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Philippen S, Hanert A, Schönfeld R, Granert O, Yilmaz R, Jensen-Kondering U, Splittgerber M, Moliadze V, Siniatchkin M, Berg D, Bartsch T. Transcranial direct current stimulation of the right temporoparietal junction facilitates hippocampal spatial learning in Alzheimer's disease and mild cognitive impairment. Clin Neurophysiol 2024; 157:48-60. [PMID: 38056370 DOI: 10.1016/j.clinph.2023.11.003] [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: 05/22/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Spatial memory deficits are an early symptom in Alzheimer's disease (AD), reflecting the neurodegenerative processes in the neuronal navigation network such as in hippocampal and parietal cortical areas. As no effective treatment options are available, neuromodulatory interventions are increasingly evaluated. Against this backdrop, we investigated the neuromodulatory effect of anodal transcranial direct current stimulation (tDCS) on hippocampal place learning in patients with AD or mild cognitive impairment (MCI). METHODS In this randomized, double-blind, sham-controlled study with a cross-over design anodal tDCS of the right temporoparietal junction (2 mA for 20 min) was applied to 20 patients diagnosed with AD or MCI and in 22 healthy controls while they performed a virtual navigation paradigm testing hippocampal place learning. RESULTS We show an improved recall performance of hippocampal place learning after anodal tDCS in the patient group compared to sham stimulation but not in the control group. CONCLUSIONS These results suggest that tDCS can facilitate spatial memory consolidation via stimulating the parietal-hippocampal navigation network in AD and MCI patients. SIGNIFICANCE Our findings suggest that tDCS of the temporoparietal junction may restore spatial navigation and memory deficits in patients with AD and MCI.
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Affiliation(s)
- S Philippen
- Dept. of Neurology, Memory Disorder and Plasticity Group, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Hanert
- Dept. of Neurology, Memory Disorder and Plasticity Group, University Hospital Schleswig-Holstein, Kiel, Germany
| | - R Schönfeld
- Psychology Department, Halle University, Germany
| | - O Granert
- Dept. of Neurology, Memory Disorder and Plasticity Group, University Hospital Schleswig-Holstein, Kiel, Germany
| | - R Yilmaz
- Dept. of Neurology, University of Ankara, Medical School, Ankara, Turkey
| | - U Jensen-Kondering
- Dept. of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany; Dept. of Neuroradiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - M Splittgerber
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Germany
| | - V Moliadze
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Germany
| | - M Siniatchkin
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Germany; Clinic for Child and Adolescent Psychiatry and Psychotherapy, Medical Center Bethel, University Clinics OWL, Bielefeld University, Germany
| | - D Berg
- Dept. of Neurology, Memory Disorder and Plasticity Group, University Hospital Schleswig-Holstein, Kiel, Germany
| | - T Bartsch
- Dept. of Neurology, Memory Disorder and Plasticity Group, University Hospital Schleswig-Holstein, Kiel, Germany.
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Berg D, Frossard L. Health Service Delivery and Economic Evaluation of Limb Lower Bone-Anchored Prostheses: A Summary of the Queensland Artificial Limb Service's Experience. Can Prosthet Orthot J 2021; 4:36210. [PMID: 37614998 PMCID: PMC10443483 DOI: 10.33137/cpoj.v4i2.36210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The emergence of skeletal prosthetic attachments leaves governmental organizations facing the challenge of implementing equitable policies that support the provision of bone-anchored prostheses (BAPs). In 2013, the Queensland Artificial Limb Service (QALS) started a five-year research project focusing on health service delivery and economic evaluation of BAPs. This paper reflects on the QALS experience, particularly the lessons learned. QALS' jurisdiction and drivers are presented first, followed by the impact of outcomes, barriers, and facilitators, as well as future developments of this work. The 21 publications produced during this project (e.g., reimbursement policy, role of prosthetists, continuous improvement procedure, quality of life, preliminary cost-utilities) were summarized. Literature on past, current, and upcoming developments of BAP was reviewed to discuss the practical implications of this work. A primary outcome of this project was a policy developed by QALS supporting up to 22 h of labor for the provision of BAP care. The indicative incremental cost-utility ratio for transfemoral and transtibial BAPs was approximately AUD$17,000 and AUD$12,000, respectively, per quality-adjusted life-year compared to socket prostheses. This project was challenged by 17 barriers (e.g., limited resources, inconsistency of care pathways, design of preliminary cost-utility analyses) but eased by 18 facilitators (e.g., action research plan, customized database, use of free repositories). In conclusion, we concluded that lower limb BAP might be an acceptable alternative to socket prostheses from an Australian government prosthetic care perspective. Hopefully, this work will inform promoters of prosthetic innovations committed to making bionic solutions widely accessible to a growing population of individuals suffering from limb loss worldwide.
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Affiliation(s)
- D Berg
- Queensland Artificial Limb Service, Brisbane, Australia
| | - L Frossard
- Your Research Project Pty Ltd, Brisbane, Australia
- Griffith University, Gold Coast, Australia
- University of the Sunshine Coast, Maroochydore, Australia
- Queensland University of Technology, Brisbane, Australia
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Christopoulos P, Ou SH, Lin J, Berg D, Hong JL, Yin Y, Lin J, Bunn V, Lin H, Mehta M, Thomas M. 1224P Systematic review and meta-analysis of immunotherapy effectiveness for pretreated patients with non-small cell lung cancer harboring EGFR exon 20 insertions. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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4
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Leypoldt F, Wandinger KP, Berg D. [Immune-mediated encephalomyelitis]. Nervenarzt 2021; 92:291-292. [PMID: 33829286 DOI: 10.1007/s00115-021-01110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- F Leypoldt
- Institut für Klinische Chemie, UKSH, Kiel/Lübeck, Arnold-Heller-Str. 2, 24105, Kiel, Deutschland. .,Klinik für Neurologie, Universität Kiel, Kiel, Deutschland.
| | - K-P Wandinger
- Institut für Klinische Chemie, UKSH, Kiel/Lübeck, Arnold-Heller-Str. 2, 24105, Kiel, Deutschland
| | - D Berg
- Klinik für Neurologie, Universität Kiel, Kiel, Deutschland
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Berg D, Eggert K, Haslinger B, Kassubek J, Mollenhauer B, Reetz K, Rogge A, Schaeffer E, Tönges L, Zeuner KE. Disease modifying treatment trials in Parkinson's disease: how to balance expectations and interests of patients, physicians and industry partners? Neurol Res Pract 2020; 2:31. [PMID: 33324933 PMCID: PMC7650104 DOI: 10.1186/s42466-020-00076-y] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/25/2020] [Indexed: 11/11/2022] Open
Abstract
Background The advent of therapeutic strategies designed to modify the disease course in Parkinson’s disease has raised great expectations in the currently conducted clinical trials. However, we see ethical challenges in the cooperation of industry and clinical partners, specifically evident in the way recruitment is performed. We here discuss the different positions and challenges of all involved to set the stage for a study and recruitment culture taking into account the expectations of all: (i) patients and their caregivers, ready to take the considerable burden of clinical trials in hope for the development of disease-modifying treatments; (ii) physicians and study nurses, obligated to the patients’ well-being and benefit who accompany and supervise patients closely as basis for the performance of elaborate clinical trials (iii) industrial partners, investing years of efforts and finances to develop new treatments. Conclusions We conclude that the current competitive race for enrollment in clinical studies in PD is challenging the primary goal to ensure patients’ benefit and formulate requests to the industrial partners to encounter these concerns.
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Affiliation(s)
- D Berg
- Department of Neurology, Christian-Albrecht University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - K Eggert
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
| | - B Haslinger
- Department of Neurology, TU-Muenchen, Munich, Germany
| | - J Kassubek
- Department of Neurology, University of Ulm, RKU, Ulm, Germany
| | | | - K Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - A Rogge
- Institute for Experimental Medicine, Medical Ethics, Christian-Albrecht University of Kiel, Kiel, Germany
| | - E Schaeffer
- Department of Neurology, Christian-Albrecht University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - L Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany
| | - K E Zeuner
- Department of Neurology, Christian-Albrecht University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
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Oyama K, Giugliano R, Berg D, Ruff C, Tang M, Murphy S, Lanz H, Grosso M, Antman E, Braunwald E, Morrow D. Serial measurement of biomarkers and the risk of stroke or systemic embolism and bleeding in patients with atrial fibrillation in ENGAGE AF-TIMI 48. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0512] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with atrial fibrillation (AF) have progressive cardiac structural changes that may be manifest by biomarkers of myocardial injury and hemodynamic stress. Baseline values of hsTnT (high-sensitivity troponin T), and NT-proBNP (N-terminal pro-brain natriuretic peptide) are associated with stroke risk and GDF-15 (growth differentiation factor-15) is associated with bleeding risk in patients with AF. However, the variability of these biomarkers over time and their associations with stroke or systemic embolism events (S/SEE) and bleeding in patients with AF remain unclear.
Purpose
We examined whether patients with AF demonstrate detectable changes in these biomarkers over 12 months and whether such changes from baseline to 12 months are associated with the subsequent risk of S/SEE (hsTnT, NT-proBNP) and bleeding (GDF-15).
Methods
ENGAGE AF-TIMI 48 was a multinational randomized trial of the oral factor Xa inhibitor edoxaban in patients with atrial fibrillation and a CHADS2 score ≥2. We performed a nested prospective biomarker study in 6062 patients, analyzing hsTnT, NT-proBNP, and GDF-15 at baseline and 12 months. Event rates were estimated and displayed with annualized event rates after 12 months.
Results
Of 6062 patients, hsTnT was dynamic in 46.9% (≥2 ng/L change), NT-proBNP in 51.9% (≥200 pg/L change), GDF-15 in 45.6% (≥300 pg/L change) between baseline and 12 months. In addition, 7.7% in hsTnT shifted from low->high categories, 9.4% in NT-proBNP from low->high, 10.6% in GDF-15 from low->high over 12 months (Figure). Elevated hsTnT (≥14 ng/L) and NT-proBNP (≥900 pg/L) either at baseline or at 12 months were independently associated with higher rates of subsequent S/SEE, and elevated GDF-15 (≥1800 pg/L) either at baseline or at 12 months were independently associated with higher rates of subsequent bleeding (P<0.001 for each). In a Cox regression model, the absolute changes in log2-transformed hsTnT and NT-proBNP were associated with increased risk of S/SEE (adj-HR, 1.75; 95% CI, 1.38–2.23; p<0.001, and adj-HR, 1.31; 95% CI, 1.11–1.55; p=0.002, respectively) and log2-transformed GDF-15 with bleeding (adj-HR, 1.42; 95% CI, 1.04–1.92; p=0.025). Analyzed in a categorical manner (Figure), patients who increased hsTnT or NT-proBNP between baseline and 12 months or had high hsTnT or NT-proBNP at both timepoints were at higher risk for S/SEE (adj-HR 1.87 and 1.50 for hsTnT; adj-HR 1.80 and 2.59 for NT-proBNP, respectively). Patients with persistently elevated GDF-15 appeared to be at higher risk for bleeding (adj-HR,1.35) (Figure).
Conclusions
Serial assessment of hsTnT, NT-proBNP, and GDF-15 revealed a substantial proportion of patients with AF had dynamic values. Patients with either persistently elevated or dynamic values were at higher risk of adverse clinical outcomes. Those biomarkers may play a role in personalizing preventive strategies in patients with AF based on risk.
Change in biomarkers and event rate
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Pharma Development
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Affiliation(s)
- K Oyama
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Giugliano
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - D Berg
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - C Ruff
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Tang
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - S Murphy
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - H Lanz
- Daiichi Sankyo, Munich, Germany
| | - M Grosso
- Daiichi Sankyo, Basking Ridge, United States of America
| | - E Antman
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - E Braunwald
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - D Morrow
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
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Jänne P, Wu YL, Kato T, Besse B, Peters S, Nguyen D, Berg D, Lin J, Feng Z, Mok T. 1412TiP Mobocertinib (TAK-788) as first-line treatment vs platinum-based chemotherapy (CT) for NSCLC with EGFR exon 20 insertions (exon20ins). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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8
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Kunz M, Gorges M, Liepelt-Scarfone I, Storch A, Dodel R, Consortium L, Hilker-Roggendorf R, Berg D, Kalbe E, Müller H, Baudrexel S, Kassubek J. FV4 Brain atrophy distribution and rate of change in patients with advanced Parkinsons disease and cognitive impairment. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Schaeffer E, Streich S, Wurster I, Schubert R, Reilmann R, Wolfram S, Berg D. How to evaluate effects of occupational therapy - lessons learned from an exploratory randomized controlled trial. Parkinsonism Relat Disord 2019; 67:42-47. [PMID: 31621606 DOI: 10.1016/j.parkreldis.2019.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 08/25/2019] [Accepted: 09/14/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although occupational therapy (OT) is frequently prescribed in clinical practice, there is still insufficient evidence regarding its efficacy to improve Parkinson's Disease (PD)-related activity limitations. OBJECTIVES To evaluate the efficacy of OT and the validity of different outcome-parameters to reflect efficacy, including gold-standard clinical rating scales and quantitative motor assessments. METHODS 40 patients were included in an exploratory, randomized-controlled, single-blinded trial, receiving either (I) ten weeks of OT, with a main focus on motor aspects of activity limitations and a ten-week follow-up assessment or (II) no intervention. Inclusion criteria were diagnosis of PD and Hoehn & Yahr stage 2-3. Patients with major depression, other neurological or orthopedic diseases or OT beforehand were excluded from the study. To monitor treatment effects the MDS-UPDRS part II and III were used for patient- and clinician-based assessment. Objective Pegboard as well as Q-Motor "tremormotography" and "digitomotography" were applied. RESULTS The interventional group reported a subjective amelioration of activity limitations, with a significant improvement of MDS-UPDRS part II at the end of the study (p = 0.030). However, clinician's rating and quantitative motor assessment failed to detect a significant improvement of motor impairment and fine motor control. CONCLUSIONS This study goes in line with previous trials, showing an individual improvement of activity limitations from the patients' point of view. The discrepancy between self-perception, focusing on activity limitation, and clinician-based rating, focusing on motor impairment, challenges the current gold standard assessments as valid outcome parameters for occupational therapy trials aiming for an individualized improvement of disease burden.
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Affiliation(s)
- E Schaeffer
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany.
| | - S Streich
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - I Wurster
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - R Schubert
- George Huntington Institute, Münster, Germany
| | - R Reilmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; George Huntington Institute, Münster, Germany; Department of Clinical Radiology, University of Münster, Münster, Germany
| | - S Wolfram
- Center for Outpatient Rehabilitation (ZAR), Tuebingen, Germany
| | - D Berg
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Berg D, Wiviott S, Scirica B, Gurmu Y, Mosenzon O, Murphy S, Bhatt D, Leiter L, McGuire D, Wilding J, Johansson P, Langkilde A, Raz I, Braunwald E, Sabatine M. 410Heart failure risk stratification and efficacy of dapagliflozin in patients with type 2 diabetes mellitus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing heart failure (HF). Treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors reduces the risk of hospitalization for HF (HHF) in patients with T2DM.
Purpose
To develop and validate a practical, multivariable clinical risk score for HHF in patients with T2DM and assess whether this score can identify high-risk patients with T2DM who have the greatest reduction in risk for HHF with an SGLT2 inhibitor.
Methods
We developed a clinical risk score for centrally-adjudicated HHF using independent clinical risk indicators of HHF in 8212 patients with T2DM in the placebo arm of SAVOR-TIMI 53. Candidate variables were assessed using multivariable Cox regression and independent clinical risk indicators achieving statistical significance of p<0.001 were included in the risk score and given weights proportional to the regression coefficients. We externally validated the score in 8578 patients with T2DM in the placebo arm of DECLARE-TIMI 58. Discrimination was assessed using Harrell's c-index. The relative and absolute risk reductions in HHF with the SGLT2 inhibitor dapagliflozin were assessed by baseline HHF risk.
Results
The 5 independent clinical risk indicators were prior heart failure, atrial fibrillation, coronary artery disease, estimated glomerular filtration rate (eGFR), and urine albumin/creatinine ratio (UACR) (Figure, left). A simple integer-based scheme using these predictors identified a strong >16-fold gradient of HHF risk (p-trend <0.001) in both the derivation and validation cohorts, with c-indices of 0.81 and 0.78, respectively. Whereas relative risk reductions were similar across the risk score (25–34%), absolute risk reductions were greater in those at higher baseline risk (interaction p-value for absolute risk reduction <0.01), with high-risk (2 points) and very high-risk patients (≥3 points) having 1.5% and 2.7% absolute risk reductions in HHF at 4 years with dapagliflozin, translating into NNTs of only 65 and 36, respectively (Figure, right).
Conclusion(s)
Risk stratification using a novel clinical risk score for HHF in patients with T2DM identifies patients at higher risk for HHF who derive greater benefit from treatment with the SGLT2 inhibitor dapagliflozin.
Acknowledgement/Funding
SAVOR-TIMI 53 and DECLARE-TIMI 58 were sponsored by AstraZeneca.
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Affiliation(s)
- D Berg
- Brigham and Womens Hospital, Boston, United States of America
| | - S Wiviott
- Brigham and Womens Hospital, Boston, United States of America
| | - B Scirica
- Brigham and Womens Hospital, Boston, United States of America
| | - Y Gurmu
- Brigham and Womens Hospital, Boston, United States of America
| | - O Mosenzon
- Hadassah University Medical Center, Jerusalem, Israel
| | - S Murphy
- Brigham and Womens Hospital, Boston, United States of America
| | - D Bhatt
- Brigham and Womens Hospital, Boston, United States of America
| | - L Leiter
- St. Michael's Hospital, Toronto, Canada
| | - D McGuire
- University of Texas Southwestern Medical School, Dallas, United States of America
| | - J Wilding
- Aintree University Hospital, Liverpool, United Kingdom
| | | | | | - I Raz
- Hadassah University Medical Center, Jerusalem, Israel
| | - E Braunwald
- Brigham and Womens Hospital, Boston, United States of America
| | - M Sabatine
- Brigham and Womens Hospital, Boston, United States of America
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Coward J, Kichenadasse G, Harnett P, Moore K, Barve M, Berg D, Garner J, Dizon D. Phase I study of intraperitoneal TRX-E-002-1 in subjects with persistent or recurrent ovarian, fallopian tube or primary peritoneal cancer: Three-month follow-up results of the dose escalation phase. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Zimmermann M, Wurster I, Lerche S, Roeben B, Machetanz G, Sünkel U, von Thaler A, Eschweiler G, Fallgatter AJ, Maetzler W, Berg D, Brockmann K. Orthostatic hypotension as a risk factor for longitudinal deterioration of cognitive function in the elderly. Eur J Neurol 2019; 27:160-167. [DOI: 10.1111/ene.14050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/22/2019] [Indexed: 01/08/2023]
Affiliation(s)
- M. Zimmermann
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - I. Wurster
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - S. Lerche
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - B. Roeben
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - G. Machetanz
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - U. Sünkel
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
| | - A.‐K. von Thaler
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
| | - G. Eschweiler
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
- Department of Psychiatry University of Tübingen TübingenGermany
| | - A. J. Fallgatter
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
- Department of Psychiatry University of Tübingen TübingenGermany
| | - W. Maetzler
- Department of Neurology Christian‐Albrechts‐University of Kiel Kiel Germany
| | - D. Berg
- Department of Neurology Christian‐Albrechts‐University of Kiel Kiel Germany
| | - K. Brockmann
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
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Chaturvedi M, Yilmaz R, Gschwandtner U, Greulich K, Reimold M, Fuhr P, Roth V, Timmers M, Streffer J, Berg D, Liepelt-Scarfone I. FV 4 Electroencephalographic Activity as a potential prodromal marker for Parkinson’s disease. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.614] [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: 10/26/2022]
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Bartsch T, Rempe T, Leypoldt F, Riedel C, Jansen O, Berg D, Deuschl G. The spectrum of progressive multifocal leukoencephalopathy: a practical approach. Eur J Neurol 2019; 26:566-e41. [PMID: 30629326 DOI: 10.1111/ene.13906] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/08/2019] [Indexed: 12/21/2022]
Abstract
John Cunningham virus (JCV) infection of the central nervous system causes progressive multifocal leukoencephalopathy (PML) in patients with systemic immunosuppression. With the increased application of modern immunotherapy and biologics in various immune-mediated disorders, the PML risk spectrum has changed. Thus, new tools and strategies for risk assessment and stratification in drug-associated PML such as the JCV antibody indices have been introduced. Imaging studies have highlighted atypical presentations of cerebral JCV disease such as granule cell neuronopathy. Imaging markers have been developed to differentiate PML from new multiple sclerosis lesions and to facilitate the early identification of pre-clinical manifestations of PML and its immune reconstitution inflammatory syndrome. PML can be diagnosed either by brain biopsy or by clinical, radiographic and virological criteria. Experimental treatment options including immunization and modulation of interleukin-mediated immune response are emerging. PML should be considered in any patient with compromised systemic or central nervous system immune surveillance presenting with progressive neurological symptoms.
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Affiliation(s)
- T Bartsch
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Rempe
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Department of Neurology, University of Florida, Gainesville, FL, USA
| | - F Leypoldt
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Department of Neuroimmunology, Institute of Clinical Chemistry, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C Riedel
- Institute of Neuroradiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - O Jansen
- Institute of Neuroradiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - D Berg
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - G Deuschl
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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15
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Zimmermann M, Gaenslen A, Prahl K, Srulijes K, Hauser AK, Schulte C, Csoti I, Berg D, Brockmann K. Patient's perception: shorter and more severe prodromal phase in GBA-associated PD. Eur J Neurol 2018; 26:694-698. [PMID: 30107068 DOI: 10.1111/ene.13776] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/09/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prevalence and time of occurrence of prodromal symptoms of Parkinson's disease (PD) in relation to the onset of classical motor manifestation varies between patients. Possible modifying factors might be different genetic architectures predisposing to varying burden of manifestations. OBJECTIVES To characterize the prodromal phase in PD patients with heterozygous mutations in the GBA gene compared to PD patients without GBA mutation. METHODS In a retrospective design, 151 participants [47 PD patients carrying a GBA mutation (PDGBA ), 52 idiopathic PD patients (PDidiopathic ), 52 healthy elderly (CON)] underwent a validated structured interview designed to assess prevalence and time of occurrence of prodromal symptoms. RESULTS PDGBA showed a higher prevalence of prodromal symptoms and almost simultaneous occurrence of non-motor and early motor symptoms shortly before PD diagnosis whereas PDidiopathic reported a longer prodromal phase starting with non-motor symptoms. CONCLUSION The short and severe prodromal phase in PDGBA might call for shorter assessment intervals in yet premanifest GBA mutation carriers.
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Affiliation(s)
- M Zimmermann
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - A Gaenslen
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - K Prahl
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - K Srulijes
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - A-K Hauser
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - C Schulte
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - I Csoti
- Gertrudis Klinik, Leun-Biskirchen, Germany
| | - D Berg
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - K Brockmann
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
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16
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Shorten P, Donnison M, McDonald R, Meier S, Ledgard A, Berg D. A mathematical model of in vivo bovine blastocyst developmental to gestational Day 15. J Dairy Sci 2018; 101:8401-8416. [DOI: 10.3168/jds.2017-14306] [Citation(s) in RCA: 1] [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] [Received: 12/17/2017] [Accepted: 04/26/2018] [Indexed: 01/05/2023]
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17
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Reuter S, Deuschl G, Berg D, Helmers A, Falk D, Witt K. Life-threatening DBS withdrawal syndrome in Parkinson's disease can be treated with early reimplantation. Parkinsonism Relat Disord 2018; 56:88-92. [PMID: 30007510 DOI: 10.1016/j.parkreldis.2018.06.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/07/2018] [Accepted: 06/30/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The deep brain stimulation (DBS) withdrawal syndrome (DBS-WDS) is a rare, life-threatening complication in Parkinson's disease (PD) patients with long disease duration and stimulation when stimulation is terminated for extended periods mostly due to infection of the DBS-hardware. METHODS, RESULTS In five patients explantation became necessary because of infection after a mean of 11.4 years (range 4-15 years) of DBS and a mean disease duration of 24.6 years (range 3-22 years). Mean UPDRS motor-score pre-explantation was 38 points (range 24-55 points) which increased to a mean of 78.4 points (range 58-90 points) after explantation, despite optimal Levodopa dosing. Reimplantation of the hardware after 23 days (range 3-45 days) under antibiotic treatment led to an improvement to a mean of 40 points (range 25-73 points) and a complication free survival. CONCLUSION Early reimplantation of the DBS-hardware is a treatment option of the DBS-WDS when the life-threatening urgency overrides surgical standards. Observation of the syndrome indicates pharmacological unresponsiveness of the dopaminergic system in advanced PD and long-term DBS.
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Affiliation(s)
- S Reuter
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany
| | - G Deuschl
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany
| | - D Berg
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany.
| | - A Helmers
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany
| | - D Falk
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany
| | - K Witt
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany; Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
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18
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Brockmann K, Schulte C, Schneiderhan-Marra N, Apel A, Pont-Sunyer C, Vilas D, Ruiz-Martinez J, Langkamp M, Corvol JC, Cormier F, Knorpp T, Joos TO, Bernard A, Gasser T, Marras C, Schüle B, Aasly JO, Foroud T, Marti-Masso JF, Brice A, Tolosa E, Berg D, Maetzler W. Inflammatory profile discriminates clinical subtypes in LRRK2-associated Parkinson's disease. Eur J Neurol 2018; 24:427-e6. [PMID: 28102045 DOI: 10.1111/ene.13223] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/07/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE The presentation of Parkinson's disease patients with mutations in the LRRK2 gene (PDLRRK2 ) is highly variable, suggesting a strong influence of modifying factors. In this context, inflammation is a potential candidate inducing clinical subtypes. METHODS An extensive battery of peripheral inflammatory markers was measured in human serum in a multicentre cohort of 142 PDLRRK2 patients from the MJFF LRRK2 Consortium, stratified by three different subtypes as recently proposed for idiopathic Parkinson's disease: diffuse/malignant, intermediate and mainly pure motor. RESULTS Patients classified as diffuse/malignant presented with the highest levels of the pro-inflammatory proteins interleukin 8 (IL-8), monocyte chemotactic protein 1 (MCP-1) and macrophage inflammatory protein 1-β (MIP-1-β) paralleled by high levels of the neurotrophic protein brain-derived neurotrophic factor (BDNF). It was also possible to distinguish the clinical subtypes based on their inflammatory profile by using discriminant and area under the receiver operating characteristic curve analysis. CONCLUSIONS Inflammation seems to be associated with the presence of a specific clinical subtype in PDLRRK2 that is characterized by a broad and more severely affected spectrum of motor and non-motor symptoms. The pro-inflammatory metabolites IL-8, MCP-1 and MIP-1-β as well as BDNF are interesting candidates to be included in biomarker panels that aim to differentiate subtypes in PDLRRK2 and predict progression.
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Affiliation(s)
- K Brockmann
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - C Schulte
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - N Schneiderhan-Marra
- Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - A Apel
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - C Pont-Sunyer
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - D Vilas
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Ruiz-Martinez
- Hospital Universitario Donostia, Biodonostia Institut, San Sebastián, Guipuzcoa, Spain
| | | | - J-C Corvol
- Département de Génétique et Cytogénétique, Hôpital de la Pitié Salpêtrière, Sorbonne Universités, INSERM, Paris, France
| | - F Cormier
- Département de Génétique et Cytogénétique, Hôpital de la Pitié Salpêtrière, Sorbonne Universités, INSERM, Paris, France
| | - T Knorpp
- Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - T O Joos
- Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - A Bernard
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - T Gasser
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - C Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - B Schüle
- Parkinson Institute and Clinical Center, Sunnyvale, CA, USA
| | - J O Aasly
- Department of Neurology, St Olavs Hospital, Trondheim, Norway
| | - T Foroud
- Department of Medical and Molecular Genetics, Indiana University, Bloomington, IN, USA
| | - J F Marti-Masso
- Hospital Universitario Donostia, Biodonostia Institut, San Sebastián, Guipuzcoa, Spain
| | - A Brice
- Département de Génétique et Cytogénétique, Hôpital de la Pitié Salpêtrière, Sorbonne Universités, INSERM, Paris, France
| | - E Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - D Berg
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - W Maetzler
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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19
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20
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21
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Liepelt-Scarfone I, Brändle B, Yilmaz R, Gauss K, Schaeffer E, Timmers M, Wurster I, Brockmann K, Maetzler W, Van Nueten L, Streffer JR, Berg D. Progression of prodromal motor and non-motor symptoms in the premotor phase study - 2-year follow-up data. Eur J Neurol 2017; 24:1369-1374. [DOI: 10.1111/ene.13397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- I. Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research; Department of Neurodegeneration; University of Tuebingen; Tuebingen Germany
- German Center for Neurodegenerative Diseases; Tuebingen Germany
| | - B. Brändle
- Hertie Institute for Clinical Brain Research; Department of Neurodegeneration; University of Tuebingen; Tuebingen Germany
- German Center for Neurodegenerative Diseases; Tuebingen Germany
| | - R. Yilmaz
- Department of Neurology; Christian-Albrechts-University of Kiel; Kiel Germany
| | - K. Gauss
- Hertie Institute for Clinical Brain Research; Department of Neurodegeneration; University of Tuebingen; Tuebingen Germany
- German Center for Neurodegenerative Diseases; Tuebingen Germany
| | - E. Schaeffer
- Department of Neurology; Christian-Albrechts-University of Kiel; Kiel Germany
| | - M. Timmers
- Janssen Research and Development; a division of Janssen Pharmaceutica N.V.; Beerse Belgium
- Reference Center for Biological Markers of Dementia (BIODEM); Institute Born-Bunge; University of Antwerp; Antwerp Belgium
| | - I. Wurster
- Hertie Institute for Clinical Brain Research; Department of Neurodegeneration; University of Tuebingen; Tuebingen Germany
- German Center for Neurodegenerative Diseases; Tuebingen Germany
| | - K. Brockmann
- Hertie Institute for Clinical Brain Research; Department of Neurodegeneration; University of Tuebingen; Tuebingen Germany
- German Center for Neurodegenerative Diseases; Tuebingen Germany
| | - W. Maetzler
- Hertie Institute for Clinical Brain Research; Department of Neurodegeneration; University of Tuebingen; Tuebingen Germany
- Department of Neurology; Christian-Albrechts-University of Kiel; Kiel Germany
| | - L. Van Nueten
- Janssen Research and Development; a division of Janssen Pharmaceutica N.V.; Beerse Belgium
- Reference Center for Biological Markers of Dementia (BIODEM); Institute Born-Bunge; University of Antwerp; Antwerp Belgium
| | - J. R. Streffer
- Janssen Research and Development; a division of Janssen Pharmaceutica N.V.; Beerse Belgium
- Reference Center for Biological Markers of Dementia (BIODEM); Institute Born-Bunge; University of Antwerp; Antwerp Belgium
| | - D. Berg
- Hertie Institute for Clinical Brain Research; Department of Neurodegeneration; University of Tuebingen; Tuebingen Germany
- Department of Neurology; Christian-Albrechts-University of Kiel; Kiel Germany
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22
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Obeso J, Stamelou M, Goetz C, Poewe W, Lang A, Weintraub D, Burn D, Halliday G, Bezard E, Przedborski S, Lehericy S, Brooks D, Rothwell J, Hallett M, DeLong M, Marras C, Tanner C, Ross G, Langston J, Klein C, Bonifati V, Jankovic J, Lozano A, Deuschl G, Bergman H, Tolosa E, Rodriguez-Violante M, Fahn S, Postuma R, Berg D, Marek K, Standaert D, Surmeier D, Olanow C, Kordower J, Calabresi P, Schapira A, Stoessl A. Past, present, and future of Parkinson's disease: A special essay on the 200th Anniversary of the Shaking Palsy. Mov Disord 2017; 32:1264-1310. [PMID: 28887905 PMCID: PMC5685546 DOI: 10.1002/mds.27115] [Citation(s) in RCA: 469] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022] Open
Abstract
This article reviews and summarizes 200 years of Parkinson's disease. It comprises a relevant history of Dr. James Parkinson's himself and what he described accurately and what he missed from today's perspective. Parkinson's disease today is understood as a multietiological condition with uncertain etiopathogenesis. Many advances have occurred regarding pathophysiology and symptomatic treatments, but critically important issues are still pending resolution. Among the latter, the need to modify disease progression is undoubtedly a priority. In sum, this multiple-author article, prepared to commemorate the bicentenary of the shaking palsy, provides a historical state-of-the-art account of what has been achieved, the current situation, and how to progress toward resolving Parkinson's disease. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- J.A. Obeso
- HM CINAC, Hospital Universitario HM Puerta del Sur, Mostoles, Madrid, Spain
- Universidad CEU San Pablo, Madrid, Spain
- CIBERNED, Madrid, Spain
| | - M. Stamelou
- Department of Neurology, Philipps University, Marburg, Germany
- Parkinson’s Disease and Movement Disorders Department, HYGEIA Hospital and Attikon Hospital, University of Athens, Athens, Greece
| | - C.G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - W. Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - A.E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - D. Weintraub
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Corporal Michael J. Crescenz Veteran’s Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - D. Burn
- Medical Sciences, Newcastle University, Newcastle, UK
| | - G.M. Halliday
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
- School of Medical Sciences, University of New South Wales and Neuroscience Research Australia, Sydney, Australia
| | - E. Bezard
- Université de Bordeaux, Institut des Maladies Neurodégénératives, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5293, Institut des Maladies Neurodégénératives, Bordeaux, France
- China Academy of Medical Sciences, Institute of Lab Animal Sciences, Beijing, China
| | - S. Przedborski
- Departments of Neurology, Pathology, and Cell Biology, the Center for Motor Neuron Biology and Disease, Columbia University, New York, New York, USA
- Columbia Translational Neuroscience Initiative, Columbia University, New York, New York, USA
| | - S. Lehericy
- Institut du Cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, Sorbonne Universités, UPMC Univ Paris 06, Inserm U1127, CNRS UMR 7225, Paris, France
- Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - D.J. Brooks
- Clinical Sciences Department, Newcastle University, Newcastle, UK
- Department of Nuclear Medicine, Aarhus University, Aarhus, Denmark
| | - J.C. Rothwell
- Human Neurophysiology, Sobell Department, UCL Institute of Neurology, London, UK
| | - M. Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - M.R. DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson’s disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - C.M. Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, University of California–San Francisco, San Francisco, California, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - G.W. Ross
- Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii, USA
| | | | - C. Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - V. Bonifati
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J. Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - A.M. Lozano
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - G. Deuschl
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian Albrechts University Kiel, Kiel, Germany
| | - H. Bergman
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, Jerusalem, Israel
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - E. Tolosa
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - M. Rodriguez-Violante
- Movement Disorders Clinic, Clinical Neurodegenerative Research Unit, Mexico City, Mexico
- Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - S. Fahn
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - R.B. Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
| | - D. Berg
- Klinikfür Neurologie, UKSH, Campus Kiel, Christian-Albrechts-Universität, Kiel, Germany
| | - K. Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - D.G. Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D.J. Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - C.W. Olanow
- Departments of Neurology and Neuroscience, Mount Sinai School of Medicine, New York, New York, USA
| | - J.H. Kordower
- Research Center for Brain Repair, Rush University Medical Center, Chicago, Illinois, USA
- Neuroscience Graduate Program, Rush University Medical Center, Chicago, Illinois, USA
| | - P. Calabresi
- Neurological Clinic, Department of Medicine, Hospital Santa Maria della Misericordia, University of Perugia, Perugia, Italy
- Laboratory of Neurophysiology, Santa Lucia Foundation, IRCCS, Rome, Italy
| | - A.H.V. Schapira
- University Department of Clinical Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - A.J. Stoessl
- Pacific Parkinson’s Research Centre, Division of Neurology & Djavadf Mowafaghian Centre for Brain Health, University of British Columbia, British Columbia, Canada
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
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23
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Yilmaz R, Pilotto A, Roeben B, Preische O, Suenkel U, Heinzel S, Metzger FG, Laske C, Maetzler W, Berg D. Erratum: Structural Ultrasound of the Medial Temporal Lobe in Alzheimer's Disease. Ultraschall Med 2017; 38:e16. [PMID: 27459251 DOI: 10.1055/s-0035-1567111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- R Yilmaz
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - A Pilotto
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - B Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - O Preische
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - U Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - S Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - F G Metzger
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Geriatric Center at the University Hospital, University of Tuebingen, Tuebingen, Germany
| | - C Laske
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Geriatric Center at the University Hospital, University of Tuebingen, Tuebingen, Germany
- Section for Dementia Research, University of Tuebingen, Tuebingen, Germany
| | - W Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - D Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
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Berg D. [Parkinson - 200 years after first description of the shaking palsy]. Nervenarzt 2017; 88:343-344. [PMID: 28289793 DOI: 10.1007/s00115-017-0303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D Berg
- Klinik für Neurologie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
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25
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Brockmann K, Berg D. [New therapy approaches for Parkinson's disease]. Nervenarzt 2017; 88:391-396. [PMID: 28289790 DOI: 10.1007/s00115-017-0299-x] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last years major advances have been made in the identification of specific pathways underlying the pathophysiology of subgroups of patients with Parkinson' disease. These pathways include mitochondrial and lysosomal dysfunction as well as inflammatory patterns and represent the basis for new causative and disease-modifying treatment strategies, possibly not only for the respective subgroups of patients but hopefully also for the majority of patients with idiopathic Parkinson's disease. This article highlights the main treatment strategies focusing on causative and disease course-modifying strategies as well as quality of life.
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Affiliation(s)
- K Brockmann
- Zentrum für Neurologie, Abteilung Neurodegeneration, Hertie-Institut für klinische Hirnforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen, Universität Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
| | - D Berg
- Zentrum für Neurologie, Abteilung Neurodegeneration, Hertie-Institut für klinische Hirnforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen, Universität Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
- Klinik für Neurologie, Christian-Albrechts-Universität, Kiel, Deutschland
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Affiliation(s)
- F. Kubli
- Universitäts-Frauenklinik; Frankfurt am Main Germany
| | - H. Rüttgers
- Universitäts-Frauenklinik; Frankfurt am Main Germany
| | - U. Lorenz
- Universitäts-Frauenklinik; Frankfurt am Main Germany
| | - D. Berg
- Universitäts-Frauenklinik; Frankfurt am Main Germany
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27
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Blohberger J, Buck T, Berg D, Berg U, Kunz L, Mayerhofer A. L-DOPA in the hu man ovarian follicular fluid acts as an antioxidant factor on granulosa cells. J Ovarian Res 2016; 9:62. [PMID: 27686972 PMCID: PMC5043631 DOI: 10.1186/s13048-016-0269-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A previous study showed that dopamine (DA), which is contained in follicular fluid (FF) from IVF patients, strongly increased the production of reactive oxygen species (ROS) by cultured human granulosa cells (GCs). ROS, including H2O2, are assumed to play roles in ovarian physiology and pathology. Ovarian DA could be derived from the circulation, ovarian innervation and/or unknown ovarian sources. L-DOPA is the direct precursor of DA in its synthetic pathway. It was not yet described in FF. We examined L-DOPA levels in FF from IVF patients. As it may exert anti-oxidative and ROS-scavenging functions, we studied whether it exerts such actions in human GCs and whether DOPA-decarboxylase (DDC), the enzyme converting L-DOPA to DA, is expressed in the human ovary. RESULTS ELISA measurements revealed that human IVF-derived FF contains L-DOPA. In cultured human GCs automated confluence analyses showed that L-DOPA enhanced their survival. This is in contrast to the actions of DA, which reduced cell survival. A dose-dependent mode of action of L-DOPA was identified using a fluorescent ROS indicator. The results showed that it antagonized intracellular ROS accumulation induced by exogenous H2O2. DDC was absent in follicular GCs, but immunohistochemistry identified it in theca cells (TCs) of large follicles in the human ovary. Laser micro-dissection followed by RT-PCR corroborated the expression. DDC was also identified in the steroidogenic cells of the corpus luteum. CONCLUSIONS L-DOPA in FF is an antioxidant factor and exerts positive influences on GCs. Ovarian DA is derived from L-DOPA and has opposite actions. Exogenous L-DOPA is a standard therapy for Parkinson's disease, and the results raise the possibility that it may be able to exert positive actions as an antioxidant in ovarian conditions, as well.
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Affiliation(s)
- J Blohberger
- Biomedical Center (BMC), Cell Biology, Anatomy III, Ludwig-Maximilian-University (LMU), Grosshaderner Strasse 9, D-82152, Planegg, Germany
| | - T Buck
- Biomedical Center (BMC), Cell Biology, Anatomy III, Ludwig-Maximilian-University (LMU), Grosshaderner Strasse 9, D-82152, Planegg, Germany
| | - D Berg
- A.R.T. Bogenhausen, D-81675, Munich, Germany
| | - U Berg
- A.R.T. Bogenhausen, D-81675, Munich, Germany
| | - L Kunz
- Division of Neurobiology, Department of Biology II, Ludwig-Maximilian-University (LMU), D-82152, Planegg, Germany
| | - A Mayerhofer
- Biomedical Center (BMC), Cell Biology, Anatomy III, Ludwig-Maximilian-University (LMU), Grosshaderner Strasse 9, D-82152, Planegg, Germany.
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Schaeffer E, Berg D. 'Cycling' with long-acting dopamine agonists for augmentation in restless legs syndrome. Eur J Neurol 2016; 23:e17-8. [PMID: 26918749 DOI: 10.1111/ene.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/01/2015] [Indexed: 12/01/2022]
Affiliation(s)
- E Schaeffer
- Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - D Berg
- Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
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29
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Yilmaz R, Behnke S, Liepelt-Scarfone I, Roeben B, Pausch C, Runkel A, Heinzel S, Niebler R, Suenkel U, Eschweiler GW, Maetzler W, Berg D. Substantia nigra hyperechogenicity is related to decline in verbal memory in healthy elderly adults. Eur J Neurol 2016; 23:973-8. [DOI: 10.1111/ene.12974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- R. Yilmaz
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - S. Behnke
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - I. Liepelt-Scarfone
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - B. Roeben
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - C. Pausch
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - A. Runkel
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - S. Heinzel
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - R. Niebler
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
- Geriatric Center at the University Hospital Tübingen; Tübingen Germany
| | - U. Suenkel
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - G. W. Eschweiler
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
- Geriatric Center at the University Hospital Tübingen; Tübingen Germany
| | - W. Maetzler
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - D. Berg
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
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Abstract
BACKGROUND Lumbar back pain is a frequent symptom in patients with advanced Parkinson's disease. We examined the effect of modification of the dopaminergic medication, x-ray-controlled lumbar spine injections and analgesics combined with physiotherapy. METHODS The data from 50 patients with Parkinson's disease and lumbar back pain were retrospectively analyzed. A structured L-dopa test was performed with all patients, whereby the pain intensity and mobility were monitored before and after the administration of L-dopa. Dopaminergic medication was adjusted in patients who reported either a reduction in pain intensity (> 20%) and/or an improvement of measured mobility and X-ray controlled lumbar spine injections were conducted in patients who reported persistent pain. Analgesics were introduced or dosages were raised in patients who had already received lumbar spine injections and continued to report pain. All patients participated in a daily physiotherapy program. RESULTS In the L-dopa test an improvement of mobility could be demonstrated in 40 patients and reduced pain intensity in 21 patients. In 37 patients with a positive L-dopa test the dopaminergic medication was adjusted. In 12 of these patients (24%) a decrease of pain intensity could be observed. Due to persisting back pain in 30 patients lumbar spine injections were conducted. Of these patients 17 (34%) had pain improvement. In 20 patients analgesics were applied and induced pain relief in 15 patients (30%). Overall 44 patients (88%) had an improvement in pain. DISCUSSION Even in cases of severe lumbar spine pathology adjustment of dopaminergic medication should be tested in all patients with Parkinson's disease and lumbar back pain. In patients with persistent pain facet joint injections as well as analgesics may be helpful and should be tested according to the predominant pain characteristics.
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Affiliation(s)
- O Rommel
- Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland.
| | - D Wejwer
- Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland
| | - K Schybek
- Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland
| | - T Przybilski
- Abteilung für Orthopädie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland
| | - G Jäger
- Abteilung für Orthopädie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland
| | - S Gräber
- Abteilung für Neurodegenerative Erkrankungen, Hertie-Institut für Hirnforschung, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - D Berg
- Abteilung für Neurodegenerative Erkrankungen, Hertie-Institut für Hirnforschung, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
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Stassek J, Ohnolz F, Hanusch Y, Schmidmayr M, Berg D, Kiechle M, Seifert-Klauss VR. Do Pregnancy and Parenthood Affect the Course of PCO Syndrome? Initial Results from the LIPCOS Study (Lifestyle Intervention for Patients with Polycystic Ovary Syndrome [PCOS]). Geburtshilfe Frauenheilkd 2016; 75:1153-1160. [PMID: 26719599 DOI: 10.1055/s-0035-1558186] [Citation(s) in RCA: 2] [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] [Indexed: 10/22/2022] Open
Abstract
Introduction: The impact of pregnancy and parenthood on the long-term course of PCOS (polycystic ovary syndrome is still not known. The LIPCOS study (Lifestyle Intervention for Patients with Polycystic Ovary Syndrome [PCOS] - using the example of pregnancy and parenthood) systematically investigates long-term changes in PCOS symptoms. Method and Patients: The LIPCOS pilot study sent out a questionnaire to 403 patients who had presented with oligomenorrhea between 1991 and 2002. The prospective LIPCOS main study systematically investigated 64 women using structured interviews about lifestyle changes in the last 10 years, created a detailed hormone profile of these women and carried out vaginal ultrasound to calculate ovarian score. Results: Ovarian volume and ovarian score were not significantly lower for women with children (n = 25) compared to women with PCOS who had not had children (n = 39; p = 0.226). More women with children than women who did not have children currently reported a regular daily lifestyle, and the difference was statistically significant (92 % [n = 23/25] vs. 61.5 % [n = 24/39]; p = 0.009). Ten years ago or before the birth of their first child, respectively, no such difference was found between both groups (52 vs. 51.3 %). Over the last 10 years, women with children were more likely to have shorter cycles compared to women without children (p = 0.441). 88 % of women with children compared to 69.2 % of women without children reported that currently they had a "healthy diet" (p = 0.130). Serum testosterone levels were slightly lower for women with children (67.6 % of the upper limits of normal ranges) compared to women without children (80 % of the upper limits of normal ranges), but because of the small subgroup sizes the difference was not statistically significant (p = 0.106). Conclusion: The LIPCOS study shows for the first time that pregnancy and parenthood may have an impact on the long-term course of PCOS. Women with children reported shorter cycles and had lower testosterone levels compared to women without children.
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Affiliation(s)
- J Stassek
- Gyn. Ambulanz, Frauenklinik und Poliklinik der TU München, München
| | - F Ohnolz
- Frauenklinik, Klinikum rechts der Isar der Technischen Universität München, München
| | - Y Hanusch
- Frauenklinik, Klinikum rechts der Isar der Technischen Universität München, München
| | - M Schmidmayr
- Frauenklinik, Klinikum rechts der Isar der Technischen Universität München, München
| | - D Berg
- Akademische Lehrpraxis der Technischen Universität München, Reproduktionsmedizin Bogenhausen, München
| | - M Kiechle
- Frauenklinik, Klinikum rechts der Isar der Technischen Universität München, München
| | - V R Seifert-Klauss
- Gyn. Ambulanz, Frauenklinik und Poliklinik der TU München, München ; Interdisziplinäres Osteoporosezentrum IOZ, Klinikum rechts der Isar, München
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Pilotto A, Schulte C, Hauser AK, Biskup S, Munz M, Brockmann K, Schaeffer E, Synofzik M, Maetzler W, Suenkel U, Srulijes K, Gasser T, Berg D. GBA-associated parkinsonism and dementia: beyond α-synucleinopathies? Eur J Neurol 2015; 23:520-6. [PMID: 26549049 DOI: 10.1111/ene.12894] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/24/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE To date the role of GBA mutations beyond α-synucleinopathies in the parkinsonism-dementia spectrum is still unclear. The aim of the study was to screen for GBA mutations in progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), primary progressive aphasia (PPA) and the behavioural variant of frontotemporal dementia (bvFTD). METHODS In all, 303 patients with a clinical diagnosis of PSP (n = 157), CBS (n = 39), PPA (n = 35) and bvFTD (n = 72) and 587 neurologically healthy controls were screened for the most common GBA mutations. RESULTS GBA mutations were detected in one healthy control and four patients with a clinical diagnosis of PSP (n = 1), probable CBS (n = 2) and PPA (n = 1, with concomitant C9orf72 expansion). Overall the prevalence of GBA mutations was low in non-α-synucleinopathies but significantly higher in the CBS subgroup compared to controls. CONCLUSION Although numbers are small, our findings indicate that the clinical phenotype of GBA-associated neurodegenerative disease is more heterogeneous than previously assumed, including phenotypes not usually associated with underlying α-synucleinopathies. This may be of relevance, once causal therapeutic strategies for GBA-associated neurodegenerative disease are developed.
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Affiliation(s)
- A Pilotto
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - C Schulte
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - A K Hauser
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - S Biskup
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.,CeGaT GmbH, Tübingen, Germany
| | - M Munz
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - K Brockmann
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - E Schaeffer
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - M Synofzik
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - W Maetzler
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - U Suenkel
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - K Srulijes
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - T Gasser
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - D Berg
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
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Gasser T, Berg D. Genetik neurodegenerativer Erkrankungen. Akt Neurol 2015. [DOI: 10.1055/s-0034-1396883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- T. Gasser
- Neurodegenerative Erkrankungen, DZNE – Deutsches Zentrum für Neurodegenerative Erkrankungen, Tübingen
| | - D. Berg
- Neurodegenerative Erkrankungen, DZNE – Deutsches Zentrum für Neurodegenerative Erkrankungen, Tübingen
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Rominger M, Berg D, Frauenfelder T, Ramaswamy A, Timmesfeld N. Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer? Eur Radiol 2015; 26:1457-65. [DOI: 10.1007/s00330-015-3935-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
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Heinzel S, Hasmann S, Hobert M, Heger T, Berg D, Maetzler W. P167. Dual tasking deficits in motor tasks predict falls in Parkinson’s disease. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hobert M, Hasmann S, Eschweiler G, Berg D, Maetzler W. P40. Quantitative gait parameter changes under challenging single and dual tasking conditions are associated with Trail Making Test performance: Cross-sectional analysis in 661 elderly. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elshehabi M, Maier K, Hasmann S, Heger T, Nußbaum S, Berg D, Hobert M, Maetzler W. P178. The effect of cognitively challenging tasks on walking in Parkinson’s Patients. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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van Uem J, Ainsworth E, Hasmann S, Heger T, Hobert M, Amigo EM, Walgaard S, van Lummel R, Berg D, Maetzler W. P171. The relationship between quantitative parameters of the Timed-up-and-Go phases, and health-related quality of life in Parkinson’s disease. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maier K, Nußbaum S, Elshehabi M, Hobert M, Hasmann S, Berg D, Maetzler W. P176. Quantitative analysis of anticipatory postural adjustment in patients with Parkinson’s disease. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Hasmann S, Hobert M, Meyer S, Eschweiler G, Berg D, Maetzler W. V41. Static sway patterns of individuals with increased risk for, and converters to Parkinson’s disease. Analysis of 700 participants of the TREND-study. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ritzinger A, Lesoine B, Kiechle M, Berg D, Schmidmayr M, Seifert-Klauss VR. Haben Ovulationen Einfluss auf FSH und Knochenstoffwechsel-Parameter bei Kinderwunsch-Patienten? Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Berg D, Schäfer K, Körner A, Tillmann W, Möller M, Witschas M. Barriereschichten in Kunststoffverpackungen und Auswirkungen auf das Recycling. CHEM-ING-TECH 2014. [DOI: 10.1002/cite.201450196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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White B, Berg D, Ikeda T, Levy R, Itti L, Munoz D. Comparison of superior colliculus and primary visual cortex in the coding of visual saliency. J Vis 2014. [DOI: 10.1167/14.10.517] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Seifert-Klauss V, Ritzinger AC, Lesoine B, Kiechle M, Schmidmayr M, Berg D. Ovulation influences bone metabolism in women undergoing controlled ovarian stimulation. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stassek J, Ohnolz F, Erdmann J, Berg D, Kiechle M, Seifert-Klauss V. Long-term follow-up of PCOS-patients – the LIPCOS Trial. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372094] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kampfer C, Saller S, Windschüttl S, Berg D, Berg U, Mayerhofer A. Pigment-Epithelium Derived Factor (PEDF) and the human ovary: A role in the generation of ROS in granulosa cells. Life Sci 2014; 97:129-36. [DOI: 10.1016/j.lfs.2013.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/04/2013] [Accepted: 12/07/2013] [Indexed: 11/16/2022]
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Gaenslen A, Wurster I, Brockmann K, Huber H, Godau J, Faust B, Lerche S, Eschweiler GW, Maetzler W, Berg D. Prodromal features for Parkinson's disease--baseline data from the TREND study. Eur J Neurol 2014; 21:766-72. [PMID: 24612314 DOI: 10.1111/ene.12382] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 01/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE A number of non-motor features are known to precede motor manifestations of Parkinson's disease (PD). They are supposed to already represent the prodromal neurodegenerative state in those who later develop PD and are thus called prodromal markers. In this study, three prodromal markers, depression, rapid eye movement behaviour disorder (RBD) and hyposmia, were selected and were related to other prodromal features in elderly individuals without PD. METHODS From the Tübinger Evaluation of Risk Factors for Early Detection of Neurodegeneration (TREND) study, 698 healthy individuals aged 50-80 years reporting one or more of the selected prodromal markers (SPMs), but without neurodegenerative disorders, were evaluated and classified according to the status of prodromal markers. Other prodromal PD-related features were assessed with a 23-item questionnaire and compared between participants with and without the three SPMs. RESULTS Individuals with the SPMs for PD endorsed more of the additional possible prodromal features of PD than those without; of 23 possible prodromal features, the median number identified amongst participants with no SPMs was two, compared with four with one marker, five with two and seven with three (P < 0.001). Regarding individual SPMs, participants with depression and RBD endorsed five of 23 markers, compared with three for those with hyposmia (P = 0.001). There was no significant increase in the number of prodromal features amongst those with two SPMs compared with those with only one marker. CONCLUSIONS Individuals with the SPMs for PD report a higher prevalence of other prodromal PD symptoms. This may indicate that these markers can identify individuals at risk for PD.
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Affiliation(s)
- A Gaenslen
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
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Saller S, Kunz L, Berg D, Berg U, Lara H, Urra J, Hecht S, Pavlik R, Thaler CJ, Mayerhofer A. Dopamine in human follicular fluid is associated with cellular uptake and metabolism-dependent generation of reactive oxygen species in granulosa cells: implications for physiology and pathology. Hum Reprod 2013; 29:555-67. [PMID: 24287819 DOI: 10.1093/humrep/det422] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION Is the neurotransmitter dopamine (DA) in the human ovary involved in the generation of reactive oxygen species (ROS)? SUMMARY ANSWER Human ovarian follicular fluid contains DA, which causes the generation of ROS in cultured human granulosa cells (GCs), and alterations of DA levels in follicular fluid and DA uptake/metabolism in GCs in patients with polycystic ovary syndrome (PCOS) are linked to increased levels of ROS. WHAT IS KNOWN ALREADY DA is an important neurotransmitter in the brain, and the metabolism of DA results in the generation of ROS. DA was detected in human ovarian homogenates, but whether it is present in follicular fluid and plays a role in the follicle is not known. STUDY DESIGN, SIZE AND DURATION We used human follicular fluid from patients undergoing in vitro fertilization (IVF), GCs from patients with or without PCOS and also employed mathematical modeling to investigate the presence of DA and its effects on ROS. PARTICIPANTS/MATERIALS, SETTING AND METHODS DA in follicular fluid and GCs was determined by enzyme-linked immunosorbent assay. GC viability, apoptosis and generation of ROS were monitored in GCs upon addition of DA. Inhibitors of DA uptake and metabolism, an antioxidant and DA receptor agonists, were used to study cellular uptake and the mechanism of DA-induced ROS generation. Human GCs were examined for the presence and abundance of transcripts of the DA transporter (DAT; SLC6A3), the DA-metabolizing enzymes monoamine oxidases A/B (MAO-A/B) and catechol-O-methyltransferase and the vesicular monoamine transporter. A computational model was developed to describe and predict DA-induced ROS generation in human GCs. MAIN RESULTS AND ROLE OF CHANCE We found DA in follicular fluid of ovulatory follicles of the human ovary and in GCs. DAT and MAO-A/B, which are expressed by GCs, are prerequisites for a DA receptor-independent generation of ROS in GCs. Blockers of DAT and MAO-A/B, as well as an antioxidant, prevented the generation of ROS (P < 0.05). Agonists of DA receptors (D1 and D2) did not induce ROS. DA, in the concentration range found in follicular fluid, did not induce apoptosis of cultured GCs. Computational modeling suggested, however, that ROS levels in GCs depend on the concentrations of DA and on the cellular uptake and metabolism. In PCOS-derived follicular fluid, the levels of DA were higher (P < 0.05) in GCs, the transcript levels of DAT and MAO-A/B in GCs were 2-fold higher (P < 0.05) and the DA-induced ROS levels were found to be more than 4-fold increased (P < 0.05) compared with non-PCOS cells. Furthermore, DA at a high concentration induced apoptosis in PCOS-derived GCs. LIMITATIONS, REASONS FOR CAUTION While the results in IVF-derived follicular fluid and in GCs reveal for the first time the presence of DA in the human follicular compartment, functions of DA could only be studied in IVF-derived GCs, which can be viewed as a cellular model for the periovulatory follicular phase. The full functional importance of DA-induced ROS in small follicles and other compartments of the ovary, especially in PCOS samples, remains to be shown. WIDER IMPLICATIONS OF THE FINDINGS The results identify DA as a factor in the human ovary, which, via ROS generation, could play a role in ovarian physiology and pathology. The results obtained in samples from women with PCOS suggest the involvement of DA, acting via ROS, in this condition. STUDY FUNDING/COMPETING INTERESTS This work was supported by a grant from DFG MA1080/17-3 and in part MA1080/19-1. There are no competing interests.
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Affiliation(s)
- S Saller
- Anatomy III-Cell Biology, Ludwig Maximilian University Munich, Munich, Germany
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Srulijes K, Hauser AK, Guella I, Asselta R, Brockmann K, Schulte C, Soldà G, Cilia R, Maetzler W, Schols L, Wenning GK, Poewe W, Barone P, Wüllner U, Oertel W, Berg D, Goldwurm S, Gasser T. No association of GBA mutations and multiple system atrophy. Eur J Neurol 2013; 20:e61-2. [PMID: 23490118 DOI: 10.1111/ene.12086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/30/2012] [Indexed: 11/28/2022]
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Berardelli A, Wenning GK, Antonini A, Berg D, Bloem BR, Bonifati V, Brooks D, Burn DJ, Colosimo C, Fanciulli A, Ferreira J, Gasser T, Grandas F, Kanovsky P, Kostic V, Kulisevsky J, Oertel W, Poewe W, Reese JP, Relja M, Ruzicka E, Schrag A, Seppi K, Taba P, Vidailhet M. EFNS/MDS-ES/ENS [corrected] recommendations for the diagnosis of Parkinson's disease. Eur J Neurol 2013; 20:16-34. [PMID: 23279440 DOI: 10.1111/ene.12022] [Citation(s) in RCA: 323] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/18/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson's disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD. METHODS Following the EFNS instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations. RESULTS For the clinical diagnosis, we recommend the use of the Queen Square Brain Bank criteria (Level B). Genetic testing for specific mutations is recommended on an individual basis (Level B), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate PD from other parkinsonian disorders including recessive forms (Level A). Screening for pre-motor PD with olfactory testing requires additional tests due to limited specificity. Drug challenge tests are not recommended for the diagnosis in de novo parkinsonian patients. There is an insufficient evidence to support their role in the differential diagnosis between PD and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for REM sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected PD cases (Level A). Transcranial sonography is recommended for the differentiation of PD from atypical and secondary parkinsonian disorders (Level A), for the early diagnosis of PD and in the detection of subjects at risk for PD (Level A), although the technique is so far not universally used and requires some expertise. Because specificity of TCS for the development of PD is limited, TCS should be used in conjunction with other screening tests. Conventional magnetic resonance imaging and diffusion-weighted imaging at 1.5 T are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (MSA) or progressive supranuclear palsy versus PD on the basis of regional atrophy and signal change as well as diffusivity patterns (Level A). DaTscan SPECT is registered in Europe and the United States for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level A). More specifically, DaTscan is indicated in the presence of significant diagnostic uncertainty such as parkinsonism associated with neuroleptic exposure and atypical tremor manifestations such as isolated unilateral postural tremor. Studies of [(123) I]MIBG/SPECT cardiac uptake may be used to identify patients with PD versus controls and MSA patients (Level A). All other SPECT imaging studies do not fulfil registration standards and cannot be recommended for routine clinical use. At the moment, no conclusion can be drawn as to diagnostic efficacy of autonomic function tests, neurophysiological tests and positron emission tomography imaging in PD. CONCLUSIONS The diagnosis of PD is still largely based on the correct identification of its clinical features. Selected investigations (genetic, olfactory, and neuroimaging studies) have an ancillary role in confirming the diagnosis, and some of them could be possibly used in the near future to identify subjects in a pre-symptomatic phase of the disease.
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Affiliation(s)
- A Berardelli
- Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute, Sapienza, Università di Roma, Rome, Italy.
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