency department of Nambour Hospital, Queensland, Australia between 2000 and 2008. We determined their clinical characteristics, the distribution of organisms and also assessed patient characteristics associated with discharge from the emergency department. Results A total of 885 patients with 915 presentations of community-acquired bacteraemia were included. While having bacteraemia, 33 patients (3.6%) were discharged from the emergency department. Age, mode of presentation, altered mental state, presence of immunocompromise, presence of respiratory distress, C reactive protein, Charlson score, age score and estimated 10 years survival were significant factors discriminating the admitted from discharged patients. The most commonly found organism in blood cultures of discharged patients was Staphylococcus aureus (27.3%), whereas in admitted patients it was E. coli (27.7%). Methicillin-resistant Staphylococcus aureus accounted for 1.7% of cases of community-acquired bacteraemia. Conclusions Emergency physicians only rarely discharge patients with community-acquired bacteraemia using current assessment tools and decision-making rules. However, they tend to discharge younger self-presenting patients with good baseline function.
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Affiliation(s)
| | - D Sowden
- Nambour General Hospital, Department of Infectious Diseases, Hospital Road, Nambour QLD 4560, Australia; David Sowden, MBBS
| | - C Anstey
- Nambour General Hospital, Department of Intensive Care Medicine, Hospital Road, Nambour QLD 4560, Australia; Chris Anstey, MBBS, FANZCA, FCICM
| | - B Stephensen
- Nambour General Hospital, Department of Surgery, Hospital Road, Nambour QLD, 4560 Australia; Bree Stephensen, MBBS, BSc
| | - H Newman
- Nambour General Hospital, Department of Anaesthetics, Hospital Road, Nambour QLD 4560, Australia; Helen Newman, MBBS
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Warren N, O'Gorman C, Lehn A, Siskind D. Dopamine dysregulation syndrome in Parkinson's disease: a systematic review of published cases. J Neurol Neurosurg Psychiatry 2017; 88:1060-1064. [PMID: 29018160 DOI: 10.1136/jnnp-2017-315985] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/13/2017] [Accepted: 08/01/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Dopamine dysregulation syndrome (DDS) is an uncommon complication of the treatment of Parkinson's disease, characterised by addictive behaviour and excessive use of dopaminergic medication. DDS may frequently go unrecognised or misdiagnosed. We aimed to clarify current understanding of presentation, risk factors, comorbidities and management of DDS. METHODS Case reports were identified through a systematic search of databases (PubMed, Embase) with the following terms: dopaminergic dysregulation syndrome, hedonistic homeostatic dysregulation, dopamine/levodopa addiction. RESULTS We reviewed 390 articles, identifying 98 cases of DDS. Early-onset Parkinson's disease (67%) and male gender (83%) were common. DDS presented with significant physical and social impairment, actions to enable or prevent detection of overuse, as well as mood, anxiety and motor fluctuations. All DDS cases met DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) substance use disorder criteria. Past substance and psychiatric history was present in 15.3% and 10.2% of cases. Comorbid impulse control disorders (61%), psychosis (32%) and panic attacks (14%) were common. A large variety of management strategies were used; only 56% of cases resolving. Sodium valproate was successful in 5/5 cases. The response to deep brain stimulation varied. CONCLUSIONS Given the functional impairment, medical and psychiatric consequences and the difficulties of treatment, early identification of DDS should be a priority.
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Affiliation(s)
- Nicola Warren
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Psychiatry, Metro South Addiction and Mental Health Services, Brisbane, Queensland, Australia
| | - Cullen O'Gorman
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dan Siskind
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Psychiatry, Metro South Addiction and Mental Health Services, Brisbane, Queensland, Australia
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Campbell TG, Lehn A, Blum S, Airey C, Brown H. iPad colour vision apps for dyschromatopsia screening. J Clin Neurosci 2016; 29:92-4. [PMID: 26896905 DOI: 10.1016/j.jocn.2015.10.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
Abstract
Optic neuritis (ON) is a common and important cause of vision loss or vision disturbances in the community, particularly amongst the young, and it is often associated with a persistent dyschromatopsia. Traditionally screening for dyschromatopsia has been carried out using pseudo-isochromatic Ishihara plates. These colour plates were originally developed for testing of colour blindness, and indeed have only more recently been applied to ON. As the Ishihara plate books used for testing are expensive, unwieldy, and are not commonly available in many clinics or wards, many neurologists and ophthalmologists have taken to using untested and unstudied downloadable software packages on portable electronic devices for testing. This study compared the efficacy of printed and iPad (Apple, Cupertino, CA, USA) versions of the Ishihara plates in screening for dyschromatopsia in patients who were suspected of having ON. The main finding was that dyschromatopsia testing using a commercially available application on an iPad was comparable to using the current pragmatic clinical benchmark, the pseudo-isochromatic plates of Ishihara. These findings provide support for the increasingly common practice of screening for dyschromatopsia using the iPad.
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Affiliation(s)
- Thomas Gordon Campbell
- School of Medicine, University of Queensland, Herston, Brisbane, QLD 4072, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Caroline Airey
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Helen Brown
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Abstract
The epidemiology of functional neurologic disorders (FND) is complex and has been hampered over the years by a lack of clear definition, with previous definitions struggling with an uneasy mix of both physical and psychologic components. The recent changes in DSM-5 to a definition based on positive identification of physical symptoms which are incongruent and inconsistent with neurologic disease and the lack of need for any associated psychopathology represent a significant step forward in clarifying the disorder. On this basis, FND account for approximately 6% of neurology outpatient contacts and putative community incidence rates of 4-12 per 100 000 per annum. Comorbid neurologic disease occurs in around 10% of cases. The diagnosis is reliable, with revision rates less than 5%. Of note, this revision rate was consistent prior to the widespread utilization of computed tomography and magnetic resonance imaging. FND symptoms are disabling and associated with significant distress. They are more common in women and have a peak incidence between the ages of 35 and 50; however the presentation is common in men and throughout the lifespan. The issues surrounding case definition, ascertainment, misdiagnosis, and risk factors are discussed in detail.
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Affiliation(s)
- A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - A Lehn
- Department of Neurology, Princess Alexandra Hospital and School of Medicine, University of Queensland, Brisbane, Australia
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Lehn A, Gelauff J, Hoeritzauer I, Ludwig L, McWhirter L, Williams S, Gardiner P, Carson A, Stone J. Functional neurological disorders: mechanisms and treatment. J Neurol 2015; 263:611-20. [DOI: 10.1007/s00415-015-7893-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/28/2015] [Accepted: 08/28/2015] [Indexed: 12/01/2022]
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Lehn A. Will next-generation sequencing also take us to the next level of understanding disease mechanisms? Mov Disord 2014; 29:868. [PMID: 24797999 DOI: 10.1002/mds.25905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/08/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Alexander Lehn
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom
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Lehn A, Airey C, Olson S, O'Sullivan JD, Boyle R. Deep Brain Stimulation for DYT3 Dystonia. Mov Disord Clin Pract 2014; 1:73-75. [PMID: 30363859 DOI: 10.1002/mdc3.12017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/14/2014] [Accepted: 02/19/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Alexander Lehn
- Department of Neurology Princess Alexandra Hospital Brisbane Australia.,Department of Neurology Royal Brisbane and Women's Hospital Brisbane Australia
| | - Caroline Airey
- Department of Neurology Princess Alexandra Hospital Brisbane Australia
| | - Sarah Olson
- Department of Neurosurgery Princess Alexandra Hospital Brisbane Australia
| | - John D O'Sullivan
- Department of Neurology Royal Brisbane and Women's Hospital Brisbane Australia.,Royal Brisbane & Women's Clinical School University of Queensland Brisbane Australia
| | - Richard Boyle
- Department of Neurology Princess Alexandra Hospital Brisbane Australia
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Lehn A, Mellick G, Boyle R. Psychiatric disorders in idiopathic-isolated focal dystonia. J Neurol 2014; 261:668-74. [DOI: 10.1007/s00415-014-7244-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/05/2014] [Accepted: 01/07/2014] [Indexed: 11/28/2022]
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Dziewulska D, Doi H, Fasano A, Erro R, Fatehi F, Fekete R, Gatto EM, Pablos EG, Lehn A, Miyajima H, Piperno A, Pellechia MT, Wu YR, Yoshida K, Zarruk JG, Jingli S, Schrag A, McNeill A. Olfactory impairment and pathology in neurodegenerative disorders with brain iron accumulation. Acta Neuropathol 2013; 126:151-3. [PMID: 23722254 DOI: 10.1007/s00401-013-1136-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/23/2013] [Accepted: 05/24/2013] [Indexed: 11/30/2022]
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Dionisio S, Brown H, Lander C, Airey C, Lehn A, Nooruddin H, Blum S. Immunoglobulin-responsive refractory epilepsy – 3 cases with a similar EEG pattern. Seizure 2013; 22:403-8. [DOI: 10.1016/j.seizure.2013.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 02/20/2013] [Accepted: 02/22/2013] [Indexed: 01/17/2023] Open
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Affiliation(s)
- Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.
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Abstract
Neuroferritinopathy is an autosomal dominantly inherited disorder caused by mutations in the gene encoding the ferritin light chain polypeptide. It leads to iron deposition particularly in the cerebellum, basal ganglia and motor cortex. The disease becomes clinically apparent in adulthood mainly with extrapyramidal signs and progresses slowly over decades. Patients usually have intact cognition until the very late stages of this disorder. Neuroimaging is the most helpful investigation and shows a very distinctive picture. So far no medication has been shown to have a disease-modifying effect. We present five new cases of this condition and review the current understanding of the pathogenesis and its clinical findings.
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Affiliation(s)
- Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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Affiliation(s)
- Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba QLD 4102, Australia.
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Schneider-Brachert W, Tchikov V, Merkel O, Jakob M, Hallas C, Kruse ML, Groitl P, Lehn A, Hildt E, Held-Feindt J, Dobner T, Kabelitz D, Krönke M, Schütze S. Inhibition of TNF receptor 1 internalization by adenovirus 14.7K as a novel immune escape mechanism. J Clin Invest 2006; 116:2901-13. [PMID: 17024246 PMCID: PMC1590267 DOI: 10.1172/jci23771] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 08/15/2006] [Indexed: 01/08/2023] Open
Abstract
The adenoviral protein E3-14.7K (14.7K) is an inhibitor of TNF-induced apoptosis, but the molecular mechanism underlying this protective effect has not yet been explained exhaustively. TNF-mediated apoptosis is initiated by ligand-induced recruitment of TNF receptor-associated death domain (TRADD), Fas-associated death domain (FADD), and caspase-8 to the death domain of TNF receptor 1 (TNFR1), thereby establishing the death-inducing signaling complex (DISC). Here we report that adenovirus 14.7K protein inhibits ligand-induced TNFR1 internalization. Analysis of purified magnetically labeled TNFR1 complexes from murine and human cells stably transduced with 14.7K revealed that prevention of TNFR1 internalization resulted in inhibition of DISC formation. In contrast, 14.7K did not affect TNF-induced NF-kappaB activation via recruitment of receptor-interacting protein 1 (RIP-1) and TNF receptor-associated factor 2 (TRAF-2). Inhibition of endocytosis by 14.7K was effected by failure of coordinated temporal and spatial assembly of essential components of the endocytic machinery such as Rab5 and dynamin 2 at the site of the activated TNFR1. Furthermore, we found that the same TNF defense mechanisms were instrumental in protecting wild-type adenovirus-infected human cells expressing 14.7K. This study describes a new molecular mechanism implemented by a virus to escape immunosurveillance by selectively targeting TNFR1 endocytosis to prevent TNF-induced DISC formation.
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Affiliation(s)
- Wulf Schneider-Brachert
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Vladimir Tchikov
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Oliver Merkel
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Marten Jakob
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Cora Hallas
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Marie-Luise Kruse
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Peter Groitl
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Alexander Lehn
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Eberhard Hildt
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Janka Held-Feindt
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Thomas Dobner
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Dieter Kabelitz
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Martin Krönke
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Stefan Schütze
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
Institute of Immunology and
Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Medicine II, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Institute for Medical Microbiology, Immunology, and Hygiene, Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany
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Simon L, Souyris F, Suquet P, Blotman F, Brami S, Lehn A, Rousse M. [The salivary glands during rheumatoid arthritis]. Rev Rhum Mal Osteoartic 1976; 43:185-92. [PMID: 1083553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Salivary gland lesions were studied in 65 non-selected, confirmed rheumatoid polyarthritis patients. The investigations included a careful clinical study, the Schirmer test, sialography, sequential scintigraphy with Technetium 99, and a histological study of the sublingual glands. Tests were also made for salivary gland anti-epithelium antibodies. The frequency of sialography and scintigraphy anomalies is emphasized. In different degrees, two of of three patients presented anatomical or functional anomalies of the salivary glands. These disturbances were not related to the duration, the functional severity, or the treatment of the disease or to the presence of anti-salivary gland antibodies. On the other hand, there was a clear relation with both the presence of anti-nuclear antibodies and an increase in the serum gammaglobulin levels. The limits of the Gougerot syndrome are discussed and it is proposed that there is a need for a second nosological class grouping the minor scintigraphic and sialographic anomalies related to rheumatoid arthritis that has been suggested by several authors.
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Lehn A. Die neuen Verbandstoffe. Arch Pharm (Weinheim) 1881. [DOI: 10.1002/ardp.18812190104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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