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Roth C, Yavuz R, Maschita C, Ferbert A, Matthaei J. Chronic basilar artery occlusion: a retrospective monocentric study. J Neurol 2024:10.1007/s00415-024-12375-4. [PMID: 38676723 DOI: 10.1007/s00415-024-12375-4] [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: 02/01/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Acute basilar artery occlusion is a life-threatening medical emergency with a highly elevated mortality rate when left untreated. Little is known about symptoms and clinical progression of chronic occlusions. The aim of this study was to systematically analyze the clinical presentation of patients with chronic basilar artery occlusion (CBAO). METHODS Monocentric retrospective analysis of adult patients with CBAO was treated between 2015 and 2023 in the Department of Neurology, Klinikum Kassel. Inclusion criteria were basilar artery occlusion without brainstem infarction as well as patients with a basilar artery occlusion in whom revascularization could not be achieved and a follow-up period of at least 3 months. RESULTS A total of 15 patients were found. In five patients basilar artery occlusion was diagnosed as an incidental finding, four patients had neurological symptoms but no proven brainstem infarction (3 × transient ischemic attack, 1 × isolated posterior artery infarct) and six patients presented with acute basilar artery occlusion and a follow-up > 3 months. The most common site of occlusion was midbasilar (80%, n = 12), isolated (n = 7) or in combination with other locations (n = 5). In all cases collateralization could be demonstrated by the posterior communicating arteries. The most common vascular risk factors (VRF) were hypertension (100%) and hypercholesterolemia (67%). CONCLUSIONS Patients with CBAO may present with only mild symptoms or may even be asymptomatic. This condition may be survived for a long time. The high percentage of vascular risk factors and further cerebral vessel occlusions suggest arteriosclerosis as the major causing factor of CBAO.
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Affiliation(s)
- Christian Roth
- Departement of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany.
- Departement of Neurology, Philipps-Marburg University, Marburg, Germany.
| | - Rosa Yavuz
- Kassel School of Medicine, Kassel, Germany
| | | | - Andreas Ferbert
- Departement of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany
| | - Johannes Matthaei
- Departement of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany
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2
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Thomsen M, Marth K, Loens S, Everding J, Junker J, Borngräber F, Ott F, Jesús S, Gelderblom M, Odorfer T, Kuhlenbäumer G, Kim HJ, Schaeffer E, Becktepe J, Kasten M, Brüggemann N, Pfister R, Kollewe K, Krauss JK, Lohmann E, Hinrichs F, Berg D, Jeon B, Busch H, Altenmüller E, Mir P, Kamm C, Volkmann J, Zittel S, Ferbert A, Zeuner KE, Rolfs A, Bauer P, Kühn AA, Bäumer T, Klein C, Lohmann K. Large-Scale Screening: Phenotypic and Mutational Spectrum in Isolated and Combined Dystonia Genes. Mov Disord 2024; 39:526-538. [PMID: 38214203 DOI: 10.1002/mds.29693] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Pathogenic variants in several genes have been linked to genetic forms of isolated or combined dystonia. The phenotypic and genetic spectrum and the frequency of pathogenic variants in these genes have not yet been fully elucidated, neither in patients with dystonia nor with other, sometimes co-occurring movement disorders such as Parkinson's disease (PD). OBJECTIVES To screen >2000 patients with dystonia or PD for rare variants in known dystonia-causing genes. METHODS We screened 1207 dystonia patients from Germany (DysTract consortium), Spain, and South Korea, and 1036 PD patients from Germany for pathogenic variants using a next-generation sequencing gene panel. The impact on DNA methylation of KMT2B variants was evaluated by analyzing the gene's characteristic episignature. RESULTS We identified 171 carriers (109 with dystonia [9.0%]; 62 with PD [6.0%]) of 131 rare variants (minor allele frequency <0.005). A total of 52 patients (48 dystonia [4.0%]; four PD [0.4%, all with GCH1 variants]) carried 33 different (likely) pathogenic variants, of which 17 were not previously reported. Pathogenic biallelic variants in PRKRA were not found. Episignature analysis of 48 KMT2B variants revealed that only two of these should be considered (likely) pathogenic. CONCLUSION This study confirms pathogenic variants in GCH1, GNAL, KMT2B, SGCE, THAP1, and TOR1A as relevant causes in dystonia and expands the mutational spectrum. Of note, likely pathogenic variants only in GCH1 were also found among PD patients. For DYT-KMT2B, the recently described episignature served as a reliable readout to determine the functional effect of newly identified variants. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mirja Thomsen
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katrin Marth
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Judith Everding
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johanna Junker
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Fabian Ott
- Medical Systems Biology Group, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Odorfer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jos Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Ebba Lohmann
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE)-Tübingen, Tübingen, Germany
| | - Frauke Hinrichs
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Hauke Busch
- Medical Systems Biology Group, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Christoph Kamm
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Arndt Rolfs
- Medical Faculty, University of Rostock, Rostock, Germany
- Agyany Pharmaceuticals, Jerusalem, Israel
| | | | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Center of Rare Diseases, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Bremer J, Meinhardt A, Katona I, Senderek J, Kämmerer‐Gassler EK, Roos A, Ferbert A, Schröder JM, Nikolin S, Nolte K, Sellhaus B, Popzhelyazkova K, Tacke F, Schara‐Schmidt U, Neuen‐Jacob E, de Groote CC, de Jonghe P, Timmerman V, Baets J, Weis J. Myelin protein zero mutation-related hereditary neuropathies: Neuropathological insight from a new nerve biopsy cohort. Brain Pathol 2024; 34:e13200. [PMID: 37581289 PMCID: PMC10711263 DOI: 10.1111/bpa.13200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023] Open
Abstract
Myelin protein zero (MPZ/P0) is a major structural protein of peripheral nerve myelin. Disease-associated variants in the MPZ gene cause a wide phenotypic spectrum of inherited peripheral neuropathies. Previous nerve biopsy studies showed evidence for subtype-specific morphological features. Here, we aimed at enhancing the understanding of these subtype-specific features and pathophysiological aspects of MPZ neuropathies. We examined archival material from two Central European centers and systematically determined genetic, clinical, and neuropathological features of 21 patients with MPZ mutations compared to 16 controls. Cases were grouped based on nerve conduction data into congenital hypomyelinating neuropathy (CHN; n = 2), demyelinating Charcot-Marie-Tooth (CMT type 1; n = 11), intermediate (CMTi; n = 3), and axonal CMT (type 2; n = 5). Six cases had combined muscle and nerve biopsies and one underwent autopsy. We detected four MPZ gene variants not previously described in patients with neuropathy. Light and electron microscopy of nerve biopsies confirmed fewer myelinated fibers, more onion bulbs and reduced regeneration in demyelinating CMT1 compared to CMT2/CMTi. In addition, we observed significantly more denervated Schwann cells, more collagen pockets, fewer unmyelinated axons per Schwann cell unit and a higher density of Schwann cell nuclei in CMT1 compared to CMT2/CMTi. CHN was characterized by basal lamina onion bulb formation, a further increase in Schwann cell density and hypomyelination. Most late onset axonal neuropathy patients showed microangiopathy. In the autopsy case, we observed prominent neuromatous hyperinnervation of the spinal meninges. In four of the six muscle biopsies, we found marked structural mitochondrial abnormalities. These results show that MPZ alterations not only affect myelinated nerve fibers, leading to either primarily demyelinating or axonal changes, but also affect non-myelinated nerve fibers. The autopsy case offers insight into spinal nerve root pathology in MPZ neuropathy. Finally, our data suggest a peculiar association of MPZ mutations with mitochondrial alterations in muscle.
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Affiliation(s)
- Juliane Bremer
- Institute of NeuropathologyRWTH Aachen University HospitalAachenGermany
| | - Axel Meinhardt
- Institute of NeuropathologyRWTH Aachen University HospitalAachenGermany
| | - Istvan Katona
- Institute of NeuropathologyRWTH Aachen University HospitalAachenGermany
| | - Jan Senderek
- Friedrich Baur Institute at the Department of NeurologyUniversity Hospital, LMU MunichMunichGermany
| | | | - Andreas Roos
- Institute of NeuropathologyRWTH Aachen University HospitalAachenGermany
- Department of NeuropaediatricsUniversity of EssenEssenGermany
| | | | | | - Stefan Nikolin
- Institute of NeuropathologyRWTH Aachen University HospitalAachenGermany
| | - Kay Nolte
- Institute of NeuropathologyRWTH Aachen University HospitalAachenGermany
| | - Bernd Sellhaus
- Institute of NeuropathologyRWTH Aachen University HospitalAachenGermany
| | | | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité—Universitätsmedizin BerlinCampus Virchow‐Klinikum (CVK) and Campus Charité Mitte (CCM)BerlinGermany
| | | | - Eva Neuen‐Jacob
- Department of NeuropathologyUniversity Hospital, Heinrich‐Heine University DüsseldorfDüsseldorfGermany
| | - Chantal Ceuterick de Groote
- Laboratory of Neuromuscular Pathology, Institute Born‐Bunge, and Translational Neurosciences, Faculty of MedicineUniversity of AntwerpBelgium
| | - Peter de Jonghe
- Laboratory of Neuromuscular Pathology, Institute Born‐Bunge, and Translational Neurosciences, Faculty of MedicineUniversity of AntwerpBelgium
- Department of NeurologyUniversity Hospital AntwerpAntwerpBelgium
| | - Vincent Timmerman
- Laboratory of Neuromuscular Pathology, Institute Born‐Bunge, and Translational Neurosciences, Faculty of MedicineUniversity of AntwerpBelgium
- Peripheral Neuropathy Research Group, Department of Biomedical SciencesUniversity of AntwerpAntwerpBelgium
| | - Jonathan Baets
- Laboratory of Neuromuscular Pathology, Institute Born‐Bunge, and Translational Neurosciences, Faculty of MedicineUniversity of AntwerpBelgium
- Department of NeurologyUniversity Hospital AntwerpAntwerpBelgium
| | - Joachim Weis
- Institute of NeuropathologyRWTH Aachen University HospitalAachenGermany
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Buchner H, Ferbert A. Zuverlässigkeit der Elektroneuro-, myografie: Aspekte zur
neurologischen Begutachtung. KLIN NEUROPHYSIOL 2022. [DOI: 10.1055/a-1889-3323] [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: 10/15/2022]
Abstract
ZusammenfassungVon einem Gutachten wird eine zuverlässige Bewertung erwartet. Aspekte
der Zuverlässigkeit der Elektroneuro-, myografie werden vorgestellt.
Ihre Bedeutung für die Begutachtung wird mit Blick auf Diagnostik und
das Ausmaß eines ggf. vorhandenen funktionellen Defizits besprochen.
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Mair D, Biskup S, Kress W, Abicht A, Brück W, Zechel S, Knop KC, Koenig FB, Tey S, Nikolin S, Eggermann K, Kurth I, Ferbert A, Weis J. Differential diagnosis of vacuolar myopathies in the NGS era. Brain Pathol 2020; 30:877-896. [PMID: 32419263 PMCID: PMC8017999 DOI: 10.1111/bpa.12864] [Citation(s) in RCA: 9] [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: 01/03/2020] [Revised: 04/10/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
Altered autophagy accompanied by abnormal autophagic (rimmed) vacuoles detectable by light and electron microscopy is a common denominator of many familial and sporadic non-inflammatory muscle diseases. Even in the era of next generation sequencing (NGS), late-onset vacuolar myopathies remain a diagnostic challenge. We identified 32 adult vacuolar myopathy patients from 30 unrelated families, studied their clinical, histopathological and ultrastructural characteristics and performed genetic testing in index patients and relatives using Sanger sequencing and NGS including whole exome sequencing (WES). We established a molecular genetic diagnosis in 17 patients. Pathogenic mutations were found in genes typically linked to vacuolar myopathy (GNE, LDB3/ZASP, MYOT, DES and GAA), but also in genes not regularly associated with severely altered autophagy (FKRP, DYSF, CAV3, COL6A2, GYG1 and TRIM32) and in the digenic facioscapulohumeral muscular dystrophy 2. Characteristic histopathological features including distinct patterns of myofibrillar disarray and evidence of exocytosis proved to be helpful to distinguish causes of vacuolar myopathies. Biopsy validated the pathogenicity of the novel mutations p.(Phe55*) and p.(Arg216*) in GYG1 and of the p.(Leu156Pro) TRIM32 mutation combined with compound heterozygous deletion of exon 2 of TRIM32 and expanded the phenotype of Ala93Thr-caveolinopathy and of limb-girdle muscular dystrophy 2i caused by FKRP mutation. In 15 patients no causal variants were detected by Sanger sequencing and NGS panel analysis. In 12 of these cases, WES was performed, but did not yield any definite mutation or likely candidate gene. In one of these patients with a family history of muscle weakness, the vacuolar myopathy was eventually linked to chloroquine therapy. Our study illustrates the wide phenotypic and genotypic heterogeneity of vacuolar myopathies and validates the role of histopathology in assessing the pathogenicity of novel mutations detected by NGS. In a sizable portion of vacuolar myopathy cases, it remains to be shown whether the cause is hereditary or degenerative.
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Affiliation(s)
- Dorothea Mair
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany.,Department of Neurology, Kassel School of Medicine, Klinikum Kassel, Kassel, Germany.,University of Southampton, Southampton, UK
| | - Saskia Biskup
- Centre for Genomics and Transcriptomics CeGaT, Tübingen, Germany
| | - Wolfram Kress
- Institute of Human Genetics, University Würzburg, Würzburg, Germany
| | | | - Wolfgang Brück
- Institute of Neuropathology, Göttingen University, Göttingen, Germany
| | - Sabrina Zechel
- Institute of Neuropathology, Göttingen University, Göttingen, Germany
| | | | | | - Shelisa Tey
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany
| | - Stefan Nikolin
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany
| | - Katja Eggermann
- Institute of Human Genetics, RWTH Aachen University, Aachen, Germany
| | - Ingo Kurth
- Institute of Human Genetics, RWTH Aachen University, Aachen, Germany
| | - Andreas Ferbert
- Department of Neurology, Kassel School of Medicine, Klinikum Kassel, Kassel, Germany
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany
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Kleffmann J, Pahl R, Ferbert A, Roth C. Factors influencing intracranial pressure (ICP) during percutaneous tracheostomy. Clin Neurol Neurosurg 2020; 195:105869. [PMID: 32353664 DOI: 10.1016/j.clineuro.2020.105869] [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: 06/30/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Percutaneous tracheostomy (PT) is common on ICUs. An increase of intracranial pressure (ICP) can be observed in patients with acute cerebral diseases. Factors determining ICP increase remain unclear. PATIENTS AND METHODS Data for all PTs were collected prospectively. ICP, cerebral perfusion pressure (CPP), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), and heart rate (HR) were monitored continuously every minute. Primary outcome parameter was an increase of ICP during PT (ICP > 20 mmHg). Influencing factors were evaluated by the means of logistic regression analysis: Body mass index (BMI), age, gender, physician performing the procedure (neurologist vs. neurosurgeon), duration of the procedure, underlying disease, duration of mechanical ventilation, and baseline ICP value before the procedure. RESULTS A total of 175 PTs were performed during the observation period between 2010 and 2013. Of these, 54 received ICP monitoring and were included into this study. Median initial ICP value was 10.4 mmHg and rose significantly to a median value of 18.4 mmHg (p < 0.05). In 21 patients (38,9%) an increase of median ICP above 20 mmHg was seen during at least one interval. Comparing patients with and without pathological ICP increase a significant difference between the two groups was only observed for patients with an increased baseline ICP above 15 mmHg. All other factors had no significant influence on the development of a pathological ICP peaks during PT. CONCLUSION Percutaneous tracheostomies in patients with cerebral injury leads to a significant increase of ICP during the procedure. Patients with a baseline ICP > 15 mmHg are at risk to develop harmful ICP crises.
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Affiliation(s)
- Jens Kleffmann
- Neurocenter Kassel, Marburger Str. 85, 34127 Kassel, Germany; Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany
| | - Roman Pahl
- Institute of Medical Biometry and Epidemiology (IMBE), Philipps University Marburg, Bunsenstraße 3, 35037 Marburg, Germany
| | - Andreas Ferbert
- Department of Neurology, DRK-Kliniken Nordhessen, Hansteinstraße 29, 34121 Kassel, Germany
| | - Christian Roth
- Department of Neurology, DRK-Kliniken Nordhessen, Hansteinstraße 29, 34121 Kassel, Germany; Department of Neurology, Philipps University Marburg, Baldingerstraße, 35037 Marburg, Germany.
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Ferbert A, Roth C. [Hereditary Polyneuropathies]. Fortschr Neurol Psychiatr 2020; 88:198-209. [PMID: 32232809 DOI: 10.1055/a-1009-2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hereditary neuropathies are a group of diseases of which the most prevalent is Charcot Marie Tooth disease (CMT). From the clinical point of view pes cavus is a typical yet not specific sign for CMT. Motor signs like bilateral foot drop are dominant over sensory signs. Mutations in some 80 genes can lead to CMT. Whereas clinical sign can hardly differentiate between these genotypes, there is a clear differentiation by classical neurography: median nerve conduction velocity of less or more than 38 m / s differentiates between CMT type 1 and CMT type 2. The two most common forms are CMT1A induced by duplication of the PMP22 gene and hereditary neuropathy with liability to pressure palsy (HNPP) induced by deletion of the PMP22 gene.
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Ferbert A, Roth C. Hereditäre Polyneuropathien. KLIN NEUROPHYSIOL 2019. [DOI: 10.1055/a-0925-1719] [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: 10/26/2022]
Abstract
Polyneuropathien zählen zu den häufigsten neurologischen Erkrankungen. Die Charcot-Marie-Tooth Erkrankung (CMT) ist ihre häufigste erblich bedingte Form. Orthopädische Symptome wie ein Hohlfuß oder Krallenzehen können ein erstes Anzeichen der Krankheit sein. Verdachtsfälle können mithilfe elektrophysiologischer und sonografischer Methoden abgeklärt und ggf. molekulargenetisch genau charakterisiert werden.
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9
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Olschewski L, Jesús S, Kim HJ, Tunc S, Löns S, Junker J, Zeuner KE, Kühn AA, Kuhlenbäumer G, Schäffer E, Berg D, Kasten M, Ferbert A, Altenmüller E, Brüggemann N, Bauer P, Rolfs A, Jeon B, Bäumer T, Mir P, Klein C, Lohmann K. Role of ANO3 mutations in dystonia: A large-scale mutational screening study. Parkinsonism Relat Disord 2019; 62:196-200. [DOI: 10.1016/j.parkreldis.2018.12.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/29/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022]
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Klein C, Baumann H, Olschewski L, Hanssen H, Münchau A, Ferbert A, Brüggemann N, Lohmann K. De-novo KMT2B mutation in a consanguineous family: 15-Year follow-up of an Afghan dystonia patient. Parkinsonism Relat Disord 2019; 64:337-339. [PMID: 30935829 DOI: 10.1016/j.parkreldis.2019.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Hauke Baumann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Luisa Olschewski
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Henrike Hanssen
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany; Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | | | | | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany; Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
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Roth C, Ferbert A, Matthaei J, Kaestner S, Engel H, Gehling M. Progress of intracranial pressure and cerebral perfusion pressure in patients during the development of brain death. J Neurol Sci 2019; 398:171-175. [PMID: 30731304 DOI: 10.1016/j.jns.2019.01.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/17/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clinical investigations of brain death are supposed to prove absence of cerebral perfusion. However, only limited data are available documenting intracranial pressure (ICP) and cerebral perfusion pressure (CPP) during the development of brain death. Our study presents additional data to understand the course of ICP and CPP in patients developing brain death. MATERIAL AND METHODS We analyzed retrospective data of 18 patients with ICP monitoring during the development of brain death due to primary brain lesions. ICP and CPP values were continuously measured between two clinically defined time points: 1. non-reactive and widened pupils, 2. brain death determination. We analyzed ICP and CPP at the above-mentioned end points. Additionally, we investigated maximum ICP and minimal CPP values between these time points. RESULTS Patients developed fixed and dilated pupils with a median of 38 h before brain death determination. During brain death determination median ICP and median CPP were 103.5 and -2.5 mmHg, respectively. Maximum ICP before brain death determination was significantly higher and minimal CPP values were significantly lower compared to the time point of brain death. During the investigation period all patients experienced ICP values >95 mmHg and CPP < 10 mmHg. All but one patient had documented CPP values of ≤0 mmHg. This single patient had a minimum CPP of 8 mmHg with a maximum ICP of 145 mmHg. CONCLUSION Cerebral perfusion pressure during brain death determination may be positive in some patients. Our results showed variable values of ICP and CPP. However, extremely elevated ICP values before or during brain death in combination with low CPP values suggest absence of cerebral perfusion. The occurrence of positive CPP values during brain death determination therefore depends on the time point at which brain death determination is performed.
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Affiliation(s)
- Christian Roth
- Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany; Department of Neurology, University of Marburg, Germany.
| | | | | | | | - Holger Engel
- Department of Plastic-Reconstructive, Aesthetic and Handsurgery, Klinikum Kassel, Kassel, Germany
| | - Markus Gehling
- Department of Anesthesiology, University of Marburg, Marburg, Germany; Pain Center, Kassel, Germany
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12
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Abstract
ZusammenfassungDie Neurografie des N. suralis hat große Bedeutung in der Diagnose von Polyneuropathien. Dieser Artikel stellt unterschiedliche Untersuchungstechniken mit ihren Vor- und Nachteilen vor, bespricht Messergebnisse und Normalwerte und nennt Anhaltspunkte für die Unterscheidung des axonalen und demyelinisierenden Läsionstyps. Letztlich wird ein Standard für die neurografische Untersuchung und deren Bewertung vorgeschlagen.
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13
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Gahn G, Gaidzik P, Bergmann F, Hauth I, Tronnier V, Zumkeller M, Ferbert A, Widder B. [Structured Curricular Advanced Education in "Medical Assessment" : Combined Concept of DGNB, DGN, DGNC, and DGPPN]. Nervenarzt 2018; 89:565-569. [PMID: 29728718 DOI: 10.1007/s00115-018-0526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- G Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Moltkestraße 90, 76133, Karlsruhe, Deutschland.
| | | | - F Bergmann
- Zentrum für Neurologie und Seelische Gesundheit im Kapuziner Karree, KV Nordrhein, Kapuzinergraben 19, 52062, Aachen, Deutschland.
| | - I Hauth
- Zentrum für Neurologie, Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Joseph Krankenhaus, Berlin, Deutschland
| | - V Tronnier
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - M Zumkeller
- Neurochirurgische Klinik, Diakovere Friederikenstift, Hannover, Deutschland
| | - A Ferbert
- Neurologische Klinik, Klinikum Kassel, Kassel, Deutschland
| | - B Widder
- Klinik für Neurologie und Neurologische Rehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
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Braun H, Ferbert A, Stirner H, Weiller C, Ringelstein EB, Buell U. Combined SPECT Imaging of Regional Cerebral Blood Flow (99mTc-HexamethylPropyleneamine Oxime, HMPAO) and Blood Volume (99mTc-RBC) to Assess Regional Cerebral Perfusion Reserve in Patients with Cerebrovascular Disease. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In 53 patients with cerebrovascular disease (CVD), regional cerebral blood flow (CBF) and blood volume (CBV) were imaged by SPECT within one session. Slice division (CBF: CBV) yielded distribution of regional cerebral perfusion reserve (CPR). Semiquantitative evaluation was obtained from manually set ROIs by interhemispherical ratios (for CBF, CBV and CPR), using 2 SD from a normal group (n = 10) as a threshold. Sensitivities were 59% for CBF, 94% for CBV and 83% for CPR. Combined sensitivity was 98%. Establishing three constellations for CBF, CBV and CPR, regionally normal CBFs but quantitatively increased CBVs (+69%) and decreased CPRs (−31 %) were found in relatively early stages of CVD. Very advanced cases showed decreased CBFs (−65%), CBVs (−40%), CPRs (−49%) and a surrounding penumbra. In 87% (46/53 patients), such Theologically postulated constellations could be demonstrated. We conclude that combined CBF and CBV SPECT, assisted by CPR images, is a promising tool to detect CVD and to assess its individual regional severity.
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15
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Dohrn MF, Glöckle N, Mulahasanovic L, Heller C, Mohr J, Bauer C, Riesch E, Becker A, Battke F, Hörtnagel K, Hornemann T, Suriyanarayanan S, Blankenburg M, Schulz JB, Claeys KG, Gess B, Katona I, Ferbert A, Vittore D, Grimm A, Wolking S, Schöls L, Lerche H, Korenke GC, Fischer D, Schrank B, Kotzaeridou U, Kurlemann G, Dräger B, Schirmacher A, Young P, Schlotter-Weigel B, Biskup S. Frequent genes in rare diseases: panel-based next generation sequencing to disclose causal mutations in hereditary neuropathies. J Neurochem 2017; 143:507-522. [DOI: 10.1111/jnc.14217] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/30/2017] [Accepted: 09/07/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Maike F. Dohrn
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
- Department of Neurology; Medical Faculty; RWTH Aachen University; Aachen Germany
| | - Nicola Glöckle
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
| | | | - Corina Heller
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
| | - Julia Mohr
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
| | - Christine Bauer
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
| | - Erik Riesch
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
| | - Andrea Becker
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
| | - Florian Battke
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
| | | | - Thorsten Hornemann
- Institute for Clinical Chemistry; University Hospital Zürich; Zurich Switzerland
| | | | - Markus Blankenburg
- Department of Pediatric Neurology Klinikum Stuttgart; Olgahospital, Stuttgart Germany
- Faculty of Health; Witten/Herdecke University; Witten Germany
| | - Jörg B. Schulz
- Department of Neurology; Medical Faculty; RWTH Aachen University; Aachen Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging; Forschungszentrum Jülich GmbH and RWTH Aachen University; Aachen Germany
| | - Kristl G. Claeys
- Department of Neurology; University Hospitals Leuven and University of Leuven (KU Leuven); Leuven Belgium
| | - Burkhard Gess
- Department of Neurology; Medical Faculty; RWTH Aachen University; Aachen Germany
| | - Istvan Katona
- Institute of Neuropathology; Medical Faculty; RWTH Aachen University; Aachen Germany
| | | | - Debora Vittore
- Department of Neurology and Epileptology; Hertie Institute for Clinical Brain Research; University of Tübingen; Tuebingen Germany
| | - Alexander Grimm
- Department of Neurology and Epileptology; Hertie Institute for Clinical Brain Research; University of Tübingen; Tuebingen Germany
| | - Stefan Wolking
- Department of Neurology and Epileptology; Hertie Institute for Clinical Brain Research; University of Tübingen; Tuebingen Germany
| | - Ludger Schöls
- Department of Neurology and Epileptology; Hertie Institute for Clinical Brain Research; University of Tübingen; Tuebingen Germany
| | - Holger Lerche
- Department of Neurology and Epileptology; Hertie Institute for Clinical Brain Research; University of Tübingen; Tuebingen Germany
| | | | - Dirk Fischer
- Department of Neurology; University of Basel Hospital; Basel Switzerland
| | - Bertold Schrank
- Department of Neurology; Deutsche Klinik für Diagnostik; Wiesbaden Germany
| | - Urania Kotzaeridou
- Department of General Pediatrics; Division of Inherited Metabolic Diseases; University Children's Hospital; Heidelberg Germany
| | - Gerhard Kurlemann
- Department of Neuropediatrics; University Hospital Münster; Muenster Germany
| | - Bianca Dräger
- Department of Sleep Medicine and Neuromuscular Disorders; University Hospital Münster; Muenster Germany
| | - Anja Schirmacher
- Department of Sleep Medicine and Neuromuscular Disorders; University Hospital Münster; Muenster Germany
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders; University Hospital Münster; Muenster Germany
| | - Beate Schlotter-Weigel
- Department of Neurology; Friedrich-Baur-Institute; Ludwig-Maximilians-University of Munich; Munich Germany
| | - Saskia Biskup
- CeGaT GmbH and Praxis für Humangenetik Tübingen; Tuebingen Germany
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Dunkel J, Roth C, Erbguth F, Dietrich W, Hügens-Penzel M, Ferbert A. Cerebral Fat Embolism: Clinical Presentation, Diagnostic Steps and Long-Term Follow-Up. Eur Neurol 2017; 78:181-187. [PMID: 28898867 DOI: 10.1159/000479002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/13/2016] [Accepted: 06/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Symptomatic cerebral fat embolism (CFE) is a rare complication that occurs after a traumatic injury or orthopaedic surgery and is diagnostically challenging. No data is currently available concerning long-term follow-up. METHODS We identified from medical records 9 patients with CFE and revised the clinical signs and the diagnostic process. We then analysed long-term follow-up data, targeting clinical course after discharge, neurological impairment, and current quality of life, using the Barthel index and the modified Rankin Scale. RESULTS All 9 patients initially showed severe neurological deficits, including disturbance of consciousness ranging from somnolence to coma. During the follow-up period for 3-58 months after the insult 2 patients had died. The 7 patients who remained alive had either recovered completely or showed only minor neurological deficits after rehabilitation. They were nearly independent in daily life and needed only minimal assistance. We performed the first brain biopsy in a patient with CFE. CONCLUSION Most patients had a good outcome after long-term follow-up. In patients with an unexplained altered state of consciousness after a traumatic injury or an orthopaedic surgery, an MRI with diffusion-weighted imaging must be performed to uncover the characteristic pattern of disseminated hyperintense lesions in the white matter that are associated with CFE.
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Affiliation(s)
- Juliane Dunkel
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - Christian Roth
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - Frank Erbguth
- Department of Neurology, Klinikum Nürnberg Süd, Nürnberg, Germany
| | - Wenke Dietrich
- Department of Neurology, Klinikum Nürnberg Süd, Nürnberg, Germany
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17
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Abstract
Principally, in the fourth update of the rules for the procedure to finally determine the irreversible cessation of function of the cerebrum, the cerebellum and the brainstem, the importance of an electroencephalogram (EEG), somatosensory evoked potentials (SEP) and brainstem auditory evoked potentials (BAEP) are confirmed. This paper presents the reliability and validity of the electrophysiological diagnosis, discusses the amendments in the fourth version of the guidelines and introduces the practical application, problems and sources of error.An EEG is the best established supplementary diagnostic method for determining the irreversibility of clinical brain death syndrome. It should be noted that residual brain activity can often persist for many hours after the onset of brain death syndrome, particularly in patients with primary brainstem lesions. The derivation and analysis of an EEG requires a high level of expertise to be able to safely distinguish artefacts from primary brain activity. The registration of EEGs to demonstrate the irreversibility of clinical brain death syndrome is extremely time consuming.The BAEPs can only be used to confirm the irreversibility of brain death syndrome in serial examinations or in the rare cases of a sustained wave I or sustained waves I and II. Very often, an investigation cannot be reliably performed because of existing sound conduction disturbances or failure of all potentials even before the onset of clinical brain death syndrome. This explains why BAEPs are only used in exceptional cases.The SEPs of the median nerve can be very reliably derived, are technically simple and with few sources of error. A serial investigation is not required and the time needed for examination is short. For these reasons SEPs are given preference over EEGs and BAEPs for establishing the irreversibility of clinical brain death syndrome.
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Affiliation(s)
- H Buchner
- Klinik für Neurologie u. klinische Neurophysiologie, Klinikum Vest GmbH, Behandlungszentrum, Knappschaftskrankenhaus Recklinghausen, Dorstener Str. 151, 45657, Recklinghausen, Deutschland.
| | - A Ferbert
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
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18
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Affiliation(s)
- A Ferbert
- Neurologische Klinik, Klinikum Kassel, Mönchebergstr. 41-43, 34125, Kassel, Deutschland.
| | - C Weiller
- Neurologische Universitätsklinik, Breisacher Str. 64, 79106, Freiburg, Deutschland.
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19
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Mair D, Huegens-Penzel M, Kress W, Roth C, Ferbert A. Leg Muscle Involvement in Facioscapulohumeral Muscular Dystrophy: Comparison between Facioscapulohumeral Muscular Dystrophy Types 1 and 2. Eur Neurol 2016; 77:32-39. [PMID: 27855411 DOI: 10.1159/000452763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Facioscapulohumeral muscular dystrophy (FSHD) presents with 2 genetically distinct types. We describe for the first time the MRI patterns of leg muscle involvement in type 2 and compare it with type 1. METHODS The intramuscular fat content was assessed on lower extremity axial T1-weighted MRI scans in 6 FSHD1 and 5 FSHD2 patients. RESULTS Overall, the muscle involvement profile did not differ substantially between FSHD1 and FSHD2. In the thigh, the dorsomedial compartment including the semimembranosus, semitendinosus and adductor magnus was the most affected. The quadriceps was mostly spared, but isolated involvement of the rectus femoris was common. Fat infiltration in the distal soleus and the medial gastrocnemius with sparing of the lateral gastrocnemius was a common finding; involvement of the tibialis anterior was less frequent. A proximal-to-distal increase in fat content was frequently present in some muscles. CONCLUSION Muscle involvement appears to be independent of type, confirming a similar pathophysiological pathway in FSHD1 and FSHD2.
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Affiliation(s)
- Dorothea Mair
- Department of Neurology, Klinikum Kassel - University Hospital of the University of Southampton, Kassel, Germany
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20
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Unger A, Dekomien G, Güttsches A, Dreps T, Kley R, Tegenthoff M, Ferbert A, Weis J, Heyer C, Linke WA, Martinez-Carrera L, Storbeck M, Wirth B, Hoffjan S, Vorgerd M. Expanding the phenotype of
BICD2
mutations toward skeletal muscle involvement. Neurology 2016; 87:2235-2243. [DOI: 10.1212/wnl.0000000000003360] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/12/2016] [Indexed: 11/15/2022] Open
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21
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Grütz K, Volpato CB, Domingo A, Alvarez-Fischer D, Gebert U, Schifferle G, Buffone E, Wszolek ZK, Rademakers R, Ferbert A, Hicks AA, Klein C, Pramstaller PP, Westenberger A. Primary familial brain calcification in the 'IBGC2' kindred: All linkage roads lead to SLC20A2. Mov Disord 2016; 31:1901-1904. [PMID: 27671522 DOI: 10.1002/mds.26768] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 05/18/2016] [Revised: 07/12/2016] [Accepted: 08/07/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Linkage analyses of families with primary familial brain calcification (formerly idiopathic basal ganglia calcification [IBGC]) identified 3 candidate loci (IBGC1-3). Recently, SLC20A2 mutations were found in the IBGC1 and IBGC3 families, merging these 2 loci. We here elucidate the genetic cause of primary familial brain calcification in the 'IBGC2' kindred. METHODS We sequenced known primary familial brain calcification genes and quantified SLC20A2 and PDGFB. Moreover, CT scans of affected and unaffected family members were evaluated by 2 blinded neuroradiologists for distribution of brain calcification. RESULTS A heterozygous multiexonic SLC20A2 deletion was detected in several affected family members. A reevaluation of neuroimaging data revealed a subset of mutation-negative individuals with only mild and/or unilateral calcification. CONCLUSIONS The identified SLC20A2 mutation resolves the genetic cause of primary familial brain calcification in the 'IBGC2' kindred, collapsing 'IBGC2' into IBGC1. We suggest an algorithm for predicting the chances of finding genetic mutations that has to be validated in further studies. Our study enhances criteria for the evaluation of neuroimaging data, contributing further to the much needed harmonization of diagnostic and research data collection in primary familial brain calcification. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Karen Grütz
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Claudia B Volpato
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano, Italy-Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - Aloysius Domingo
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Graduate School Lübeck, Lübeck, Germany
| | - Daniel Alvarez-Fischer
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Uwe Gebert
- Department of Radiology, Hospital of Bresanone/Brixen, Italy
| | | | - Ebba Buffone
- Department of Neurology, Hospital of Bussolengo, Verona, Italy
| | | | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Andrew A Hicks
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano, Italy-Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Peter P Pramstaller
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano, Italy-Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - Ana Westenberger
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Roth C, Stitz H, Kleffmann J, Kaestner S, Deinsberger W, Ferbert A, Gehling M. Early Physiotherapy by Passive Range of Motion Does Not Affect Partial Brain Tissue Oxygenation in Neurocritical Care Patients. J Neurol Surg A Cent Eur Neurosurg 2016; 78:42-45. [PMID: 27673345 DOI: 10.1055/s-0036-1592160] [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: 10/20/2022]
Abstract
Background Studies investigating multimodal cerebral monitoring including partial brain tissue oxygen monitoring (ptiO2) in neuro-intensive care patients during physiotherapy are completely lacking in the literature. Materials and Methods We performed a post hoc analysis of prospectively collected data of patients on multimodal cerebral monitoring by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurement as well as ptiO2. Patients with severe brain diseases were treated with passive range of motion (PROM). We recorded ICP, CPP, and ptiO2 continuously every minute at baseline (15 minutes), during treatment (26 minutes), and 15 minutes after treatment with PROM. Results Overall, 25 treatment units with PROM in 10 patients with combined ICP/CPP and ptiO2 monitoring were evaluated. Median ICP, CPP, and ptiO2 at baseline were 12 ± 6.1 mm Hg, 86 ± 17.1 mm Hg, and 27 ± 14.3 mm Hg, respectively. Values for ICP, CPP, and ptiO2 did not change significantly when comparing mean values before, during, and after therapy. Conclusions Based on ptiO2 measurements, our data provide new information about the feasibility and safety of physiotherapy in patients with severe brain diseases.
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Affiliation(s)
- Christian Roth
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - Hubertus Stitz
- Department of Physiotherapy, Klinikum Kassel, Kassel, Germany
| | - Jens Kleffmann
- Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
| | | | | | | | - Markus Gehling
- Department of Anesthesiology, Klinikum Kassel, Kassel, Germany
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Pfeilschifter W, Farahmand D, Niemann D, Ikenberg B, Hohmann C, Abruscato M, Thonke S, Strzelczyk A, Hedtmann G, Neumann-Haefelin T, Kollmar R, Singer OC, Ferbert A, Steiner T, Steinmetz H, Reihs A, Misselwitz B, Foerch C. Estimating the Quantitative Demand of NOAC Antidote Doses on Stroke Units. Cerebrovasc Dis 2016; 42:415-420. [PMID: 27438461 DOI: 10.1159/000447952] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit. METHODS We extracted data of patients with acute ischemic stroke and ICH (<24 h after symptom onset) in the years 2012-2015 from a state-wide prospective stroke inpatient registry. We selected 8 stroke units and determined the mode of OAT upon admission in 2012-2013. In 2015, the mode of OAT became a mandatory item of the inpatient registry. From the number of anticoagulated patients and the NOAC share, we estimated the current and future demand for NOAC antidote doses on stroke units. RESULTS Eighteen percent of ICH patients within 6 h of symptom onset or an unknown symptom onset were on OAT. Given a NOAC share at admission of 40%, about 7% of all ICH patients may qualify for NOAC reversal therapy. Thirteen percent of ischemic stroke patients admitted within 4 h presented on anticoagulation. Given the availability of an appropriate antidote, a NOAC share of 50% could lead to a 6.1% increase in thrombolysis rate. CONCLUSIONS Stroke units serving populations with a comparable demographic structure should prepare to treat up to 1% of all acute ischemic stroke patients and 7% of all acute ICH patients with NOAC antidotes. These numbers may increase with the mounting prevalence of atrial fibrillation and an increasing use of NOAC.
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Abstract
BACKGROUND Worldwide there are differences in the procedure of determining brain death. An irreversible loss of all brain functions, including cerebrum, cerebellum and brainstem is mandatory for the diagnosis of brain death in Germany. On the basis of a case report some important aspects of the new recommendations of the German guidelines are discussed. CASE REPORT We present the case of a 41-year old patient who was admitted to our clinic due to acute subarachnoid hemorrhage (SAH). Angiography revealed an aneurysm of the posterior inferior cerebellar artery. The patient was comatose without any brainstem reflexes and showed apnoea. However, on day 3, EEG showed alpha activity as a sign of residual cortical function. We diagnosed an isolated brainstem death. The next day EEG was isoelectric and brain death was confirmed. DISCUSSION The diagnosis of isolated brainstem death does not allow a confirmation of death in Germany. Our case presents a primary infratentorial brain damage mandating additional confirmatory tests.
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26
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Roth C, Stitz H, Roth C, Ferbert A, Deinsberger W, Pahl R, Engel H, Kleffmann J. Craniocervical manual lymphatic drainage and its impact on intracranial pressure - a pilot study. Eur J Neurol 2016; 23:1441-6. [PMID: 27238738 DOI: 10.1111/ene.13055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/17/2016] [Accepted: 04/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Theoretical considerations and the results of animal studies indicate that manual lymphatic drainage (MLD) might have an impact on intracranial pressure (ICP). There is a lack of clinically qualitative investigations on patients with severe cerebral diseases. METHODS Between April 2013 and January 2015 a prospective observational study was performed on patients who were undergoing intracranial pressure measurement and treatment with MLD. ICP, cerebral perfusion pressure, mean arterial pressure (MAP), heart rate and oxygen saturation were recorded continuously 15 min before the procedure, during MLD (22 min) and for 15 min after the procedure. For analysis the data treatment units were divided into two groups: patients with a mean baseline ICP <15 mmHg (group 1) and patients with a mean ICP ≥15 mmHg before MLD (group 2). RESULTS A total of 133 treatment units (61 patients) were analysed (group 1 n = 99; group 2 n = 34). The mean baseline ICP was 10.4 mmHg overall, and 8.3 mmHg and 18.6 mmHg respectively in group 1 and group 2; ICP significantly decreased during therapy with MLD and this persisted during the follow-up period in group 2. MAP did not show any significant differences between the different periods. CONCLUSIONS Our data showed a significant reduction of ICP during therapy with craniocervical MLD in patients with severe cerebral diseases.
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Affiliation(s)
- C Roth
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - H Stitz
- Department of Physiotherapy, Klinikum Kassel, Kassel, Germany
| | - C Roth
- Department of Physiotherapy, Klinikum Kassel, Kassel, Germany
| | - A Ferbert
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - W Deinsberger
- Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
| | - R Pahl
- Institute of Medical Biometry and Epidemiology (IMBE), Philipps University Marburg, Marburg, Germany
| | - H Engel
- Department of Hand, Plastic and Reconstructive Surgery, Klinikum Kassel, Kassel, Germany
| | - J Kleffmann
- Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
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Walter U, Brandt S, Ferbert A, Förderreuther S, Hansen HC, Hinrichs H, Kaps M, Müllges W. Empfehlungen der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung zur Diagnostik des irreversiblen Hirnfunktionsausfalls. KLIN NEUROPHYSIOL 2016. [DOI: 10.1055/s-0041-111342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- U. Walter
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - S. Brandt
- Klinik für Neurologie, Campus Mitte, Charité – Universitätsmedizin Berlin
| | - A. Ferbert
- Neurologische Klinik, Klinikum Kassel GmbH
| | - S. Förderreuther
- Neurologische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München
| | - H.-C. Hansen
- Klinik für Neurologie und Psychiatrie, Friedrich-Ebert-Krankenhaus Neumünster GmbH
| | - H. Hinrichs
- Universitätsklinik für Neurologie, Universitätsklinikum Magdeburg A. ö. R
| | - M. Kaps
- Klinik für Neurologie am Standort Gießen, Universitätsklinikum Gießen und Marburg
| | - W. Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg
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Roth C, Deinsberger W, Kleffmann J, Ferbert A. Controversies about irreversible loss of brain functions and cerebral perfusion in brain death. Eur J Neurol 2016; 23:e8. [PMID: 26806220 DOI: 10.1111/ene.12876] [Citation(s) in RCA: 2] [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: 07/07/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C Roth
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - W Deinsberger
- Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
| | - J Kleffmann
- Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
| | - A Ferbert
- Department of Neurology, Klinikum Kassel, Kassel, Germany
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Roth C, Ferbert A. Aneurysmatische Subarachnoidalblutung und Entwicklung eines „isolierten Hirnstammtods“. KLIN NEUROPHYSIOL 2016. [DOI: 10.1055/s-0041-108146] [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] [Indexed: 10/22/2022]
Affiliation(s)
- C. Roth
- Neurologische Klinik, Klinikum Kassel
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Derevenciuc AI, Abicht A, Hamza S, Roth C, Ferbert A. Thomsen myotonia--A 4-generation family with a new mutation and a mild phenotype. Muscle Nerve 2015; 53:653-4. [PMID: 26566215 DOI: 10.1002/mus.24971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Angela Abicht
- Medizinisch Genetisches Zentrum München, Münche, Germany
| | - Suad Hamza
- Department of Neurology Klinikum Kassel, Kassel, Germany
| | - Christian Roth
- Department of Neurology Klinikum Kassel, Kassel, Germany
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Lange M, Kasper B, Bohring A, Rutsch F, Kluger G, Hoffjan S, Spranger S, Behnecke A, Ferbert A, Hahn A, Oehl-Jaschkowitz B, Graul-Neumann L, Diepold K, Schreyer I, Bernhard MK, Mueller F, Siebers-Renelt U, Beleza-Meireles A, Uyanik G, Janssens S, Boltshauser E, Winkler J, Schuierer G, Hehr U. 47 patients with FLNA associated periventricular nodular heterotopia. Orphanet J Rare Dis 2015; 10:134. [PMID: 26471271 PMCID: PMC4608144 DOI: 10.1186/s13023-015-0331-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background Heterozygous loss of function mutations within the Filamin A gene in Xq28 are the most frequent cause of bilateral neuronal periventricular nodular heterotopia (PVNH). Most affected females are reported to initially present with difficult to treat seizures at variable age of onset. Psychomotor development and cognition may be normal or mildly to moderately impaired. Distinct associated extracerebral findings have been observed and may help to establish the diagnosis including patent ductus arteriosus Botalli, progressive dystrophic cardiac valve disease and aortic dissection, chronic obstructive lung disease or chronic constipation. Genotype-phenotype correlations could not yet be established. Methods Sanger sequencing and MLPA was performed for a large cohort of 47 patients with Filamin A associated PVNH (age range 1 to 65 years). For 34 patients more detailed clinical information was available from a structured questionnaire and medical charts on family history, development, epileptologic findings, neurological examination, cognition and associated clinical findings. Available detailed cerebral MR imaging was assessed for 20 patients. Results Thirty-nine different FLNA mutations were observed, they are mainly truncating (37/39) and distributed throughout the entire coding region. No obvious correlation between the number and extend of PVNH and the severity of the individual clinical manifestation was observed. 10 of the mutation carriers so far are without seizures at a median age of 19.7 years. 22 of 24 patients with available educational data were able to attend regular school and obtain professional education according to age. Conclusions We report the clinical and mutation spectrum as well as MR imaging for a large cohort of 47 patients with Filamin A associated PVNH including two adult males. Our data are reassuring in regard to psychomotor and cognitive development, which is within normal range for the majority of patients. However, a concerning median diagnostic latency of 17 to 20 years was noted between seizure onset and the genetic diagnosis, intensely delaying appropriate medical surveillance for potentially life threatening cardiovascular complications as well as genetic risk assessment and counseling prior to family planning for this X-linked dominant inherited disorder with high perinatal lethality in hemizygous males.
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Affiliation(s)
- Max Lange
- Department of Neurosurgery, University of Regensburg, Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Burkhard Kasper
- Department of Neurology, Epilepsy Center, University of Erlangen, Medical Center, Erlangen, Germany.
| | - Axel Bohring
- Institute of Human Genetics, University of Muenster, Muenster, Germany.
| | - Frank Rutsch
- Department of General Pediatrics, Muenster University Children's Hospital, Muenster, Germany.
| | - Gerhard Kluger
- Neuropädiatrie, Schön Klinik Vogtareuth, Vogtareuth, Germany und Paracelsus Medical University, Salzburg/Austria, Salzburg, Austria.
| | - Sabine Hoffjan
- Department of Human Genetics, Ruhr-University Bochum, Bochum, Germany.
| | | | - Anne Behnecke
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany.
| | - Andreas Ferbert
- Klinik für Neurologie, Klinikum Kassel and Medical School, Kassel, Germany.
| | - Andreas Hahn
- Department of Neuropediatrics, University of Giessen, Giessen, Germany.
| | | | - Luitgard Graul-Neumann
- Ambulantes Gesundheitszentrum der Charité (Humangenetik), Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | - Matthias K Bernhard
- Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany.
| | | | | | - Ana Beleza-Meireles
- Genetics Clinic, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Goekhan Uyanik
- Zentrum für Medizinische Genetik, Hanusch-Krankenhaus der Wiener Gebietskrankenkasse, Wien, Austria.
| | - Sandra Janssens
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
| | - Eugen Boltshauser
- Division of Neuropediatrics, University Children's Hospital Zürich, Zürich, Switzerland.
| | - Juergen Winkler
- Division of Molecular Neurology, University Hospital, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany.
| | - Gerhard Schuierer
- Department of Neuroradiology, University of Regensburg, Medical Center, Regensburg, Germany.
| | - Ute Hehr
- Department of Human Genetics, University of Regensburg, Medical Center, Regensburg, Germany.
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Safka Brozkova D, Deconinck T, Griffin LB, Ferbert A, Haberlova J, Mazanec R, Lassuthova P, Roth C, Pilunthanakul T, Rautenstrauss B, Janecke AR, Zavadakova P, Chrast R, Rivolta C, Zuchner S, Antonellis A, Beg AA, De Jonghe P, Senderek J, Seeman P, Baets J. Loss of function mutations in HARS cause a spectrum of inherited peripheral neuropathies. Brain 2015; 138:2161-72. [PMID: 26072516 DOI: 10.1093/brain/awv158] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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: 02/19/2015] [Accepted: 04/17/2015] [Indexed: 12/12/2022] Open
Abstract
Inherited peripheral neuropathies are a genetically heterogeneous group of disorders characterized by distal muscle weakness and sensory loss. Mutations in genes encoding aminoacyl-tRNA synthetases have been implicated in peripheral neuropathies, suggesting that these tRNA charging enzymes are uniquely important for the peripheral nerve. Recently, a mutation in histidyl-tRNA synthetase (HARS) was identified in a single patient with a late-onset, sensory-predominant peripheral neuropathy; however, the genetic evidence was lacking, making the significance of the finding unclear. Here, we present clinical, genetic, and functional data that implicate HARS mutations in inherited peripheral neuropathies. The associated phenotypic spectrum is broad and encompasses axonal and demyelinating motor and sensory neuropathies, including four young patients presenting with pure motor axonal neuropathy. Genome-wide linkage studies in combination with whole-exome and conventional sequencing revealed four distinct and previously unreported heterozygous HARS mutations segregating with autosomal dominant peripheral neuropathy in four unrelated families (p.Thr132Ile, p.Pro134His, p.Asp175Glu and p.Asp364Tyr). All mutations cause a loss of function in yeast complementation assays, and p.Asp364Tyr is dominantly neurotoxic in a Caenorhabditis elegans model. This study demonstrates the role of HARS mutations in peripheral neuropathy and expands the genetic and clinical spectrum of aminoacyl-tRNA synthetase-related human disease.
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Affiliation(s)
- Dana Safka Brozkova
- 1 DNA Laboratory, Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague 150 06, Czech Republic
| | - Tine Deconinck
- 2 Neurogenetics Group, VIB-Department of Molecular Genetics, University of Antwerp, Antwerpen 2610, Belgium 3 Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerpen 2610, Belgium
| | - Laurie Beth Griffin
- 4 Cellular and Molecular Biology Program, University of Michigan Medical School, Ann Arbor, MI-48109, USA 5 Medical Scientist Training Program, University of Michigan Medical School, Ann Arbor, MI-48109, USA
| | - Andreas Ferbert
- 6 Department of Neurology, Klinikum Kassel, Kassel 34125, Germany
| | - Jana Haberlova
- 1 DNA Laboratory, Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague 150 06, Czech Republic
| | - Radim Mazanec
- 7 Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague 150 06, Czech Republic
| | - Petra Lassuthova
- 1 DNA Laboratory, Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague 150 06, Czech Republic
| | - Christian Roth
- 6 Department of Neurology, Klinikum Kassel, Kassel 34125, Germany
| | - Thanita Pilunthanakul
- 8 Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI-48109, USA
| | - Bernd Rautenstrauss
- 9 Medizinisch Genetisches Zentrum, Munich 80335, Germany 10 Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University, Munich 80336, Germany
| | - Andreas R Janecke
- 11 Division of Human Genetics and Department of Pediatrics I, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Petra Zavadakova
- 12 Department of Medical Genetics, University of Lausanne, Lausanne 1005, Switzerland
| | - Roman Chrast
- 12 Department of Medical Genetics, University of Lausanne, Lausanne 1005, Switzerland
| | - Carlo Rivolta
- 12 Department of Medical Genetics, University of Lausanne, Lausanne 1005, Switzerland
| | - Stephan Zuchner
- 13 Dr John T McDonald Foundation Department of Human Genetics, John P Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL-33136, USA
| | - Anthony Antonellis
- 4 Cellular and Molecular Biology Program, University of Michigan Medical School, Ann Arbor, MI-48109, USA 14 Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI-48109, USA 15 Department of Neurology, University of Michigan Medical School, Ann Arbor, MI-48109, USA
| | - Asim A Beg
- 8 Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI-48109, USA
| | - Peter De Jonghe
- 2 Neurogenetics Group, VIB-Department of Molecular Genetics, University of Antwerp, Antwerpen 2610, Belgium 3 Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerpen 2610, Belgium 16 Department of Neurology, Antwerp University Hospital, Antwerpen 2610, Belgium
| | - Jan Senderek
- 10 Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University, Munich 80336, Germany
| | - Pavel Seeman
- 1 DNA Laboratory, Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague 150 06, Czech Republic
| | - Jonathan Baets
- 2 Neurogenetics Group, VIB-Department of Molecular Genetics, University of Antwerp, Antwerpen 2610, Belgium 3 Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerpen 2610, Belgium 16 Department of Neurology, Antwerp University Hospital, Antwerpen 2610, Belgium
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Roth C, Ferbert A, Deinsberger W, Kleffmann J, Kästner S, Godau J, Schüler M, Tryba M, Gehling M. Does prone positioning increase intracranial pressure? A retrospective analysis of patients with acute brain injury and acute respiratory failure. Neurocrit Care 2015; 21:186-91. [PMID: 24985500 DOI: 10.1007/s12028-014-0004-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The objective of our trial was to obtain more comprehensive data on the risks and benefits of kinetic therapy in intensive care patients with intracerebral pathology. METHODS Standardized data of prone positioning in our NeuroIntensive Care Unit were collected from 2007 onward. A post hoc analysis of all available data was undertaken, with special consideration given to values of intracranial pressure (ICP), cerebral perfusion pressure (CPP) and oxygenation in correlation to prone (PP), or supine positioning (SP) of patients. Cases were considered eligible if kinetic therapy and ICP were documented. Prone positioning was performed in a 135° position for 8 h per treatment unit. RESULTS A total of 115 patients treated with prone positioning from 2007 to 2013 were identified in our medical records. Of these, 29 patients received ICP monitoring. Overall, 119 treatment units of prone positioning with a mean duration of 2.5 days per patient were performed. The mean baseline ICP in SP was 9.5 ± 5.9 mmHg and was increased significantly during PP (p < 0.0001). There was no significant difference between CPP in SP (82 ± 14.5 mmHg) compared to PP (p > 0.05). ICP values >20 mmHg occurred more often during PP than SP (p < 0.0001) and were associated with significantly more episodes of decreased CPP <70 mmHg (p < 0.0022). The mean paO(2)/FiO(2) ratio (P/F ratio) was increased significantly in prone positioning of patients (p < 0.0001). CONCLUSIONS The analyzed data allow a more precise understanding of changes in ICP and oxygenation during prone positioning in patients with acute brain injury and almost normal baseline ICP. Our study shows a moderate, yet significant elevation of ICP during prone positioning. However, the achieved increase of oxygenation by far exceeded the changes in ICP. It is evident that continuous monitoring of cerebral pressure is required in this patient group.
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Affiliation(s)
- Christian Roth
- Department of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany,
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Roth C, Deinsberger W, Kleffmann J, Ferbert A. Intracranial pressure and cerebral perfusion pressure during apnoea testing for the diagnosis of brain death - an observational study. Eur J Neurol 2015; 22:1208-14. [DOI: 10.1111/ene.12727] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/26/2015] [Indexed: 12/01/2022]
Affiliation(s)
- C. Roth
- Department of Neurology; Klinikum Kassel; Kassel Germany
| | - W. Deinsberger
- Department of Neurosurgery; Klinikum Kassel; Kassel Germany
| | - J. Kleffmann
- Department of Neurosurgery; Klinikum Kassel; Kassel Germany
| | - A. Ferbert
- Department of Neurology; Klinikum Kassel; Kassel Germany
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Kleffmann J, Ferbert A, Deinsberger W, Roth C. Extensive ischemic brainstem lesions and pneumocephalus after application of hydrogen peroxide (H2O2) during lumbar spinal surgery. Spine J 2015; 15:e5-7. [PMID: 25485485 DOI: 10.1016/j.spinee.2014.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Received: 06/27/2014] [Revised: 10/27/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The hemostatic properties of hydrogen peroxide (H2O2) are often used in neurosurgical practice. CASE REPORT We present the case of an 81-year-old woman who underwent lumbar spinal surgery (microsurgical decompression) in an external hospital. H2O2 was used during the procedure. The patient was transferred to our hospital. She remained unconscious postoperatively, with progressive loss of brainstem reflexes. Computed tomography showed intra- and extradurally trapped air ascending from the operated lumbar segment up to frontal lobe. Magnetic resonance imaging demonstrated severe brainstem lesions on T2- and diffusion-weighted series. The patient died 10 days after surgery. Autopsy was not performed. CONCLUSIONS Our case demonstrates a fatal complication with ischemic brainstem lesions and pneumocephalus after the use of hydrogen peroxide. Therefore, H2O2 should only be used in cases without any signs of dural injury.
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Affiliation(s)
- Jens Kleffmann
- Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany.
| | - Andreas Ferbert
- Deparment of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany
| | - Wolfgang Deinsberger
- Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany
| | - Christian Roth
- Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany; Deparment of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany
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Schroeter M, Lüßem B, Engelhardt A, Erbguth F, Ferbert A, Steinmetz H, Vieregge P, Fink G. Ergebnisse der 11. Erhebung der Deutschen Gesellschaft für Neurologie zur Struktur der neurologischen Kliniken der Akutversorgung in Deutschland. Akt Neurol 2015. [DOI: 10.1055/s-0034-1387579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Schroeter
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
| | - B. Lüßem
- Institut für Medizinökonomie und Medizinische Versorgungsforschung, Rheinische Fachhochschule Köln
| | - A. Engelhardt
- Neurologische Klinik, Evangelisches Krankenhaus Oldenburg
| | - F. Erbguth
- Klinik für Neurologie, Klinikum Nürnberg
| | | | - H. Steinmetz
- Neurologische Klinik, Johann-Wolfgang-von-Goethe-Universität Frankfurt
| | | | - G. Fink
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
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Semmler A, Sacconi S, Bach J, Liebe C, Bürmann J, Kley R, Ferbert A, Anderheiden R, Van den Bergh P, Martin J, Jonghe PD, Neuen-Jacob E, Müller O, Deschauer M, Bergmann M, Schröder J, Vorgerd M, Schulz J, Weis J, Kress W, Claeys K. A.P.3. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.133] [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: 10/24/2022]
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Semmler AL, Sacconi S, Bach JE, Liebe C, Bürmann J, Kley RA, Ferbert A, Anderheiden R, Van den Bergh P, Martin JJ, De Jonghe P, Neuen-Jacob E, Müller O, Deschauer M, Bergmann M, Schröder JM, Vorgerd M, Schulz JB, Weis J, Kress W, Claeys KG. Unusual multisystemic involvement and a novel BAG3 mutation revealed by NGS screening in a large cohort of myofibrillar myopathies. Orphanet J Rare Dis 2014; 9:121. [PMID: 25208129 PMCID: PMC4347565 DOI: 10.1186/s13023-014-0121-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/21/2014] [Indexed: 12/14/2022] Open
Abstract
Background Myofibrillar myopathies (MFM) are a group of phenotypically and genetically heterogeneous neuromuscular disorders, which are characterized by protein aggregations in muscle fibres and can be associated with multisystemic involvement. Methods We screened a large cohort of 38 index patients with MFM for mutations in the nine thus far known causative genes using Sanger and next generation sequencing (NGS). We studied the clinical and histopathological characteristics in 38 index patients and five additional relatives (n = 43) and particularly focused on the associated multisystemic symptoms. Results We identified 14 heterozygous mutations (diagnostic yield of 37%), among them the novel p.Pro209Gln mutation in the BAG3 gene, which was associated with onset in adulthood, a mild phenotype and an axonal sensorimotor polyneuropathy, in the absence of giant axons at the nerve biopsy. We revealed several novel clinical phenotypes and unusual multisystemic presentations with previously described mutations: hearing impairment with a FLNC mutation, dysphonia with a mutation in DES and the first patient with a FLNC mutation presenting respiratory insufficiency as the initial symptom. Moreover, we described for the first time respiratory insufficiency occurring in a patient with the p.Gly154Ser mutation in CRYAB. Interestingly, we detected a polyneuropathy in 28% of the MFM patients, including a BAG3 and a MYOT case, and hearing impairment in 13%, including one patient with a FLNC mutation and two with mutations in the DES gene. In four index patients with a mutation in one of the MFM genes, typical histological findings were only identified at the ultrastructural level (29%). Conclusions We conclude that extraskeletal symptoms frequently occur in MFM, particularly cardiac and respiratory involvement, polyneuropathy and/or deafness. BAG3 mutations should be considered even in cases with a mild phenotype or an adult onset. We identified a genetic defect in one of the known genes in less than half of the MFM patients, indicating that more causative genes are still to be found. Next generation sequencing techniques should be helpful in achieving this aim.
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Affiliation(s)
- Anna-Lena Semmler
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany.
| | - Sabrina Sacconi
- Centre de Référence des Maladies Neuromusculaires, Nice Hospital and UMR CNRS6543, Nice University, Nice, France.
| | - J Elisa Bach
- Department of Human Genetics, University of Würzburg, Würzburg, Germany.
| | - Claus Liebe
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany.
| | - Jan Bürmann
- Department of Neurology, Saarland University, Homburg/Saar, Germany.
| | - Rudolf A Kley
- Department of Neurology, Neuromuscular Center Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
| | | | | | - Peter Van den Bergh
- Department of Neurology, Neuromuscular Reference Center, University Hospital Saint-Luc, Brussel, Belgium.
| | | | - Peter De Jonghe
- Institute Born-Bunge, University of Antwerpen, Antwerpen, Belgium. .,Neurogenetics Group, VIB-Department of Molecular Genetics, University of Antwerpen, Antwerpen, Belgium. .,Department of Neurology, University Hospital of Antwerpen, Antwerpen, Belgium.
| | - Eva Neuen-Jacob
- Institute of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Oliver Müller
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany.
| | - Marcus Deschauer
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
| | - Markus Bergmann
- Institute of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany.
| | | | - Matthias Vorgerd
- Department of Neurology, Neuromuscular Center Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
| | - Wolfram Kress
- Department of Human Genetics, University of Würzburg, Würzburg, Germany.
| | - Kristl G Claeys
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
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Vulinovic F, Lohmann K, Rakovic A, Capetian P, Alvarez-Fischer D, Schmidt A, Weißbach A, Erogullari A, Kaiser FJ, Wiegers K, Ferbert A, Rolfs A, Klein C, Seibler P. Unraveling cellular phenotypes of novel TorsinA/TOR1A mutations. Hum Mutat 2014; 35:1114-22. [PMID: 24931141 DOI: 10.1002/humu.22604] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 02/14/2014] [Accepted: 06/04/2014] [Indexed: 01/17/2023]
Abstract
A three-nucleotide (GAG) deletion (ΔE) in TorsinA (TOR1A) has been identified as the most common cause of dominantly inherited early-onset torsion dystonia (DYT1). TOR1A encodes a chaperone-like AAA+-protein localized in the endoplasmic reticulum. Currently, only three additional, likely mutations have been reported in single dystonia patients. Here, we report two new, putative TOR1A mutations (p.A14_P15del and p.E121K) that we examined functionally in comparison with wild-type (WT) protein and two known mutations (ΔE and p.R288Q). While inclusion formation is a characteristic feature for ΔE TOR1A, elevated levels of aggregates for other mutations were not observed when compared with WT TOR1A. WT and mutant TOR1A showed preferred degradation through the autophagy-lysosome pathway, which is most pronounced for p.A14_P15del, p.R288Q, and ΔE TOR1A. Notably, blocking of the autophagy pathway with bafilomycin resulted in a significant increase in inclusion formation in p.E121K TOR1A. In addition, all variants had an influence on protein stability. Although the p.A14_P15del mutation affects the proposed oligomerization domain of TOR1A, this mutation did not disturb the ability to dimerize. Our findings demonstrate functional changes for all four mutations on different levels. Thus, both diagnostic and research genetic screening of dystonia patients should not be limited to testing for the ∆E mutation.
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Affiliation(s)
- Franca Vulinovic
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Kumar KR, Lohmann K, Masuho I, Miyamoto R, Ferbert A, Lohnau T, Kasten M, Hagenah J, Brüggemann N, Graf J, Münchau A, Kostic VS, Sue CM, Domingo AR, Rosales RL, Lee LV, Freimann K, Westenberger A, Mukai Y, Kawarai T, Kaji R, Klein C, Martemyanov KA, Schmidt A. Mutations in GNAL: a novel cause of craniocervical dystonia. JAMA Neurol 2014; 71:490-4. [PMID: 24535567 DOI: 10.1001/jamaneurol.2013.4677] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Mutations in the GNAL gene have recently been shown to cause primary torsion dystonia. The GNAL-encoded protein (Gαolf) is important for dopamine D1 receptor function and odorant signal transduction. We sequenced all 12 exons of GNAL in 461 patients from Germany, Serbia, and Japan, including 318 patients with dystonia (190 with cervical dystonia), 51 with hyposmia and Parkinson disease, and 92 with tardive dyskinesia or acute dystonic reactions. OBSERVATIONS We identified the following two novel heterozygous putative mutations in GNAL: p.Gly213Ser in a German patient and p.Ala353Thr in a Japanese patient. These variants were predicted to be pathogenic in silico, were absent in ethnically matched control individuals, and impaired Gαolf coupling to D1 receptors in a bioluminescence energy transfer (BRET) assay. Two additional variants appeared to be benign because they behaved like wild-type samples in the BRET assay (p.Ala311Thr) or were detected in ethnically matched controls (p.Thr92Ala). Both patients with likely pathogenic mutations had craniocervical dystonia with onset in the fifth decade of life. No pathogenic mutations were detected in the patients with hyposmia and Parkinson disease, tardive dyskinesias, or acute dystonic reactions. CONCLUSIONS AND RELEVANCE Mutations in GNAL can cause craniocervical dystonia in different ethnicities. The BRET assay may be a useful tool to support the pathogenicity of identified variants in the GNAL gene.
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Affiliation(s)
- Kishore R Kumar
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany2Department of Neurogenetics, Kolling Medical Institute, Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - Katja Lohmann
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Ikuo Masuho
- Department of Neuroscience, The Scripps Research Institute, Jupiter, Florida
| | - Ryosuke Miyamoto
- Department of Clinical Neuroscience, Institute of Health Bioscience, Graduate School of Medicine, University of Tokushima, Tokushima, Japan
| | | | - Thora Lohnau
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Meike Kasten
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Johann Hagenah
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | | | - Julia Graf
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Alexander Münchau
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany7Department of Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | | | - Carolyn M Sue
- Department of Neurogenetics, Kolling Medical Institute, Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - Aloysius R Domingo
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany9Department of Neurosciences, Philippine General Hospital, Manila, Philippines
| | - Raymond L Rosales
- Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines
| | - Lilian V Lee
- Child Neurology Section, Philippine Children's Medical Center, Quezon City, Philippines
| | - Karen Freimann
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Ana Westenberger
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Youhei Mukai
- Department of Clinical Neuroscience, Institute of Health Bioscience, Graduate School of Medicine, University of Tokushima, Tokushima, Japan
| | - Toshitaka Kawarai
- Department of Clinical Neuroscience, Institute of Health Bioscience, Graduate School of Medicine, University of Tokushima, Tokushima, Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Health Bioscience, Graduate School of Medicine, University of Tokushima, Tokushima, Japan
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
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Spiegler S, Najm J, Liu J, Gkalympoudis S, Schröder W, Borck G, Brockmann K, Elbracht M, Fauth C, Ferbert A, Freudenberg L, Grasshoff U, Hellenbroich Y, Henn W, Hoffjan S, Hüning I, Korenke GC, Kroisel PM, Kunstmann E, Mair M, Munk-Schulenburg S, Nikoubashman O, Pauli S, Rudnik-Schöneborn S, Sudholt I, Sure U, Tinschert S, Wiednig M, Zoll B, Ginsberg MH, Felbor U. High mutation detection rates in cerebral cavernous malformation upon stringent inclusion criteria: one-third of probands are minors. Mol Genet Genomic Med 2014; 2:176-85. [PMID: 24689081 PMCID: PMC3960060 DOI: 10.1002/mgg3.60] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 09/02/2013] [Revised: 11/22/2013] [Accepted: 12/02/2013] [Indexed: 11/09/2022] Open
Abstract
Cerebral cavernous malformations (CCM) are prevalent vascular malformations occurring in familial autosomal dominantly inherited or isolated forms. Once CCM are diagnosed by magnetic resonance imaging, the indication for genetic testing requires either a positive family history of cavernous lesions or clinical symptoms such as chronic headaches, epilepsy, neurological deficits, and hemorrhagic stroke or the occurrence of multiple lesions in an isolated case. Following these inclusion criteria, the mutation detection rates in a consecutive series of 105 probands were 87% for familial and 57% for isolated cases. Thirty-one novel mutations were identified with a slight shift towards proportionally more CCM3 mutations carriers than previously published (CCM1: 60%, CCM2: 18%, CCM3: 22%). In-frame deletions and exonic missense variants requiring functional analyses to establish their pathogenicity were rare: An in-frame deletion within the C-terminal FERM domain of CCM1 resulted in decreased protein expression and impaired binding to the transmembrane protein heart of glass (HEG1). Notably, 20% of index cases carrying a CCM mutation were below age 10 and 33% below age 18 when referred for genetic testing. Since fulminant disease courses during the first years of life were observed in CCM1 and CCM3 mutation carriers, predictive testing of minor siblings became an issue.
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Affiliation(s)
- Stefanie Spiegler
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald Greifswald, Germany
| | - Juliane Najm
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald Greifswald, Germany
| | - Jian Liu
- Department of Medicine, University of California San Diego San Diego, California
| | - Stephanie Gkalympoudis
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald Greifswald, Germany
| | - Winnie Schröder
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald Greifswald, Germany
| | - Guntram Borck
- Institute of Human Genetics, University of Ulm Ulm, Germany
| | - Knut Brockmann
- Department of Paediatrics and Paediatric Neurology, University of Göttingen Göttingen, Germany
| | - Miriam Elbracht
- Institute of Human Genetics, University of Aachen Aachen, Germany
| | - Christine Fauth
- Division of Human Genetics, Medical University Innsbruck Innsbruck, Austria
| | - Andreas Ferbert
- Department of Neurology, Klinikum Kassel GmbH Kassel, Germany
| | - Leonie Freudenberg
- Department of Neuropaediatrics, University Hospital Dresden Dresden, Germany
| | - Ute Grasshoff
- Institute of Medical Genetics and Applied Genomics, Rare Disease Center Tübingen, University of Tübingen Tübingen, Germany
| | | | - Wolfram Henn
- Department of Human Genetics, Saarland University Homburg/Saar, Germany
| | - Sabine Hoffjan
- Department of Human Genetics, Ruhr-University Bochum, Germany
| | - Irina Hüning
- Institute of Human Genetics, University of Lübeck Lübeck, Germany
| | | | - Peter M Kroisel
- Institute of Human Genetics, Medical University Graz Graz, Austria
| | - Erdmute Kunstmann
- Institute of Human Genetics, University of Würzburg Würzburg, Germany
| | - Martina Mair
- Department of Human Genetics, Saarland University Homburg/Saar, Germany
| | | | - Omid Nikoubashman
- Department for Interventional and Diagnostic Neuroradiology, University Hospital Aachen Aachen, Germany
| | - Silke Pauli
- Institute of Human Genetics, University of Göttingen Göttingen, Germany
| | | | - Irene Sudholt
- Institute of Medical Genetics, University of Zürich Zürich, Switzerland
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen Essen, Germany
| | - Sigrid Tinschert
- Institute of Clinical Genetics, Technical University of Dresden Dresden, Germany
| | - Michaela Wiednig
- Department of Environmental Dermatology and Venereology, Medical University Graz Graz, Austria
| | - Barbara Zoll
- Institute of Human Genetics, University of Göttingen Göttingen, Germany
| | - Mark H Ginsberg
- Department of Medicine, University of California San Diego San Diego, California
| | - Ute Felbor
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald Greifswald, Germany
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Dohrn MF, Röcken C, De Bleecker JL, Martin JJ, Vorgerd M, Van den Bergh PY, Ferbert A, Hinderhofer K, Schröder JM, Weis J, Schulz JB, Claeys KG. Diagnostic hallmarks and pitfalls in late-onset progressive transthyretin-related amyloid-neuropathy. J Neurol 2013; 260:3093-108. [PMID: 24101130 DOI: 10.1007/s00415-013-7124-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 01/29/2023]
Abstract
Familial amyloid polyneuropathy (FAP) is a progressive systemic autosomal dominant disease caused by pathogenic mutations in the transthyretin (TTR) gene. We studied clinical, electrophysiological, histopathological, and genetic characteristics in 15 (13 late-onset and two early-onset) patients belonging to 14 families with polyneuropathy and mutations in TTR. In comparison, we analysed the features of nine unrelated patients with an idiopathic polyneuropathy, in whom TTR mutations have been excluded. Disease occurrence was familial in 36 % of the patients with TTR-associated polyneuropathy and the late-onset type was observed in 86 % (mean age at onset 65.5 years). Clinically, all late-onset TTR-mutant patients presented with distal weakness, pansensory loss, absence of deep tendon reflexes, and sensorimotor hand involvement. Afferent-ataxic gait was present in 92 % leading to wheelchair dependence in 60 % after a mean duration of 4.6 years. Autonomic involvement was observed in 60 %, and ankle edema in 92 %. The sensorimotor polyneuropathy was from an axonal type in 82 %, demyelinating or mixed type in 9 % each. Compared to the TTR-unmutated idiopathic polyneuropathy patients, we identified rapid progression, early ambulatory loss, and autonomic disturbances, associated with a severe polyneuropathy as red flags for TTR-FAP. In 18 % of the late-onset TTR-FAP patients, no amyloid was found in nerve biopsies. Further diagnostic pitfalls were unspecific electrophysiology, and coincident diabetes mellitus (23 %) or monoclonal gammopathy (7 %). We conclude that a rapid disease course, severely ataxic gait, hand involvement, and autonomic dysfunction are diagnostic hallmarks of late-onset TTR-FAP. Genetic analysis should be performed even when amyloid deposits are lacking or when polyneuropathy-causing comorbidities are concomitant.
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Affiliation(s)
- Maike F Dohrn
- Department of Neurology, RWTH Aachen University, Aachen, Germany
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Roth C, Freilinger T, Kirovski G, Dunkel J, Shah Y, Wilken B, Rautenstrauß B, Ferbert A. Clinical spectrum in three families with familial hemiplegic migraine type 2 including a novel mutation in the ATP1A2 gene. Cephalalgia 2013; 34:183-90. [PMID: 24096472 DOI: 10.1177/0333102413506128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 11/17/2022]
Abstract
INTRODUCTION Familial hemiplegic migraine (FHM) is a rare subtype of migraine with transient hemiplegic aura. PATIENTS AND METHODS We describe three unrelated families with familial hemiplegic migraine type II (FHM2). Retrospectively, information on 47 family members could be obtained, 15 by personal examination and 32 by indirect anamnesis from relatives. Genetic analyses were performed in 13 patients. RESULTS One family had a novel missense mutation in the ATP1A2 gene (c.659C>T, p.Ser220Leu) that segregated with the phenotype in three generations. Two further unrelated families with different ethnic backgrounds (one from Germany and one from Russia) had a missense mutation that has not been described as yet in FHM, but occurred in only a single patient with sporadic hemiplegic migraine (c.2723G>A, p.Arg908Gln). Clinically the patients had severe attacks lasting up to several weeks as well as epileptic seizures. Three patients with a proven mutation in the ATP1A2 gene clinically presented without hemiparesis. Furthermore, there was a possible relation of FHM2 to mental retardation in another two patients. CONCLUSION Clinical symptoms may last for several weeks in some patients. Patients with FHM2 may also present without hemiplegia. Therefore, the full family history has to be taken into account to establish the diagnosis of FHM.
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Roth C, Kleffmann J, Bergmann C, Deinsberger W, Ferbert A. Ruptured cerebral aneurysm and acute bilateral carotid artery dissection in a patient with polycystic kidney disease and polycystic liver disease. Cerebrovasc Dis 2013; 35:590-1. [PMID: 23859882 DOI: 10.1159/000350727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Christian Roth
- Department of Neurology, Klinikum Kassel, Kassel, Germany.
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45
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Lohmann K, Wilcox RA, Winkler S, Ramirez A, Rakovic A, Park JS, Arns B, Lohnau T, Groen J, Kasten M, Brüggemann N, Hagenah J, Schmidt A, Kaiser FJ, Kumar KR, Zschiedrich K, Alvarez-Fischer D, Altenmüller E, Ferbert A, Lang AE, Münchau A, Kostic V, Simonyan K, Agzarian M, Ozelius LJ, Langeveld APM, Sue CM, Tijssen MAJ, Klein C. Whispering dysphonia (DYT4 dystonia) is caused by a mutation in the TUBB4 gene. Ann Neurol 2013; 73:537-45. [PMID: 23595291 DOI: 10.1002/ana.23829] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/13/2012] [Accepted: 11/30/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A study was undertaken to identify the gene underlying DYT4 dystonia, a dominantly inherited form of spasmodic dysphonia combined with other focal or generalized dystonia and a characteristic facies and body habitus, in an Australian family. METHODS Genome-wide linkage analysis was carried out in 14 family members followed by genome sequencing in 2 individuals. The index patient underwent a detailed neurological follow-up examination, including electrophysiological studies and magnetic resonance imaging scanning. Biopsies of the skin and olfactory mucosa were obtained, and expression levels of TUBB4 mRNA were determined by quantitative real-time polymerase chain reaction in 3 different cell types. All exons of TUBB4 were screened for mutations in 394 unrelated dystonia patients. RESULTS The disease-causing gene was mapped to a 23cM region on chromosome 19p13.3-p13.2 with a maximum multipoint LOD score of 5.338 at markers D9S427 and D9S1034. Genome sequencing revealed a missense variant in the TUBB4 (tubulin beta-4; Arg2Gly) gene as the likely cause of disease. Sequencing of TUBB4 in 394 unrelated dystonia patients revealed another missense variant (Ala271Thr) in a familial case of segmental dystonia with spasmodic dysphonia. mRNA expression studies demonstrated significantly reduced levels of mutant TUBB4 mRNA in different cell types from a heterozygous Arg2Gly mutation carrier compared to controls. INTERPRETATION A mutation in TUBB4 causes DYT4 dystonia in this Australian family with so-called whispering dysphonia, and other mutations in TUBB4 may contribute to spasmodic dysphonia. Given that TUBB4 is a neuronally expressed tubulin, our results imply abnormal microtubule function as a novel mechanism in the pathophysiology of dystonia.
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Affiliation(s)
- Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Schroeter M, Engelhardt A, Erbguth F, Ferbert A, Reinhardt FM, Vieregge P, Wallesch CW, Widder B, Fink G. Ergebnisse der 10. Erhebung zur Struktur der neurologischen Kliniken der Akutversorgung in Deutschland. Akt Neurol 2013. [DOI: 10.1055/s-0033-1337972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Schroeter
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
| | - A. Engelhardt
- Neurologische Klinik, Evangelisches Krankenhaus Oldenburg
| | - F. Erbguth
- Klinik für Neurologie, Klinikum Nürnberg
| | | | | | | | | | - B. Widder
- Klinik für Neurologie und Neurologische Rehabilitation, BKH Günzburg
| | - G. Fink
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
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Roth C, Stitz H, Kalhout A, Kleffmann J, Deinsberger W, Ferbert A. Effect of Early Physiotherapy on Intracranial Pressure and Cerebral Perfusion Pressure. Neurocrit Care 2012. [DOI: 10.1007/s12028-012-9799-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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Kleffmann J, Pahl R, Deinsberger W, Ferbert A, Roth C. Effect of percutaneous tracheostomy on intracerebral pressure and perfusion pressure in patients with acute cerebral dysfunction (TIP Trial): an observational study. Neurocrit Care 2012; 17:85-9. [PMID: 22539153 DOI: 10.1007/s12028-012-9709-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Bedside percutaneous tracheostomy (PT) is very commonly used for patients who require prolonged mechanical ventilation. The effect of tracheostomy on intracranial pressure (ICP) is currently a subject of controversy. The aim of our study is to clarify the relation between PT and its effect on ICP and cerebral perfusion pressure. METHODS 38 patients on our intensive care unit were included prospectively in an observational study. We examined mean values of HF, SpO(2), ICP, CPP, and MAP for changes over five different phases of the procedure using paired Mann-Whitney U tests. A p value of <0.05 was considered significant. p values were Bonferroni corrected for multiple testing. RESULTS PT was performed on 38 patients (f = 19, m = 19; mean = 56 years). Median ICP before intervention was 9 mmHg. During positioning of the patient, ICP had risen to 14, during bronchoscopy to 16, and during tracheostomy to 18 mmHg, all being significantly higher than baseline level. Monitoring of MAP showed a significant increase to 101 mmHg only during tracheostomy. SpO(2) and HF did not show any significant changes. Mean duration of positioning, bronchoscopy and tracheostomy was 19, 10, and 17 min. 8 patients received osmotherapy due to a rise of ICP of more than 30 mmHg. CONCLUSION PT only leads to a significant rise of ICP during the procedure. Nevertheless, therapy of ICP is necessary in some patients. From our point of view, therefore, tracheostomy should only be performed under continuous monitoring of ICP and CPP in patients with severe cerebral dysfunctions and critically elevated ICP.
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Affiliation(s)
- Jens Kleffmann
- Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany.
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Kleffmann J, Frank V, Ferbert A, Bergmann C. Dosage-sensitive network in polycystic kidney and liver disease: multiple mutations cause severe hepatic and neurological complications. J Hepatol 2012; 57:476-7. [PMID: 22406737 DOI: 10.1016/j.jhep.2012.03.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 02/27/2012] [Accepted: 03/01/2012] [Indexed: 12/22/2022]
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Abstract
The posterior reversible encephalopathy syndrome is an increasingly recognised disorder. Most patients have several symptoms; seizures are the most frequent, often multiple or status epilepticus. A combination of seizures, visual disturbance and/or headache, in particular, should lead to an early brain MRI to reveal the typical pattern of bilateral hyperintensities on fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. There seem to be many possible triggers, including abrupt arterial hypertension, impaired renal function, pregnancy, immunosuppressive therapies and various inflammatory conditions. The clinical outcome is excellent, with recovery within a few days, while the MRI abnormalities resolve much more slowly. Little is known about the best management. Seizures do not normally progress to chronic epilepsy so antiepileptic drugs should be discontinued after about 3 months.
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Affiliation(s)
- C Roth
- Department of Neurology, Klinikum Kassel, Kassel, Germany.
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