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Zinganell A, Göbel G, Berek K, Hofer B, Asenbaum-Nan S, Barang M, Böck K, Bsteh C, Bsteh G, Eger S, Eggers C, Fertl E, Joldic D, Khalil M, Langenscheidt D, Komposch M, Kornek B, Kraus J, Krendl R, Rauschka H, Sellner J, Auer M, Hegen H, Pauli FD, Deisenhammer F. Multiple sclerosis in the elderly: a retrospective cohort study. J Neurol 2024; 271:674-687. [PMID: 37855871 DOI: 10.1007/s00415-023-12041-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There is a lack of knowledge of disease course, prognosis, comorbidities and potential treatments of elderly MS patients. OBJECTIVE To characterize the disease course including disability progression and relapses, to quantify the use of DMTs and to identify comorbidities and risk factors for progression in elderly multiple sclerosis (MS) patients. METHODS This is a retrospective study of 1200 Austrian MS patients older than 55 years as of May 1st, 2017 representing roughly one-third of all the MS patients of this age in Austria. Data were collected from 15 MS centers including demographics, first symptom at onset, number of relapses, evolvement of disability, medication, and comorbidities. RESULTS Median observation time was 17.1 years with 957 (80%) relapsing and 243 (20%) progressive onsets. Average age at diagnosis was 45 years with a female predominance of 71%. Three-hundred and twenty-six (27%) patients were never treated with a DMT, while most treated patients received interferons (496; 41%) at some point. At last follow-up, 420 (35%) patients were still treated with a DMT. No difference was found between treated and never-treated patients in terms of clinical outcome; however, patients with worse disability progression had significantly more DMT switches. Pyramidal onset, number of comorbidities, dementia, epilepsy, and psychiatric conditions as well as a higher number of relapses were associated with worse outcome. The risk of reaching EDSS 6 rose with every additional comorbidity by 22%. In late and very-late-onset MS (LOMS, VLOMS) time to diagnosis took nearly twice the time compared to adult and early onset (AEOMS). The overall annualized relapse rate (ARR) decreased over time and patients with AEOMS had significantly higher ARR compared to LOMS and VLOMS. Four percent of MS patients had five medications or more fulfilling criteria of polypharmacy and 20% of psychiatric drugs were administered without a matching diagnosis. CONCLUSIONS In this study, we identified number of comorbidities, pyramidal and cerebellar signs, and a higher number of relapses as unfavorable prognostic factors in elderly MS patients filling gaps of knowledge in patients usually underrepresented in clinical trials and may guide future therapeutic studies.
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Affiliation(s)
- Anne Zinganell
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Barbara Hofer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Matin Barang
- Department of Neurology, Hospital of St. Pölten, St. Pölten, Austria
| | - Klaus Böck
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | | | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stephan Eger
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | - Christian Eggers
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | - Elisabeth Fertl
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Damir Joldic
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Martina Komposch
- Department of Neurology, Hospital of Klagenfurt, Klagenfurt, Austria
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jörg Kraus
- Neurologist, Zell Am See, Austria
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Reinhard Krendl
- Department of Neurology, Hospital of Villach, Villach, Austria
| | - Helmut Rauschka
- Department of Neurology, Klinik Donaustadt, Vienna, Austria
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Department of Neurology, Klinik Donaustadt, Vienna, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach, Mistelbach, Austria
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Panholzer J, Kellermair L, Eggers C. Hypoglossal nerve palsy after SARS-CoV-2 vaccination – report of two cases. BMC Neurol 2022; 22:416. [PMCID: PMC9643981 DOI: 10.1186/s12883-022-02929-2] [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: 04/26/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background SARS-CoV-2 vaccination is associated with an increased risk for Bell’s palsy and some other neurological disorders assumed to be of autoimmune origin. While facial nerve palsy is frequent and usually idiopathic, hypoglossal nerve palsy is rare, and a specific cause is almost always found. We firstly report two patients who developed isolated hypoglossal nerve palsy shortly after SARS-CoV-2 vaccination. Case presentation Two otherwise healthy patients, a 49-year-old man and a 39-year-old woman, developed unilateral hypoglossal nerve palsy 10 and 7 days after the second SARS-CoV-2-vaccination (AstraZeneca and BioNTech/Pfizer), respectively. In both subjects, needle electromyography showed denervation and rarefication of motor units. CT, MRI, examination of blood and CSF as well as ENT exam were unremarkable. In both subjects symptoms gradually improved. Conclusion Due to close temporal relationship, the absence of other etiologies, and spontaneous improvement we suspect the vaccination as the cause for hypoglossal nerve palsy in both patients. This is further supported by the rarity of isolated hypoglossal nerve palsies, especially in idiopathic cases. We suggest the addition of hypoglossal nerve palsy to the list of neurological injuries potentially caused by SARS-CoV-2 vaccination.
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Affiliation(s)
- J. Panholzer
- grid.473675.4Department of Neurology, Kepler University Hospital, Linz, Austria
| | - L. Kellermair
- grid.473675.4Department of Neurology, Kepler University Hospital, Linz, Austria
| | - C. Eggers
- grid.473675.4Department of Neurology, Kepler University Hospital, Linz, Austria
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3
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Ransmayr L, Fuchs A, Ransmayr-Tepser S, Kommenda R, Kögl M, Schwingenschuh P, Fellner F, Guger M, Eggers C, Darkow R, Mangesius S, Ransmayr G. Differences in aphasia syndromes between progressive supranuclear palsy-Richardson's syndrome, behavioral variant frontotemporal dementia and Alzheimer's dementia. J Neural Transm (Vienna) 2022; 129:1039-1048. [PMID: 35821453 DOI: 10.1007/s00702-022-02524-2] [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: 03/30/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Language impairments, hallmarks of speech/language variant progressive supranuclear palsy, also occur in Richardson's syndrome (PSP-RS). Impaired communication may interfere with daily activities. Therefore, assessment of language functions is crucial. It is uncertain whether the Aachen Aphasia Test (AAT) is practicable in PSP-RS, behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's dementia (AD) and language deficits differ in these disorders. 28 PSP-RS, 24 AD, and 24 bvFTD patients were investigated using the AAT and the CERAD-Plus battery. 16-25% of all patients failed in AAT subtests for various reasons. The AAT syndrome algorithm diagnosed amnestic aphasia in 5 (23%) PSP-RS, 7 (36%) bvFTD and 6 (30%) AD patients, Broca aphasia in 1 PSP-RS and 1 bvFTD patient, Wernicke aphasia in 1 bvFTD and 3 (15%) AD patients. However, aphasic symptoms resembled non-fluent primary progressive aphasia in 14 PSP-RS patients. In up to 46% of PSP-RS patients, 61% of bvFTD and 64% of AD patients significant impairments were found in the AAT subtests spontaneous speech, written language, naming, language repetition, language comprehension and the Token subtest. The CERAD-Plus subtest semantic fluency revealed significant impairment in 81% of PSP-RS, 61% of bvFTD, 44% of AD patients, the phonemic fluency subtest in 31, 40 and 31%, respectively. In contrast to bvFTD and AD, severity of language impairment did not correlate with cognitive decline in PSP-RS. In summary, the patterns of aphasia differ between the diagnoses. Local frontal language networks might be impaired in PSP-RS, whereas in AD and bvFTD, more widespread neuropathology might underly language impairment.
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Affiliation(s)
- Lucia Ransmayr
- Institute for Logopedics, FH Joanneum, University of Applied Sciences, Graz, Austria.,Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria
| | - Alexandra Fuchs
- Department of Clinical and Health Psychology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Sibylle Ransmayr-Tepser
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria
| | - Romana Kommenda
- Department of Clinical and Health Psychology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Mariella Kögl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Franz Fellner
- Central Institute of Radiology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Michael Guger
- Department of Neurology, Pyhrn-Eisenwurzen Hospital Steyr, Steyr, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Christian Eggers
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Robert Darkow
- Institute for Logopedics, FH Joanneum, University of Applied Sciences, Graz, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria. .,Faculty of Medicine, Johannes Kepler University, Linz, Austria.
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4
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Guger M, Raschbacher S, Kellermair L, Vosko MR, Eggers C, Forstner T, Leitner K, Fuchs A, Fellner F, Ransmayr G. Caregiver burden in patients with behavioural variant frontotemporal dementia and non-fluent variant and semantic variant primary progressive aphasia. J Neural Transm (Vienna) 2021; 128:1623-1634. [PMID: 34282470 PMCID: PMC8528762 DOI: 10.1007/s00702-021-02378-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
Studies on caregiver burden in patients with frontotemporal lobar degeneration are rare, differ methodologically and show variable results. Single center longitudinal pilot study on caregiver burden and potential risk factors in patients with behavioural variant frontotemporal dementia (bvFTD) and semantic (svPPA) and non-fluent variants (nfvPPA) primary progressive aphasia. Forty-six bvFTD, nine svPPA, and six nfvPPA patients and caring relatives were analysed for up to 2 years using the Mini-Mental State Examination as global measure for cognitive performance, Frontal Assessment Battery (frontal lobe functions), Frontal Behavioural Inventory (personality and behaviour), Neuropsychiatric Inventory (dementia-related neuropsychiatric symptoms), Barthel Index and Lawton IADL Scale (basic and instrumental activities of daily living), the Caregiver Strain Index (CSI), and in most participants also the Zarit Burden Interview (ZBI). CSI baseline sum scores were highest in bvFTD (mean ± SD 5.5 ± 3.4, median 5, IQR 6), intermediate in svPPA (2.9 ± 2.3; 3; 3.5) and low in nfvPPA (1.6 ± 2.1; 1; 2). Similar differences of caregiver burden were found using the ZBI. During follow-up, CSI and ZBI sum scores deteriorated in svPPA, not in bvFTD and nfvPPA, and correlated significantly with personality and behaviour, neuropsychiatric symptoms, caregiver age, and instrumental, but not basic activities of daily living, Mini-Mental State Examination scores or frontal lobe functions. This study reveals differences in caregiver burden in variants of frontotemporal lobar degeneration. Caregivers should be systematically asked for caregiver burden from the time of the diagnosis to provide comprehensive support in time.
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Affiliation(s)
- Michael Guger
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Stefan Raschbacher
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
| | - Lukas Kellermair
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Milan R Vosko
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Christian Eggers
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Thomas Forstner
- Department of Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria
| | - Karin Leitner
- Clinical and Health Psychology Unit, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Alexandra Fuchs
- Clinical and Health Psychology Unit, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Franz Fellner
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Central Radiology Institute, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria.
- Medical Faculty, Johannes Kepler University, Linz, Austria.
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5
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Eggers C, Kopatz V, Dörr W, Lassmann H, Geinitz H. Localised multiple sclerosis-like disease after irradiation of the cervicothoracic spinal cord. Mult Scler Relat Disord 2020; 45:102443. [PMID: 32827971 DOI: 10.1016/j.msard.2020.102443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radiation has been discussed as a potential causative factor for Multiple Sclerosis (MS). However, it is unresolved whether radiation increases the aggressiveness of the immune system or whether it alters the nervous tissue to become vulnerable to a pre-existing autoimmune attackdisposition. We report a patient with an MS-like disease confined to the irradiated part of his central nervous system (CNS). CASE REPORT within the course of a year, a 29 year-old man developed three relapses that were distinguishable regarding their neurological signs and symptoms. Clinically and on MRI, all relapses were localised to the cervico-thoracic spinal cord (sensory level Th6, monoparesis right leg, sign of Lhermitte). Four years before, he had been diagnosed with supradiaphragmatic Hodgkin´s lymphoma stage IIa. Four courses of chemotherapy with the ABVD-protocol and irradiation with 29,5 Gray led to complete tumour remission. Consecutive MR-imaging of the brain and spinal cord revealed fluctuating and partially contrast-enhancing lesions exclusively in those sections of the spinal cord that were localised in the field irradiated four years before. Treatment with pulsed i.v. steroids led to improvement. CSF analysis showed mild pleocytosis and isolated oligoclonal bands. Extensive work-up for differential diagnoses was negative. Genetic sequencing for DNA repair enzymes and in-vitro assays of the patients peripheral blood mononuclear cells for increased sensitivity to irradiation was unrevealing. CONCLUSION The fact that this patients MS-like disease was strictly confined to the irradiated parts of the body suggests that the co-occurrence of Hodgkins and MS-like disease was not simple coincidence but that they are pathogenetically linked. An increased aggressiveness of the immune system caused by the radiation is an unlikely explanation as the autoimmune attack would not be expected to spare the non-radiated parts of the CNS. We propose that in our patient the nervous tissue in the radiation clinical target volume was altered by radiation. This alteration of antigenic make-up, in turn, may have enabled an MS-specific autoimmune attack by a pre-existent immunological mechanism. This hypothesis is supported by experimental studies of induction of experimental autoimmune encephalitis (EAE) in irradiated rats.
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Affiliation(s)
| | - Verena Kopatz
- Applied and Translational Radiology, Dept. Radiation Oncology, Medical University, Vienna, Austria
| | - Wolfgang Dörr
- Applied and Translational Radiology, Dept. Radiation Oncology, Medical University, Vienna, Austria
| | - Hans Lassmann
- Department of Neuroimmunology, Medical University, Vienna, Austria
| | - Hans Geinitz
- Dept. of Radiation Oncology, Ordensklinikum Linz, Linz, Austria
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Walleczek NK, Frommlet F, Bsteh G, Eggers C, Rauschka H, Koppi S, Assar H, Ehling R, Birkl C, Salhofer-Polanyi S, Baumgartner A, Blechinger S, Buchinger D, Sellner J, Kraus J, Moser H, Mayr M, Guger M, Rathmaier S, Raber B, Liendl H, Hiller MS, Parigger S, Morgenstern G, Kempf I, Spiss HK, Meister B, Heine M, Cisar A, Bachler H, Khalil M, Fuchs S, Enzinger C, Fazekas F, Leutmezer F, Berger T, Kristoferitsch W, Aboulenein-Djamshidian F. Month-of-birth-effect in multiple sclerosis in Austria. Mult Scler 2018; 25:1870-1877. [PMID: 30463473 DOI: 10.1177/1352458518810924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The month-of-birth-effect (MoBE) describes the finding that multiple sclerosis (MS) patients seem to have been born significantly more frequently in spring, with a rise in May, and significantly less often in autumn and winter with the fewest births in November. OBJECTIVES To analyse if the MoBE can also be found in the Austrian MS population, and if so, whether the pattern is similar to the reported pattern in Canada, United Kingdom, and some Scandinavian countries. METHODS The data of 7886 MS patients in Austria were compared to all live births in Austria from 1940 to 2010, that is, 7.256545 data entries of the Austrian birth registry and analysed in detail. RESULTS Patterns observed in our MS cohort were not different from patterns in the general population, even when stratifying for gender. However, the noticeable and partly significant ups and downs over the examined years did not follow the distinct specific pattern with highest birth rates in spring and lowest birth rates in autumn that has been described previously for countries above the 49th latitude. CONCLUSION After correcting for month-of-birth patterns in the general Austrian population, there is no evidence for the previously described MoBE in Austrian MS patients.
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Affiliation(s)
- Nina-Katharina Walleczek
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Eggers
- Department of Neurology, Krankenhaus der Barmherzigen Brüder Linz, Linz, Austria
| | - Helmut Rauschka
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria/Department of Neurology, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Stefan Koppi
- Department of Neurology, Landeskrankenhaus Rankweil, Rankweil, Austria
| | - Hamid Assar
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | - Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Christoph Birkl
- Department of Neurology, Medical University Graz, Graz, Austria
| | | | - Anna Baumgartner
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | | | | | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
| | - Jörg Kraus
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany/Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
| | | | - Markus Mayr
- Department of Neurology, Bezirkskrankenhaus Kufstein, Austria
| | - Michael Guger
- Clinic for Neurology 2, Kepler University Clinic, Linz, Austria
| | | | - Bettina Raber
- Departement of Neurology, LKH Murtal Standort Knittelfeld
| | - Herburg Liendl
- Departement of Neurology, LKH Murtal Standort Knittelfeld
| | - Maria-Sophie Hiller
- Department of Neurology, Sozialmedizinisches Zentrum Baumgartner-Höhe-Otto-Wagner-Spital, Vienna, Austria
| | | | | | - Ines Kempf
- Department of Gerontoneurology / Neurological Rehabilitation, Haus der Barmherzigkeit, Vienna, Austria
| | | | - Birgit Meister
- Department of Neurology, Landeskrankenhaus Feldbach-Fürstenfeld, Austria
| | - Martin Heine
- Department of Neurology, Landeskrankenhaus Feldbach-Fürstenfeld, Austria
| | | | | | - Michael Khalil
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Siegrid Fuchs
- Department of Neurology, Medical University Graz, Graz, Austria
| | | | - Franz Fazekas
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Kristoferitsch
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Fahmy Aboulenein-Djamshidian
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria/Department of Neurology, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
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Fosmire ST, Gibson GN, Copeland JC, Maydew MS, Eggers C. Pulmonary Infarction: Right Upper Quadrant Pain as a Presenting Symptom With Review of Typical Computed Tomography Imaging Features. Mil Med 2018; 183:e779-e782. [DOI: 10.1093/milmed/usy128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Steven T Fosmire
- Department of Aerospace Medicine, Aerospace Medicine Clinic, BLDG 830, 100th Air Refueling Wing, RAF Mildenhall, APO, AE
| | - Guy N Gibson
- Department of Diagnostic Radiology, 55th Medical Group, Erhling Bergquist Clinic, 2501 Capehart Rd, Offutt AFB, NE
| | - John C Copeland
- Department of Aerospace Medicine, 19th Medical Group, 1090 Arnold Dr., Little Rock AFB, Jacksonville, AR
| | - Marcus S Maydew
- Department of Diagnostic Radiology, 55th Medical Group, Erhling Bergquist Clinic, 2501 Capehart Rd, Offutt AFB, NE
| | - Christian Eggers
- Visual Communication Design, University of Northern Colorado, 501 20th Street, Greeley, CO
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Husstedt IW, Maschke M, Eggers C, Neuen-Jacob E, Arendt G. [Zika virus infection and the nervous system]. Nervenarzt 2018; 89:136-143. [PMID: 29318332 DOI: 10.1007/s00115-017-0472-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zika virus is an arbovirus from the family of flaviviruses, which is transmitted by the mosquito Aedes aegyptii and also by the Asian mosquito Aedes albopticus. The largest observed Zika virus epidemic is currently taking place in North and South America, in the Caribbean, southern USA and Southeast Asia. In most cases the infection is an unspecific, acute, febrile disease. Neurological manifestations consist mainly of microcephaly in newborns and Guillain-Barré syndrome but other rare manifestations have also become known in the meantime, such as meningoencephalitis and myelitis. Therefore, the Zika virus, similar to other flaviviruses, has neuropathogenic properties. In particular, the drastic increase in microcephaly cases in Brazil has induced great research activities. The virus is transmitted perinatally and can be detected in the amniotic fluid, placenta and brain tissue of the newborn. Vaccination or a causal therapy does not yet exist. The significant increase in Guillain-Barré syndrome induced by the Zika virus was observed during earlier outbreaks. In the meantime, scientifically clear connections between a Zika virus infection and these neurological manifestations have been shown. Long-term studies and animal models should be used for a better understanding of the pathomechanisms of this disease.
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Affiliation(s)
- I W Husstedt
- Klinik Maria Frieden und Medizinische Fakultät, Westfälische Wilhelms-Universität Münster, Am Krankenhaus 1, 48291, Telgte, Deutschland.
| | - M Maschke
- Klinik für Neurologie, Krankenhaus der Barmherzigen Brüder, Trier, Deutschland
| | - C Eggers
- Krankenhaus der Barmherzigen Brüder, Linz, Österreich
| | - E Neuen-Jacob
- Institut für Neuropathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - G Arendt
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Eggers C, Holstein A, Schneider C, Pedrosa DJ, Dietlein M, Kobe C, Timmermann L, Schmidt M, Kahraman D. 123I-FP-CIT SPECT imaging of the dopaminergic state. Nuklearmedizin 2017; 51:244-51. [DOI: 10.3413/nukmed-0449-11-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 04/17/2012] [Indexed: 11/20/2022]
Abstract
Summary123I-N-ω-fluoropropyl-2β-carbomethoxy-3β- (4-iodophenyl)nortropan (123I-FP-CIT) single photon emission computed tomography (SPECT) can be evaluated by both visual assessment and quantitative analysis to assess the striatal dopamine state in vivo. The aim of our study was to investigate if visual assessment according to a predefined image grading scale reflects the results of quantitative assessment techniques. Patients, methods: 195 patients with a clinical diagnosis of idiopathic Parkinson's disease (n = 134), atypical parkinsonian syndrome (n = 47) or essential tremor (n = 14) were examined with 123I-FP-CIT SPECT and included in this retrospective study. Results were analysed according to predefined visual patterns of dopaminergic degeneration and graded as normal (grade 5) or abnormal (grade 1–4) independently by three raters. Quantitative two-dimensional (2D) operator-dependent, manual and three-dimensional (3D) operator- independent, automated approaches were used for quantitative analysis of the specific 123I-FP-CIT tracer binding ratio (SBR) for caudate and putamen. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of visual assessment of 123I-FP-CIT SPECT for the diagnosis of a neuro degenerative Parkinson's syndrome were 99%, 86%, 99%, 86% and 98%, respectively. Visual assessment and quantitative analysis agreed well in evaluating the degree of dopaminergic degeneration. Significant differences (p < 0.001) were found between degeneration patterns. Only between the so-called eagle wing degeneration and the normal pattern no significant differences in SBR caudate and putamen were found, neither by the quantitative manual (p = 1.00; p = 0.196) nor by the quantitative automated method (p = 1.0; p = 0.785). Inter-rater agreement for visual assessment was substantial for all possible pairs of the three raters (κ = 0.70 to 0.74). Strong correlations were observed between the quantitative manual and quantitative automated methods for quantification of SBR caudatum (r = 0.920, r2 = 0.846, p < 0.001) and SBR putamen (r = 0.908, r2 = 0.824, p < 0.001). Conclusion: Visual assessment was highly consistent with the results obtained by quantitative analysis and showed a substantial inter-rater agreement between experienced and inexperienced raters. Our findings indicate that visual assessment might be a reliable analysis approach for clinical routine.
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Eggers C, Arendt G, Hahn K, Husstedt IW, Maschke M, Neuen-Jacob E, Obermann M, Rosenkranz T, Schielke E, Straube E. HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. J Neurol 2017; 264:1715-1727. [PMID: 28567537 PMCID: PMC5533849 DOI: 10.1007/s00415-017-8503-2] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 01/05/2023]
Abstract
The modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. With the exception of the most severe dementia manifestations, the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) have not decreased, and HAND continues to be relevant in daily clinical practice. Now, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the widespread use of combination antiretroviral treatment (cART). The predominant clinical feature is a subcortical dementia with deficits in the domains concentration, attention, and memory. Motor signs such as gait disturbance and impaired manual dexterity have become less prominent. Prior to the advent of cART, the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In subjects where cART has led to undetectable or at least very low viral load, the pathogenic virus-brain interaction is less direct, and an array of poorly understood immunological and probably toxic phenomena are discussed. This paper gives an overview of the current concepts in the field of HAND and provides suggestions for the diagnostic and therapeutic management.
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Affiliation(s)
- Christian Eggers
- Department of Neurology, Krankenhaus Barmherzige Brüder, Seilerstätte 2, 4021, Linz, Austria.
| | - Gabriele Arendt
- Neurologische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Katrin Hahn
- Neurologische Klinik, Charité, Berlin, Germany
| | - Ingo W Husstedt
- Klinik für Neurologie, Universitätsklinikum Münster, Münster, Germany
| | - Matthias Maschke
- Neurologische Abteilung, Brüderkrankenhaus Trier, Trier, Germany
| | - Eva Neuen-Jacob
- Institut für Neuropathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Mark Obermann
- Direktor des Zentrums für Neurologie, Asklepios Kliniken Schildautal, Seesen, Germany
| | - Thorsten Rosenkranz
- Neurologische Abteilung, Asklepios-Klinik Hamburg-St. Georg, Hamburg, Germany
| | - Eva Schielke
- Praxis für Neurologie Berlin-Mitte, 10117, Berlin, Germany
| | - Elmar Straube
- HIV-Schwerpunktpraxis, 30890, Barsinghausen, Germany
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11
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Dieplinger B, Bocksrucker C, Egger M, Eggers C, Haltmayer M, Mueller T. Prognostic Value of Inflammatory and Cardiovascular Biomarkers for Prediction of 90-Day All-Cause Mortality after Acute Ischemic Stroke—Results from the Linz Stroke Unit Study. Clin Chem 2017; 63:1101-1109. [DOI: 10.1373/clinchem.2016.269969] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/24/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Early outcome prediction after acute ischemic stroke is of great interest. The aim of our study was to evaluate the prognostic value of blood biomarkers in patients with acute ischemic stroke.
METHODS
We measured interleukin-6 (IL-6), d-dimer, amino-terminal pro–B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T, and soluble ST2 plasma concentrations within 24 h after admission to our stroke unit in 721 consecutive acute ischemic stroke patients. End point was 90-day all-cause mortality.
RESULTS
During follow-up 81 patients died (11%). In univariate Cox proportional hazards regression analyses with the biochemical markers dichotomized according to median values, all baseline blood biomarkers were strong prognostic markers. However, in the multivariate analysis after adjustment for several clinical variables and the NIH Stroke Scale (NIHSS), only NIHSS >3 [risk ratio (RR) 7.87, 95% CI, 3.61–17.16; P < 0.001], IL-6 > 7 pg/mL (RR 4.09, 95% CI, 2.02–8.29; P < 0.001), and NT-proBNP >447 ng/L (RR 4.88, 95% CI, 2.41–9.88; P < 0.001) remained independent predictors. Using a simple multimarker approach combining these 3 complementary markers, we demonstrated that patients with increased NIHSS, IL-6, and NT-proBNP had the poorest outcome with a mortality rate of 38%, whereas no patient with negative readings for all 3 markers died during follow-up.
CONCLUSIONS
In this large cohort of patients with acute ischemic stroke, IL-6 and NT-proBNP at admission were strong and independent prognostic markers for 90-day all-cause mortality, and provided complementary prognostic information to the routinely used stroke severity score NIHSS.
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Affiliation(s)
| | | | | | - Christian Eggers
- Neurology, Konventhospital Barmherzige Brueder Linz, Linz, Austria
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12
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Hahn K, Maschke M, Eggers C, Husstedt IW, Arendt G. [Update HIV and neurology]. Dtsch Med Wochenschr 2015; 141:51-7. [PMID: 26710206 DOI: 10.1055/s-0041-102893] [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: 10/22/2022]
Abstract
With modern antiretroviral drug regimens, HIV-infected people are living longer and HIV has transformed into a chronic illness. The review summarizes pathophysiological as well as clinical aspects of a chronic infection from a neurological point of view including neurocognitive impairment, depression, neuropathies and myopathies. It also draws attention to comorbidities such as syphilis and hepatitis C. They are of particular neurological interest because of the interaction of the pathogens.
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13
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Markser A, Maier F, Lewis CJ, Dembek TA, Pedrosa D, Eggers C, Timmermann L, Kalbe E, Fink GR, Burghaus L. Deep brain stimulation and cognitive decline in Parkinson's disease: The predictive value of electroencephalography. J Neurol 2015; 262:2275-84. [PMID: 26159102 DOI: 10.1007/s00415-015-7839-8] [Citation(s) in RCA: 13] [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: 06/09/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
Some Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) develop new-onset cognitive decline. We examined whether clinical EEG recordings can be used to predict cognitive deterioration in PD patients undergoing STN-DBS. In this retrospective study, we used the Grand Total EEG (GTE)-score (short and total) to evaluate pre- and postoperative EEGs. In PD patients undergoing STN-DBS (N = 30), cognitive functioning was measured using Mini-Mental State Test and DemTect before and after surgery. Severity of motor impairment was assessed using the Unified Parkinson's Disease Rating Scale-III. Patients were classified into patients with or without cognitive decline after STN-DBS surgery. Epidemiological data, pre- and postoperative EEG recordings as well as neuropsychological and neurological data, electrode positions and the third ventricle width were compared. A logistic regression model was used to identify predictors of cognitive decline. Motor deficits significantly improved from pre- to post-surgery, while the mean GTE-scores increased significantly. Six patients developed cognitive deterioration 4-12 months postoperatively. These patients had significantly higher preoperative GTE-scores than patients without cognitive deterioration, although preoperative cognitive functioning was comparable. Electrode positions, brain atrophy and neurological data did not differ between groups. Logistic regression analysis identified the GTE-score as a significant predictor of postoperative cognitive deterioration. Data suggest that the preoperative GTE-score can be used to identify PD patients that are at high risk for developing cognitive deterioration after STN-DBS surgery even though their preoperative cognitive state was normal.
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Affiliation(s)
- A Markser
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - Franziska Maier
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.
| | - C J Lewis
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - T A Dembek
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - D Pedrosa
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - C Eggers
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - L Timmermann
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - E Kalbe
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.,Institute of Gerontology, Psychological Gerontology and Center for Neuropsychological Diagnostics and Intervention, University of Vechta, Vechta, Germany
| | - G R Fink
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Juelich, Juelich, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
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Lewis CJ, Maier F, Horstkötter N, Zywczok A, Witt K, Eggers C, Meyer TD, Dembek TA, Maarouf M, Moro E, Zurowski M, Woopen C, Kuhn J, Timmermann L. Subjectively perceived personality and mood changes associated with subthalamic stimulation in patients with Parkinson's disease. Psychol Med 2015; 45:73-85. [PMID: 25066623 DOI: 10.1017/s0033291714001081] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Clinical and ethical implications of personality and mood changes in Parkinson's disease (PD) patients treated with subthalamic deep brain stimulation (STN-DBS) are under debate. Although subjectively perceived personality changes are often mentioned by patients and caregivers, few empirical studies concerning these changes exist. Therefore, we analysed subjectively perceived personality and mood changes in STN-DBS PD patients. METHOD In this prospective study of the ELSA-DBS group, 27 PD patients were assessed preoperatively and 1 year after STN-DBS surgery. Two categories, personality and mood changes, were analysed with semi-structured interviews. Patients were grouped into personality change yes/no, as well as positive/negative mood change groups. Caregivers were additionally interviewed about patients' personality changes. Characteristics of each group were assessed with standard neurological and psychiatric measurements. Predictors for changes were analysed. RESULTS Personality changes were perceived by six of 27 (22%) patients and by 10 of 23 caregivers (44%). The preoperative hypomania trait was a significant predictor for personality change perceived by patients. Of 21 patients, 12 (57%) perceived mood as positively changed. Higher apathy and anxiety ratings were found in the negative change group. CONCLUSIONS Our results show that a high proportion of PD patients and caregivers perceived personality changes under STN-DBS, emphasizing the relevance of this topic. Mood changed in positive and negative directions. Standard measurement scales failed to adequately reflect personality or mood changes subjectively perceived by patients. A more individualized preoperative screening and preparation for patients and caregivers, as well as postoperative support, could therefore be useful.
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Affiliation(s)
- C J Lewis
- Department of Neurology,University of Cologne,Cologne,Germany
| | - F Maier
- Department of Neurology,University of Cologne,Cologne,Germany
| | - N Horstkötter
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - A Zywczok
- Department of Neurology,University of Cologne,Cologne,Germany
| | - K Witt
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - C Eggers
- Department of Neurology,University of Cologne,Cologne,Germany
| | - T D Meyer
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - T A Dembek
- Department of Neurology,University of Cologne,Cologne,Germany
| | - M Maarouf
- Department of Stereotaxy and Functional Neurosurgery,University of Cologne,Cologne,Germany
| | - E Moro
- Movement Disorders Unit, Department of Psychiatry and Neurology,University Hospital Center (CHU) of Grenoble,Grenoble,France
| | - M Zurowski
- Department of Psychiatry,University of Toronto, University Health Network,Toronto,Canada
| | - C Woopen
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - J Kuhn
- Department of Psychiatry and Psychotherapy,University of Cologne,Cologne,Germany
| | - L Timmermann
- Department of Neurology,University of Cologne,Cologne,Germany
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Eggers C, Müller J, Schultze-Mosgau S. VEGF transfer based on gene-modified fibroblasts using a hypoxia-induced vector to modulate neoangiogenesis in ischaemic regions of myocutaneous transplants. Int J Oral Maxillofac Surg 2014; 44:267-76. [PMID: 25441860 DOI: 10.1016/j.ijom.2014.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/14/2013] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Abstract
The effect of a hypoxia-inducible VEGF-expressing on wound healing in an ischaemic hind leg rat model was evaluated in this study. 180 Wistar rats were assigned randomly to three groups. After ligation of the femoral artery, group 1 received pRTP801-VEGF165, group 2 untransfected fibroblasts, group 3 saline; injection was into the subcutaneous tissue, proximal and distal to the artery ligation. Biopsy specimens were obtained on days 3, 5, 7, 14 after implementation. VEGF transgene expression, vessel architecture, the amount and total area of vessel formation were investigated. Results showed a significantly higher level of VEGF protein expression in group 1 compared to group 2 (P≤0.001) throughout the investigational period. Group 1 exhibited a significant growth of CD31-positive blood vessels in the subcutaneous tissue on day 14 compared to groups 2 and 3 (P≤0.001) (group 1, 62.20±1.92; group 2, 20.60±1.67; group 3, 12.40±1.14). Alpha-SMA-positive staining also showed significant vessel growth in group 1 on day 5 (group 1, 27.00±1.87; group 2, 7.20±1.48; group 3, 10.00±1.73). These results were confirmed in the distal muscle tissue. No significant results were obtained for the proximal muscle tissue. The subcutaneous application of pRTP801-VEGF165 showed a long-lasting effect, with an increased expression of VEGF over the entire observation period. It appears that the use of fibroblasts transfected with VEGF is a promising way to increase early angiogenesis in ischaemic tissue.
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Affiliation(s)
- C Eggers
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany.
| | - J Müller
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany
| | - S Schultze-Mosgau
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany
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Nilsson J, Schoser B, Laforet P, Kalev O, Lindberg C, Romero NB, Dávila López M, Akman HO, Wahbi K, Iglseder S, Eggers C, Engel AG, Dimauro S, Oldfors A. Polyglucosan body myopathy caused by defective ubiquitin ligase RBCK1. Ann Neurol 2014; 74:914-9. [PMID: 23798481 DOI: 10.1002/ana.23963] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/20/2013] [Accepted: 06/07/2013] [Indexed: 12/25/2022]
Abstract
Glycogen storage diseases are important causes of myopathy and cardiomyopathy. We describe 10 patients from 8 families with childhood or juvenile onset of myopathy, 8 of whom also had rapidly progressive cardiomyopathy, requiring heart transplant in 4. The patients were homozygous or compound heterozygous for missense or truncating mutations in RBCK1, which encodes for a ubiquitin ligase, and had extensive polyglucosan accumulation in skeletal muscle and in the heart in cases of cardiomyopathy. We conclude that RBCK1 deficiency is a frequent cause of polyglucosan storage myopathy associated with progressive muscle weakness and cardiomyopathy.
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Affiliation(s)
- Johanna Nilsson
- Department of Pathology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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Eggers C, Müller O, Thordsen I, Schreiber M, Methner A. Genetic shift of env V3 loop viral sequences in patients with HIV-associated neurocognitive disorder during antiretroviral therapy. J Neurovirol 2013; 19:523-30. [PMID: 24101298 DOI: 10.1007/s13365-013-0207-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/10/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
Abstract
The development of human immunodeficiency virus type 1 (HIV)-associated neurocognitive disorder (HAND) involves the adaptation of viral sequences coding for the V3 loop of the env protein. The plasma and cerebrospinal fluid (CSF) may contain viral populations from various cellular sources and with differing pathogenicity. Combination antiretroviral therapy (cART) may alter the relative abundance of these viral populations, leading to a genetic shift. We characterized plasma and CNS viral populations prior to and during cART and relate the findings to viral elimination kinetics and the clinical phenotype. Longitudinal plasma and CSF samples of five chronically infected HIV patients, four of whom had HAND, and one seroconverter were analyzed for V3 sequences by RT-PCR and sequence analysis. In the chronically infected patients, pre-cART plasma and CSF viral sequences were different irrespective of viral elimination kinetics and clinical phenotype. cART induced replacement of plasma viral populations in all subjects. CSF viral populations underwent a clear genetic shift in some patients but remained stable in others. This was not dependent on the presence of HAND. The genetic shift of CSF V3 sequences was absent in the two subjects whose CSF viral load initially increased during cART. In one patient, pre- and post-treatment CSF sequences were closely related to the post-treatment plasma sequences, suggesting a common cellular source. We found heterogeneous patterns of genetic compartmentalization and genetic shift over time. Although these did not closely match viral elimination kinetics and clinical phenotype, the results imply different patterns of the dynamics and relative contribution of compartment-specific virus populations in chronic HIV infection.
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Affiliation(s)
- Christian Eggers
- Department of Neurology, Krankenhaus der Barmherzigen Brüder, 4020, Linz, Austria,
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18
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Schwartz F, Tang C, Eidelberg D, Timmermann L, Eggers C. Bildgebende Differenzierung von Subtypen des Morbus Parkinson mittels Multitracer-Positronen-Emissions-Tomografie (PET). KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337292] [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: 10/27/2022]
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Seiler S, Schmidt H, Lechner A, Benke T, Sanin G, Ransmayr G, Lehner R, Dal-Bianco P, Santer P, Linortner P, Eggers C, Haider B, Uranues M, Marksteiner J, Leblhuber F, Kapeller P, Bancher C, Schmidt R. Driving cessation and dementia: results of the prospective registry on dementia in Austria (PRODEM). PLoS One 2012; 7:e52710. [PMID: 23300746 PMCID: PMC3530518 DOI: 10.1371/journal.pone.0052710] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the influence of cognitive, functional and behavioral factors, co-morbidities as well as caregiver characteristics on driving cessation in dementia patients. METHODS The study cohort consists of those 240 dementia cases of the ongoing prospective registry on dementia in Austria (PRODEM) who were former or current car-drivers (mean age 74.2 (±8.8) years, 39.6% females, 80.8% Alzheimer's disease). Reasons for driving cessation were assessed with the patients' caregivers. Standardized questionnaires were used to evaluate patient- and caregiver characteristics. Cognitive functioning was determined by Mini-Mental State Examination (MMSE), the CERAD neuropsychological test battery and Clinical Dementia Rating (CDR), activities of daily living (ADL) by the Disability Assessment for Dementia, behavior by the Neuropsychiatric Inventory (NPI) and caregiver burden by the Zarit burden scale. RESULTS Among subjects who had ceased driving, 136 (93.8%) did so because of "Unacceptable risk" according to caregiver's judgment. Car accidents and revocation of the driving license were responsible in 8 (5.5%) and 1(0.7%) participant, respectively. Female gender (OR 5.057; 95%CI 1.803-14.180; p = 0.002), constructional abilities (OR 0.611; 95%CI 0.445-0.839; p = 0.002) and impairment in Activities of Daily Living (OR 0.941; 95%CI 0.911-0.973; p<0.001) were the only significant and independent associates of driving cessation. In multivariate analysis none of the currently proposed screening tools for assessment of fitness to drive in elderly subjects including the MMSE and CDR were significantly associated with driving cessation. CONCLUSION The risk-estimate of caregivers, but not car accidents or revocation of the driving license determines if dementia patients cease driving. Female gender and increasing impairment in constructional abilities and ADL raise the probability for driving cessation. If any of these factors also relates to undesired traffic situations needs to be determined before recommendations for their inclusion into practice parameters for the assessment of driving abilities in the elderly can be derived from our data.
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Affiliation(s)
- Stephan Seiler
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Helena Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
- Institute of Molecular Biology and Biochemistry, Centre for Molecular Medicine, Medical University of Graz, Graz, Austria
| | - Anita Lechner
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Guenter Sanin
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Riccarda Lehner
- Department of Neurology, General Hospital Linz, Linz, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Santer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Patricia Linortner
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Christian Eggers
- Department of Neurology, Konventhospital der Barmherzigen Brüder Linz, Linz, Austria
| | - Bernhard Haider
- Department of Neurology, Konventhospital der Barmherzigen Brüder Linz, Linz, Austria
| | - Margarete Uranues
- Department of Geriatric Psychiatry, Landesnervenklinik Sigmund Freud Graz, Graz, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Friedrich Leblhuber
- Department of Neurology and Geriatric Psychiatry, Nervenklinik Wagner-Jauregg Linz, Linz, Austria
| | - Peter Kapeller
- Department of Neurology and Psychosomatic Medicine, Regional Hospital Villach, Villach, Austria
| | | | - Reinhold Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
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Kopish K, Hall M, Binkowski B, Valley M, Butler B, Machleidt T, Robers M, Eggers C, Encell L, Wood K. 188 NanoLuc: a Smaller, Brighter, and More Versatile Luciferase Reporter. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71986-x] [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: 12/01/2022]
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21
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Timmermann L, Eggers C, Salimi Dafsari H, Pauls K, Barbe M. Morbus Parkinson: Aktuelle Standards in Diagnostik und Therapie. Fortschr Neurol Psychiatr 2012; 80:560-9. [DOI: 10.1055/s-0032-1312738] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- L. Timmermann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
| | - C. Eggers
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
| | | | - K. Pauls
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
| | - M. Barbe
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
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Eggers C, Pedrosa DJ, Kahraman D, Maier F, Lewis C, Fink GR, Schmidt M, Timmermann L. Serial dopamine-transporter imaging of Parkinson's disease: faster progression of clinical and in-vivo patterns in akinetic-rigid patients. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301622] [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: 10/28/2022]
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Burghaus L, Liu WC, Eggers C, Dohmen C, Haupt WF, Fink GR. Prognostic value of electroencephalography and evoked potentials in the early course of malignant middle cerebral artery infarction. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301575] [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: 10/28/2022]
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Kahraman D, Eggers C, Timmermann L, Schmidt M. Visual assessment of degeneration pattern in 123I-FP-CIT SPECT differentiates patients with atypical parkinsonism and Parkinson's disease. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301620] [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: 10/28/2022]
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Taliaferro-Smith LD, Oberlick EM, Liu T, Eggers C, Kline ER, Nagaraju GPC, Marcus A, O'Regan R. P1-02-06: Silencing of IGF-1R Has Paradoxical Effects in Triple Negative Breast Cancer Phenotypes. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple negative (TN) breast cancers are a heterogeneous group of breast cancers with a poor prognosis in part due to a lack of effective targeted agents. Insulin-like growth factor-1 receptor (IGF-1R) has been shown to play a role in breast cancer cell proliferation, adhesion, invasion, and migration and is overexpressed in more than a third of TN breast tumors. We hypothesized that IGF-1R could be a therapeutic target for a subset of TN breast cancers. Methods: We evaluated the effects of IGF-1R silencing on the metastatic properties of TN breast cancer cells by knock down in two morphologically distinct TN breast cancer cell lines using shRNA lentiviral techniques. Reverse-transcription polymerase chain reaction (RT-PCR) and immunoblotting were used to detect mRNA and protein expression levels, respectively, of IGF-1R signaling molecules. Anchorage-dependent growth and Matrigel chamber assays were performed to assess the effects of IGF-1R silencing on colony formation and invasion of TN breast cancer cells, respectively; wound-healing and spheroid migration were also performed to assess the effects of IGF-1R inhibition on TN breast cancer cell motility. Results: Stably transfected mesenchymal MDA-MB-231 TN cells showed effective downregulation of IGF-1R protein expression, which resulted in mesenchymal-to-epithelial transition (MET), confirmed by upregulation of the epithelial marker E-cadherin and downregulation of the mesenchymal marker vimentin. Importantly, this MET resulted in reduced colony formation (p<0.0042) and cell motility and dramatically reduced invasion (p<0.0001). Conversely, silencing of IGF-1R in epithelial MDA-MB-468 TN cells induced epithelial-to-mesenchymal transition (EMT), confirmed by downregulation of E-cadherin and upregulation of vimentin expression, with resultant increased colony formation (p<0.006), cell motility, and invasion (p<0.0001). Conclusion: Collectively, these results demonstrate a paradoxical effect of targeting IGF-1R in TN breast cancers of mesenchymal and epithelial origin. Targeting IGF-1R in TN breast cancers with a mesenchymal phenotype decreases invasion and metastatic potential. In contrast, targeting IGF-1R in TN breast cancers with an epithelial phenotype could have potentially detrimental effects. Our data suggest that IGF-1R inhibition should be explored as a therapeutic modality in TN breast cancers with a mesenchymal phenotype.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-02-06.
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Affiliation(s)
- LD Taliaferro-Smith
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - EM Oberlick
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - T Liu
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - C Eggers
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - ER Kline
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - GPC Nagaraju
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - A Marcus
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - R O'Regan
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
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Diels A, Pfeifenbring S, Eggers C, Galldiks N, Fink GR, Burghaus L. [Diagnostic work-up in Whipple's disease with cerebral involvement]. Fortschr Neurol Psychiatr 2011; 79:298-303. [PMID: 21544762 DOI: 10.1055/s-0031-1273232] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The diagnostic work-up in the case of a suspected cerebral involvement of Whipple's disease involves neuroimaging and analysis of cerebrospinal fluid (CSF) including polymerase chain reaction (PCR) assays for Tropheryma whipplei. As neurological findings may be complex and unspecific, extracerebral symptoms often lead to the suspicion of Whipple's disease. We report the cases of two patients in whom the suspected diagnosis of Whipple's disease could not be proved either by endoscopy or by the analysis of CSF. Only by means of a cerebral biopsy was the diagnosis assumed and specific therapy was initiated.
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Affiliation(s)
- A Diels
- Klinik und Poliklinik für Neurologie, Uniklinik Köln.
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Eggers C. [Juvenile schizophrenia: diagnosis, therapy, prognosis]. MMW Fortschr Med 2011; 153:73-75. [PMID: 21966876 DOI: 10.1007/bf03368109] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Christian Eggers
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters Rheinische Kliniken Essen.
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Duddy M, Haghikia A, Cocco E, Eggers C, Drulovic J, Carmona O, Zéphir H, Gold R. Managing MS in a changing treatment landscape. J Neurol 2011; 258:728-39. [DOI: 10.1007/s00415-011-6009-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 03/04/2011] [Accepted: 03/10/2011] [Indexed: 01/19/2023]
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Eggers C, Kahraman D, Fink G, Schmidt M, Timmermann L. P145 Akinetic-rigid and tremor-dominant Parkinson’s disease patients show different patterns of FP-CIT SPECT. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.baga.2011.01.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sommer R, Überall B, Eggers C. Botulinumneurotoxin-A (BoNT-A) Injektion in den oberen Ösophagussphinkter (OÖS) bei oropharyngealer Dysphagie durch Einschlusskörperchenmyositis (IBM) - ein Fallbericht. Akt Neurol 2011. [DOI: 10.1055/s-0031-1276564] [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: 10/18/2022]
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Eggers C, Liu W, Brinker G, Fink GR, Burghaus L. Do negative CCT and CSF findings exclude a subarachnoid haemorrhage? A retrospective analysis of 220 patients with subarachnoid haemorrhage. Eur J Neurol 2011; 18:300-305. [DOI: 10.1111/j.1468-1331.2010.03168.x] [Citation(s) in RCA: 9] [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: 01/23/2023]
Affiliation(s)
- C. Eggers
- Department of Neurology, University Hospital Cologne, Cologne
| | - W. Liu
- Department of Neurology, University Hospital Cologne, Cologne
| | - G. Brinker
- Department of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - G. R. Fink
- Department of Neurology, University Hospital Cologne, Cologne
| | - L. Burghaus
- Department of Neurology, University Hospital Cologne, Cologne
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Burghaus L, Liu W, Fink GR, Eggers C. [Acute headache: limitations of cerebral computed tomography and analysis of cerebrospinal fluid in the diagnosis of subarachnoid haemorrhage]. Fortschr Neurol Psychiatr 2010; 79:41-5. [PMID: 21128197 DOI: 10.1055/s-0029-1245780] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Subarachnoid haemorrhage constitutes a neurological emergency. In most cases the diagnosis is easy to establish by cerebral computed tomography or cerebrospinal fluid tap. However, in rare cases verification of the diagnosis is more difficult and a residual uncertainty remains. We describe three patients supposed to have a subarachnoid haemorrhage without pathological findings in both cerebral computed tomography and cerebrospinal fluid. In these cases vasospasm or cerebral aneurysm were detected by means of transcranial Doppler sonography and/or conventional angiography. We comment on the special features of this rare presentation of a severe acute neurological emergency, and we discuss diagnostic work-up and differential diagnoses.
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Affiliation(s)
- L Burghaus
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln, Kerpener Strasse 62, Köln.
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Hemmerle MJ, Röpcke B, Eggers C, Oades RD. [Evaluation of a two-year intensive outpatient care programme for adolescents with schizophrenia]. Z Kinder Jugendpsychiatr Psychother 2010; 38:361-9. [PMID: 20809472 DOI: 10.1024/1422-4917/a000060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Trialog project offers patients with early-onset schizophrenia (EOS) a two-year programme of residential outpatient care following discharge from a clinic. The programme aims to support their further recovery and independence and encompasses interactive and psycho-educational multifamily care, coping with persistent symptoms, development of socio-emotional competence, independent house keeping, and support of school and vocational training. METHODS To evaluate psychopathology along with social and neuropsychological function for 12 participants over a period of 2 years. Their progress was compared with that of 12 EOS patients who did not attend Trialog following discharge. RESULTS Participants showed a significantly greater decrease of positive and negative symptoms, as opposed to an increase in positive symptoms in the comparison group. Measures of social function, neuropsychological indicators of memory, (selective) attention, and psychomotor speed improved more than in the comparison subjects. Neither group showed changes in measures of intelligence or in the subjective quality of life. CONCLUSIONS First analyses raise hope that monitoring participant performance in the programme of the "Trialog project" will improve the treatment and care of EOS-patients in the critical first years following the onset of schizophrenia.
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Lackner P, Kuenz B, Reindl M, Morandell M, Berger T, Schmutzhard E, Eggers C. Antibodies to myelin oligodendrocyte glycoprotein in HIV-1 associated neurocognitive disorder: a cross-sectional cohort study. J Neuroinflammation 2010; 7:79. [PMID: 21083890 PMCID: PMC2998475 DOI: 10.1186/1742-2094-7-79] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [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: 09/20/2010] [Accepted: 11/17/2010] [Indexed: 11/12/2022] Open
Abstract
Background Neuroinflammation and demyelination have been suggested as mechanisms causing HIV-1 associated neurocognitive disorder (HAND). This cross-sectional cohort study explores the potential role of antibodies to myelin oligodendrocyte glycoprotein (MOG), a putative autoantigen in multiple sclerosis, in the pathogenesis of HAND. Methods IgG antibodies against MOG were measured by ELISA in sera and cerebrospinal fluid (CSF) of 65 HIV-positive patients with HAND (n = 14), cerebral opportunistic infections (HIVOI, n = 25), primary HIV infection (HIVM, n = 5) and asymptomatic patients (HIVasy, n = 21). As control group HIV-negative patients with bacterial or viral CNS infections (OIND, n = 18) and other neurological diseases (OND, n = 22) were included. In a subset of HAND patients MOG antibodies were determined before and during antiviral therapy. Results In serum, significantly higher MOG antibody titers were observed in HAND compared to OND patients. In CSF, significantly higher antibody titers were observed in HAND and HIVOI patients compared to HIVasy and OND patients and in OIND compared to OND patients. CSF anti-MOG antibodies showed a high sensitivity and specificity (85.7% and 76.2%) for discriminating patients with active HAND from asymptomatic HIV patients. MOG immunopositive HAND patients performed significantly worse on the HIV dementia scale and showed higher viral load in CSF. In longitudinally studied HAND patients, sustained antibody response was noted despite successful clearance of viral RNA. Conclusions Persistence of MOG antibodies despite viral clearance in a high percentage of HAND patients suggests ongoing neuroinflammation, possibly preventing recovery from HAND.
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Affiliation(s)
- Peter Lackner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Timmermann L, Maier F, Eggers C, Schmidt M, Kalbe E. Demenz bei Morbus Parkinson: Sinnvolle Diagnostik und rationale Therapie. Fortschr Neurol Psychiatr 2010; 78:513-8. [DOI: 10.1055/s-0029-1245644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Burghaus L, Kuhn J, Liu W, Eggers C, Fink GR, Dohmen C. [Thrombolytic therapy in conversion disorder with sensorimotor hemisyndrome]. Fortschr Neurol Psychiatr 2010; 78:414-418. [PMID: 20514605 DOI: 10.1055/s-0029-1245403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We here report on a 43-year-old man who was repeatedly admitted to our stroke unit with acute onset of sensorimotor hemisyndrome of acute onset. In most cases symptoms ceased shortly after admission, but twice when symptoms persisted thrombolytic therapy was applied. This case demonstrates that in emergency situations a rare differential diagnosis like conversion disorder with sensorimotor deficits may be hard to establish even if the patient presents to the same emergency unit.
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Affiliation(s)
- L Burghaus
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln, Kerpener Strasse 62, Köln.
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Eggers C, Schmidt A, Hagenah J, Brüggemann N, Klein JC, Tadic V, Kertelge L, Kasten M, Binkofski F, Siebner H, Neumaier B, Fink GR, Hilker R, Klein C. Progression of subtle motor signs in PINK1 mutation carriers with mild dopaminergic deficit. Neurology 2010; 74:1798-805. [PMID: 20513816 DOI: 10.1212/wnl.0b013e3181e0f79c] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While homozygous mutations in the PINK1 gene cause recessively inherited early-onset Parkinson disease (PD), heterozygous mutations have been suggested as a susceptibility factor. METHODS To evaluate this hypothesis, 4 homozygous PINK1 patients with PD and 10 asymptomatic carriers of a single heterozygous mutation from a large German family (family W) were included in this study. Clinical follow-up of the heterozygous mutation carriers 3 years after the initial visit included a detailed videotaped neurologic examination using the Unified Parkinson's Disease Rating Scale III protocol and smell and color discrimination testing. At follow-up, PET with 18-fluorodopa (FDOPA) of 13 family members was obtained in order to evaluate the clinical phenotype in light of nigostriatal dopaminergic functioning. The clinical and PET data were compared to those of healthy controls. RESULTS While there was mild worsening of clinical signs in previously affected heterozygous mutation carriers upon follow-up, 3 additional individuals had newly developed signs of possible PD. Hyposmia was found in 7 of the heterozygous mutation carriers, diminished color discrimination in 4. The homozygous mutation carriers who were all definitely affected with PD showed a severe, 60% decrease of caudate and putaminal FDOPA uptake; heterozygous offspring also had a significant 20% putaminal FDOPA uptake reduction compared to controls. CONCLUSIONS Our findings strengthen the hypothesis that heterozygous PINK1 mutations act as a susceptibility factor to develop at least subtle Parkinson disease motor and nonmotor signs, as supported by the finding of a reduced striatal dopaminergic FDOPA uptake not only in homozygous but also, albeit to a lesser extent, in heterozygous mutation carriers.
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Affiliation(s)
- C Eggers
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Burghaus L, Liu W, Eggers C, Müller-Ehmsen J, Fink GR. [Mistaking a long QT syndrome for epilepsy: does every seizure call for an ECG?]. Fortschr Neurol Psychiatr 2010; 78:419-24. [PMID: 20533164 DOI: 10.1055/s-0029-1245443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Syncope is a common and difficult differential diagnosis for epilepsy. One possible cause for a cardiac syncope is a long QT syndrome (LQTS). LQTS with torsade de pointes tachycardia can lead to lethal ventricular fibrillation and cardiac arrest. Patients with LQTS when first diagnosed as suffering from epileptic fits often experience a particularly long diagnostic delay which may even take years. In some cases, the diagnosis of LQTS is not made until the patient needs resuscitation due to a cardiac arrest. Therefore, ECG recording should be performed for every patient presenting with a seizure considered to be of epileptic origin not only at the beginning of the disease but also when fits occur in spite of antiepileptic treatment in order to prevent an incorrect diagnosis and delay in making the correct diagnosis.
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Affiliation(s)
- L Burghaus
- Klinik und Poliklinik für Neurologie, Uniklinik Köln, Kerpener Strasse 62, Köln.
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Klein JC, Eggers C, Kalbe E, Weisenbach S, Hohmann C, Vollmar S, Baudrexel S, Diederich NJ, Heiss WD, Hilker R. Neurotransmitter changes in dementia with Lewy bodies and Parkinson disease dementia in vivo. Neurology 2010; 74:885-92. [PMID: 20181924 DOI: 10.1212/wnl.0b013e3181d55f61] [Citation(s) in RCA: 249] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Although Parkinson disease with dementia (PDD) and dementia with Lewy bodies (DLB) show a wide clinical and neuropathologic overlap, they are differentiated according to the order and latency of cognitive and motor symptom appearance. Whether both are distinct disease entities is an ongoing controversy. Therefore, we directly compared patients with DLB and PDD with multitracer PET. METHODS PET with (18)fluorodopa (FDOPA), N-(11)C-methyl-4-piperidyl acetate (MP4A), and (18)fluorodeoxyglucose (FDG) was performed in 8 patients with PDD, 6 patients with DLB, and 9 patients with PD without dementia vs age-matched controls. Data were analyzed with voxel-based statistical parametric mapping and region of interest-based statistics. RESULTS We found a reduced FDOPA uptake in the striatum and in limbic and associative prefrontal areas in all patient groups. Patients with PDD and patients with DLB showed a severe MP4A and FDG binding reduction in the neocortex with increasing signal diminution from frontal to occipital regions. Significant differences between PDD and DLB were not found in any of the radioligands used. Patients with PD without dementia had a mild cholinergic deficit and no FDG reductions vs controls. CONCLUSIONS Patients with dementia with Lewy bodies and Parkinson disease dementia share the same dopaminergic and cholinergic deficit profile in the brain and seem to represent 2 sides of the same coin in a continuum of Lewy body diseases. Cholinergic deficits seem to be crucial for the development of dementia in addition to motor symptoms. The spatial congruence of cholinergic deficits and energy hypometabolism argues for cortical deafferentation due to the degeneration of projection fibers from the basal forebrain.
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Affiliation(s)
- J C Klein
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
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Gneiss C, Koudouovoh-Tripp PM, Ropele S, Gotwald T, Ehling R, Lutterotti A, Aichner F, Ladurner G, Eggers C, Schautzer F, Künz B, Millonig A, Aspeck E, Reindl M, Berger T, Fazekas F, Deisenhammer F. Influence of interferon-beta therapy switching on neutralizing antibody titres: results from the Austrian Switch Study. Mult Scler 2009; 15:1481-8. [PMID: 19965519 DOI: 10.1177/1352458509347153] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neutralizing antibodies against interferon-beta are associated with a reduction of the efficacy of this drug. Continuing treatment leads to a decline or even loss of neutralizing antibodies over years. No strategies are currently available to shorten the period of neutralizing antibody positivity. The objective of this study was to investigate the effect of switching between high and low immunogenic interferon-beta products on neutralising antibody titres. Twenty-four patients treated with the subcutaneously administered interferon-beta 1b or 1a and high titres of neutralizing antibodies were included. At baseline interferon-beta therapy was interrupted for 3 months and two pulses of high dose methylprednisolone were applied. Patients were then randomized to receive either the previous interferon-beta preparation or the low immunogenic intramuscular interferon-beta 1a. The primary end-point was the change of neutralizing antibody titres 12 months after randomization. Twelve patients were switched to interferon-beta 1a intramuscularly and 12 patients remained on previous treatment. Median neutralizing antibody titres were 846 NU at baseline and 196 NU at the end of the study. The median change of neutralizing antibody titres did not differ significantly between therapy switchers and non-switchers. Baseline and final neutralizing antibody titres correlated significantly. In conclusion, neither switching nor continuous therapy with any subcutaneous interferon-beta preparation significantly changed neutralizing antibody titres.
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Affiliation(s)
- Claudia Gneiss
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Iglseder S, Eggers C. Migräne, partielle Anfälle und Wesensänderung bei Sjögren Syndrom. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238840] [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: 10/20/2022]
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Eggers C, Iglseder S, Weis S, Kubisch C, Schoser BGH. Wurmartige Muskelbewegungen bei elektrischer Stille – Rippling Muscle Disease. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238693] [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: 10/20/2022]
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Eggers C, Hilker R, Burghaus L, Schumacher B, Heiss W. High resolution positron emission tomography demonstrates basal ganglia dysfunction in early Parkinson's disease. J Neurol Sci 2009; 276:27-30. [DOI: 10.1016/j.jns.2008.08.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 08/14/2008] [Accepted: 08/19/2008] [Indexed: 11/28/2022]
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Hemmerle M, Röpcke B, Eggers C, Oades R. Evaluation of 2 Years’ Residential Care Treatment for Adolescents and Young Adults with Schizophrenia. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70577-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims:In 2002 the Professor Eggers Foundation started a 2-year-programme for patients suffering from early-onset schizophrenia (EOS) following discharge from a clinic (outpatient care). The aim is with intense residential care and treatment to support recovery and independence. Interactive and psychoeducational family care, coping with persistent symptoms, development of social and emotional competence, independent house keeping, and support of school and vocational training are the main features.Methods:Psychopathology, social and neuropsychological function were assessed with a set of questionnaires and tests at the start, after 1 year and after 2 years on completion of the programme for 12 participants. Living and working situation were monitored. The results were compared with the progress of 12 EOS patients treated as usual (comparison group).Results:Positive and negative symptoms showed a significantly greater decrease with respect to the comparison group. Social function improved considerably stronger in the participants. Working memory, attention and some executive functions also improved in the participants, while there was a deterioration of speed and selective attention (trend) in the comparison group. Neither group showed changes in measures of intelligence or the subjective quality of life with the exception of increased contentedness with family relations in the participants.Conclusions:We show the benefits of an early intensive residential training programme for EOS patients. Further research may be able to show if these improvements can be maintained and whether the costs of the programme are economical avoiding continued residential care.
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Eggers C, Grüner U, Fink G, Nowak D. tCDS präkonditionierte 1Hz-rTMS des Handareals über M1 verbessert die Bradykinese des idiopathischen Parkinson-Syndroms. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086805] [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: 10/21/2022]
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Eggers C, Grüner U, Fink GR, Nowak DA. t-DCS-preconditioned low-frequency rTMS of the hand area of M1 to improve bradykinesia in Parkinson's disease. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1073010] [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: 10/21/2022]
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