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Winter S, Heiling B, Eckardt N, Kloos C, Axer H. Hoffmann's syndrome in the differential work-up of myopathic complaints: a case report. J Med Case Rep 2023; 17:473. [PMID: 37907975 PMCID: PMC10617199 DOI: 10.1186/s13256-023-04184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Hoffmann's syndrome is a rare form of hypothyroid myopathy in adults, which is mainly characterized by muscular weakness and muscular pseudohypertrophy. CASE PRESENTATION We report about a 61-year-old Western European man with myalgia, myxedema and pseudohypertrophy of the calf muscles. Laboratory tests revealed significantly elevated thyroid stimulating hormone (TSH) and creatine kinase (CK). Muscle MRI showed muscular hypertrophy of the lower limbs, but no signs of myositis or myopathy (no gadolinium enhancement, no edema, no fatty degeneration). In addition, electromyography (EMG) detected spontaneous activity. After the beginning of thyroxin-therapy it took six months until the muscle weakness improved and the myalgia regressed. CONCLUSIONS Here, we focus on diagnostic routines and typical findings to differentiate Hoffmann's syndrome from other myopathies. Clinical hallmarks of Hoffmann's syndrome are pseudohypertrophy and weakness of the calf muscles in combination with elevated CK and elevated TSH. EMG is well suited to detect the involvement of the muscles and muscle MRI helps to differentiate it from other myopathies. Hoffmann's syndrome is a rare myopathy due to hypothyroidism and plays a role in the differential diagnosis of myopathic complaints even if hypothyroidism has not been detected before.
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Affiliation(s)
- Sabine Winter
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Bianka Heiling
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Clinical Scientist Program OrganAge, Jena University Hospital, Jena, Germany
| | - Niklas Eckardt
- Department of Radiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Christof Kloos
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
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Tawfik EA, Cartwright MS, van Alfen N, Axer H, Boon AJ, Crump N, Grimm A, Hobson-Webb LD, Kerasnoudis A, Mandeville R, Preston DC, Sakamuri S, Shahrizaila N, Shin S, Shook SJ, Wilder-Smith E, Walker FO. Neuromuscular ultrasound standardized scanning techniques and protocols: Expert panel recommendations. Muscle Nerve 2023; 68:375-379. [PMID: 37074101 DOI: 10.1002/mus.27830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
Neuromuscular ultrasound has become an integral part of the diagnostic workup of neuromuscular disorders at many centers. Despite its growing utility, uniform standard scanning techniques do not currently exist. Scanning approaches for similar diseases vary in the literature creating heterogeneity in the studies as reported in several meta-analysis. Moreover, neuromuscular ultrasound experts including the group in this study have different views with regards to technical aspects, scanning protocols, and the parameters that should be assessed. Establishing standardized neuromuscular scanning protocols is essential for the development of the subspeciality to ensure uniform clinical and research practices. Therefore, we aimed to recommend consensus-based standardized scanning techniques and protocols for common neuromuscular disorders using the Delphi approach. A panel of 17 experts participated in the study, which consisted of three consecutive electronic surveys. The first survey included voting on six scanning protocols addressing the general scanning technique and five common categories of suspected neuromuscular disorders. The subsequent surveys focused on refining the protocols and voting on new steps, rephrased statements, or areas of non-agreement. A high degree of consensus was achieved on the general neuromuscular ultrasound scanning technique and the scanning protocols for focal mononeuropathies, brachial plexopathies, polyneuropathies, amyotophic lateral sclerosis, and muscle diseases. In this study, a group of neuromuscular ultrasound experts developed six consensus-based neuromuscular ultrasound scanning protocols that may serve as references for clinicians and researchers. The standardized protocols could also aid in achieving high-quality uniform neuromuscular ultrasound practices.
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Affiliation(s)
- Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Crump
- Department of Neurology, Austin Health and University of Melbourne, Heidelberg, Australia
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan Shin
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA
| | - Steven J Shook
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital, Lucerne, Switzerland
- Department of Neurology, University of Berne, Bern, Switzerland
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Klawitter F, Walter U, Axer H, Ehler J. [Intensive care unit-acquired weakness-Diagnostic value of neuromuscular ultrasound]. Anaesthesiologie 2023; 72:543-554. [PMID: 37310449 DOI: 10.1007/s00101-023-01300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/14/2023]
Abstract
Intensive care unit-acquired weakness (ICUAW) is one of the most common neuromuscular complications in intensive care medicine. The clinical diagnosis and assessment of the severity using established diagnostic methods (e.g., clinical examination using the Medical Research Council Sum Score or electrophysiological examination) can be difficult or even impossible, especially in sedated, ventilated and delirious patients. Neuromuscular ultrasound (NMUS) has increasingly been investigated in ICUAW as an easy to use noninvasive and mostly patient compliance-independent diagnostic alternative. It has been shown that NMUS appears to be a promising tool to detect ICUAW, to assess the severity of muscular weakness and to monitor the clinical progression. Further studies are needed to standardize the methodology, to evaluate the training effort and to optimize outcome predication. The formulation of an interdisciplinary neurological and anesthesiological training curriculum is warranted to establish NMUS as a complementary diagnostic method of ICUAW in daily clinical practice.
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Affiliation(s)
- Felix Klawitter
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - Uwe Walter
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland
| | - Hubertus Axer
- Klinik für Neurologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Johannes Ehler
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Klawitter F, Walter U, Axer H, Patejdl R, Ehler J. Neuromuscular Ultrasound in Intensive Care Unit-Acquired Weakness: Current State and Future Directions. Medicina (Kaunas) 2023; 59:medicina59050844. [PMID: 37241077 DOI: 10.3390/medicina59050844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
Intensive care unit-acquired weakness (ICUAW) is one of the most common causes of muscle atrophy and functional disability in critically ill intensive care patients. Clinical examination, manual muscle strength testing and monitoring are frequently hampered by sedation, delirium and cognitive impairment. Many different attempts have been made to evaluate alternative compliance-independent methods, such as muscle biopsies, nerve conduction studies, electromyography and serum biomarkers. However, they are invasive, time-consuming and often require special expertise to perform, making them vastly impractical for daily intensive care medicine. Ultrasound is a broadly accepted, non-invasive, bedside-accessible diagnostic tool and well established in various clinical applications. Hereby, neuromuscular ultrasound (NMUS), in particular, has been proven to be of significant diagnostic value in many different neuromuscular diseases. In ICUAW, NMUS has been shown to detect and monitor alterations of muscles and nerves, and might help to predict patient outcome. This narrative review is focused on the recent scientific literature investigating NMUS in ICUAW and highlights the current state and future opportunities of this promising diagnostic tool.
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Affiliation(s)
- Felix Klawitter
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Robert Patejdl
- Department of Medicine, Health and Medical University Erfurt, 99089 Erfurt, Germany
| | - Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Heiling B, Karl A, Fedtke N, Müller N, Kloos C, Grimm A, Axer H. Evaluating Diagnostic Ultrasound of the Vagus Nerve as a Surrogate Marker for Autonomic Neuropathy in Diabetic Patients. Medicina (Kaunas) 2023; 59:medicina59030525. [PMID: 36984526 PMCID: PMC10058247 DOI: 10.3390/medicina59030525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: Diagnostic ultrasound of the vagus nerve has been used to examine different polyneuropathies, and it has been suggested to be useful as a marker of autonomic dysfunction in diabetic patients. Materials and Methods: We analyzed the cross-sectional area (CSA) of the right vagus nerve of 111 patients with type 2 diabetes in comparison to 104 healthy adults and 41 patients with CIDP (chronic inflammatory demyelinating polyneuropathy). In the diabetes group, sympathetic skin response (SSR) was measured as an indicator for autonomic neuropathy. Carotid intima-media thickness (CIMT) was measured as a surrogate for atherosclerosis. Clinical symptoms of polyneuropathy were assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Results: In total, 61.3% of the diabetes patients had clinical signs of polyneuropathy; 23.4% had no SSR at the feet as an indicator of autonomic neuropathy. Mean vagus nerve CSA did not differ in patients with and without diabetic polyneuropathy or in diabetic patients with and without SSR at the feet. No significant correlation was found between vagus nerve CSA and CIMT or SSR parameters in diabetic patients. Mean CSA of the right vagus nerve was slightly larger in diabetic patients (p = 0.028) and in patients with CIDP (p = 0.015) than in healthy controls. Conclusions: Effect sizes and mean differences were rather small so that a reliable diagnosis cannot be performed based on the vagus nerve measurement of a single person alone. Vagus nerve CSA seems not suitable as an indicator of autonomic dysfunction or cardiovascular risk in diabetic patients.
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Affiliation(s)
- Bianka Heiling
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
- Clinician Scientist Program OrganAge, Jena University Hospital, 07747 Jena, Germany
| | - Adriana Karl
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Nadin Fedtke
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Nicolle Müller
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Christof Kloos
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Alexander Grimm
- Department of Neurology, Tübingen University Hospital, 72076 Tübingen, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
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Prell T, Axer H. Avoidance Behavior in Patients with Chronic Dizziness: A Prospective Observational Study. J Clin Med 2022; 11:jcm11247473. [PMID: 36556088 PMCID: PMC9785738 DOI: 10.3390/jcm11247473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Avoidance behavior in adults with chronic dizziness is common. Here, we analyzed factors that are associated with avoidance behavior in a sample of adults with chronic dizziness and/or vertigo. Therefore, 595 patients with chronic vertigo and dizziness who had been subjected to our 5-day multimodal treatment program in a tertiary care outpatient clinic for vertigo and dizziness were prospectively investigated. Both general and dizziness/vertigo-specific data were collected at baseline (n = 595) and at 6-month follow-up (n = 262). Avoidance behavior was measured using the Mobility Inventory for Agoraphobia (MI). The Hospital Anxiety and Depression Scale was used to estimate anxiety (HADS-A) and depression (HADS-D). At baseline, higher MI (higher level of avoidance) was associated with female gender, higher HADS-D, higher HADS-A, and of a higher age. HADS-D provoked the strongest effect on public places, while gender had the strongest effect on open spaces. The majority (79%) reported improvement of MI and 21% reported that MI had worsened or remained stable at follow-up. In the Generalized Estimating Equations, female gender, higher HADS-A, higher HADS-D, and of a higher age predicted higher MI at follow-up. In particular, older female persons with depressive and anxiety symptoms have a high risk for avoidance behavior related to dizziness.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, 06120 Halle, Germany
- Center for Healthy Ageing, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
- Correspondence:
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Metzner K, Darawsha O, Wang M, Gaur N, Cheng Y, Rödiger A, Frahm C, Witte OW, Perocchi F, Axer H, Grosskreutz J, Brill MS. Age-dependent increase of cytoskeletal components in sensory axons in human skin. Front Cell Dev Biol 2022; 10:965382. [PMID: 36393849 PMCID: PMC9664158 DOI: 10.3389/fcell.2022.965382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
Aging is a complex process characterized by several molecular and cellular imbalances. The composition and stability of the neuronal cytoskeleton is essential for the maintenance of homeostasis, especially in long neurites. Using human skin biopsies containing sensory axons from a cohort of healthy individuals, we investigate alterations in cytoskeletal content and sensory axon caliber during aging via quantitative immunostainings. Cytoskeletal components show an increase with aging in both sexes, while elevation in axon diameter is only evident in males. Transcriptomic data from aging males illustrate various patterns in gene expression during aging. Together, the data suggest gender-specific changes during aging in peripheral sensory axons, possibly influencing cytoskeletal functionality and axonal caliber. These changes may cumulatively increase susceptibility of aged individuals to neurodegenerative diseases.
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Affiliation(s)
- Klara Metzner
- Department of Neurology, Jena University Hospital, Jena, Germany,Institute of Neuronal Cell Biology, Technical University Munich, Munich, Germany
| | - Omar Darawsha
- Institute of Neuronal Cell Biology, Technical University Munich, Munich, Germany
| | - Mengzhe Wang
- Institute of Neuronal Cell Biology, Technical University Munich, Munich, Germany
| | - Nayana Gaur
- Department of Neurology, Jena University Hospital, Jena, Germany,Laboratory Animal Centre, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Yiming Cheng
- Helmholtz Diabetes Center (HDC), Helmholtz Center Munich, Institute for Diabetes and Obesity, Munich, Germany
| | | | - Christiane Frahm
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W. Witte
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Fabiana Perocchi
- Institute of Neuronal Cell Biology, Technical University Munich, Munich, Germany,Helmholtz Diabetes Center (HDC), Helmholtz Center Munich, Institute for Diabetes and Obesity, Munich, Germany,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Julian Grosskreutz
- Precision Neurology of the University of Lübeck, Lübeck, Germany,PMI Cluster, University of Lübeck, Lübeck, Germany
| | - Monika S. Brill
- Institute of Neuronal Cell Biology, Technical University Munich, Munich, Germany,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany,*Correspondence: Monika S. Brill,
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Schroeter T, Gühne F, Schwab M, Drescher R, Axer H. Differentiation of Reversible Hemichorea Due to Vitamin B12 Deficiency From Huntington Disease Via FDG PET. Clin Nucl Med 2022; 47:830-831. [PMID: 35695745 DOI: 10.1097/rlu.0000000000004313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Vitamin B12 deficiency may present with diverse symptoms, complicating the differential diagnosis. Extrapyramidal movement disorders, for instance, are a rare manifestation of vitamin B12 deficiency. MRI of the brain frequently remains without conclusive findings. However, 18 F-FDG PET/CT may reveal characteristic changes in the metabolism of the basal ganglia and thus contribute to an accurate diagnosis. We demonstrate the case of a woman with left-sided hemichoreatic movements due to vitamin B12 deficiency showing a contralateral putaminal hypermetabolism, which normalized after vitamin B12 supplementation, ruling out other deviating causes, particularly Huntington disease.
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Affiliation(s)
| | - Falk Gühne
- Nuclear Medicine, Jena University Hospital, Jena, Germany
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Prell T, Mendorf S, Axer H. Tolerance to Dizziness Intensity Increases With Age in People With Chronic Dizziness. Front Neurol 2022; 13:934627. [PMID: 35911923 PMCID: PMC9330066 DOI: 10.3389/fneur.2022.934627] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Dizziness is a common complaint in older adults. To know which factors are instrumental in enabling patients with chronic dizziness to tolerate their symptoms to a certain degree in everyday life can help to develop tailored therapies. Methods Data from 358 patients with chronic dizziness and vertigo who had attended a multimodal daycare treatment program were recorded. Data included sociodemographic parameters, dizziness-related characteristics, the Vertigo Symptom Scale (VSS), and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics, elastic net regression, and mediation analysis were used. Results A higher tolerance of dizziness was associated with higher age, higher intensity of dizziness, lower burden of dizziness, higher HADS depression, structural reason for dizziness (type), permanent dizziness, absence of attacks, and longer disease duration. In contrast, younger persons with attack-like dizziness reported to tolerate less dizziness. Age had a significant direct effect on tolerance (72% of the total effect) and a significant indirect effect via intensity on tolerance (28% of the total effect) in the mediation analysis. Conclusion It can only be speculated that negative stereotypes about age-related complaints may play a role in this. Why older people tolerate more dizziness and to what extent this may contribute to lower healthcare utilization need to be investigated in further studies.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- *Correspondence: Tino Prell ; orcid.org/0000-0002-6423-3108
| | - Sarah Mendorf
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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Abstract
OBJECTIVE The incidence of dizziness and vertigo is increasing with age, and symptoms lead to significant limitations in daily living and to disability in older patients. METHOD Data of 1,752 patients with chronic dizziness/vertigo subjected to a tertiary care, specialized interdisciplinary vertigo center were analyzed. Age, gender, symptoms, medical diagnosis, and Dizziness Handicap Inventory (DHI) were collected based on a questionnaire and analysis of associated patient records. The patients were assigned to 3 age groups (< 41, 41-65, and > 65 years). RESULTS 33.7% of the patients were older than 65 years. Frequency of symptoms and DHI score increased with age. Older patients reported less frequently about coexisting symptoms such as nausea, headache, tinnitus, ear pressure, and visual impairment. Multisensory deficit, central vertigo, bilateral vestibulopathy, and benign paroxysmal positional vertigo were diagnosed increasingly with age, while persistent postural-perceptual dizziness and vestibular migraine were diagnosed in the younger age groups. CONCLUSION In the diagnostic work-up of older patients age-specific characteristics of dizziness/vertigo have to be considered. The older patient generally is more impaired by the symptoms but possibly will not report typical diagnosis-defining symptoms.
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Affiliation(s)
- Alexander Wassermann
- Department of Neurology, Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Sigrid Finn
- Department of Neurology, Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany,Hubertus Axer, Department of Neurology, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany.
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Heiling B, Wiedfeld LIEE, Müller N, Kobler NJ, Grimm A, Kloos C, Axer H. Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes. J Clin Med 2022; 11:jcm11123374. [PMID: 35743445 PMCID: PMC9225449 DOI: 10.3390/jcm11123374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/18/2022] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022] Open
Abstract
In diabetic patients, controversies still exist about the validity of electrodiagnostic and nerve ultrasound diagnosis for carpal tunnel syndrome (CTS). We analyzed 69 patients with type 2 diabetes. Nerve conduction studies and peripheral nerve ultrasound of the median nerve over the carpal tunnel were performed. CTS symptoms were assessed using the Boston Carpal Tunnel Questionnaire. Polyneuropathy was assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Although 19 patients reported predominantly mild CTS symptoms, 37 patients met the electrophysiological diagnosis criteria for CTS, and six patients were classified as severe or extremely severe. The sonographic cross-sectional area (CSA) of the median nerve at the wrist was larger than 12 mm2 in 45 patients (65.2%), and the wrist-to-forearm-ratio was larger than 1.4 in 61 patients (88.4%). Receiver operating characteristic analysis showed that neither the distal motor latency, the median nerve CSA, nor the wrist-to-forearm-ratio could distinguish between patients with and without CTS symptoms. Diagnosis of CTS in diabetic patients should primarily be based upon typical clinical symptoms and signs. Results of electrodiagnostic testing and nerve ultrasound have to be interpreted with caution and additional factors have to be considered especially polyneuropathy, but also body mass index and hyperglycemia.
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Affiliation(s)
- Bianka Heiling
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.I.E.E.W.); (N.J.K.); (H.A.)
- Clinician Scientist Program OrganAge, Jena University Hospital, 07747 Jena, Germany
- Correspondence:
| | - Leonie I. E. E. Wiedfeld
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.I.E.E.W.); (N.J.K.); (H.A.)
| | - Nicolle Müller
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (N.M.); (C.K.)
| | - Niklas J. Kobler
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.I.E.E.W.); (N.J.K.); (H.A.)
| | - Alexander Grimm
- Department of Neurology, Tuebingen University Hospital, 72076 Tuebingen, Germany;
| | - Christof Kloos
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (N.M.); (C.K.)
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.I.E.E.W.); (N.J.K.); (H.A.)
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Rödiger A, Metzner K, Wolfrum T, Zhiti A, Steinbach R, Axer H, Brill M, Grosskreutz J. FV 3 Cytoskeletal analysis in sensory nerve fibre endings show a decrease of neurofilaments in high aggressive spinal Amyotrophic lateral sclerosis. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heiling B, Kobler N, Müller N, Grimm A, Kloos C, Axer H. P 78 Sonographic and electrophysiological characterization of peripheral nerves in patients with diabetes type 2. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.01.109] [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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Prell T, Finn S, Zipprich HM, Axer H. What Predicts Improvement of Dizziness after Multimodal and Interdisciplinary Day Care Treatment? J Clin Med 2022; 11:jcm11072005. [PMID: 35407613 PMCID: PMC8999937 DOI: 10.3390/jcm11072005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/11/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Vertigo and dizziness are common in community-dwelling people and can be treated in specialized multidisciplinary settings. To develop tailored interventions, however, we have to explore risk factors for favorable and unfavorable outcomes. Methods: We prospectively investigated patients with chronic vertigo and dizziness subjected to our 5-day multimodal and interdisciplinary day care treatment in the Center for Vertigo and Dizziness of Jena University Hospital, Germany. The Vertigo Severity Scale (VSS), the Body Sensations Questionnaire (BSQ), the Hospital Anxiety and Depression Scale (HADS), the Agoraphobic Cognitions Questionnaire (ACQ), the Mobility Inventory (MI), and the burden and intensity of dizziness (using a visual analogue scale) were assessed at baseline (n = 754) and after 6 months (n = 444). In addition, 14 Likert-scaled questions were used to quantify the change in personal attitude and behavior towards the complaints after 6 months. Results: Dizziness-related burden and intensity improved with a large effect size. The largest improvement was seen in the attitudes towards dizziness, the understanding of somatic causes, and the perceived ability to influence dizziness. However, the ability to work and to carry out professional activity was improved to a lesser extent. The overall improvement of dizziness was associated with the absence of a depressive mood, a short duration of vertigo, a lower VSS, a lower perceived intensity of vertigo, and distinct vertigo diagnoses, namely Meniere’s disease, vestibular migraine, vestibular neuritis, vestibular paroxysmia, and vestibular schwannoma. Worsening of dizziness/vertigo was associated with depressive symptoms, permanent vertigo, distinct vertigo diagnoses (central vertigo, multisensory deficit), and a higher perceived burden due to vertigo. Conclusion: The six-month outcome of patients with dizziness presented to a specialized outpatient clinic appears to be favorable. Nevertheless, people with the abovementioned risk factors at baseline have less benefit and probably need adapted and tailored vertigo interventions to improve long-term outcome.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, 06120 Halle, Germany;
| | - Sigrid Finn
- Center for Vertigo and Dizziness, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany;
| | - Hannah M. Zipprich
- Center for Healthy Ageing, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany;
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany
- Correspondence: ; Tel.: +49-3641-9323454; Fax: +49-3641-9323402
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15
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Prell T, Finn S, Axer H. How Healthcare Utilization Due to Dizziness and Vertigo Differs Between Older and Younger Adults. Front Med (Lausanne) 2022; 9:852187. [PMID: 35252281 PMCID: PMC8889010 DOI: 10.3389/fmed.2022.852187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Vertigo and dizziness are common in older adults. We describe self-reported healthcare utilization because of dizziness and vertigo in older adults attending a tertiary care specialized vertigo center. Methods Data from 765 patients (45% were ≥60 years old) with chronic dizziness and vertigo who attended a daycare multimodal treatment program were recorded. Data included sociodemographic parameters, dizziness-related characteristics, the Body Sensations Questionnaire (BSQ), the Agoraphobic Cognitions Questionnaire (ACQ), and the Hospital Anxiety and Depression Scale (HADS). Also, healthcare utilization, including (1) physician and clinical services, (2) hospitalizations in the year before consulting the vertigo center, (3) prescription of drugs and other professional services were included. Descriptive statistics, exploratory data analysis, and regression models were used. Results Intensity of dizziness was similar in both age groups, however, distress due to dizziness was more severe in younger persons. Dizziness symptoms lasted longer in older adults than in younger persons. Older adults had a somatic diagnosis (74.6 vs. 35.0%) more frequently and reported more falls (37.2 vs. 28.5%) than younger individuals. Anxiety about bodily sensations was higher in younger patients (mean BSQ1 = 9.33 ± 5.6) than in older patients (mean BSQ1 = 6.72 ± 5.4). Older persons had fewer depressive symptoms (mean HADS depression = 5.8 ± 3.6 vs. 6.5 ± 4.1) and less anxiety (mean HADS anxiety = 5.7 ± 3.7 vs. 7.8 ± 4.1) than younger individuals. Younger people were more frequently hospitalized (24.4%) than older adults (16.3%) in the year before consulting the vertigo center. Also, younger patients and patients with non-somatic etiologies had considerably more consultations with healthcare providers than older patients. Older adults received less medication (50.3%), less physiotherapy (41%), and less psychological therapy (11.6%) for vertigo than younger people (59.7, 52.2, 20.4%, respectively). Conclusion Age-associated differences in healthcare utilization were defined in selected patients attending a specialized vertigo center. Since dizziness is frequently a heterogeneous disorder requiring interdisciplinary care, its diagnostic and therapeutic work-up must be improved for older patients with dizziness.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
| | - Sigrid Finn
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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16
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Prell T, Wassermann A, Zipprich HM, Finn S, Axer H. Impact of Common Dizziness Associated Symptoms on Dizziness Handicap in Older Adults. Front Neurol 2022; 12:801499. [PMID: 34975741 PMCID: PMC8718649 DOI: 10.3389/fneur.2021.801499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/29/2021] [Indexed: 01/19/2023] Open
Abstract
Background: A cross-sectional observational study was designed to determine the impact of dizziness associated symptoms on the dizziness handicap inventory (DHI) in older adults (≥60 years). Methods: In total, 785 individuals referred to a multidisciplinary dizziness unit were assessed. Participants completed self-report questionnaires with general questions about symptoms of dizziness as well as the DHI. The DHI subscores (physical, functional, emotional) were calculated. Medical diagnoses were collected from the medical records of the patients. One-way MANOVA and networking analysis were used to analyze the impact of dizziness associated symptoms on dizziness handicap. Results: Most patients reported swaying dizziness (60.6%) and feeling of unsteadiness (59.8%) with substantial overlap between the types of dizziness. Most frequent dizziness associated symptoms were ear noise/tinnitus, visual problems, and nausea/vomiting. Network analysis revealed that visual disturbances, headache, and hearing impairment were associated with higher DHI and explained 12% of the DHI variance in the linear regression. In the one-way MANOVA visual problems and headache had an effect on all three DHI subscores, while hearing impairment was associated with the functional and emotional subscores of DHI. Conclusion: Distinct dizziness associated symptoms have substantial impact on dizziness handicap in older adults. A multifactorial assessment including these symptoms may assist in tailoring therapies to alleviate dizziness handicap in this group.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Alexander Wassermann
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Hannah M Zipprich
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany.,Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Sigrid Finn
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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17
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Barth E, Srivastava A, Wengerodt D, Stojiljkovic M, Axer H, Witte OW, Kretz A, Marz M. Age-dependent expression changes of circadian system-related genes reveal a potentially conserved link to aging. Aging (Albany NY) 2021; 13:25694-25716. [PMID: 34923482 PMCID: PMC8751596 DOI: 10.18632/aging.203788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022]
Abstract
The circadian clock system influences the biology of life by establishing circadian rhythms in organisms, tissues, and cells, thus regulating essential biological processes based on the day/night cycle. Circadian rhythms change over a lifetime due to maturation and aging, and disturbances in the control of the circadian system are associated with several age-related pathologies. However, the impact of chronobiology and the circadian system on healthy organ and tissue aging remains largely unknown. Whether aging-related changes of the circadian system’s regulation follow a conserved pattern across different species and tissues, hence representing a common driving force of aging, is unclear. Based on a cross-sectional transcriptome analysis covering 329 RNA-Seq libraries, we provide indications that the circadian system is subjected to aging-related gene alterations shared between evolutionarily distinct species, such as Homo sapiens, Mus musculus, Danio rerio, and Nothobranchius furzeri. We discovered differentially expressed genes by comparing tissue-specific transcriptional profiles of mature, aged, and old-age individuals and report on six genes (per2, dec2, cirp, klf10, nfil3, and dbp) of the circadian system, which show conserved aging-related expression patterns in four organs of the species examined. Our results illustrate how the circadian system and aging might influence each other in various tissues over a long lifespan and conceptually complement previous studies tracking short-term diurnal and nocturnal gene expression oscillations.
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Affiliation(s)
- Emanuel Barth
- Bioinformatics/High Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany
| | - Akash Srivastava
- Bioinformatics/High Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany.,FLI Leibniz Institute for Age Research, Jena, Germany.,Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Diane Wengerodt
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Milan Stojiljkovic
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexandra Kretz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Manja Marz
- Bioinformatics/High Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany.,FLI Leibniz Institute for Age Research, Jena, Germany.,German Center for Integrative Biodiversity Research (iDiv), Halle-Jena-Leipzig, Germany.,European Virus Bioinformatics Center (EVBC), Jena, Germany
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18
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Holtz B, Grimm A, Axer H. Patients' attitude towards vaccination after Guillain Barré syndrome. Health Sci Rep 2021; 4:e469. [PMID: 34984239 PMCID: PMC8691489 DOI: 10.1002/hsr2.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Guillain Barré syndrome (GBS) could be triggered by an infectious disease but by vaccination as well. Thus, suffering GBS may influence patients' attitudes towards vaccination. METHODS An anonymous questionnaire consisting of the Overall Neuropathy Limitations Score (ONLS), the short form-36 health survey (SF-36), and questions addressing patients' attitude towards vaccination was sent to members of a German GBS support group and to patients with GBS diagnosis who were treated at Jena University Hospital. RESULTS Ninety-seven questionnaires clearly stated GBS as a diagnosis and were included in the analysis. Although 19.6% of the GBS patients reported having no disability in the long-time follow-up, a considerable number of patients still had persistent neurological symptoms; 74.2% of the GBS patients reported being able to walk at least 10 m independently. However, 5.2% were restricted to wheelchair. The patients reached lower scores in all domains of quality of life compared to German controls. Moreover, patients showed a more critical attitude towards vaccination compared to a German representative survey. Fewer patients (58.8%) received a vaccination after suffering from GBS than before (77.3%). Every tenth patient believed that vaccination was the trigger for the GBS. 32% of the patients did not receive a vaccination in the last 5 years mainly because of the fear of adverse effects (32%) or disadvise of the general practitioners (25.8%). DISCUSSION Although the risk of relapse following immunization may be rather low, uncertainties and fears still impair the counseling of these patients by their medical practitioner.
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Affiliation(s)
- Ben‐Ole Holtz
- Department of NeurologyJena University HospitalJenaGermany
| | - Alexander Grimm
- Department of NeurologyTuebingen University HospitalTuebingenGermany
| | - Hubertus Axer
- Department of NeurologyJena University HospitalJenaGermany
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19
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Holtz B, Axer H, Witte O. P 47. Disability, quality of life, and vaccination behavior after Guillain-Barré-Syndrome. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.365] [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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20
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Wassermann A, Finn S, Axer H. P 29. Age-associated characteristics in chronic vertigo patients: A survey of a specialized center for vertigo and dizziness. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.350] [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: 11/30/2022]
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21
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Tawfik EA, Cartwright MS, Grimm A, Boon AJ, Kerasnoudis A, Preston DC, Wilder‐Smith E, Axer H, Hobson‐Webb LD, Alfen N, Crump N, Shahrizaila N, Inkpen P, Mandeville R, Sakamuri S, Shook SJ, Shin S, Walker FO. Neuromuscular ultrasound competency assessment: Consensus‐based survey. Muscle Nerve 2021; 63:651-656. [DOI: 10.1002/mus.27163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Eman A. Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine Ain Shams University Cairo Egypt
| | - Michael S. Cartwright
- Department of Neurology Wake Forest School of Medicine, Medical Center Blvd Winston‐Salem North Carolina USA
| | - Alexander Grimm
- Department of Neurology University Hospital Tuebingen Tuebingen Germany
| | - Andrea J. Boon
- Department of Physical Medicine and Rehabilitation Mayo Clinic Rochester Minnesota USA
| | - Antonios Kerasnoudis
- Department of Neurology St Luke's Hospital Thessaloniki Greece
- Department of Neurology St Josef Hospital, Ruhr University Bochum Bochum Germany
| | - David C. Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center Case Western Reserve University Cleveland Ohio USA
| | - Einar Wilder‐Smith
- Department of Neurology Kantonsspital Lucerne Switzerland
- Department of Neurology University of Berne Bern Switzerland
| | - Hubertus Axer
- Hans Berger Department of Neurology Jena University Hospital Jena Germany
| | - Lisa D. Hobson‐Webb
- Department of Neurology, Neuromuscular Division Duke University School of Medicine Durham North Carolina USA
| | - Nens Alfen
- Department of Neurology and Clinical Neurophysiology Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen The Netherlands
| | - Nicholas Crump
- Department of Neurology Austin Health and University of Melbourne Heidelberg Australia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Peter Inkpen
- Division of Physical Medicine and Rehabilitation University of British Columbia British Columbia Vancouver Canada
| | - Ross Mandeville
- Department of Neurosciences University of California San Diego School of Medicine La Jolla California USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences Stanford University Stanford California USA
| | - Steven J Shook
- Neuromuscular Center, Neurologic Institute Cleveland Clinic Cleveland Ohio USA
| | - Susan Shin
- Department of Neurology Mount Sinai School of Medicine New York New York USA
| | - Francis O. Walker
- Department of Neurology Wake Forest School of Medicine, Medical Center Blvd Winston‐Salem North Carolina USA
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22
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Axer H, Finn S, Wassermann A, Guntinas-Lichius O, Klingner CM, Witte OW. Multimodal treatment of persistent postural-perceptual dizziness. Brain Behav 2020; 10:e01864. [PMID: 32989916 PMCID: PMC7749543 DOI: 10.1002/brb3.1864] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Persistent postural-perceptual dizziness (PPPD) is a chronic disorder with fluctuating symptoms of dizziness, unsteadiness, or vertigo for at least three months. Its pathophysiological mechanisms give theoretical support for the use of multimodal treatment. However, there are different therapeutic programs and principles available, and their clinical effectiveness remains elusive. METHODS A database of patients who participated in a day care multimodal treatment program was analyzed regarding the therapeutic effects on PPPD. Vertigo Severity Scale (VSS) and Hospital Anxiety and Depression Scale (HADS) were assessed before and 6 months after therapy. RESULTS Of a total of 657 patients treated with a tertiary care multimodal treatment program, 46.4% met the criteria for PPPD. PPPD patients were younger than patients with somatic diagnoses and complained more distress due to dizziness. 63.6% completed the follow-up questionnaire. All patients showed significant changes in VSS and HADS anxiety, but the PPPD patients generally showed a tendency to improve more than the patients with somatic diagnoses. The change in the autonomic-anxiety subscore of VSS only reached statistical significance when comparing PPPD with somatic diagnoses (p = .002). CONCLUSIONS Therapeutic principles comprise cognitive-behavioral therapy, vestibular rehabilitation exercises, and serotonergic medication. However, large-scale, randomized, controlled trials are still missing. Follow-up observations after multimodal interdisciplinary therapy reveal an improvement in symptoms in most patients with chronic dizziness. The study was not designed to detect diagnosis-specific effects, but patients with PPPD and patients with other vestibular disorders benefit from multimodal therapies.
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Affiliation(s)
- Hubertus Axer
- Center for Vertigo and Dizziness, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sigrid Finn
- Center for Vertigo and Dizziness, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Wassermann
- Center for Vertigo and Dizziness, Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Carsten M Klingner
- Center for Vertigo and Dizziness, Department of Neurology, Jena University Hospital, Jena, Germany.,Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Center for Vertigo and Dizziness, Department of Neurology, Jena University Hospital, Jena, Germany
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23
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Brunkhorst FM, Weigand MA, Pletz M, Gastmeier P, Lemmen SW, Meier-Hellmann A, Ragaller M, Weyland A, Marx G, Bucher M, Gerlach H, Salzberger B, Grabein B, Welte T, Werdan K, Kluge S, Bone HG, Putensen C, Rossaint R, Quintel M, Spies C, Weiß B, John S, Oppert M, Jörres A, Brenner T, Elke G, Gründling M, Mayer K, Weimann A, Felbinger TW, Axer H, Heller T, Gagelmann N. [S3 guideline sepsis-prevention, diagnosis, treatment, and aftercare : Summary of the strong recommendations]. Med Klin Intensivmed Notfmed 2020; 115:178-188. [PMID: 32185422 DOI: 10.1007/s00063-020-00671-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- F M Brunkhorst
- Zentrum für Klinische Studien, Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Salvador-Allende-Platz 27, 07747, Jena, Deutschland.
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S W Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - A Meier-Hellmann
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Helios-Klinikum Erfurt GmbH, Erfurt, Deutschland
| | - M Ragaller
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Dresden, Deutschland
| | - A Weyland
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Bucher
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Halle, Halle, Deutschland
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - B Salzberger
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene, Klinikum der Universität München, München, Deutschland
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Klinikum der MLU Halle-Wittenberg, Halle, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H G Bone
- Zentrum für Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
| | - C Putensen
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Rossaint
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Quintel
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Spies
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - B Weiß
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S John
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Klinikum Nürnberg, Nürnberg, Deutschland
| | - M Oppert
- Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann Potsdam, Potsdam, Deutschland
| | - A Jörres
- Medizinische Klinik I, Klinik für Nephrologie, Transplantationsmedizin und internistische Intensivmedizin, Krankenhaus Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - T Brenner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G Elke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Kiel, Kiel, Deutschland
| | - M Gründling
- Klinik für Anästhesiologie - Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsklinikum Greifswald, Greifswald, Deutschland
| | - K Mayer
- Medizinische Klinik und Poliklinik II, Klinikum der Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - A Weimann
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum "St. Georg" Leipzig gGmbH, Leipzig, Deutschland
| | - T W Felbinger
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Städtisches Klinikum München, München, Deutschland
| | - H Axer
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - T Heller
- Universitätsklinikum Jena, Jena, Deutschland
| | - N Gagelmann
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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24
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Barth E, Srivastava A, Stojiljkovic M, Frahm C, Axer H, Witte OW, Marz M. Conserved aging-related signatures of senescence and inflammation in different tissues and species. Aging (Albany NY) 2019; 11:8556-8572. [PMID: 31606727 PMCID: PMC6814591 DOI: 10.18632/aging.102345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/27/2019] [Indexed: 12/14/2022]
Abstract
Increasing evidence indicates that chronic inflammation and senescence are the cause of many severe age-related diseases, with both biological processes highly upregulated during aging. However, until now, it has remained unknown whether specific inflammation- or senescence-related genes exist that are common between different species or tissues. These potential markers of aging could help to identify possible targets for therapeutic interventions of aging-associated afflictions and might also deepen our understanding of the principal mechanisms of aging. With the objective of identifying such signatures of aging and tissue-specific aging markers, we analyzed a multitude of cross-sectional RNA-Seq data from four evolutionarily distinct species (human, mouse and two fish) and four different tissues (blood, brain, liver and skin). In at least three different species and three different tissues, we identified several genes that displayed similar expression patterns that might serve as potential aging markers. Additionally, we show that genes involved in aging-related processes tend to be tighter controlled in long-lived than in average-lived individuals. These observations hint at a general genetic level that affect an individual’s life span. Altogether, this descriptive study contributes to a better understanding of common aging signatures as well as tissue-specific aging patterns and supplies the basis for further investigative age-related studies.
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Affiliation(s)
- Emanuel Barth
- Bioinformatics/High Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany.,FLI Leibniz Institute for Age Research, Jena, Germany
| | - Akash Srivastava
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Milan Stojiljkovic
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christiane Frahm
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Manja Marz
- Bioinformatics/High Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany.,FLI Leibniz Institute for Age Research, Jena, Germany.,European Virus Bioinformatics Center (EVBC), Jena, Germany
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Tawfik EA, Cartwright MS, Grimm A, Boon AJ, Kerasnoudis A, Preston DC, Wilder‐Smith E, Axer H, Hobson‐Webb LD, Alfen N, Crump N, Shahrizaila N, Inkpen P, Mandeville R, Sakamuri S, Shook SJ, Shin S, Walker FO. Guidelines for neuromuscular ultrasound training. Muscle Nerve 2019; 60:361-366. [DOI: 10.1002/mus.26642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Eman A. Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of MedicineAin Shams University Cairo Egypt
| | | | - Alexander Grimm
- Department of NeurologyUniversity Hospital Tuebingen Tuebingen Germany
| | - Andrea J. Boon
- Department of Physical Medicine and RehabilitationMayo Clinic Rochester Minnesota
| | | | - David C. Preston
- Neurological Institute, University Hospitals, Cleveland Medical CenterCase Western Reserve University Cleveland Ohio
| | - Einar Wilder‐Smith
- Department of NeurologyYong Loo Lin School of Medicine, National University Singapore Singapore
| | - Hubertus Axer
- Hans Berger Department of NeurologyJena University Hospital Jena Germany
| | - Lisa D. Hobson‐Webb
- Department of Neurology, Neuromuscular DivisionDuke University School of Medicine Durham North Carolina
| | - Nens Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and BehaviorRadboud University Medical Center Nijmegen The Netherlands
| | - Nicholas Crump
- Department of NeurologyAustin Health and University of Melbourne Heidelberg Victoria Australia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Peter Inkpen
- Division of Physical Medicine and RehabilitationUniversity of British Columbia Vancouver British Columbia Canada
| | - Ross Mandeville
- Department of NeurosciencesUniversity of California San Diego School of Medicine La Jolla California
| | - Sarada Sakamuri
- Department of Neurology and Neurological SciencesStanford University Stanford California
| | - Steven J. Shook
- Department of NeurologyNeuromuscular Center, Cleveland Clinic Cleveland Ohio
| | - Susan Shin
- Department of Neurology, Mount Sinai School of Medicine New York New York
| | - Francis O. Walker
- Department of NeurologyWake Forest School of Medicine Winston‐Salem North Carolina
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26
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Grimm A, Oertl H, Auffenberg E, Schubert V, Ruschil C, Axer H, Winter N. Differentiation Between Guillain-Barré Syndrome and Acute-Onset Chronic Inflammatory Demyelinating Polyradiculoneuritis-a Prospective Follow-up Study Using Ultrasound and Neurophysiological Measurements. Neurotherapeutics 2019; 16:838-847. [PMID: 30756363 PMCID: PMC6694337 DOI: 10.1007/s13311-019-00716-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Differentiation of Guillain-Barré syndrome (GBS) and acute-onset chronic inflammatory demyelinating polyradiculoneuritis (CIDP) might be intricate in early stages. We compared electrodiagnostics (EDx) and nerve ultrasound (NUS) as tools for early distinction and follow-up. NUS and EDx have been performed at first visitation and after 6 months. The nerve conduction study score (NCSS), the ultrasound pattern sum score (UPSS), and clinical scores were used for comparison. Compared with the 33 GBS patients, the 34 CIDP patients (50% with symptoms < 4 weeks) revealed significant nerve enlargement in ultrasound (p < 0.001) except for the roots and vagus, which exhibited increased values in both groups. EDx has no significant differences between both groups except for the A-wave frequency and the sural sparing pattern, which is more frequent in GBS (Fisher's exact p < 0.05). In the latter, particularly, pure sensory nerves were not enlarged in contrast to CIDP, in which those were mostly enlarged (p < 0.001). This ultrasonic sensory sparing pattern (uSSP) in combination with enlarged roots/vagus is the hallmark finding in GBS with sensitivity, specificity, and positive predictive value > 85%, whereas in CIDP, enlarged sensory und multifocally enlarged sensorimotor nerves are key differentiation features to GBS. Increased echointensity of the nerves further arises only in CIDP. After 6 months, in CIDP, the significant nerve enlargement persisted, whereas in GBS, all segments almost normalized. Clinical, ultrasonic, and NCS scores correlated significantly over the time. Enlarged roots/vagus in combination with uSSP might facilitate differentiation of GBS and CIDP in the early stage, and ultrasonic 6-month normalization underlines the diagnosis of GBS in cases of uncertainty. Trial Registration: DRKS-ID 00005253.
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Affiliation(s)
- Alexander Grimm
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Hannah Oertl
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Eva Auffenberg
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Victoria Schubert
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christoph Ruschil
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Natalie Winter
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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27
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David S, Heemskerk AM, Corrivetti F, Thiebaut de Schotten M, Sarubbo S, Corsini F, De Benedictis A, Petit L, Viergever MA, Jones DK, Mandonnet E, Axer H, Evans J, Paus T, Leemans A. The Superoanterior Fasciculus (SAF): A Novel White Matter Pathway in the Human Brain? Front Neuroanat 2019; 13:24. [PMID: 30890921 PMCID: PMC6412356 DOI: 10.3389/fnana.2019.00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/07/2019] [Indexed: 01/01/2023] Open
Abstract
Fiber tractography (FT) using diffusion magnetic resonance imaging (dMRI) is widely used for investigating microstructural properties of white matter (WM) fiber-bundles and for mapping structural connections of the human brain. While studying the architectural configuration of the brain's circuitry with FT is not without controversy, recent progress in acquisition, processing, modeling, analysis, and visualization of dMRI data pushes forward the reliability in reconstructing WM pathways. Despite being aware of the well-known pitfalls in analyzing dMRI data and several other limitations of FT discussed in recent literature, we present the superoanterior fasciculus (SAF), a novel bilateral fiber tract in the frontal region of the human brain that-to the best of our knowledge-has not been documented. The SAF has a similar shape to the anterior part of the cingulum bundle, but it is located more frontally. To minimize the possibility that these FT findings are based on acquisition or processing artifacts, different dMRI data sets and processing pipelines have been used to describe the SAF. Furthermore, we evaluated the configuration of the SAF with complementary methods, such as polarized light imaging (PLI) and human brain dissections. The FT results of the SAF demonstrate a long pathway, consistent across individuals, while the human dissections indicate fiber pathways connecting the postero-dorsal with the antero-dorsal cortices of the frontal lobe.
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Affiliation(s)
- Szabolcs David
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Anneriet M. Heemskerk
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | | | | | - Silvio Sarubbo
- Structural and Functional Connectivity Lab Project, Department of Emergency, Division of Neurosurgery, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Francesco Corsini
- Structural and Functional Connectivity Lab Project, Department of Emergency, Division of Neurosurgery, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Alessandro De Benedictis
- Department of Neurosciences, Division of Neurosurgery, “Bambino Gesù” Children Hospital, IRCCS, Rome, Italy
| | - Laurent Petit
- Groupe d’Imagerie Neurofonctionnelle (GIN), Institut des Maladies Neurodégératives (IMN)-UMR5293-CNRS, CEA, Université de Bordeaux, Bordeaux, France
| | - Max A. Viergever
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Derek K. Jones
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, United Kingdom
| | | | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
| | - John Evans
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, United Kingdom
| | - Tomáš Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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28
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Dietzek M, Finn S, Karvouniari P, Zeller MA, Klingner CM, Guntinas-Lichius O, Witte OW, Axer H. In Older Patients Treated for Dizziness and Vertigo in Multimodal Rehabilitation Somatic Deficits Prevail While Anxiety Plays a Minor Role Compared to Young and Middle Aged Patients. Front Aging Neurosci 2018; 10:345. [PMID: 30425637 PMCID: PMC6218593 DOI: 10.3389/fnagi.2018.00345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/28/2018] [Accepted: 10/11/2018] [Indexed: 01/20/2023] Open
Abstract
Objective: Many patients with dizziness and vertigo are of older age. It is still unclear which age-associated factors play a role in the treatment of dizziness and vertigo. Therefore, age-associated characteristics of patients subjected to an interdisciplinary day care approach for chronic vertigo and dizziness were analyzed. Subjects and Methods: 650 patients with chronic dizziness/vertigo subjected to a multimodal vestibular rehabilitation day care program were analyzed. Information concerning age, gender, medical diagnosis, medical consultations, technical diagnostics performed and therapy achieved before attending the clinic were collected. Furthermore, data were gathered using the Vertigo Severity Scale (VSS), Hospital Anxiety and Depression Scale (HADS), Mobility Inventory (MI), as well as the intensity of and the distress due to vertigo/dizziness using visual analog scales. As a follow-up, the VSS, HADS, MI, and the visual analog scales were collected again 6 months after attending the therapy program. Three age groups were compared to each other (<41, 41–65, and >65 years of age). Results: One-third of the patients were older than 65 years. This group had typical diagnoses with mainly organic deficits. In contrast to the dominance of mainly multifactorial, organic deficits the older patients reported less medical consultations, fewer technical diagnostics and even fewer treatments than the younger patients. The elderly scored significantly lower in total VSS, in VSS-V (vestibular-balance subscale), in VSS-A (autonomic-anxiety subscale) and in HADS-anxiety. Psychological diagnoses were clearly associated to the younger patients. 424 patients (65.2%) completed the follow-up questionnaire 6 months after attending the therapy week. The older patients revealed improvements of VSS-V and the Avoidance Alone scale of MI as well as decreased distress due to vertigo/dizziness. Conclusion: In the older patients, who took part in our vestibular rehabilitation program, mainly somatic deficits prevail while anxiety plays a minor role compared to young and middle aged patients. Older patients profited from vestibular rehabilitation especially in mobility and vestibular-balance. Therefore, vestibular rehabilitation programs for the elderly with a focus on physio- and occupational therapeutic interventions and less cognitive behavioral therapy may be reasonable.
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Affiliation(s)
- Maren Dietzek
- Center for Vertigo and Dizziness, Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sigrid Finn
- Center for Vertigo and Dizziness, Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Panagiota Karvouniari
- Center for Vertigo and Dizziness, Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Maja A Zeller
- Center for Vertigo and Dizziness, Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Carsten M Klingner
- Center for Vertigo and Dizziness, Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany.,Biomagnetic Center, Jena University Hospital, Jena, Germany
| | | | - Otto W Witte
- Center for Vertigo and Dizziness, Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Center for Vertigo and Dizziness, Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
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29
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Walker FO, Cartwright MS, Alter KE, Visser LH, Hobson-Webb LD, Padua L, Strakowski JA, Preston DC, Boon AJ, Axer H, van Alfen N, Tawfik EA, Wilder-Smith E, Yoon JS, Kim BJ, Breiner A, Bland JDP, Grimm A, Zaidman CM. Indications for neuromuscular ultrasound: Expert opinion and review of the literature. Clin Neurophysiol 2018; 129:2658-2679. [PMID: 30309740 DOI: 10.1016/j.clinph.2018.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
Over the last two decades, dozens of applications have emerged for ultrasonography in neuromuscular disorders. We wanted to measure its impact on practice in laboratories where the technique is in frequent use. After identifying experts in neuromuscular ultrasound and electrodiagnosis, we assessed their use of ultrasonography for different indications and their expectations for its future evolution. We then identified the earliest papers to provide convincing evidence of the utility of ultrasound for particular indications and analyzed the relationship of their date of publication with expert usage. We found that experts use ultrasonography often for inflammatory, hereditary, traumatic, compressive and neoplastic neuropathies, and somewhat less often for neuronopathies and myopathies. Usage significantly correlated with the timing of key publications in the field. We review these findings and the extensive evidence supporting the value of neuromuscular ultrasound. Advancement of the field of clinical neurophysiology depends on widespread translation of these findings.
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Affiliation(s)
- Francis O Walker
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Michael S Cartwright
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Katharine E Alter
- Department of Rehabilitation Medicine, National INeurolnstitutes of Health, Bethesda, MD 20892, USA.
| | - Leo H Visser
- Departments of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, NC, USA.
| | - Luca Padua
- Don Carlo Gnocchi ONLUS Foundation, Piazzale Rodolfo Morandi, 6, 20121 Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Universita Cattolica del Sacro Cuore, Rome, Italy.
| | - Jeffery A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA; Department of Physical Medicine and Rehabilitation, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA; OhioHealth McConnell Spine, Sport and Joint Center, Columbus, OH, USA.
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena 07747, Germany.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Einar Wilder-Smith
- Department of Neurology, Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Neurology, Kantonsspital Lucerne, Switzerland; Department of Neurology, Inselspital Berne, Switzerland.
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Canada.
| | - Jeremy D P Bland
- Deparment of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Craig M Zaidman
- Division of Neuromuscular Medicine, Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Box 8111, St. Louis, MO 63110, USA.
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30
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Heiling B, Waschke A, Ceanga M, Grimm A, Witte OW, Axer H. Not your average Saturday night palsy–High resolution nerve ultrasound resolves rare cause of wrist drop. Clin Neurol Neurosurg 2018; 172:160-161. [DOI: 10.1016/j.clineuro.2018.07.006] [Citation(s) in RCA: 3] [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] [Received: 11/08/2017] [Revised: 07/01/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022]
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31
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Rödiger A, Gaur N, Hohmann M, Appelfeller M, Tümmler A, Ringer T, Gunkel A, Stubendorff B, Axer H, Witte O, Grosskreutz J. P45. Reduction in motor unit number index (MUNIX) in the course of ALS in relation to the D50 ALS disease progression model. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.683] [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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32
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Heiling B, Ceanga M, Fedtke N, Stubendorff B, Grimm A, Rödiger A, Axer H, Witte O, Grosskreutz J. P49. Prognostic value of muscle ultrasound in the D50 progression model of amyotrophic lateral sclerosis. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.687] [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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33
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Grimm A, Winter N, Axer H, Koch M, Auffenberg E. P125. A look inside the nerve – morphology of nerve fascicles in healthy controls and patients with polyneuropathy. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.739] [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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34
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Grimm A, Axer H. [Not Available]. Fortschr Neurol Psychiatr 2018; 86:439-452. [PMID: 30029283 DOI: 10.1055/s-0044-101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Die Diagnose einer immunvermittelten Neuropathie ist eine der wichtigsten Differenzialdiagnosen bei Polyneuropathien. Chronisch inflammatorische Neuropathien haben oft eine schwere neurologische Beeinträchtigung zur Folge, weswegen eine frühzeitige Diagnose zur Einleitung einer antientzündlichen Therapie essenziell ist. Therapiekonzepte beinhalten je nach Pathologie Immunglobuline, Kortikosteroide oder Plasmaaustauschverfahren.
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35
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Grimm A, Axer H, Heiling B, Winter N. Nerve ultrasound normal values – Readjustment of the ultrasound pattern sum score UPSS. Clin Neurophysiol 2018; 129:1403-1409. [DOI: 10.1016/j.clinph.2018.03.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/06/2018] [Accepted: 03/18/2018] [Indexed: 12/28/2022]
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36
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Härtig F, Ross M, Dammeier NM, Fedtke N, Heiling B, Axer H, Décard BF, Auffenberg E, Koch M, Rattay TW, Krumbholz M, Bornemann A, Lerche H, Winter N, Grimm A. Nerve Ultrasound Predicts Treatment Response in Chronic Inflammatory Demyelinating Polyradiculoneuropathy-a Prospective Follow-Up. Neurotherapeutics 2018; 15:439-451. [PMID: 29435815 PMCID: PMC5935640 DOI: 10.1007/s13311-018-0609-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
As reliable biomarkers of disease activity are lacking, monitoring of therapeutic response in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) remains a challenge. We sought to determine whether nerve ultrasound and electrophysiology scoring could close this gap. In CIDP patients (fulfilling EFNS/PNS criteria), we performed high-resolution nerve ultrasound to determine ultrasound pattern sum scores (UPSS) and predominant echotexture nerve conduction study scores (NCSS) as well as Medical Research Council sum scores (MRCSS) and inflammatory neuropathy cause and treatment disability scores (INCAT) at baseline and after 12 months of standard treatment. We retrospectively correlated ultrasound morphology with nerve histology when available. 72/80 CIDP patients featured multifocal nerve enlargement, and 35/80 were therapy-naïve. At baseline, clinical scores correlated with NCSS (r2 = 0.397 and r2 = 0.443, p < 0.01), but not or hardly with UPSS (Medical Research Council sum scores MRCSS r2 = 0.013, p = 0.332; inflammatory neuropathy cause and treatment disability scores INCAT r2 = 0.053, p = 0.048). Longitudinal changes in clinical scores, however, correlated significantly with changes in both UPSS and NCSS (r2 = 0.272-0.414, p < 0.0001). Combining nerve/fascicle size with echointensity and histology at baseline, we noted 3 distinct classes: 1) hypoechoic enlargement, reflecting active inflammation and onion bulbs; 2) nerve enlargement with additional hyperechogenic fascicles/perifascicular tissue in > 50% of measured segments, possibly reflecting axonal degeneration; and 3) almost no enlargement, reflecting "burned-out" or "cured" disease without active inflammation. Clinical improvement after 12 months was best in patients with pattern 1 (up to 75% vs up to 43% in pattern 2/3, Fisher's exact test p < 0.05). Nerve ultrasound has additional value not only for diagnosis, but also for classification of disease state and may predict treatment response.
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Affiliation(s)
- Florian Härtig
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Marlene Ross
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
| | - Nele Maria Dammeier
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Nadin Fedtke
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Bianka Heiling
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, Basel, 4031, Switzerland
| | - Eva Auffenberg
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Marilin Koch
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Tim W Rattay
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Markus Krumbholz
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Antje Bornemann
- Institute of Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Holger Lerche
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Natalie Winter
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Alexander Grimm
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany.
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany.
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Abstract
Abstract:In stereotaxic neurosurgery, a variety of operative procedures focus on thalamic targets. The nomenclature of thalamic nuclei and sub-nuclei, however, has not yet been settled. In clinical and laboratory environments several terminologies coexist. This is an obstacle to both communication and a better understanding of recent electrophysiological findings. In the late 1980s, the application of new histochemical and immunohisto-chemical methods led to a deeper insight into existing correlations between the nomenclatures. As a uniform terminology of the thalamus is still lacking, we created a knowledge-based system (thalamus) which gives a comprehensible survey about the most important terminologies. The different nomenclatures are related to each other by organizing them in a component-integral relation. This part-whole relation contains both the knowledge on the subdivisions of the thalamus as well as the knowledge on the correlations between the various nomenclatures.
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Grimm A, Winter N, Rattay TW, Härtig F, Dammeier NM, Auffenberg E, Koch M, Axer H. A look inside the nerve - Morphology of nerve fascicles in healthy controls and patients with polyneuropathy. Clin Neurophysiol 2017; 128:2521-2526. [PMID: 28958781 DOI: 10.1016/j.clinph.2017.08.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/31/2017] [Accepted: 08/20/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Polyneuropathies are increasingly analyzed by ultrasound. Summarizing, diffuse enlargement is typical in Charcot-Marie Tooth type 1 (CMT1a), regional enlargement occurs in inflammatory neuropathies. However, a distinction of subtypes is still challenging. Therefore, this study focused on fascicle size and pattern in controls and distinct neuropathies. METHODS Cross-sectional area (CSA) of the median, ulnar and peroneal nerve (MN, UN, PN) was measured at predefined landmarks in 50 healthy controls, 15 CMT1a and 13 MMN patients. Additionally, largest fascicle size and number of visible fascicles was obtained at the mid-upper arm cross-section of the MN and UN and in the popliteal fossa cross-section of the PN. RESULTS Cut-off normal values for fascicle size in the MN, UN and PN were defined (<4.8mm2, <2.8mm2 and <3.5mm2). In CMT1a CSA and fascicle values are significantly enlarged in all nerves, while in MMN CSA and fascicles are regionally enlarged with predominance in the upper arm nerves. The ratio of enlarged fascicles and all fascicles was significantly increased in CMT1a (>50%) in all nerves (p<0.0001), representing diffuse fascicle enlargement, and moderately increased in MMN (>20%), representing differential fascicle enlargement (enlarged and normal fascicles at the same location) sparing the peroneal nerve (regional fascicle enlargement). Based on these findings distinct fascicle patterns were defined. CONCLUSION Normal values for fascicle size could be evaluated; while CMT1a features diffuse fascicle enlargement, MMN shows regional and differential predominance with enlarged fascicles as single pathology. SIGNIFICANCE Pattern analysis of fascicles might facilitate distinction of several otherwise similar neuropathies.
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Affiliation(s)
- Alexander Grimm
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Natalie Winter
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Tim W Rattay
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
| | - Florian Härtig
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Nele M Dammeier
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Eva Auffenberg
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Marilin Koch
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany.
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Rattay TW, Winter N, Décard BF, Dammeier NM, Härtig F, Ceanga M, Axer H, Grimm A. Nerve ultrasound as follow-up tool in treated multifocal motor neuropathy. Eur J Neurol 2017; 24:1125-1134. [PMID: 28681489 DOI: 10.1111/ene.13344] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution ultrasound is a valuable tool in supporting the diagnosis of multifocal motor neuropathy (MMN) but longitudinal data under therapy are lacking. METHODS The change in peripheral nerve ultrasound pattern in patients with MMN was assessed over time. Patients with MMN received a thorough initial examination and follow-up over a period of 6-12 months using high-resolution ultrasound of the cervical roots and the nerves of the arms and legs, nerve conduction studies, Medical Research Council Sum Score (MRCSS) and Rotterdam Inflammatory Neuropathy Cause and Treatment Group (INCAT) score to evaluate changes under treatment. The Ultrasound Pattern Sum Score (UPSS) was used as standardized peripheral nerve ultrasound protocol. RESULTS Seventeen patients with MMN received initial examinations of whom 12 were successfully followed up. All patients with MMN showed at least localized but often multifocal peripheral nerve enlargement. An enlarged overall cross-sectional area as well as enlarged single fascicles (>3 mm²) in clinically and electrophysiologically affected (>90%) and unaffected (>70%) nerves were found. The UPSS did not correlate with clinical disability at both visits. However, the change in clinical disability (evaluated as difference in MRCSS) and the change in UPSS correlated significantly inversely (P = 0.004). CONCLUSIONS High-resolution sonography of peripheral nerves revealed multifocal nerve enlargement in MMN. Distinct enlargement patterns may support the diagnosis. Ultrasound findings did not correlate well with clinical severity or electrophysiological findings at initial presentation. As changes in UPSS correlated significantly with the clinical course in terms of muscle strength (MRCSS), sonographic assessment may represent a useful tool for therapeutic monitoring.
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Affiliation(s)
- T W Rattay
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany.,Hertie Institute for Clinical Brain Research and German Center of Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - N Winter
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - B F Décard
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - N M Dammeier
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - F Härtig
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - M Ceanga
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - H Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - A Grimm
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
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Finn S, Dietzek M, Karvouniari P, Klingner CM, Neumann R, Guntinas-Lichius O, Witte OW, Axer H. Bilateral vestibulopathy with positive Tullio phenomenon. Laryngoscope 2017; 128:1223-1225. [DOI: 10.1002/lary.26690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Sigrid Finn
- Hans Berger Department of Neurology; Jena University Hospital; Jena Germany
- Center for Vertigo and Dizziness; Jena University Hospital; Jena Germany
| | - Maren Dietzek
- Hans Berger Department of Neurology; Jena University Hospital; Jena Germany
- Center for Vertigo and Dizziness; Jena University Hospital; Jena Germany
| | | | | | - Rotraud Neumann
- Department of Neuroradiology; Jena University Hospital; Jena Germany
| | - Orlando Guntinas-Lichius
- Center for Vertigo and Dizziness; Jena University Hospital; Jena Germany
- Department of Otolaryngology; Jena University Hospital; Jena Germany
| | - Otto W. Witte
- Hans Berger Department of Neurology; Jena University Hospital; Jena Germany
- Center for Vertigo and Dizziness; Jena University Hospital; Jena Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology; Jena University Hospital; Jena Germany
- Center for Vertigo and Dizziness; Jena University Hospital; Jena Germany
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Grimm A, Winter N, Wolking S, Vittore D, Biskup S, Axer H. Nerve enlargement in an unusual case of inflammatory neuropathy and new gene mutation-morphology is the key. Neurol Sci 2017; 38:1525-1527. [PMID: 28424919 DOI: 10.1007/s10072-017-2960-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/08/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Alexander Grimm
- Department of Neurology, Tübingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, D-72072, Tübingen, Germany.
| | - Natalie Winter
- Department of Neurology, Tübingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, D-72072, Tübingen, Germany
| | - Stefan Wolking
- Department of Neurology, Tübingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, D-72072, Tübingen, Germany
| | - Debora Vittore
- Department of Neurology, Tübingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, D-72072, Tübingen, Germany
| | - Saskia Biskup
- Center for Genomics and Transcriptions, Tuebingen, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
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Winter N, Rattay TW, Axer H, Schäffer E, Décard BF, Gugel I, Schuhmann M, Grimm A. Ultrasound assessment of peripheral nerve pathology in neurofibromatosis type 1 and 2. Clin Neurophysiol 2017; 128:702-706. [PMID: 28315612 DOI: 10.1016/j.clinph.2017.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The neurofibromatoses (NF) type 1 and 2 are hereditary tumor predisposition syndromes caused by germline mutations in the NF1 and NF2 tumor suppressor genes. In NF1 and 2, peripheral nerve tumors occur regularly. For further characterizing nerve ultrasound was performed in patients with NF1 and 2. METHODS Patients with established diagnosis of NF1 (n=27) and NF2 (n=10) were included. Ultrasound of peripheral nerves and cervical roots was performed during routine follow-up visits. Healthy volunteers were studied for comparison. RESULTS In patients with NF1, median cross-sectional area (CSA) of most nerves was significantly increased compared to controls and to NF2 due to generalized plexiform tumors, which arose out of multiple fascicles in 23 of 27 patients (85%). These were often accompanied by cutaneous or subcutaneous neurofibromas. In NF2, the overall aspect of peripheral nerves consisted of localized schwannomas (80%) and, apart from that, normal nerve segments. CONCLUSION Nerve ultrasound is able to visualize different nerve pathologies in NF1 and NF2. It is a precise and inexpensive screening method for peripheral nerve manifestation in neurofibromatosis and should be considered as the first choice screening imaging modality for all peripheral nerves within reach of non-invasive ultrasound techniques. SIGNIFICANCE Ultrasound patterns of peripheral nerve pathologies are described for the first time in a large cohort of patients with NF1 and NF2. It is a suitable screening tool and enables targeted MRI analysis.
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Affiliation(s)
- Natalie Winter
- Center of Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard-Karl University Tübingen, Tübingen, Germany
| | - Tim W Rattay
- Center of Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard-Karl University Tübingen, Tübingen, Germany; German Research Center for Neurodegenerative Diseases, (DZNE), Tübingen, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich-Schiller University Jena, Germany
| | - Eva Schäffer
- Department of Neurology, Kiel University Hospital, Albrecht-University Kiel, Germany
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, University Basel, Switzerland
| | - Isabel Gugel
- Department of Neurosurgery, Tübingen University Hospital, Eberhard-Karl University Tübingen, Germany; Center of Neurofibromatosis, Center of Rare Diseases Tübingen, Tübingen University Hospital, Eberhard-Karl University Tübingen, Germany
| | - Martin Schuhmann
- Department of Neurosurgery, Tübingen University Hospital, Eberhard-Karl University Tübingen, Germany; Center of Neurofibromatosis, Center of Rare Diseases Tübingen, Tübingen University Hospital, Eberhard-Karl University Tübingen, Germany
| | - Alexander Grimm
- Center of Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard-Karl University Tübingen, Tübingen, Germany.
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Grimm A, Schubert V, Axer H, Ziemann U. Giant nerves in chronic inflammatory polyradiculoneuropathy. Muscle Nerve 2016; 55:285-289. [PMID: 27463360 DOI: 10.1002/mus.25272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Nerve enlargement (NE) is described in inflammatory and inherited neuropathies. It is commonly multifocal and moderate in the former and homogeneous and generalized in the latter. We describe 4 cases of massive NE in inflammatory neuropathies. METHODS Patients presented with symptoms of polyneuropathy that progressed over months to years. Nerve conduction studies (NCS), laboratory analysis, nerve MRI, and nerve ultrasound were performed. RESULTS NCS revealed demyelinating neuropathy in all with multifocal conduction blocks or increased terminal latency indices. MRI/ultrasound revealed extensive NE in the roots and nerves. Detailed diagnostics including biopsies, positron emission tomography-computed tomography, and genetic testing revealed no other pathology. Chronic inflammatory demyelinating polyneuropathy variants were diagnosed in all, and immunotherapies were successfully initiated. CONCLUSIONS MRI and ultrasound contributed to diagnosis and therapy. All patients had giant NE in common, which strongly suggested inherited neuropathy. However, the final diagnosis was inflammatory neuropathy. Impressive NE can occur in immune-mediated neuropathies and should be carefully differentiated from inherited neuropathies. Muscle Nerve 55: 285-289, 2017.
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Affiliation(s)
- Alexander Grimm
- Center of Neurology, Tübingen University Hospital, and Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Hoppe-Seyler Str. 3, D-72076, Tübingen, Germany
| | - Victoria Schubert
- Center of Neurology, Tübingen University Hospital, and Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Hoppe-Seyler Str. 3, D-72076, Tübingen, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Ulf Ziemann
- Center of Neurology, Tübingen University Hospital, and Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Hoppe-Seyler Str. 3, D-72076, Tübingen, Germany
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Grimm A, Rattay TW, Winter N, Axer H. Peripheral nerve ultrasound scoring systems: benchmarking and comparative analysis. J Neurol 2016; 264:243-253. [PMID: 27878436 DOI: 10.1007/s00415-016-8305-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/07/2016] [Indexed: 02/06/2023]
Abstract
Ultrasound of the nerves is an additive diagnostic tool to evaluate polyneuropathy. Recently, the need for standardized scoring systems has widely been discussed; different scores are described so far. Therefore, 327 patients with polyneuropathy were analyzed by ultrasound in our laboratory. Consequently, several ultrasound scoring tools were applied, i.e., the nerve pattern classification according to Padua et al. in all patients with CIDP and variants, the Bochum ultrasound score (BUS) and the neuritis ultrasound protocol in immune-mediated neuritis, the ultrasound pattern sum score, the homogeneity score, and the nerve enlargement distribution score in all neuropathies if possible. For all scores good accuracy was found. Most patients with CIDP revealed hypoechoic enlarged nerves (Class 1), the BUS/NUP was useful to identify GBS (sensitivity >85%), MMN (100%) and CIDP (>70%), while the UPSS showed high sensitivity and positive/negative predictive values (N/PPV) in the diagnosis of GBS (>70%), CIDP (>85%) and axonal non-inflammatory neuropathies (>90%). Homogeneous nerves were found in most CMT1 patients (66.7%), while immune-mediated neuropathies mostly show regional nerve enlargement. The HS was suitable to identify CMT patients with an HS ≥5 points. All scores were easily applicable with high accuracy. The former-reported results could be similarly confirmed. However, all sores have some incompleteness concerning unselected polyneuropathy population, particularly rare and focal types. Scoring systems are useful and easily applicable. They show high accuracy in certain neuropathies, but also offer some gaps and can, therefore, only be used in addition to standard diagnostic routines such as electrophysiology.
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Affiliation(s)
- Alexander Grimm
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research Eberhard-Karls University Tübingen, Tübingen, Germany.
| | - Tim W Rattay
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research Eberhard-Karls University Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Natalie Winter
- Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital Friedrich-Schiller University Jena, Jena, Germany
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Abram K, Bohne S, Bublak P, Karvouniari P, Klingner CM, Witte OW, Guntinas-Lichius O, Axer H. The Effect of Spinal Tap Test on Different Sensory Modalities of Postural Stability in Idiopathic Normal Pressure Hydrocephalus. Dement Geriatr Cogn Dis Extra 2016; 6:447-457. [PMID: 27790243 PMCID: PMC5075737 DOI: 10.1159/000450602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Postural instability in patients with normal pressure hydrocephalus (NPH) is a most crucial symptom leading to falls with secondary complications. The aim of the current study was to evaluate the therapeutic effect of spinal tap on postural stability in these patients. METHODS Seventeen patients with clinical symptoms of NPH were examined using gait scale, computerized dynamic posturography (CDP), and neuropsychological assessment. Examinations were done before and after spinal tap test. RESULTS The gait score showed a significant improvement 24 h after spinal tap test in all subtests and in the sum score (p < 0.003), while neuropsychological assessment did not reveal significant differences 72 h after spinal tap test. CDP showed significant improvements after spinal tap test in the Sensory Organization Tests 2 (p = 0.017), 4 (p = 0.001), and 5 (p = 0.009) and the composite score (p = 0.01). Patients showed best performance in somatosensory and worst performance in vestibular dominated tests. Vestibular dominated tests did not improve significantly after spinal tap test, while somatosensory and visual dominated tests did. CONCLUSION Postural stability in NPH is predominantly affected by deficient vestibular functions, which did not improve after spinal tap test. Conditions which improved best were mainly independent from visual control and are based on proprioceptive functions.
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Affiliation(s)
- Katrin Abram
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Silvia Bohne
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Peter Bublak
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Panagiota Karvouniari
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Carsten M Klingner
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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Klingner CM, Axer H, Brodoehl S, Witte OW. Vertigo and the processing of vestibular information: A review in the context of predictive coding. Neurosci Biobehav Rev 2016; 71:379-387. [PMID: 27639447 DOI: 10.1016/j.neubiorev.2016.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 12/01/2022]
Abstract
This article investigates the processing of vestibular information by interpreting current experimental knowledge in the framework of predictive coding. We demonstrate that this theoretical framework give us insights into several important questions regarding specific properties of the vestibular system. Particularly, we discuss why the vestibular network is more spatially distributed than other sensory networks, why a mismatch in the vestibular system is more clinically disturbing than in other sensory systems, why the vestibular system is only marginally affected by most cerebral lesions, and whether there is a primary vestibular cortex. The use of predictive coding as a theoretical framework further points to some problems with the current interpretation of results that are gained from vestibular stimulation studies. In particular, we argue that cortical responses of vestibular stimuli cannot be interpreted in the same way as responses of other sensory modalities. Finally, we discuss the implications of the new insights, hypotheses and problems that were identified in this review on further directions of research of vestibular information processing.
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Affiliation(s)
- Carsten M Klingner
- Hans Berger Department of Neurology, Jena University Hospital - Friedrich Schiller University Jena, Germany; Biomagnetic Center, Jena University Hospital - Friedrich Schiller University Jena, Germany.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital - Friedrich Schiller University Jena, Germany
| | - Stefan Brodoehl
- Hans Berger Department of Neurology, Jena University Hospital - Friedrich Schiller University Jena, Germany; Biomagnetic Center, Jena University Hospital - Friedrich Schiller University Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital - Friedrich Schiller University Jena, Germany
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Grimm A, Decard B, Rasenack M, Axer H. EP 39. The modified ultrasound pattern sum score mUPSS as additional diagnostic tool for genetically distinct hereditary neuropathies. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heiling B, Hammer N, Stubendorff B, Grimm A, Ringer T, Prell T, Gunkel A, Schenk A, Axer H, Witte O, Grosskreutz J. EP 15. Muscle ultrasound imaging increases diagnostic sensitivity and aids prognosis in amyotrophic lateral sclerosis. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.069] [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: 11/24/2022]
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Grimm A, Schubert V, Vittore D, Decard B, Axer H. EPV 21. Ultrasonic homogeneity score and focal nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.053] [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: 11/28/2022]
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Grimm A, Vittore D, Schubert V, Lipski C, Heiling B, Décard BF, Axer H. Ultrasound pattern sum score, homogeneity score and regional nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies. Clin Neurophysiol 2016; 127:2618-24. [PMID: 27291881 DOI: 10.1016/j.clinph.2016.04.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/22/2016] [Accepted: 04/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the use of nerve ultrasound in the differentiation between Charcot-Marie Tooth hereditary neuropathy (CMT1) and chronic inflammatory demyelinating polyradiculoneuropathies (CIDP), multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensory and motor neuropathies (MADSAM). METHODS Ultrasound/electrophysiology of predefined nerves was performed in CMT1a/b, immunoneuropathies, and healthy controls. Ultrasound pattern sum score (UPSS, sum of the amount of 12 predefined measurement points), homogeneity score (HS) and regional nerve enlargement index (RNEI) in ulnar, median, and tibial nerve were used for evaluation of morphology. RESULTS 13 CMT1, 27 CIDP, 10 MADSAM, 12 MMN, and 23 controls were included. Significant enlargement was shown in all neuropathies compared to the controls, (p<0.001), however the amount of enlargement as evaluated by the UPSS was most prominent in CMT compared to the others (median UPSS 18 vs. 11/8.5/5 in CIDP/MADSAM/MMN, p<0.001). Homogeneous enlargement was significantly more often seen in CMT (67%, HS 6 vs. 2-3 in immune-mediated PNP, p<0.001), while in CIDP the enlargement was regional, homogeneous or inhomogeneous with equal contribution. In MMN and MADSAM regional enlargement (48%/40%) next to normal segments (∼20%) predominated (RNEI in MMN=2, in MADSAM=1 vs. 0 in the others). CSAs were inversely correlated with motor conduction velocity. CONCLUSION Ultrasound, quantified by UPSS, HS, and RNEI facilitates a reliable and reproducible differentiation of immunoneuropathies and hereditary neuropathies by the use of boundary values. SIGNIFICANCE By the use of quantitative scores, ultrasound differentiation of demyelinating neuropathies is operationalized and ameliorated compared to CSA measurements only.
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Affiliation(s)
- Alexander Grimm
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany.
| | - Debora Vittore
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Victoria Schubert
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Christina Lipski
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Bianka Heiling
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
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