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Gruber N, Shemesh-Iron M, Kraft E, Mitelberg K, Mauda E, Ben-Ami M, Mazor-Aronovitch K, Levy-Shraga Y, Levran N, Levek N, Zimlichman E, Pinhas-Hamiel O. Virtual reality's impact on children with type 1 diabetes: a proof-of-concept randomized cross-over trial on anxiety, pain, adherence, and glycemic control. Acta Diabetol 2024; 61:215-224. [PMID: 37845502 DOI: 10.1007/s00592-023-02195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
AIMS Assess the effectiveness of virtual reality (VR) technology, in reducing pain and anxiety, and improving adherence and glycemic control among children with type 1 diabetes (T1D). METHODS Children with T1D, managed with continuous glucose monitoring and insulin pumps, were recruited for a randomized cross-over trial. Children were randomized to one of two interventions for diabetes management: group 1 used VR glasses first and group 2 listened to vocal-guided affective imagery first (audio). After 1 month, the interventions were crossed over. The outcome measures included pain and anxiety assessment, adherence, glycemic control, and patient-reported outcome measures (PROMs) of VR satisfaction and effectiveness. RESULTS Forty children, mean age 11.4 ± 1.8 years, were participated. During the VR part, the monthly mean pain score compared to the baseline improved in both groups by 30% (p = 0.03). A 14% reduction in the state anxiety score was observed from baseline to 1 month in both groups (p = 0.009). Glycemic control measures including time in range, time above range, and glucose management indicator improved in both groups during VR part (p < 0.004 for all), compared to audio part. After one month, the patient-reported outcome measure (PROM) of satisfaction and effectiveness was sixfold higher after 1 month in group 1 compared to group 2 (p = 0.002). Adherence improved for both groups. CONCLUSIONS VR was shown to be effective in reducing pain and anxiety, improving adherence, PROM, and glycemic control among children with T1D. We suggest incorporating VR technology in pediatric diabetes clinics to facilitate and improve coping and management of diabetes. TRIAL REGISTRATION Trial registration number and date of registration for prospectively registered trials:ClinicalTrials.gov Identifier: NCT05883267, May 10th, 2023.
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Affiliation(s)
- Noah Gruber
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
| | - Moran Shemesh-Iron
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
| | - Ethel Kraft
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Karen Mitelberg
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
| | - Elinor Mauda
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
| | - Michal Ben-Ami
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Kineret Mazor-Aronovitch
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Yael Levy-Shraga
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Neriya Levran
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Noah Levek
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Innovation and Transformation Management, Sheba Medical Center, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Schulte-Goecking H, Azqueta-Gavaldon M, Storz C, Woiczinski M, Fraenkel P, Leukert J, Azad SC, Kraft E. Psychological, social and biological correlates of body perception disturbance in complex regional pain syndrome. Curr Psychol 2020. [DOI: 10.1007/s12144-020-00635-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractBody Perception Disturbance (BPD) in Complex Regional Pain Syndrome (CRPS) still represents a poorly understood phenomenon. Research has shown that knowledge about changes in body perception can yield relevant information for understanding and treating the disease. This study addressed possible connections between BPD and psychological and social factors, pain intensity, and disease duration. Sixty patients with chronic CRPS Type I of the hand were recruited. Body Perception Disturbance was assessed using the Galer and Jensen Neurobehavioral Questionnaire (GJ) and the BATH CRPS Body Perception Disturbance Scale (BATH). Depression, anxiety, stress, childhood trauma and other life events were assessed using standardized and validated questionnaires. This study found that BPD in CRPS was significantly correlated with measures of depression, anxiety, current stress, quality of life, and pain intensity, but not with stress experienced in the twelve months preceding onset of illness, childhood trauma, or duration of illness. Future research needs to identify which patients are most likely to develop these psychological conditions of CRPS, so that early, preventive intervention is possible. This study establishes a relationship between depression, anxiety, current stress, quality of life, pain intensity, and BPD severity. It also supports literature suggesting that preexisting stress, childhood trauma, and disease duration have no influence on BPD. The findings suggest that there is a bidirectional influence between brain alterations, psychological symptoms, and illness severity.
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Boonyapaisancharoen P, Yotnuengnit P, Piravej K, Kraft E, Arnstadt N, Schulte-Goecking H, Jamin N. Differences of nature of disease, socioeconomic and psychological factors in chronic low back pain patients between Thailand and Germany. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zhang A, Ficklscherer A, Kraft E, Jansson V, Mueller P. Use of local anesthetics and cortisone in pain injection therapy–A comparison of necrosis and apoptosis-induction in joint cells. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.190] [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: 11/25/2022]
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5
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Miller C, Russo J, Kraft E. HPV+ Oropharyngeal Cancer and Feeding Tube Use With Chemoradiation. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.244] [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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6
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Storz C, Schulte-Göcking H, Azqueta M, Wania C, Neugebauer M, Reiners A, Azad S, Kraft E. [Cognitive-perceptive approaches in the treatment of chronic pain]. Schmerz 2017; 31:448-455. [PMID: 28616655 DOI: 10.1007/s00482-017-0229-7] [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: 10/19/2022]
Abstract
In the treatment of difficult chronic pain conditions, cognitive-perceptive approaches offer an alternative to conventional therapies. Especially phantom limb pain and complex regional pain syndrome (CRPS) are frequently treated with these promising modalities. This article provides an overview of the most important cognitive-perceptive therapies and the research results concerning their clinical efficacy. In addition, we discuss their neurobiological foundation and clinical perspectives.
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Affiliation(s)
- C Storz
- Klinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - H Schulte-Göcking
- Klinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.,Interdisziplinäre Schmerzambulanz, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Azqueta
- Klinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - C Wania
- Klinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - M Neugebauer
- Klinik für Frührehabilitation und Physikalische Medizin, Klinikum Bogenhausen, Städtisches Klinikum München, München, Deutschland
| | - A Reiners
- Klinik für Frührehabilitation und Physikalische Medizin, Klinikum Bogenhausen, Städtisches Klinikum München, München, Deutschland
| | - S Azad
- Interdisziplinäre Schmerzambulanz, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland.,Klinik für Anästhesiologie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - E Kraft
- Klinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.,Interdisziplinäre Schmerzambulanz, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
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7
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Azqueta-Gavaldon M, Schulte-Göcking H, Storz C, Azad S, Reiners A, Borsook D, Becerra L, Kraft E. Basal ganglia dysfunction in complex regional pain syndrome - A valid hypothesis? Eur J Pain 2016; 21:415-424. [DOI: 10.1002/ejp.975] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2016] [Indexed: 01/27/2023]
Affiliation(s)
- M. Azqueta-Gavaldon
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - H. Schulte-Göcking
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - C. Storz
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
| | - S. Azad
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Anaesthesia; Medical Centre of University of Munich; Germany
| | - A. Reiners
- Department of Rehabilitation; City Hospital Bogenhausen; Munich Germany
| | - D. Borsook
- Centre for Pain and the Brain; Boston Children's Hospital; Harvard Medical School; Boston USA
| | - L. Becerra
- Centre for Pain and the Brain; Boston Children's Hospital; Harvard Medical School; Boston USA
| | - E. Kraft
- Interdisciplinary Pain Unit; Medical Centre of University of Munich; Germany
- Department of Orthopaedics, Physical Medicine and Rehabilitation; Medical Centre of University of Munich; Germany
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8
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Eren OE, Straube A, Tonn JC, Ilmberger J, Kraft E. [Cognitive Function in Patients Before and After Micro-neurosurgical Resection of Frontal Brain Tumors]. Fortschr Neurol Psychiatr 2015; 83:628-33. [PMID: 26633842 DOI: 10.1055/s-0041-109189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with lesions of the prefrontal cortex as a result of frontal brain tumors (intra- and extra-axial) can show impairments of executive functions 1 2 3 4. Although there are a large number of psychological tests, the detection of impairments of relevant everyday executive functions in these patients is still extremely difficult. In 30 patients with lesions of the prefrontal cortex, the executive functions were tested with the Behavioral Assessment of Dysexecutive Syndrome (BADS) and 21 patients were also followed up postoperatively. Additionally, if possible, the Wisconsin Card Sorting Test (WCST), a widely used executive function test, and the Wechsler Adult Intelligence Scale (WAIS) for general cognitive performance were conducted. Pre- and postoperatively, a total of 16 patients were followed up with all three tests. The aim was to investigate the neuropsychological assessment pre- and postoperatively, to evaluate it in terms of deficits and changes in performance and to ensure that no new relevant everyday cognitive deficits arose. Preoperatively, only one patient, who could not be tested post-surgery, showed a reduced overall profile value in the BADS. In all tested patients, there was no evidence of deterioration of cognitive status 8 - 12 weeks postoperatively. Further investigations using fMRI should be used to clarify whether the results obtained should be interpreted as neuroplastic adaptations of prefrontal cognitive functions or as a failure to detect deficits due to a lack of sensitivity of the tests used.
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Affiliation(s)
- O E Eren
- Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum DSGZ, Klinikum der Universität München
| | - A Straube
- Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum DSGZ, Klinikum der Universität München
| | - J C Tonn
- Neurochirurgie, LMU Muenchen-Grosshadern, München
| | - J Ilmberger
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München
| | - E Kraft
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München
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9
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Rachinger-Adam B, Kraft E, Luchting B, Woehrle T, Hasbargen U, Krueger W, Azad S. Treatment of refractory post-dural puncture headache with low doses of the strong opioid piritramide. Br J Anaesth 2013; 110:490-1. [DOI: 10.1093/bja/aes589] [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: 12/21/2022] Open
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10
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Huge V, Müller E, Beyer A, Kraft E, Azad SC. [Patients with chronic pain syndromes. Impact of an individual outpatient therapy program on pain and health-related quality of life]. Schmerz 2011; 24:459-67. [PMID: 20821234 DOI: 10.1007/s00482-010-0968-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The study was performed to reveal the effect of an individualized personal outpatient therapy program, based on a multidisciplinary assessment, on pain and health-related quality of life in patients with chronic pain. METHODS Fifty patients were prospectively evaluated before and 3 months after establishment of an individualized outpatient therapy program. Health-related quality of life, pain and pain-related disability, depression and motivation to adopt self-management of chronic pain were assessed. Therapy adherence was tested with a structured interview. RESULTS Only marginal improvements were observed in terms of pain and health-related quality of life. Therapy adherence varied between the different therapies. CONCLUSIONS An individualized personal outpatient therapy program has only marginal effects on pain and health-related quality of life in patients with chronic pain.
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Affiliation(s)
- V Huge
- Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377 München.
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11
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Kraft E. HCV- und HIV-Therapie unter Haftbedingungen. Suchttherapie 2009. [DOI: 10.1055/s-0029-1243583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Scheuerecker J, Ufer S, Käpernick M, Wiesmann M, Brückmann H, Kraft E, Seifert D, Koutsouleris N, Möller HJ, Meisenzahl EM. Cerebral network deficits in post-acute catatonic schizophrenic patients measured by fMRI. J Psychiatr Res 2009; 43:607-14. [PMID: 18951556 DOI: 10.1016/j.jpsychires.2008.08.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [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] [Received: 02/27/2008] [Revised: 08/01/2008] [Accepted: 08/25/2008] [Indexed: 11/28/2022]
Abstract
Twelve patients with catatonic schizophrenia and 12 matched healthy controls were examined with functional MRI while performing a motor task. The aim of our study was to identify the intracerebral pathophysiological correlates of motor symptoms in catatonic patients. The motor task included three conditions: a self-initiated (SI), an externally triggered (ET) and a rest condition. Statistical analysis was performed with SPM5. During the self-initiated movements patients showed significantly less activation than healthy controls in the supplementary motor area (SMA), the prefrontal and parietal cortex. Our results suggest a dysfunction of the "medial motor system" in catatonic patients. Self-initiated and externally triggered movements are mediated by different motor loops. The "medial loop" includes the SMA, thalamus and basal ganglia, and is necessary for self-initiated movements. The "lateral loop" includes parts of the cerebellum, lateral premotor cortex, thalamus and parietal association areas. It is involved in the execution of externally triggered movements. Our findings are in agreement with earlier behavioral data, which show deficits in self-initiated movements in catatonic patients but no impairment of externally triggered movements.
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Affiliation(s)
- J Scheuerecker
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336 Munich, Germany
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Lee ST, Tan T, Poon AMT, Toh HB, Gill S, Berlangieri SU, Kraft E, Byrne AJ, Pathmaraj K, O'Keefe GJ, Tebbutt N, Scott AM. Role of low-dose, noncontrast computed tomography from integrated positron emission tomography/computed tomography in evaluating incidental 2-deoxy-2-[F-18]fluoro-D-glucose-avid colon lesions. Mol Imaging Biol 2007; 10:48-53. [PMID: 17994266 DOI: 10.1007/s11307-007-0117-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 10/03/2007] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the contribution of concurrent low-dose, noncontrast CT in the assessment of the malignant potential of incidental focal 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-avid colonic lesions on positron emission tomography/computed tomography (PET/CT). PROCEDURES Routine FDG-PET/CT scans were reviewed for identification of focal FDG-avid colon lesions, and the CT component was independently reviewed for an anatomical lesion and malignant potential based on CT criteria. Clinical, endoscopic, and histopathology follow-up was obtained. RESULTS A total of 85/2,916 (3%) oncology FDG-PET/CT scans had incidental focal colon lesions. Clinical and/or endoscopic follow-up was available in 83/85 (98%) patients. Focal, corresponding CT lesions were found in 44/83 (53%) patients, but features of malignancy were not assessable. Of the 44 patients with a final diagnosis, 32/44 (73%) were FDG-PET/CT true positives; 5/44 (11%) were false positives; and 7/44 (16%) had inconclusive FDG-PET/CT findings. CONCLUSIONS Concurrent low-dose, noncontrast CT improves localization, but does not provide independent information on the malignant potential of incidental focal colonic activity on FDG-PET/CT.
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Affiliation(s)
- S T Lee
- Centre for PET, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia.
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Kraft E, Schaal M, Koenig E, Scheidtmann K. Levodopa related reorganisation of motor representation in stroke recovery-evidence from fMRI. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.148] [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: 11/15/2022]
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Kraft E, Schaal M, Koenig E, Scheidtmann K. Levodopa related reorganisation of motor representation in stroke recovery- evidence from fMRI. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schaal M, Huber R, Becker W, König E, Scheidtmann K, Kraft E. Die funktionelle Anatomie der Bewegungsvorstellung bei Patienten nach zerebraler Ischämie. Akt Neurol 2005. [DOI: 10.1055/s-2005-919359] [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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Binder E, Becker W, Gruber O, Kraft E. Störungen der zerebralen Repräsentation des Arbeitsgedächtnisses bei Patienten mit idiopathischem Parkinson-Syndrom. Akt Neurol 2005. [DOI: 10.1055/s-2005-919298] [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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Kraft E, Höchsmann B, Landwehrmeyer B, Freund W. Toxische Myelopathie nach intrathekaler Chemotherapie bei akuter lymphatischer Leukämie: Differenzialdiagnose und therapeutische Optionen. Akt Neurol 2005. [DOI: 10.1055/s-2005-866959] [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: 10/25/2022]
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Storch A, Brockmann K, Pekrun A, Kraft E, Walter B, Krause BJ, Reske S, Tatsch K, Grön G, Gartner HJ, Sauermann W, Christen HJ, Ludolph AC, Lehmann-Horn F, Lerche H. Familial acanthocytosis with paroxysmal exertion-induced dyskinesias and epilepsy (FAPED). Akt Neurol 2004. [DOI: 10.1055/s-2004-833307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ufer S, Frodl T, Kraft E, Wiesmüller M, Brückmann H, Möller HJ, Meisenzahl EM. Differences in cortical activation by a working memory task after substitution of atypical neuroleptics. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ethofer T, Seeger U, Klose U, Erb M, Kardatzki B, Kraft E, Landwehrmeyer GB, Grodd W, Storch A. Proton MR spectroscopy in succinic semialdehyde dehydrogenase deficiency. Neurology 2004; 62:1016-8. [PMID: 15037717 DOI: 10.1212/01.wnl.0000115385.45515.df] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Succinic semialdehyde dehydrogenase (SSADH) deficiency is a rare hereditary disorder of the CNS catabolism of gamma-aminobutyric acid (GABA), leading to accumulation of the metabolite 4-hydroxybutyrate (GHB). Here the authors report on 1.5 and 3.0 T proton MR spectroscopy in a patient with SSADH deficiency. A characteristic pattern with clearly elevated GABA levels and traces of GHB was found in both the white and the gray matter of the brain. In vivo spectroscopy may be useful for diagnosis and monitoring SSADH deficiency.
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Affiliation(s)
- T Ethofer
- Section on Experimental MR of the CNS, Department of Neuroradiology, University of Tübingen, Germany
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Uttner I, Hermsdörfer J, Nowak D, Krey P, Müller F, Philipp J, Zierdt A, Kraft E. Bimanuelle Koordination und Händigkeit. Akt Neurol 2004. [DOI: 10.1055/s-2004-833064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kurt A, Lulé D, Kraft E, Kassubek J, Anders S, Birbaumer N, Ludolph AC. Kortikale Reorganisation des Motorkortex bei amyotropher Lateralsklerose. Akt Neurol 2004. [DOI: 10.1055/s-2004-833197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Müller HP, Kraft E, Ludolph A, Erné SN. New methods in fMRI analysis. Hierarchical cluster analysis for improved signal-to-noise ratio compared to standard techniques. IEEE Eng Med Biol Mag 2002; 21:134-42. [PMID: 12405067 DOI: 10.1109/memb.2002.1044183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- H P Müller
- Division for Biosignals and Imaging Technologies, Central Institute for Biomedical Engineering, Ulm University, D-89069 Ulm Germany.
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Arnold G, Schwarz J, Tatsch K, Kraft E, Wächter T, Bandmann O, Oertel WH. Steele-Richardson-Olszewski-syndrome: the relation of dopamine D2 receptor binding and subcortical lesions in MRI. J Neural Transm (Vienna) 2002; 109:503-12. [PMID: 11956969 DOI: 10.1007/s007020200041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We compared (123)I-iodobenzamide single photon emission computed tomography (IBZM-SPECT) for imaging of striatal dopamine D(2) receptors in vivo, and MRI in 32 patients with the clinical diagnosis of progressive supranuclear palsy (PSP). We found a significant inter-dependence of reduction of specific striatal IBZM binding indicative of striatal degeneration and of the absence of multiple signal hyperintensities in MRI; age had no influence neither on IBZM binding nor on signal hyperintensities. We conclude that the presence of multiple signal hyperintensities should raise doubt on the correct clinical diagnosis.
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Affiliation(s)
- G Arnold
- Department of Neurology, Klinikum Gorsshadern, University of Munich, Federal Republic of Germany
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Müller HP, Kraft E, Ludolph A, Erné S. The Functional Anatomy of Bimanual Coordination - fMRI Analysis with a New Fast and User-Independent Software Tool. BIOMED ENG-BIOMED TE 2001. [DOI: 10.1515/bmte.2001.46.s2.179] [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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Kümpfel T, Lechner C, Auer D, Kraft E, Lydtin H, Trenkwalder C. Non-convulsive status epilepticus with marked neuropsychiatric manifestations and MRI changes after treatment of hypercalcaemia. Acta Neurol Scand 2000; 102:337-9. [PMID: 11083513 DOI: 10.1034/j.1600-0404.2000.102005337.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe a 77-year-old woman who developed a confusional state, cognitive impairment, behavioural abnormalities and dysphasia after treatment of hypercalcaemia. Repeated EEG recording revealed rhythmic sharp-wave activity over the right parietal-occipital lobe. Magnetic resonance imaging (MRI) showed marked hyperintense signal changes bilaterally. The diagnosis of a non-convulsive status epilepticus (NCSE) was made. With antiepileptic treatment the patient improved and MRI as well as EEG changes were almost all reversible. NCSE is an important differential diagnosis of patients with neuropsychiatric symptoms and can develop after rapid lowering of serum calcium levels in hypercalcaemia.
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Affiliation(s)
- T Kümpfel
- Max Planck Institut of Psychiatry, Munich, Germany
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29
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Scholz VH, Flaherty AW, Kraft E, Keltner JR, Kwong KK, Chen YI, Rosen BR, Jenkins BG. Laterality, somatotopy and reproducibility of the basal ganglia and motor cortex during motor tasks. Brain Res 2000; 879:204-15. [PMID: 11011024 DOI: 10.1016/s0006-8993(00)02749-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We investigated the basal ganglia, motor cortex area 4, and supplementary motor area (SMA) using functional magnetic resonance imaging (fMRI) and five motor tasks: switching between finger and toe movements, writing, finger tapping, pronation/supination, and saccadic eye movements. We found reliable activation in the caudate nucleus and putamen in single subjects without the need for inter-subject averaging. Percent signal changes in basal ganglia were smaller by a factor of three than those in SMA or motor cortex (1% vs. 2.5-3%). There was a definite foot-dorsal, hand-ventral basal ganglia somatotopy, similar to prior data from primates. Saccadic eye movements activated the caudate nucleus significantly more than the other tasks did. Unilateral movements produced bilateral activation in the striatum even when motor cortex activation was unilateral. Surprisingly, bilateral performance of the tasks led, on average, to consistently smaller basal ganglia activation than did unilateral performance (P<0.001), suggesting less inhibition of contralateral movements during bilateral tasks. Moreover, there was a striking dominance pattern in basal ganglia motor activation: the left basal ganglia were more active than the right for right handers, regardless of the hand used. This lateralization appears much stronger than that previously reported for motor cortex. Comparisons of inter-subject and intra-subject reproducibility indicated a much larger variability in basal ganglia and SMA compared to motor cortex, in spite of similar percent signal changes in the latter two structures.
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Affiliation(s)
- V H Scholz
- MGH-NMR Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02119, USA
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30
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Jenkins BG, Chen YI, Kuestermann E, Makris NM, Nguyen TV, Kraft E, Brownell AL, Rosas HD, Kennedy DN, Rosen BR, Koroshetz WJ, Beal MF. An integrated strategy for evaluation of metabolic and oxidative defects in neurodegenerative illness using magnetic resonance techniques. Ann N Y Acad Sci 2000; 893:214-42. [PMID: 10672240 DOI: 10.1111/j.1749-6632.1999.tb07828.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The number of physiologic and metabolic phenomena amenable to analysis using magnetic resonance (MR) techniques is increasing every year. MR techniques can now evaluate tissue parameters relevant to TCA cyclemetabolism, anerobic glycolysis, ATP levels, blood-brain barrier permeability, macrophage infiltration, cytotoxic edema, spreading depression, cerebral blood flow and volume, and neurotransmitter function. The paramagnetic nature of certain oxidation states of iron leads to the ability to map out brain function using deoxyhemoglobin as an endogenous contrast agent, and also allows for mapping of local tissue iron concentrations. In addition to these metabolic parameters, the number of ways to generate anatomic contrast using MR is also expanding; and in addition to conventional anatomic scans, mapping of axonal fiber tracts can also be performed using the anisotropy of water diffusion. A strategy for integration of these multifarious parameters in a comprehensive neurofunctional exam in neurodegenerative illness is outlined in this paper. The goals of the integrated exam, as applied to a given neurodegenerative illness, can be subdivided into three categories: etiology, natural history, and therapeutic end points. The consequences of oxidative stress and/or mitochondrial dysfunction are explored in the context of the various parameters that can be measured using the integrated MR exam.
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Affiliation(s)
- B G Jenkins
- Department of Radiology, Massachusetts General Hospital NMR Center, Charlestown, USA.
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Auer DP, Pütz B, Kraft E, Lipinski B, Schill J, Holsboer F. Reduced glutamate in the anterior cingulate cortex in depression: an in vivo proton magnetic resonance spectroscopy study. Biol Psychiatry 2000; 47:305-13. [PMID: 10686265 DOI: 10.1016/s0006-3223(99)00159-6] [Citation(s) in RCA: 400] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Functional imaging studies suggest a specific role of the anterior brain regions in the pathogenesis of major depression. The aim of this study was to evaluate possible neurochemical alterations in the frontomesial cortex in patients with major depressive episode using in vivo proton magnetic resonance spectroscopy ((1)H-MRS). METHODS Single voxel (1)H-MRS was performed in 19 patients with major depressive episodes and 18 age-matched healthy controls within the anterior cingulate cortex and the parietal white matter. Absolute concentrations were estimated for N-acetyl-aspartate, choline-containing compounds, total creatine, myo-inositol, unresolved glutamate and glutamine (Glx) and glutamate alone (Glu). Voxel composition was analyzed by image segmentation into cerebrospinal fluid (CSF), grey and white matter. RESULTS MANOVA test for Glx and Glu using age, percent CSF and percent grey matter contribution as covariates yielded a significant group effect within the anterior cingulate due to decrease of Glx in patients (-10.4%, p =.013). Considering only severely depressed patients, both Glx and Glu (-14.3%, p =.03) showed a significant decrease. There was no significant group effect for the neuronal marker NAA, creatine, choline or myo-inositol in either localization. CONCLUSIONS This study suggests a possible role of altered glutamatergic neurotransmission within the anterior cingulate in the pathogenesis of mood disorders. The otherwise unremarkable findings of major brain metabolites confirms lack of neurodegenerative or membrane metabolic changes in major depression.
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Affiliation(s)
- D P Auer
- Max Planck Institute of Psychiatry, Munich, Germany
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Abstract
Magnetic resonance spectroscopy allows neurochemistry to be probed noninvasively in vivo. Recent advances in our understanding of the biochemical significance of the various neurochemicals that are observable allow a variety of pathologic states of relevance to encephalopathies and neurodegenerative disorders to be observed. Measurements of brain glutamate and glutamine allow observation of neuronal/glial substrate cycling and ammonia detoxification. Myo-inositol allows changes in cerebral osmolarity and gliosis to be observed. N-acetylaspartate is a marker of neuronal health and number. Lactate allows nonoxidative glycolysis to be observed. These molecules are now being used to ask etiologic questions that are of relevance to encephalopathies and neurodegeneration, as well to probe longitudinally both natural history and therapeutic interventions in these conditions. Combined with recent advances in anatomic magnetic resonance imaging as well as perfusion magnetic resonance imaging, magnetic resonance spectroscopy has the potential to aid greatly in our understanding of neuronal dysfunction in a wide variety of neurologic pathologies, even in single patients.
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Affiliation(s)
- B G Jenkins
- MGH-NMR Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown 02129, USA.
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Greenberg SM, O'Donnell HC, Schaefer PW, Kraft E. MRI detection of new hemorrhages: potential marker of progression in cerebral amyloid angiopathy. Neurology 1999; 53:1135-8. [PMID: 10496283 DOI: 10.1212/wnl.53.5.1135] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors used serial gradient-echo MRIs to detect new small hemorrhages in patients with previous lobar hemorrhage. Of 24 lobar hemorrhage patients (17 diagnosed with probable and 7 with possible amyloid angiopathy) who prospectively underwent repeat MRI 1.5 years after initial study, 9 (38%) demonstrated additional hemorrhages at follow-up. Interrater agreement was high. New hemorrhages were more frequent in patients with probable amyloid angiopathy (8 of 17, 47%) with more hemorrhages at baseline (p < 0.01). These results suggest a role for gradient-echo MRI in assessing disease progression in amyloid angiopathy.
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Affiliation(s)
- S M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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Abstract
We studied 13 patients with Wilson's disease (WD) using localized magnetic resonance proton spectroscopy to test whether hepatic encephalopathy or impaired energy metabolism contributes to neurological dysfunction. Levels of myoinositol (MI), choline-containing compounds (Cho), creatine (Cr), N-acetyl-aspartate (NAA), Glx (unresolved resonances of glutamate, glutamine, and gamma-aminobutyric acid) and lactate were measured using a relative quantitative approach. Results were compared with those from 12 healthy controls. In one patient with de novo WD and acute hepatic disease but no neurological symptoms we found a marked decrease in the Cho/Cr and MI/Cr ratios. However, proton spectroscopy in the white matter, gray matter, and putamen of patients with treated WD showed no significant differences compared to healthy controls. In none of the subjects studied was the lactate/Cr ratio elevated. The spectroscopic findings were compatible with subclinical hepatic encephalopathy in the one patient with de novo WD and acute hepatic disease, but this does not play a major role in brain dysfunction in patients with treated WD. Additionally, there was no evidence of increased lactate concentration, indicating that cerebral energy metabolism was not grossly impaired.
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Affiliation(s)
- E Kraft
- Max Planck-Institute of Psychiatry, Munich, Germany.
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35
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Abstract
OBJECTIVES To determine if visual hallucinations in patients with Parkinson's disease are associated with an increased prevalence of white matter lesions. PATIENTS AND METHODS Fifteen patients with (group 1) and 15 patients without (group 2) a history of visual hallucinations were studied. Both groups were matched for age. Magnetic resonance imaging was performed in all patients using standard T2 weighted Fast-Spin-Echo sequences. Assessment of cerebral white matter changes was performed using a modification of established criteria, with semiquantitative evaluation of periventricular and deep white matter changes. RESULTS There was no significant group difference with regard to the total amount of white matter changes, nor was a group difference found between the amount or extent of periventricular hyperintensities or deep white matter lesions. Group 1 was significantly (P = 0.001) more disabled as evaluated by Hoehn/Yahr stage controlling for age and duration of disease. Mean increases in Hoehn/Yahr stage were not significantly greater in group 1 compared with group 2 at a 2-year follow-up examination (0.6 vs. 0.3, P = 0.166). CONCLUSION Our data suggest that visual hallucinations are an indicator of a more aggressive course of the disease, but are not associated with a higher prevalence of global or occipital white matter lesions.
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Affiliation(s)
- E Kraft
- Max Planck Institute of Psychiatry, Munich, Germany
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Kraft E, Schwarz J, Trenkwalder C, Vogl T, Pfluger T, Oertel WH. The combination of hypointense and hyperintense signal changes on T2-weighted magnetic resonance imaging sequences: a specific marker of multiple system atrophy? Arch Neurol 1999; 56:225-8. [PMID: 10025428 DOI: 10.1001/archneur.56.2.225] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the frequency and specificity of hypointense magnetic resonance imaging (MRI) signal changes alone with the frequency and specificity of a pathological MRI pattern consisting of a hyperintense lateral rim and a dorsolateral signal attenuation on T2-weighted MRIs in patients with parkinsonism of various origins. PATIENTS Ninety patients with Parkinson disease (PD) (n = 65), progressive supranuclear palsy (PSP) (n = 10), and multiple system atrophy (MSA) of the striatonigral degeneration type (n = 15) underwent MRI. SETTING University medical center. RESULTS Nine of the 15 patients with MSA showed the pattern with hyperintense lateral rim and a dorsolateral hypointense signal attenuation on T2-weighted images within the putamen. This pattern was not found in the 65 patients with PD, nor in the 10 patients with PSP. Only hypointense changes in the putamen were found in 6 patients (9%) with PD, 4 patients (40%) with PSP, and 5 patients (36%) with MSA. CONCLUSIONS Our data suggest that the pattern consisting of hypointense and hyperintense T2 changes within the putamen is a highly specific MRI sign of MSA, while hypointensity alone remains a sensitive, but nonspecific MRI sign of MSA. In clinically doubtful cases, the appearance of a hypointense and hyperintense signal pattern on MRI makes the diagnosis of PD very unlikely, while hypointense signal changes alone do not exclude idiopathic PD.
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Affiliation(s)
- E Kraft
- Department of Neurology, Klinikum Grosshadern, Munich, Germany
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Schwarz J, Kraft E, Vogl T, Arnold G, Tatsch K, Oertel WH. Relative quantification of signal on T2-weighted images in the basal ganglia: limited value in differential diagnosis of patients with parkinsonism. Neuroradiology 1999; 41:124-8. [PMID: 10090605 DOI: 10.1007/s002340050716] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A reduction in signal in the basal ganglia on T2-weighted images is said to correlate with a poor response to L-DOPA and may help to identify patients with non-idiopathic parkinsonism. Our aim in this prospective study was to use the contrast-to-noise ratio of the MRI signal on T2-weighted images in various parts of the basal ganglia in 43 patients with de novo parkinsonism. Signal intensity measurements were compared to the response to the dopamine agonist apomorphine and dopamine-D2 receptor binding obtained by 3-iodo-6-methoxybenzamine single-photon emission computed tomography (IBZM-SPECT). A reduced contrast-to-noise ratio in the putamen correlated significantly with a negative response to apomorphine and reduced striatal IBZM binding. No additional signal intensity measurement correlated with response to apomorphine or specific IBZM binding. However, there was a considerable overlap of contrast-to-noise ratios between patients with a positive or negative response to apomorphine or normal and reduced IBZM binding. We suggest that semiquantitative assessment of signal intensity in the putamen shows a significant reduction in patients with probably nonidiopathic parkinsonism compared with patients with probably idiopathic parkinsonism. However, this method does not exclude idiopathic parkinsonism in a given patient.
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Affiliation(s)
- J Schwarz
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
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38
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Kraft E, Chen AJW, Kwong KK, Rosen BR, Anderson M, Graybiel AM, Jenkins BG. Basal Ganglia Activation induced during Typing Tasks. An fMRI study at 3T. Neuroimage 1998. [DOI: 10.1016/s1053-8119(18)31826-3] [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] Open
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Abstract
Early diagnosis of multiple-system atrophy (MSA) is important in patients presenting with late-onset cerebellar ataxia because it has a less favourable prognosis than other degenerative ataxic disorders. We report cerebellar presentation of MSA in a series of 16 patients, 3 of whom later developed parkinsonism. Two-thirds of them had early evidence of impaired postural reflexes with a history of recurrent falls. Some of these had a narrow-based, unsteady gait, unlike the more classic broad-based gait ataxia of cerebellar disease. On review of the patients' histories, genitourinary dysfunction (particularly impotence) was present at the onset of, or preceding, cerebellar ataxia in 60% of patients, but this had often been attributed to age, or to urological or gynaecological causes. External striated anal or urethral sphincter electromyography (EMG) demonstrated features of chronic denervation and reinnervation in 14 (93%) of 15 patients, consistent with degeneration in Onuf's nucleus as occurs in MSA. Autonomic function tests were abnormal in 9 (64%) of 14 patients. Our data suggest that close enquiry into genitourinary function and analysis of the gait disorder can be useful pointers to a diagnosis of MSA in patients with an unexplained adult-onset progressive cerebellar syndrome, and that sphincter EMG is the most useful investigation in this context.
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Affiliation(s)
- G K Wenning
- University Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, London, England
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40
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Auer D, Jones R, Rupprecht R, Kraft E. Does motor skill influence the cortical activation pattern in musicians? An f-MRI study. Neuroimage 1996. [DOI: 10.1016/s1053-8119(96)80376-4] [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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41
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Schwarz J, Weis S, Kraft E, Tatsch K, Bandmann O, Mehraein P, Vogl T, Oertel WH. Signal changes on MRI and increases in reactive microgliosis, astrogliosis, and iron in the putamen of two patients with multiple system atrophy. J Neurol Neurosurg Psychiatry 1996; 60:98-101. [PMID: 8558163 PMCID: PMC486200 DOI: 10.1136/jnnp.60.1.98] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A correlation of clinical, MRI, and neuropathological data is reported in two patients with multiple system atrophy (MSA). On MRI, patient 1 showed striatal atrophy, reduction of T2 relaxation times within most of the putamen, and a band of hyperintense signal changes in the lateral putamen. In patient 2, MRI disclosed only shortening of the T2 signal in the putamen. Immunohistochemistry showed pronounced reactive microgliosis and astrogliosis in the affected brain regions. In patient 1, the area with the most pronounced microgliosis and astrogliosis most likely correlated with the area of hyperintense signal changes on MRI. This area also contained the highest amount of ferric iron, which was increased in the putamen of patient 1 but not patient 2. It is unlikely that the hypointense signal changes in the putamen are due to an increase of iron alone. Reactive microglial and astroglial cells may play a part in the pathogenesis of MSA.
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Affiliation(s)
- J Schwarz
- Department of Neurology, Klinikum Grosshadern Ludwig-Maximilians-University, Munich, Germany
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42
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Schwarz J, Antonini A, Kraft E, Tatsch K, Vogl T, Kirsch CM, Leenders KL, Oertel WH. Treatment with D-penicillamine improves dopamine D2-receptor binding and T2-signal intensity in de novo Wilson's disease. Neurology 1994; 44:1079-82. [PMID: 8208404 DOI: 10.1212/wnl.44.6.1079] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We report the results of in vivo striatal dopamine D2-receptor binding assessed by PET using 11C-raclopride (only one patient) and by single-photon emission computed tomography (SPECT) using 123I-iodobenzamide (123I-IBZM) and the findings of T2-weighted MRIs in two de novo Wilson's disease patients before and 4 months after initiation of D-penicillamine treatment. Before treatment, specific 11C-raclopride binding (only patient 1) was markedly reduced, with a putamen to cerebellum ratio of 1.99 (controls: 3.99 +/- 0.55, n = 15) and a caudate to cerebellum ratio of 2.52 (controls: 3.65 +/- 0.59, n = 15). Specific 123I-IBZM binding was reduced in both patients, with a basal ganglia to frontal cortex ratio of 1.25 (patient 1) and of 1.41 (patient 2) controls: 1.57 +/- 0.04, n = 5). After 4 months of therapy, 11C-raclopride-PET improved to a putamen to cerebellum ratio of 2.52 and a caudate to cerebellum ratio of 3.06 (patient 1). 123I-IBZM-SPECT revealed an increase of basal ganglia to frontal cortex ratios of 1.34 (patient 1) and 1.55 (patient 2). On heavily T2-weighted MRI sequences, hyperintense signal changes before therapy within the putamen (both patients), brainstem (only patient 1), and caudate (only patient 2) greatly diminished after treatment. Reduced striatal dopamine D2-receptor binding in these Wilson's disease patients improved under therapy, suggesting, in part, a reversible defect of striatal neurons.
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Affiliation(s)
- J Schwarz
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Arnold G, Tatsch K, Oertel WH, Vogl T, Schwarz J, Kraft E, Kirsch CM. Clinical progressive supranuclear palsy: differential diagnosis by IBZM-SPECT and MRI. J Neural Transm Suppl 1994; 42:111-8. [PMID: 7964681 DOI: 10.1007/978-3-7091-6641-3_9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In order to in vivo identify subgroups in eight patients with the clinical diagnosis of progressive supranuclear palsy (PSP), we have performed 123I-iodobenzamide single photon emission computed tomography (IBZM-SPECT), a nuclear medicine technique, to visualize dopamine D2 receptors in vivo, and high resolution (TE/TR 2900/20-90) magnetic resonance imaging (MRI) to evaluate morphological CNS changes. All patients exhibited similar clinical features including supranuclear vertical gaze palsy, especially of downward gaze, predominantly axial rigidity especially in the neck, bradykinesia, instability of balance with easy falls, and poor response to dopaminergic drugs. Specific striatal dopamine D2 receptor binding in IBZM-SPECT, as calculated by a basal ganglia to frontal cortex ratio (BG/FC) was reduced in 5 patients, but normal in 3 patients. In MRI, these 3 patients exhibited multiple hyperintense white matter lesions; 2 of them had no midbrain atrophy. In contrast, all 5 patients with reduced IBZM binding lacked multiple white matter lesions in MRI, but 4 of them showed marked midbrain atrophy. This pilot study with IBZM-SPECT for in vivo imaging of striatal dopamine D2 receptors and T2-weighted MRI supports published neuropathological findings that clinical signs of PSP appeared to be due to heterogeneous neuropathology.
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Affiliation(s)
- G Arnold
- Department of Neurology, Ludwig-Maximilians-Universität München, Federal Republic of Germany
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Abstract
To show that Wilson's disease is one likely cause of multiple low-intensity nodules of the liver we obtained MR images in 16 patients with clinically and histopathologically confirmed Wilson's disease. Corresponding to morphological changes MRI enabled the subdivision of the patients into two groups. Using a T2-weighted spin-echo sequence (TR/TE = 2000/45-90) liver parenchyma showed multiple tiny low-intensity-nodules surrounded by high-intensity septa in 10 out of 16 patients. 5 patients had also low-intensity nodules in T1-weighted images (TR/TE = 600/20). In patients of this group histopathology revealed liver cirrhosis (n = 7) and fibrosis (n = 2). Common feature of this patient group was marked inflammatory cell infiltration into fibrous septa, increase of copper concentration in liver parenchyma and distinct pathological changes of laboratory data. In the remaining 6 patients no pathological change of liver morphology was demonstrated by MRI corresponding to slight histopathological changes of parenchyma and normal laboratory data. As low-intensity nodules surrounded by high intensity septa can be demonstrated in patients with marked inflammatory infiltration of liver parenchyma MRI may help to define Wilson patients with poorer prognosis. In patients with low-intensity nodules of the liver and unknown cause of liver cirrhosis laboratory data and histopathology should be checked when searching for disorders of copper metabolism.
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Affiliation(s)
- T J Vogl
- Strahlenklinik und Poliklinik, Universitätsklinikum Rudolf Virchow, Freie Universität Berlin
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Oertel WH, Tatsch K, Schwarz J, Kraft E, Trenkwalder C, Scherer J, Weinzierl M, Vogl T, Kirsch CM. Decrease of D2 receptors indicated by 123I-iodobenzamide single-photon emission computed tomography relates to neurological deficit in treated Wilson's disease. Ann Neurol 1992; 32:743-8. [PMID: 1471864 DOI: 10.1002/ana.410320607] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Single-photon emission computed tomography with 123I-iodobenzamide, a dopamine D2 receptor antagonist, was employed to study dopamine D2 receptor densities in 17 patients with biochemically proved Wilson's disease and stable neurological status with therapy and in 5 age-matched control subjects. Of the 17 patients with Wilson's disease, 5 were neurologically asymptomatic, 3 had cerebellar signs, 1 exhibited a mild parkinsonian syndrome, 7 showed a parkinsonian syndrome and cerebellar signs, and 1 had generalized dystonia and a parkinsonian syndrome. In 5 age-matched control subjects specific isotope binding as calculated by the basal ganglia to frontal cortex ratio was 1.57 +/- 0.04 (mean +/- standard deviation). The ratio in patients with Wilson's disease ranged from 1.56 +/- 0.05 (n = 5, asymptomatic patients) to 1.17 +/- 0.02 (n = 4, marked neurological impairment). We observed an almost linear correlation between the reduction of 123I-iodobenzamide (IBZM) binding and the severity of neurological signs at the time of IBZM-SPECT (correlation coefficient, -0.84; p < 0.01). We suggest that the reduction of postsynaptic striatal dopamine D2 receptors as detected by IBZM-SPECT reflects striatal neuronal damage in Wilson's disease.
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Affiliation(s)
- W H Oertel
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Federal Republic of Germany
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46
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Psenicka H, Gross J, Lauer HC, Kraft E. [Comparative material studies on dental stones in accordance with DIN 13911]. Dtsch Zahnarztl Z 1991; 46:480-4. [PMID: 1817911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It was the object of this investigation to compare nine high-strength stone plasters in terms of visual appearance, pouring time, setting time, setting expansion, compressive strength and detail reproduction in accordance with DIN 13911 and ISO 6873 using both standard consistency as indicated in the industrial standard and the water-to-powder ratio as indicated by the manufacturer. None of the tested stones met the visual requirements in all points. Regarding their physical properties, six tested stones were up to standard. Three stones failed to meet the DIN and ISO requirements. Following the manufacturer's mixing instructions resulted in a significant improvement in material properties as against standard consistency. Disregarding some minor improvements required, DIN 13911 and ISO 6873 are useful standards for a standardized comparison of dental plasters.
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Affiliation(s)
- H Psenicka
- Poliklinik für Zahnärztliche Prothetik der Universität München
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47
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Abstract
In 1987 and 1988 Nickisch et al. discussed the effect of infusions of prednisolone, pentoxifylline and, partially, piracetam in Ringer lactate solvent on progressive sensorineural hearing loss in childhood and adolescence. Time of observations was 4 years. Unfortunately long-term investigations could not confirm the initially good therapeutic results of 1987/88. In 35% were found permanently and in 12.5% temporarily better auditory thresholds after infusion. The loss of progressive sensorineural hearing in childhood usually takes a fateful course that can hardly be influenced. As is the case with adults, good therapeutic results can most probably be achieved by infusions starting close to the event, i.e. within 48 hours.
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Affiliation(s)
- P Zorowka
- Klinik für Kommunikationsstörungen, Johannes-Gutenberg Universität Maínz
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48
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Kraft E, Liebhardt E, Lindemaier G. National characteristics of dental treatment in disaster victim identification. J Forensic Odontostomatol 1991; 9:32-5. [PMID: 1814939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this age of mass tourism it is necessary to identify repeatedly a great number of casualties. In otherwise hopeless cases of identification dental alloys can be broken down by energy-dispersive X-ray microanalysis and an scanning electron microscope to furnish valuable clues as to the country of their origin.
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Affiliation(s)
- E Kraft
- Poliklinik für Zahnärztliche Prothetik der Universität München, Germany
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49
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Kraft E. [Dental prosthesis--backward look and outlook]. Zahnarztl Prax 1991; 42:126-9. [PMID: 1872070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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50
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Lauer HC, Hofmann F, Kraft E. [Effects of porcelain fused to metal on the accuracy of fit of various alloys]. Dtsch Zahnarztl Z 1991; 46:267-9. [PMID: 1815930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
One high gold and five low gold porcelain bonding alloys were examined for dimensional changes after fusion of the porcelain. With the same processing techniques applied, the individual firings resulted in varying changes in the accuracy of fit of the tested alloys. Averaging at -0.09 mm Bond-on 4 showed the greatest marginal discrepancies and this was the only alloy that displayed a statistically significant difference to Degudent U.
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