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Ehling R, Seebacher B, Harsányi A, Ganzbiller N, Papez S, Haider B, Hoertenhuber D, Kranz G, Tarasiewicz R, Spatt J, Moser H, Klein W, Barth C, Kubik W, Kronberger E, Winkler A, Brenneis C. Successful long-term management of spasticity in people with multiple sclerosis using a software application: Results from a randomized-controlled, multicenter study. Eur J Neurol 2022; 29:1697-1707. [PMID: 35122365 DOI: 10.1111/ene.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/20/2022] [Accepted: 02/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Successful long-term treatment of spasticity in people with multiple sclerosis (pwMS) is challenging. We investigated the effects of multidisciplinary inpatient rehabilitation (MIR) and an individualized self-training program delivered by an App on spasticity in pwMS. METHODS First we assessed the efficacy of 4-weeks MIR in ambulatory pwMS (EDSS<7.0) with moderate to severe lower limb spasticity (defined by ≥4 points on the Numeric Rating Scale for spasticity (NRSs)) in a cohort of 115 pwMS in 7 rehabilitation centers in Austria. In case of a clinically relevant improvement in spasticity of ≥20% on the NRSs following MIR (n=94), pwMS were randomly allocated in a 1:1 ratio to either a newly designed "MS-spasticity App" or to a paper-based self-training program for 12 weeks. The primary outcome was change in NRSs (DRKS00023960). RESULTS MIR led to a significant reduction of 2.0 points on the NRSs (95% Confidence Interval (CI) 2.5 to 2.0; p<0.000). MIR was further associated with a statistically significant improvement in spasticity on the modified Ashworth scale, strength and all mobility outcomes. Following MIR, self-training with "MS-spasticity App" was associated with a sustained positive effect on the NRSs, while paper-based self-training led to a worsening in spasticity (median NRSs difference 1.0; 95% CI 1.7 to 0.3; p=0.009). "MS-spasticity App" was also associated with a significantly better adherence to self-training (95% versus 72% completion rate; p<0.001). CONCLUSION In pwMS, MIR is able to significantly improve lower-limb spasticity, strength and mobility. Following MIR, an individually tailored anti-spasticity program delivered by an App leads to sustained positive long-term management.
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Affiliation(s)
- Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria.,Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Barbara Seebacher
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria.,Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Andrea Harsányi
- Department of Neurological Rehabilitation, Clinic Pirawarth, Bad Pirawarth, Austria
| | - Nicole Ganzbiller
- Department of Neurological Rehabilitation, Clinic Pirawarth, Bad Pirawarth, Austria
| | - Stephanie Papez
- Department of Neurological Rehabilitation, Clinic Pirawarth, Bad Pirawarth, Austria
| | - Bernhard Haider
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Enns, Enns, Austria
| | - Doris Hoertenhuber
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Enns, Enns, Austria
| | - Gottfried Kranz
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Rosenhuegel, Vienna, Austria
| | - Roland Tarasiewicz
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Rosenhuegel, Vienna, Austria
| | - Josef Spatt
- Department of Neurology, Evangelisches Krankenhaus, Vienna, Austria
| | - Hermann Moser
- Neurological Therapy Center Gmundnerberg, Clinic for Rehabilitation, Altmuenster am Traunsee, Austria.,Ludwig Boltzmann Institute, Rehabilitation Research, Vienna, Austria
| | - Wolfhard Klein
- Neurological Therapy Center Gmundnerberg, Clinic for Rehabilitation, Altmuenster am Traunsee, Austria
| | - Cosmas Barth
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Radkersburg, Bad Radkersburg, Austria
| | - Wolfgang Kubik
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Radkersburg, Bad Radkersburg, Austria
| | - Eva Kronberger
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Lassnitzhoehe, Lassnitzhoehe, Austria
| | - Andreas Winkler
- Department of Neurological Rehabilitation, Clinic Pirawarth, Bad Pirawarth, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria.,Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
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Kan RL, Xu GX, Shu KT, Lai FH, Kranz G, Kranz GS. Effects of non-invasive brain stimulation in multiple sclerosis: systematic review and meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223211069198. [PMID: 35126965 PMCID: PMC8814979 DOI: 10.1177/20406223211069198] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/07/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: The objective of this meta-analysis was to summarize evidence on the therapeutic effects of non-invasive brain stimulation (NIBS) on core symptoms of multiple sclerosis (MS). Specifically, findings from studies deploying transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) protocols were summarized in this review. Methods: We systematically searched articles published in four databases, until 31 May 2021, which compared the effects of active tDCS or rTMS with sham intervention in MS patients. We used a random-effects model for this meta-analysis. Meta-regression and subgroup meta-analysis were used to examine the effects of stimulation dose and different stimulation protocols, respectively. Results: Twenty-five randomized controlled trials (RCTs) were included in this review, consisting of 19 tDCS and 6 rTMS studies. tDCS led to a significant and immediate reduction of fatigue with a large effect size (Hedges’s g = −0.870, 95% confidence intervals (CI) = [−1.225 to −0.458], number needed to treat (NNT) = 2). Particularly, a subgroup analysis showed that applying tDCS over the left DLPFC and bilateral S1 led to fatigue reductions compared to sham stimulation. Furthermore, tDCS had favorable effects on fatigue in MS patients with low physical disability but not those with high physical disability, and additionally improved cognitive function. Finally, whereas rTMS was observed to reduce muscle spasticity, these NIBS protocols showed no further effect on MS-associated pain and mood symptoms. Conclusion: tDCS in MS alleviates fatigue and improves cognitive function whereas rTMS reduces muscle spasticity. More high-quality studies are needed to substantiate the therapeutic effects of different NIBS protocols in MS.
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Affiliation(s)
- Rebecca L.D. Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
| | - Grace X.J. Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
| | - Kate T. Shu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
- Department of Rehabilitation, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Frank H.Y. Lai
- Faculty of Health and Life Sciences, The Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Gottfried Kranz
- Neurological Rehabilitation Center Rosenhügel, Vienna, Austria
| | - Georg S. Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, 999077, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
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Macher S, Unger E, Zalaudek M, Weber M, Kranz G, Kranz G, Kasprian G, Sycha T. Denervation Dynamics After Intramuscular BNT Injection in Patients With Focal Spasticity Monitored by MRI and Dynamometry-a Blinded Randomized Controlled Pilot Study. Front Neurol 2021; 12:719030. [PMID: 34867709 PMCID: PMC8640502 DOI: 10.3389/fneur.2021.719030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Botulinumtoxin associated muscle denervation (BNTMD) can be detected by magnet resonance imaging (MRI), MRI may provide further insights into the exact timeline of BNTMD and the potential impact and timing of physical exercise. We aimed to assess the time interval until detection of BNTMD by MRI and whether immediate physical exercise after intramuscular BNT injection has a measurable effect on clinical parameters and the intramuscular denervation dynamics illustrated by MRI. Materials and Methods: Eleven age-matched patients were randomized to an “exercise” or “no-exercise” group. Eighty mouse-units of incobotulinumtoxin were injected into the spastic biceps muscle. MRI of the injected region, hand-held dynamometry of elbow flexor strength and clinical rating scales (mAS, CGI-I) were conducted in predefined intervals. Results: We could not detect BNTMD within 24 h but 7 days after injection independent of group allocation (exercise n = 6, no-exercise n = 5). Denervation signs were more diffuse and spread into adjacent muscles in patients having received exercise. We could not detect differences concerning clinical measures between the two groups. Conclusions: Physical exercise might influence BNTMD dynamics and promote propagation of T2-MR muscle denervation signs from the injected site into adjacent muscles. Trial registration:clinicaltrialsregister.eu, Identifier 2017-003117-25.
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Affiliation(s)
- Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Martin Zalaudek
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gottfried Kranz
- Neurologisches Rehabilitationszentrum Rosenhügel, Neurological Rehabilitation Center, Vienna, Austria
| | - Georg Kranz
- Department of Psychiatry, Medical University of Vienna, Vienna, Austria.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Sycha
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Platho-Elwischger K, Schmoeger M, Willinger U, Abdel-Aziz C, Algner J, Pretscherer S, Auff E, Kranz G, Turnbull O, Sycha T. Cognitive Performance After Facial Botulinum Toxin Treatment in a Cohort of Neurologic Patients: An Exploratory Study. Arch Phys Med Rehabil 2021; 103:402-408. [PMID: 34496270 DOI: 10.1016/j.apmr.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/30/2021] [Accepted: 08/08/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate higher cognitive functions after mimicry changes after facial botulinum toxin (BTX) injections, we tested verbal and nonverbal reasoning in patients with blepharospasm or hemifacial spasm before and after their long-term botulinum toxin treatment. DESIGN Explorative, nonrandomized, clinical trial. SETTING Patients receiving ambulatory care and control participants from the general community. PARTICIPANTS Volunteer sample (N=84) of patients (n=21) with blepharospasm or hemifacial spasm who received facial BTX injections. Control participants included patients (n=30) with cervical dystonia who received cervical BTX injections and individuals without neurological disorders (n=33). INTERVENTIONS The 2 groups receiving injections were tested before and 3 weeks after their treatment. The group without neurological disorders received no injections. MAIN OUTCOME MEASURES Verbal and nonverbal reasoning scores. RESULTS The key unexpected finding was that patients who received facial BTX injections perform significantly worse in nonverbal reasoning tasks, when compared with those who did not receive injections (P=.022). There was no significant difference in the baseline reasoning scores and at follow-up for verbal reasoning between the 3 groups. There was no correlation between toxin dose and reasoning scores (verbal: P=.132; nonverbal: P=.294). CONCLUSIONS Because of potential confounders, the results do not yet allow any conclusion on causality. Further research is needed to confirm our findings.
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Affiliation(s)
- Kirsten Platho-Elwischger
- Department of Neurology Medical University of Vienna, Vienna, Austria; Department of Neurology, Clinic Hietzing, Vienna, Austria
| | | | - Ulrike Willinger
- Department of Neurology Medical University of Vienna, Vienna, Austria
| | - Carmen Abdel-Aziz
- Department of Neurology Medical University of Vienna, Vienna, Austria
| | - Jennifer Algner
- Department of Neurology Medical University of Vienna, Vienna, Austria
| | | | - Eduard Auff
- Department of Neurology Medical University of Vienna, Vienna, Austria
| | - Gottfried Kranz
- Department of Neurology Medical University of Vienna, Vienna, Austria; Rehabilitation Center Rosenhuegel, Vienna, Austria
| | - Oliver Turnbull
- School of Psychology, Bangor University, Bangor, United Kingdom
| | - Thomas Sycha
- Department of Neurology Medical University of Vienna, Vienna, Austria
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Doummar D, Treven M, Qebibo L, Devos D, Ghoumid J, Ravelli C, Kranz G, Krenn M, Demailly D, Cif L, Davion JB, Zimprich F, Burglen L, Zech M. Childhood-onset progressive dystonia associated with pathogenic truncating variants in CHD8. Ann Clin Transl Neurol 2021; 8:1986-1990. [PMID: 34415117 PMCID: PMC8528468 DOI: 10.1002/acn3.51444] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/28/2022] Open
Abstract
Originally described as a risk factor for autism, CHD8 loss‐of‐function variants have recently been associated with a wider spectrum of neurodevelopmental abnormalities. We further expand the CHD8‐related phenotype with the description of two unrelated patients who presented with childhood‐onset progressive dystonia. Whole‐exome sequencing conducted in two independent laboratories revealed a CHD8 nonsense variant in one patient and a frameshift variant in the second. The patients had strongly overlapping phenotypes characterized by generalized dystonia with mild‐to‐moderate neurodevelopmental comorbidity. Deep brain stimulation led to clinical improvement in both cases. We suggest that CHD8 should be added to the growing list of neurodevelopmental disorder‐associated genes whose mutations can also result in dystonia‐dominant phenotypes.
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Affiliation(s)
- Diane Doummar
- Pediatric Neurology Department, Movement Disorders Center, Armand Trousseau Hospital, AP-HP.Sorbonne Université, Paris, France
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Konrad Lorenz Institute for Evolution and Cognition Research, Klosterneuburg, 3400, Austria
| | - Leila Qebibo
- Cerebellar Malformations and Congenital diseases Reference Center and Neurogenetics Lab, Department of Genetics, Armand Trousseau Hospital, AP-HP.Sorbonne Université, Paris, France
| | - David Devos
- Université de Lille, INSERM, U1172, CHU-Lille, Lille, France.,Neuroscience Cognition Research Centre, Lille, France.,Neurology and Movement Disorders Department, CHU Lille, Licend, Lille, 59000, France
| | - Jamal Ghoumid
- CHU Lille, University of Lille, ULR7364 RADEME, Lille, France
| | - Claudia Ravelli
- Pediatric Neurology Department, Movement Disorders Center, Armand Trousseau Hospital, AP-HP.Sorbonne Université, Paris, France
| | | | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,School of Medicine, Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Diane Demailly
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | - Laura Cif
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | | | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lydie Burglen
- Cerebellar Malformations and Congenital diseases Reference Center and Neurogenetics Lab, Department of Genetics, Armand Trousseau Hospital, AP-HP.Sorbonne Université, Paris, France.,Developmental Brain Disorders Laboratory, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Michael Zech
- School of Medicine, Institute of Human Genetics, Technical University of Munich, Munich, Germany.,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
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Kotzian ST, Saletu MT, Schwarzinger A, Haider S, Spatt J, Kranz G, Saletu B. Proactive telemedicine monitoring of sleep apnea treatment improves adherence in people with stroke– a randomized controlled trial (HOPES study). Sleep Med 2019; 64:48-55. [DOI: 10.1016/j.sleep.2019.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/13/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
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Platho-Elwischger K, Kranz G, Sycha T, Dunkler D, Rommer P, Mueller C, Auff E, Wiest G. Plasticity of static graviceptive function in patients with cervical dystonia. J Neurol Sci 2017; 373:230-235. [PMID: 28131194 DOI: 10.1016/j.jns.2017.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Kirsten Platho-Elwischger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Gottfried Kranz
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Thomas Sycha
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Daniela Dunkler
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna; Spitalgasse 23, BT88/E 03, 1090 Vienna, Austria.
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Christian Mueller
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Gerald Wiest
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Elwischger K, Kranz G, Sycha T, Rommer P, Müller C, Auff E, Wiest G. Effects of botulinum toxin treatment on subjective visual vertical perception in cervical dystonia. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.630] [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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Baldinger P, Kranz G, Höflich A, Savli M, Stein P, Lanzenberger R, Kasper S. [The effects of hormone replacement therapy on mind and brain]. Nervenarzt 2013; 84:14-9. [PMID: 22318360 DOI: 10.1007/s00115-011-3456-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hormonal fluctuations during the perimenopausal transition lead to physical discomfort but are also frequently accompanied by mood swings, depressive symptoms, anxiety and sleeping disorders. The important role of the neurotransmitter serotonin in the pathogenesis of anxiety disorders and major depression is unquestioned, but only little is known about the influence of sex hormones on the serotonergic system. This review provides an overview of potential risk factors for the occurrence of affective disorders in the menopausal transition and discusses possible therapeutic options. Current research findings from longitudinal studies testing the efficacy of hormone replacement therapy and antidepressants with effects on the serotonergic neurotransmission on physical and mental discomforts during menopause are presented. Furthermore, studies using positron emission tomography and genetic methods that explore the effects of sex steroids on different components of the serotonergic system are shown. The interactions between estrogen, progesterone and the serotonergic system are described, and possible neurobiological and endocrinological mechanisms underlying depressive symptoms in the perimenopause are elucidated.
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Affiliation(s)
- P Baldinger
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Österreich
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Kranz G, Shamim EA, Lin PT, Kranz GS, Hallett M. Long-term depression-like plasticity of the blink reflex for the treatment of blepharospasm. Mov Disord 2013; 28:498-503. [PMID: 23401198 DOI: 10.1002/mds.25329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 11/12/2012] [Accepted: 11/26/2012] [Indexed: 11/08/2022] Open
Abstract
Our previous work showed a beneficial therapeutic effect on blepharospasm using slow repetitive transcranial magnetic stimulation, which produces a long-term depression (LTD)-like effect. High-frequency supraorbital electrical stimulation, asynchronous with the R2 component of the blink reflex, can also induce LTD-like effects on the blink reflex circuit in healthy subjects. Patients with blepharospasm have reduced inhibition of their blink recovery curves; therefore, a LTD-like intervention might normalize the blink reflex recovery (BRR) and have a favorable therapeutic effect. This is a randomized, sham-controlled, observer-blinded prospective study. In 14 blepharospasm patients, we evaluated the effects of high-frequency supraorbital stimulation on three separate treatment days. We applied 28 trains of nine stimuli, 400 Hz, either before or after the R2 or used sham stimulation. The primary outcome was the blink rate, number of spasms rated by a blinded physician and patient rating before, immediately after and 1 hour after stimulation while resting, reading, and talking; secondary outcome was the BRR. Stimulation "before" and "after" the R2 both showed a similar improvement as sham stimulation in physician rating, but patients felt significantly better with the before condition. Improvement in recovery of the blink reflex was noted only in the before condition. Clinical symptoms differed in the three baseline conditions (resting, reading, and talking). Stimulation before R2 increased inhibition in trigeminal blink reflex circuits in blepharospasm toward normal values and produced subjective, but not objective, improvement. Inhibition of the blink reflex pathway by itself appeared to be insufficient for a useful therapeutic effect.
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Affiliation(s)
- Gottfried Kranz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
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12
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Kranz G, Hahn A, Ungersböck J, Kaufmann U, Stein P, Baldinger P, Höflich A, Zgud S, Mitterhauser M, Wadsak W, Kasper S, Lanzenberger R. Cortisol plasma levels are associated with serotonin - 1A receptor binding in postmenopausal women. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionAlterations of the serotonin-1A receptor (5-HT1A) and the hypothalamic-pituitary-adrenal (HPA) axis have been reported in depression and anxiety disorders. We previously showed a strong negative correlation between cortisol plasma levels and 5-HT1A receptor binding potential (BP) in patients with social anxiety disorder but not in healthy controls using PET [1].ObjectivesTo investigate the relationship of cortisol and the 5-HT1A BP in postmenopausal women, a population that is at increased risk of suffering from depressive symptoms.MethodsSubjects: 19 postmenopausal women, aged 55.26 ± 4.98, medication free, no current substance abuse or hormone replacement therapy.PETDynamic measurements (50 frames, 90 min) were performed using the radioligand [carbonyl-11C]WAY100635 and a GE-Advance scanner. PET data were normalized to a ligand-specific template [2]. Regions-of-interest (ROI) were defined as given in [3]. TACs within ROIs were averaged and the 5-HT1A receptor BP was quantified using Logan-plot and PMOD 3.1. Measurement of total cortisol plasma levels was done using electrochemoluminescence.ResultsWe found negative correlations between cortisol and 5-HT1A BP in the midbrain (Spearman's rs = −0.54, p = 0.02), the median raphe nucleus (rs = −0.47, p = 0.04) and the nucleus accumbens (rs = −0.505, p = 0.03).ConclusionsIn line with our previous findings [1], the observed negative association between cortisol plasma levels and 5-HT1A BP might reflect an increased vulnerability for mood disorders in postmenopausal women.
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Kranz G, Paul A, Voller B, Posch M, Windischberger C, Auff E, Sycha T. Long-term efficacy and respective potencies of botulinum toxin A and B: a randomized, double-blind study. Br J Dermatol 2010; 164:176-81. [DOI: 10.1111/j.1365-2133.2010.10085.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kranz G, Shamim EA, Lin PT, Kranz GS, Hallett M. Transcranial magnetic brain stimulation modulates blepharospasm: a randomized controlled study. Neurology 2010; 75:1465-71. [PMID: 20956792 DOI: 10.1212/wnl.0b013e3181f8814d] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Benign essential blepharospasm (BEB) is a common form of focal dystonia. Besides pathology in the basal ganglia, accumulating evidence suggests pathologic changes in the anterior cingulate cortex (ACC). METHODS This is a randomized, sham-controlled, observer-blinded prospective study. In 12 patients with BEB, we evaluated the effects of a 15-minute session of low-frequency (0.2 Hz) repetitive transcranial magnetic stimulation (rTMS) over the ACC with stimulation intensities at 100% active motor threshold with 3 stimulation coils: a conventional circular coil (C-coil), a sham coil (S-coil), and a Hesed coil (H-coil, which allows stimulation of deeper brain regions. Primary outcome was the clinical effects on BEB (blink rate, number of spasms rated by a blinded physician and patient rating before, immediately after, and 1 hour after stimulation); secondary outcome was the blink reflex recovery curve. RESULTS Subjective stimulation comfort was similar for each coil with no stimulation-associated adverse events. Stimulation with the H- and C-coils resulted in a significant improvement in all 3 outcome measures and was still detectable in physician rating and patient rating 1 hour after stimulation. S-coil stimulation had no effects. The active motor threshold was significantly lower for the H-coil compared to the other 2 coils. CONCLUSIONS rTMS could be used as a therapeutic tool in BEB. Further studies will be necessary to show whether repeated stimulation applications result in lasting clinical effects. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with BEB, H- and C-coil rTMS is safe and improves clinical symptoms of BEB immediately and 1 hour after stimulation.
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Affiliation(s)
- G Kranz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Kranz G, Shamim E, Lin P, Kranz G, Hallett M. Deep transcranial magnetic brain stimulation modulates blepharospasm: A randomized sham-controlled study. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250952] [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: 10/19/2022]
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Paul A, Kranz G, Schindl A, Kranz GS, Auff E, Sycha T. Diode laser hair removal does not interfere with botulinum toxin A treatment against axillary hyperhidrosis. Lasers Surg Med 2010; 42:211-4. [DOI: 10.1002/lsm.20891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Traditionally, benign essential blepharospasm (BEB) is considered a disorder caused by basal ganglia dysfunction. Electrophysiologic and brain imaging studies suggest pathologic changes in excitability in the primary motor cortex (MC), anterior cingulate (AC), and secondary motor areas, such as premotor (PMC) and supplementary motor cortices (SMA). METHODS In this pilot study of 7 patients with BEB, we experimentally reduced cortical excitability of 4 areas: MC (first dorsal interosseus area), PMC, SMA, and AC, each with 3 noninvasive techniques: low-frequency repetitive transcranial magnetic stimulation (lfrTMS), continuous theta burst stimulation (cTBS), and cathodal transcranial direct current stimulation (tDCS). Primary outcome was the clinical effects on blepharospasm (blink rate observation by an investigator blinded to the intervention and subjective rating by the patient); secondary outcome was the blink reflex recovery curve (BRR). RESULTS lfrTMS resulted in a significant improvement over all 4 brain areas for physician rating, patient rating, and BRR, whereas cTBS and tDCS showed only trends for improvement in physician rating, but no improvements for patient rating and BRR. lfrTMS had a significantly higher effect over AC than MC for physician rating, but no differences were seen for other pairwise comparisons of stimulated brain areas. CONCLUSIONS Electrophysiologic and clinical improvements by functional inhibition of the medial frontal areas using low-frequency repetitive transcranial magnetic stimulation suggests that hypersensitivity of the anterior cingulate is directly or indirectly involved in the pathophysiology of benign essential blepharospasm. Inhibition of these areas using low-frequency repetitive transcranial magnetic stimulation could provide a therapeutic tool and is worthy of a larger study.
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Affiliation(s)
- G Kranz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Feldmann RE, Kranz G, Praschak-Rieder N, Kasper S. Psycho-pharmacotherapy for anxiety and obsessive-compulsive disorder: the issue of prolonged barbiturate retention. Curr Med Res Opin 2009; 25:2281-5. [PMID: 19630487 DOI: 10.1185/03007990903116172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors report the case of a 32-year-old man who had been treated for anxiety and obsessive-compulsive disorder and had received 800 mg methylphenobarbital (MPB). After switching to a barbiturate-free schedule, his condition continued to be unstable for more than 21 MPB half-lives (approx. 30 days) and did not stabilize until MPB-metabolites dropped below their urinary detection limit. Considering that this article provides findings from a single patient, the authors use this experience to discuss and emphasize the importance of clinical control of barbiturates in psychiatry.
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Affiliation(s)
- Robert E Feldmann
- Department of Physiology and Pathophysiology, Division of Systems Physiology, University of Heidelberg Medical Center, Heidelberg, Germany.
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Kranz G, Haubenberger D, Voller B, Posch M, Schnider P, Auff E, Sycha T. Respective potencies of Botox and Dysport in a human skin model: a randomized, double-blind study. Mov Disord 2009; 24:231-6. [PMID: 18951439 DOI: 10.1002/mds.22336] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Mouse units used to quantify the activity of botulinum A toxin preparations are not equivalent and issues concerning efficacy and safety remain with regard to their respective potencies and diffusion qualities in human tissue. We compared the effects of Botox (BOT) and Dysport (DYS) in different doses and dilutions in a human skin model. Eighteen (8 women, 10 men) healthy volunteers, aged 28.4 years +/- 5.7 years were injected intradermally with pure saline, BOT and DYS at 16 points in the abdomen in random order and in a double-blind condition, using two conversion ratios (1:3 and 1:4) and three different dilution schemes. For an objective outcome, the Ninhydrin sweat test was used to compare the anhidrotic areas. Both preparations showed a linear dose and dilution relationship with similar variances of responses for anhidrosis and hypohidrosis, indicating the same reliability of response. The dose equivalence conversion ratios (BOT: DYS) were 1:1.3 for anhidrosis and 1:1.6 for hypohidrosis (1:1.1-1.5 and 1:1.4-1.8 95% confidence intervals). The diffusion characteristics of both products were similar. A dose equivalence factor of more than 1:2 (BOT:DYS) is not supported by these objective and reproducible data.
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Affiliation(s)
- Gottfried Kranz
- Department of Neurology, Medical University of Vienna, Wien, Austria
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Kranz G, Sycha T, Voller B, Kranz GS, Schnider P, Auff E. Neutralizing antibodies in dystonic patients who still respond well to botulinum toxin type A. Neurology 2008; 70:133-6. [PMID: 18180443 DOI: 10.1212/01.wnl.0000287087.99612.e5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Complete secondary therapy failure due to antibodies against botulinum toxin A (BoNT/A-ABs) may raise extensive treatment difficulties. We tested whether neutralizing BoNT/A-ABs can be detected in dystonic patients with good clinical responses to botulinum toxin A (BoNT/A) treatment. METHODS We used the ninhydrin sweat test (NST) and the mouse diaphragm test (MDT) in 28 subjects. Of 119 dystonic patients who responded well to BoNT/A, we randomly selected 14 and compared the results of the NST and MDT with 14 healthy controls. RESULTS Higher BoNT/A-AB titers correlated significantly with smaller anhidrotic areas. We found seven patients with borderline antibody (AB) values (MDT 0.4 to 0.8 mU/mL) with significantly smaller anhidrotic areas (NST) compared with healthy controls and AB-negative patients. Risk factors for smaller anhidrotic areas were short injection intervals but not prolonged exposure to BoNT/A or high injection doses. CONCLUSIONS These data demonstrate that >40% of dystonic patients who respond well to botulinum toxin A (BoNT/A) show partial nonresponsiveness on the ninhydrin sweat test and have low titers of neutralizing BoNT/A antibodies.
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Affiliation(s)
- G Kranz
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Sycha T, Kotzailias N, Kranz G, Trautinger F, Schnider P, Auff E. UV-B Irradiation Attenuates Dermal Effects of Botulinum Toxin A: A Randomized, Double-Blind, Placebo-Controlled Study. Dermatol Surg 2007; 33:S92-6. [PMID: 17241421 DOI: 10.1111/j.1524-4725.2006.32338.x] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Botulinum toxin type A (BoNT/A) is frequently used for cosmetic indications and hyperhidrosis. OBJECTIVES We investigated whether UV-B irradiation alleviates the BoNT/A effect on local sudomotor activity. MATERIALS AND METHODS In a randomized, double-blinded trial, the anhidrotic areas after BoNT/A (100 mU) injection 48 hours before and 14 days after UV-B irradiation were compared in six healthy volunteers. RESULTS UV-B irradiation alleviated BoNT/A effect by approximately 30% (p=.0017). The UV-B-evoked reduction of anhidrotic areas was constant over the observation period of 14 weeks. CONCLUSIONS When BoNT/A is applied intradermally, excessive exposure to UV-B and sunburn should be reconsidered. The authors have indicated no significant interest with commercial supporters.
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Affiliation(s)
- Thomas Sycha
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
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Kranz G, Sycha T, Voller B, Gleiss A, Schnider P, Auff E. Pain Sensation during Intradermal Injections of Three Different Botulinum Toxin Preparations in Different Doses and Dilutions. Dermatol Surg 2006; 32:886-90. [PMID: 16875469 DOI: 10.1111/j.1524-4725.2006.32191.x] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain sensation associated with injections of botulinum neurotoxin (BoNT) is commonly reported. To date differences in pain sensation between the commercially available products containing BoNT have not been quantified. OBJECTIVES The pain sensations during injection of Dysport, Botox, Neurobloc, and pure saline (control) were compared. In addition, the nociceptive effect of different volumes used for the dilution of the same BoNT dose was investigated. METHODS In a prospective, double-blind, controlled trial, 10 healthy subjects were injected intradermally with Dysport (12 U), Botox (3 and 4 U), Neurobloc (150 and 300 U) reconstituted in 0.9% saline, and pure saline. Pain sensation was quantified during injections. RESULTS Neurobloc injections caused significantly more injection pain than Botox, Dysport, and saline. No significant differences between Dysport, Botox, and saline were found, although there was a trend toward less pain with pure saline injections. Higher pain levels with higher volumes could not be demonstrated significantly. CONCLUSION Our data demonstrate that BoNT type B injections are associated with substantial pain. There is a considerable difference between the commercially available BoNT type B compared to the two BoNT type A preparations. Therefore, considering mitigation of injection pain seems necessary when using BoNT type B.
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Affiliation(s)
- Gottfried Kranz
- Department of Neurology, Division of Neurorehabilitation, Medical University of Vienna, Vienna, Austria.
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Voller B, Sycha T, Gustorff B, Kranz G, Auff E. An open study of botulinum-A toxin treatment of trigeminal neuralgia. Neurology 2006; 66:1458-9; author reply 1458-9. [PMID: 16685761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
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Sycha T, Kranz G, Auff E, Schnider P. Botulinum toxin in the treatment of rare head and neck pain syndromes: a systematic review of the literature. J Neurol 2004; 251 Suppl 1:I19-30. [PMID: 14991339 DOI: 10.1007/s00415-004-1106-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 11/26/2022]
Abstract
BACKGROUND Botulinum neurotoxin (BoNT) is used to treat various neurological disorders associated with pathologically increased muscle tone. Botulinum toxin inhibits the release of the neurotransmitter acetylcholine at the neuromuscular junction thereby inhibiting striatal muscle contractions. Besides the reduction in muscle tone BoNT tends to reduce pain in pain syndromes associated with muscle spasm. In addition, BoNT has been proposed as an analgesic, suggesting alternative non-cholinergic mechanisms of action.Surprisingly, BoNT was reported as a potential treatment for tension-type headache and migraine-both primary headache syndromes without an apparent muscular component-however, varying responses to BoNT have been found, overall without sufficient evidence for a general treatment. In this systematic review we set out to clarify the efficacy and safety of BoNT in the treatment of rare head and neck pain syndromes (e. g. cervicogenic headache, chronic paroxysmal hemicrania, cluster headache, trigeminal neuralgia, temporomandibular disorders, cervical dystonia and whiplash injuries). OBJECTIVES To assess the analgesic efficacy and safety of botulinum toxins versus other medicines, placebo or no treatment in rare head and neck pain syndromes. SEARCH STRATEGY We searched the bibliographic databases MEDLINE, EMBASE and PASCAL Biomed to May 2003. We also reviewed the reference lists from identified articles including reviews and meta-analyses of treatment studies. Furthermore we searched booklets of scientific congresses in the field of neurology for potentially relevant studies. Additional reports were identified from the reference list of the retrieved papers, and by contacting experts in the field. SELECTION CRITERIA Randomized controlled trials (RCTs) with any dose of BoNT for rare head and neck pain syndromes, describing subjective pain assessment as either the primary or a secondary outcome, were included in this review. DATA COLLECTION AND ANALYSIS All trials were quality scored and two independent reviewers extracted data. Results were compared for differences, and discrepancies were resolved by discussion. MAIN RESULTS Fourteen RCTs of BoNT in cervical dystonia were included in this review. All except one showed significant pain relief following BoNT treatment compared to placebo. Studies providing dichotomous outcome data were pooled using the Peto method. The overall effect was found to be highly significant (OR 4.795 [95% CI 5.551-6.473]). For cervicogenic headache, two RCTs-one positive study and one negative study-were included. Two studies addressing chronic neck pain were included in this review. Both studies did not reveal significant effects. Furthermore, one small trial (N = 15 patients) focussing BoNT in temporomandibular disorders was included,without demonstrating significant effectiveness but a high proportion of patients lost to follow-up and a high rate of adverse effects. For the use of BoNT in cluster headache, chronic paroxysmal hemicrania and trigeminal neuralgia no RCTs were identified. Adverse effects (AEs) were found to be mild to moderate and dose-dependent. They were summarized where possible, irrespective of the formulation used and condition treated (OR = 5.066 [95% CI 2.770-9.265], number-needed-to-harm (NNH) = 5.5 [range 4.4-17]). REVIEWERS' CONCLUSIONS There is convincing evidence for the effectiveness of BoNT in the treatment of pain associated with cervical dystonia. Due to the frequent adverse effects predominantly observed with higher doses, the trade off in risk and benefit should be carefully considered in each case. For all other rare head and neck pain syndromes we found no RCTs (cluster headache, chronic paroxysmal hemicrania, trigeminal neuralgia) and only a few small sized trials (cervicogenic headache, chronic neck pain, temporomandibular disorders). We were therefore unable to draw any definite conclusions.
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Affiliation(s)
- T Sycha
- Department of Neurology, Division of Neurological Rehabilitation, University of Vienna, Austria
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Schnider P, Moraru E, Kittler H, Binder M, Kranz G, Voller B, Auff E. Treatment of focal hyperhidrosis with botulinum toxin type A: long-term follow-up in 61 patients. Br J Dermatol 2001; 145:289-93. [PMID: 11531794 DOI: 10.1046/j.1365-2133.2001.04349.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [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: 11/20/2022]
Abstract
BACKGROUND The blocking action of botulinum toxin type A (BTX-A) on cholinergically innervated sweat glands has been used successfully to treat patients with focal hyperhidrosis. OBJECTIVES To investigate the long-term efficacy and safety of intradermal injections of BTX-A. METHODS We performed an open-label study in 61 patients treated over a period of 3 years for axillary or palmar hyperhidrosis. A total dose of 400 mU BTX-A (Dysport) was injected into both axillae or 460 mU BTX-A (Dysport) into both palms. The injections were repeated after relapse. Objective quantification of sweat production was performed using digitized ninhydrin-stained sheets. RESULTS Four weeks after BTX-A treatment the median reduction in sweat production was 71% compared with baseline (P < 0.001) in the axillary group and 42% (P = 0.005) in the palmar group. Subjective assessment of sweat production by the patients using a visual analogue scale (0, no sweating; 100, the most severe sweating) showed a significant reduction in both the axillary (P < 0.001) and palmar groups (P < 0.001). Secondary disturbances due to focal hyperhidrosis interfering with daily activities were markedly improved in both groups. The median time interval between the sets of injections was 34 weeks for axillary hyperhidrosis and 25 weeks for palmar hyperhidrosis. The treatment of palmar hyperhidrosis was complicated by transient but not disabling weakness of the small hand muscles in nine of 21 patients. CONCLUSIONS Repeated intradermal injections of BTX-A in patients with axillary and palmar hyperhidrosis are as effective as first treatments.
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Affiliation(s)
- P Schnider
- Division of Neurological Rehabilitation, Department of Neurology, University Clinic of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Schnider P, Moraru E, Kittler H, Voller B, Kranz G, Auff E. [Botulinum toxin in the treatment of focal hyperhidrosis]. Wien Klin Wochenschr 2001; 113 Suppl 4:36-41. [PMID: 15506051] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Botulinum A toxin (BTX-A) acts primarily at peripheral cholinergic synapses, inhibiting the release of acetylcholine. Initially it has been used to block the neuromuscular junction in focal dystonic and spastic syndromes. Recently there has been suggestions for potential clinical indications in non-muscular diseases where cholinergic terminals play a role. GUSTATORY SWEATING In 1995 physicians reported a long-lasting anhidrotic effect of intracutaneous BTX-A injections in patients suffering from gustatory sweating (Frey's syndrome). Consequently, a number of clinical studies demonstrated good efficacy of intradermal injections of botulinumtoxin in patients with focal hyperhidrosis. FOCAL HYPERHIDROSIS OF THE PALMS AND AXILLAE Focal hyperhidrosis is usually confined to the palms and axillae. Excessive sweating may be a social handicap and an occupational hazard. The management of focal hyperhidrosis remains controversial. Topical antiperspirants are only effective in very mild cases. Iontophoresis with tap water or anticholinergic drugs is messy and time consuming with only short-lived effect. Sympathectomy, the cornerstone of surgical management, is usually effective in palmar hyperhidrosis. Complications of this technique include surgical risks, postoperative and cosmetic problems and compensatory hyperhidrosis. AXILLARY HYPERHIDROSIS Several studies confirmed that intracutaneous injections of botulinum toxin are useful in the majority of patients with axillary hyperhidrosis resistant to conventional treatment. In axillary hyperhidrosis total doses are ranging from 200-400 mU Dysport or from 80 to 130 mU Botox to reach a good clinical response. Injections are usually well tolerated and no serious side-effects have been observed. The mean duration of anhidrotic effect ranges between 3 and 9 weeks. PALMAR HYPERHIDROSIS The use of botulinumtoxin in patients with palmar hyperhidrosis is rather difficult. The therapeutic window is smaller because injections are complicated by transient weakness of the small hand-muscles. Furthermore the injections at the palms are painful which can be overcomed by application of local anaesthetics or the blockade of the ulnar and median nerves. The duration of anhidrotic effect ranges from 20 to 50 weeks. CONCLUSION Intracutaneous injections of botulinum-toxin should be offered to patients with focal hyperhidrosis of the palms and axillae causing serious social, psychologic and occupational problems, resistant to other conventional treatment options.
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Affiliation(s)
- P Schnider
- Klinische Abteilung für Neurologische Rehabilitation, Universitätsklinik für Neurologie, Osterreich.
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Blumenthal G, Wegner G, M�ller D, Kranz G, Samoson A. 27Al-MAS-NMR-Untersuchung der Thermolyse von Hexaaquaaluminium-chlorid, [Al(H2O)6]Cl3 [1]. Z Anorg Allg Chem 1989. [DOI: 10.1002/zaac.19895760107] [Citation(s) in RCA: 6] [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: 11/05/2022]
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Stößer R, Nofz M, Geßner W, Schröter C, Kranz G. Paramagnetic monitors (Mn2+, Mn4+, Fe3+, and O⨪2) in the solid-state reaction yielding 12CaO · 7Al2O3 and other aluminates. J SOLID STATE CHEM 1989. [DOI: 10.1016/0022-4596(89)90002-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kranz G, Morgenstern K, Schmidt GK. Determination of elastical eigenstrains of Single-phase FCC materials from X-ray meausrements. Cryst Res Technol 1984. [DOI: 10.1002/crat.2170190326] [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: 11/08/2022]
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Huber J, Kranz G, Kreibich G, Beining K, Krüger M, Weissbach F. [Microbiological degradation of glucosinolates in defatted rapeseed meal]. Nahrung 1983; 27:257-63. [PMID: 6684210 DOI: 10.1002/food.19830270319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
During the degradation of thioglucosides in defatted rape seed meal (RES) microorganisms were found, whose ability to degrade glucosinolates (GSL) and vinyl thio-oxazolidone (VTO) was not known so far. The isolated microorganisms are two strains of bacteria of the species Bacillus cereus and the yeast Trichosporon cutaneum. The degradation of GSL and VTO in the cultural broths by the Bacillus cereus strains was the more complete the more other Gram-negative bacteria from RES were additionally present. Drinking tests with Wistar rats showed that here is a relation between the watersoluble and mainly bitter toxin substances of rape and their influence on the increase of the animals body weight.
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Collins WE, Schroeder DJ, Rice N, Mertens RA, Kranz G. Some characteristics of optokinetic eye-movement patterns: a comparative study. Aerosp Med 1970; 41:1251-62. [PMID: 5312714] [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: 01/14/2023]
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