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Brouwers K, Kruit AS, van Midden D, Zegers HJH, Doorduin J, Koers E, Hummelink S, Ulrich DJO. 24 Hours Ex-vivo Hypothermic Acellular Perfusion of Porcine Forelimb: A 7-day Follow-up Study. Plast Reconstr Surg 2024:00006534-990000000-02312. [PMID: 38616323 DOI: 10.1097/prs.0000000000011469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND One of the limiting factors for vascularized composite allograft (VCA) storage is the short viable ischemic time (4-6 hours). Hypothermic machine perfusion (MP) enables near-physiological preservation, avoiding the deleterious effects of hypoxia and static cooling. This study aims to compare muscle injury after 24-hour acellular perfusion with static cold storage (SCS) in a porcine limb replantation model, examining outcomes for up to 7 days after reperfusion. METHODS Sixteen procured porcine forelimbs were perfused hypothermic for 24 hours with Histidine-Tryptophan-Ketoglutarate (HTK, n=8) or preserved on ice for 4 hours (SCS, n=8) before orthotopic replantation. Muscle injury was assessed using biochemical markers and muscle biopsies were analyzed using the Histologic Injury Severity Score (HISS). RESULTS During preservation, limb weight decreased by 2% in the SCS group and increased by 44% in the perfusion group (p<0.001). Twelve limbs (HTK, n=6; SCS, n=6) survived for 7 days. Three days after replantation, increased creatinine kinase levels were observed in the perfusion group (33781 mmol/liter versus 2163 mmol/liter; p<0.001). Mean endpoint HISS was 3.8 (SD 0.7) in the perfusion group and 1.8 (SD 0.7) in the SCS group (p=0.008), mostly due to increased edema (p=0.004). CONCLUSION 24 hours of hypothermic MP and 4 hours of SCS of VCA demonstrated both minimal degenerated muscle tissue seven days after replantation.
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Affiliation(s)
- Kaj Brouwers
- Department of Plastic and Reconstructive Surgery, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Anne Sophie Kruit
- Department of Plastic and Reconstructive Surgery, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Dominique van Midden
- Department of Pathology, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Her J H Zegers
- Department of Cardiothoracic Surgery, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Erik Koers
- Department of Cardiothoracic Surgery, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud university Medical Center, Nijmegen, the Netherlands
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2
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de Winter JM, Molenaar JP, Yuen M, van der Pijl R, Shen S, Conijn S, van de Locht M, Willigenburg M, Bogaards SJ, van Kleef ES, Lassche S, Persson M, Rassier DE, Sztal TE, Ruparelia AA, Oorschot V, Ramm G, Hall TE, Xiong Z, Johnson CN, Li F, Kiss B, Lozano-Vidal N, Boon RA, Marabita M, Nogara L, Blaauw B, Rodenburg RJ, Küsters B, Doorduin J, Beggs AH, Granzier H, Campbell K, Ma W, Irving T, Malfatti E, Romero NB, Bryson-Richardson RJ, van Engelen BG, Voermans NC, Ottenheijm CA. KBTBD13 is an actin-binding protein that modulates muscle kinetics. J Clin Invest 2024; 134:e179111. [PMID: 38299595 PMCID: PMC10836800 DOI: 10.1172/jci179111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
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Wijntjes J, Gerritsen J, Doorduin J, van Alfen N. Comparison of muscle ultrasound and needle electromyography findings in neuromuscular disorders. Muscle Nerve 2024; 69:148-156. [PMID: 37877239 DOI: 10.1002/mus.27989] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION/AIMS Needle electromyography (EMG) and muscle ultrasound can be used to evaluate patients with suspected neuromuscular disorders. The relation between muscle ultrasound pathology and the corresponding needle EMG findings is unknown. In this study we compared the results of concurrent ultrasound and needle EMG examinations in patients suspected of a neuromuscular disorder. METHODS Retrospective data from 218 patients with pairwise ultrasound and EMG results of 796 muscles were analyzed. We compared overall quantitative and visual muscle ultrasound results to EMGs with neurogenic and myopathic abnormalities and assessed the congruency of both methods in the different clinical diagnosis categories. RESULTS In muscles of patients with a neuromuscular disorder, abnormalities were found with EMG in 71.8%, and quantitative and visual muscle ultrasound results were abnormal in 19.3% and 35.4% respectively. In muscles with neurogenic EMG abnormalities, quantitative and visual muscle ultrasound results were abnormal in 18.9% versus 35.6%, increasing up to 43.7% versus 87.5% in muscles with the most pronounced signs of denervation. Congruency of EMG and ultrasound was better for more proximal and cranial muscles than for muscles in the hand and lower limb. DISCUSSION Needle EMG and muscle ultrasound typically produce disparate results and identify different aspects of muscle pathology. Muscle ultrasound seems less suited for detecting mild neurogenic abnormalities. As the severity of neurogenic needle EMG abnormalities increased, muscle ultrasound abnormalities were also increasingly found. Visual analysis seems better suited than grayscale quantification for detecting neurogenic abnormalities.
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Affiliation(s)
- Juerd Wijntjes
- Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jimmy Gerritsen
- Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Jonkman AH, Warnaar RSP, Baccinelli W, Carbon NM, D'Cruz RF, Doorduin J, van Doorn JLM, Elshof J, Estrada-Petrocelli L, Graßhoff J, Heunks LMA, Koopman AA, Langer D, Moore CM, Nunez Silveira JM, Petersen E, Poddighe D, Ramsay M, Rodrigues A, Roesthuis LH, Rossel A, Torres A, Duiverman ML, Oppersma E. Analysis and applications of respiratory surface EMG: report of a round table meeting. Crit Care 2024; 28:2. [PMID: 38166968 PMCID: PMC10759550 DOI: 10.1186/s13054-023-04779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.
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Affiliation(s)
- A H Jonkman
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R S P Warnaar
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - W Baccinelli
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - N M Carbon
- Department of Anesthesiology, Friedrich Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Erlangen, Germany
| | - R F D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Elshof
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L Estrada-Petrocelli
- Facultad de Ingeniería and Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) - Sistema Nacional de Investigación (SNI), Universidad Latina de Panamá (ULATINA), Panama, Panama
| | - J Graßhoff
- Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
| | - L M A Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A A Koopman
- Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - D Langer
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - C M Moore
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - J M Nunez Silveira
- Hospital Italiano de Buenos Aires, Unidad de Terapia Intensiva, Ciudad de Buenos Aires, Argentina
| | - E Petersen
- Technical University of Denmark (DTU), DTU Compute, 2800, Kgs. Lyngby, Denmark
| | - D Poddighe
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - M Ramsay
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Rodrigues
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - L H Roesthuis
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rossel
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - A Torres
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona Institute of Science and Technology (BIST) and Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
| | - M L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands.
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Bouman K, van Doorn JLM, Groothuis JT, Wijkstra PJ, van Engelen BGM, Erasmus CE, Doorduin J, Voermans NC. Respiratory function in LAMA2-related muscular dystrophy and SELENON-related congenital myopathy, a 1.5-year natural history study. Eur J Paediatr Neurol 2024; 48:30-39. [PMID: 38008001 DOI: 10.1016/j.ejpn.2023.11.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION LAMA2-related muscular dystrophy (LAMA2-MD) and SELENON(SEPN1)-related congenital myopathy (SELENON-RM) are rare neuromuscular diseases with respiratory impairment from a young age. Prospective natural history studies are needed for prevalence estimations, respiratory characterization, optimizing clinical care and selecting outcome measures for trial readiness. METHODS Our prospective 1.5-year natural history study included spirometry (forced vital capacity (FVC); difference between upright and supine vital capacity (dVC)), respiratory muscle strength tests (sniff nasal inspiratory pressure (SNIP)) (age≥5 years), and diaphragm ultrasound (thickness; thickening; echogenicity; all ages). RESULTS Twenty-six LAMA2-MD patients (M = 8, median 21 [9; 31] years) and 11 SELENON-RM patients (M = 8, 20 [10; 33] years) were included. At baseline, 17 (85 %) LAMA2-MD (FVC%: 59 % [33; 68]) and all SELENON-RM patients (FVC%: 34 % [31; 46]) had an impaired respiratory function (FVC%<80 %). Nine (35 %) LAMA2-MD and eight (73 %) SELENON-RM patients received mechanical ventilation at baseline, and two additional SELENON-RM patients started during follow-up. Contrarily to LAMA2-MD, SELENON-RM patients had severe diaphragm atrophy (diaphragm thickness z-score: 2.5 [-3.1; -2.1]) and dysfunction (diaphragm thickness ratio: 1.2 [1.0; 1.7]; dVC: 30 % [7.7; 41]). SNIP was low in both neuromuscular diseases and correlated with motor function. In SELENON-RM, respiratory function decreased during follow-up. CONCLUSION The majority of LAMA2-MD and all SELENON-RM patients had respiratory impairment. SELENON-RM patients showed lower respiratory function which was progressive, more prevalent mechanical ventilation, and more severe diaphragm atrophy and dysfunction than LAMA2-MD patients. Spirometry (FVC%, dVC) and respiratory muscle strength tests (SNIP) are useful in clinical care and as outcome measure in clinical trials. CLINICAL TRIAL NUMBER NCT04478981.
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Affiliation(s)
- Karlijn Bouman
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands.
| | - Jeroen L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen, Groningen, the Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
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6
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Bouman K, Groothuis JT, Doorduin J, van Alfen N, Udink Ten Cate FEA, van den Heuvel FMA, Nijveldt R, Kamsteeg EJ, Dittrich ATM, Draaisma JMT, Janssen MCH, van Engelen BGM, Erasmus CE, Voermans NC. LAMA2-Related Muscular Dystrophy Across the Life Span: A Cross-sectional Study. Neurol Genet 2023; 9:e200089. [PMID: 37476021 PMCID: PMC10356133 DOI: 10.1212/nxg.0000000000200089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/12/2023] [Accepted: 05/31/2023] [Indexed: 07/22/2023]
Abstract
Background and Objectives LAMA2-related muscular dystrophy (LAMA2-MD) is a rare neuromuscular disease characterized by proximal and axial muscle weakness, rigidity of the spine, scoliosis, and respiratory impairment. No curative treatment options exist, yet promising preclinical studies are ongoing. Currently, there is a paucity on natural history data, and appropriate clinical and functional outcome measures are needed. We aim for deep clinical phenotyping, establishment of a well-characterized baseline cohort for prospective follow-up and recruitment for future clinical trials, improvement of clinical care, and selection of outcome measures for reaching trial readiness. Methods We performed a cross-sectional, single-center, observational study. This study included neurologic examination and functional measurements among others the Motor Function Measure 20/32 (MFM-20/32) as primary outcome measure, accelerometry, questionnaires, muscle ultrasound, respiratory function tests, electrocardiography and echocardiography, and dual-energy X-ray absorptiometry. Results Twenty-seven patients with genetically confirmed LAMA2-MD were included (21 ± 13 years; M = 9; ambulant = 7). Axial and proximal muscle weakness was most pronounced. The mean MFM-20/32 score was 42.0% ± 29.4%, with domain 1 (standing and transfers) being severely affected and domain 3 (distal muscle function) relatively spared. Physical activity as measured through accelerometry showed very strong correlations to MFM-20/32 (Pearson correlation, -0.928, p < 0.01). Muscle ultrasound showed symmetrically increased echogenicity, with the sternocleidomastoid muscle most affected. Respiratory function was impaired in 85% of patients without prominent diaphragm dysfunction and was independent of age. Ten patients (37%) needed (non)invasive ventilatory support. Cardiac assessment revealed QRS fragmentation in 62%, abnormal left ventricular global longitudinal strain in 25%, and decreased left ventricular ejection fraction in 14% of patients. Decreased bone quality leading to fragility fractures was seen in most of the patients. Discussion LAMA2-MD has a widely variable phenotype. Based on the results of this cross-sectional study and current standards of care for congenital muscular dystrophies, we advise routine cardiorespiratory follow-up and optimization of bone quality. We propose MFM-20/32, accelerometry, and muscle ultrasound for assessing disease severity and progression. For definitive clinical recommendations and outcome measures, natural history data are needed. Clinical Trials Registration This study was registered at clinicaltrials.gov (NCT04478981, 21 July 2020). The first patient was enrolled in September 2020.
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Affiliation(s)
- Karlijn Bouman
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris E A Udink Ten Cate
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederik M A van den Heuvel
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin Nijveldt
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne T M Dittrich
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mirian C H Janssen
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Bouma S, Cobben N, Bouman K, Gaytant M, van de Biggelaar R, van Doorn J, Reumers SFI, Voet NB, Doorduin J, Erasmus CE, Kamsteeg EJ, Jungbluth H, Wijkstra P, Voermans NC. Respiratory features of centronuclear myopathy in the Netherlands. Neuromuscul Disord 2023; 33:580-588. [PMID: 37364426 DOI: 10.1016/j.nmd.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
Centronuclear myopathy (CNM) is a heterogeneous group of muscle disorders primarily characterized by muscle weakness and variable degrees of respiratory dysfunction caused by mutations in MTM1, DNM2, RYR1, TTN and BIN1. X-linked myotubular myopathy has been the focus of recent natural history studies and clinical trials. Data on respiratory function for other genotypes is limited. To better understand the respiratory properties of the CNM spectrum, we performed a retrospective study in a non-selective Dutch CNM cohort. Respiratory dysfunction was defined as an FVC below 70% of predicted and/or a daytime pCO2 higher than 6 kPa. We collected results of other pulmonary function values (FEV1/FVC ratio) and treatment data from the home mechanical ventilation centres. Sixty-one CNM patients were included. Symptoms of respiratory weakness were reported by 15/47 (32%) patients. Thirty-three individuals (54%) with different genotypes except autosomal dominant (AD)-BIN1-related CNM showed respiratory dysfunction. Spirometry showed decreased FVC, FEV1 & PEF values in all but two patients. Sixteen patients were using HMV (26%), thirteen of them only during night-time. In conclusion, this study provides insight into the prevalence of respiratory symptoms in four genetic forms of CNM in the Netherlands and offers the basis for future natural history studies.
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Affiliation(s)
- Sietse Bouma
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicolle Cobben
- Department of Pulmonary Diseases & Home Mechanical Ventilation, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Karlijn Bouman
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michael Gaytant
- Center for Home Mechanical Ventilation, Department of Pulmonology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ries van de Biggelaar
- Department of Pulmonary Diseases & Home Mechanical Ventilation, Erasmus MC, Rotterdam, the Netherlands
| | - Jeroen van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stacha F I Reumers
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicoline Bm Voet
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Rehabilitation Center Klimmendaal, Arnhem, the Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center - Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, FoLSM, King's College, London, UK
| | - Peter Wijkstra
- Department of Pulmonary Diseases & Home Mechanical Ventilation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
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8
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Kramer JJ, Boon HTM, Leijten QH, Ter Laak H, Eshuis L, Kusters B, van Doorn JLM, Kamsteeg EJ, Eymard B, Doorduin J, Voermans NC. Dystrophic Myopathy of the Diaphragm with Recurrent Severe Respiratory Failure is Congenital Myasthenic Syndrome 11. J Neuromuscul Dis 2023; 10:271-277. [PMID: 36591657 PMCID: PMC10041432 DOI: 10.3233/jnd-221542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We here present the case of a patient with a congenital myasthenic syndrome (CMS) due to pathogenic variants in the RAPSN gene. During childhood he experienced recurrent episodes of respiratory failure during respiratory infections. This and other cases were reported as isolated dystrophy of the diaphragmatic musculature. In adulthood, whole exome sequencing revealed two heterozygous pathogenic variants in the RAPSN gene. This led to the revision of the diagnosis to rapsyn CMS11 (OMIM:616326, MONDO:0014588). EMG, muscle ultrasound and the revision of muscle biopsies taken in childhood support this diagnosis. After the revision of the diagnosis, treatment with pyridostigmine was started. This resulted in a reduction of fatigability and an improvement in functional abilities and quality of life.
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Affiliation(s)
- J J Kramer
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H T M Boon
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Henk Ter Laak
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L Eshuis
- Department of Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Kusters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Eymard
- Institute de Myologie, Paris, France
| | - J Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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9
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Bouman K, Groothuis JT, Doorduin J, van Alfen N, Udink ten Cate FE, van den Heuvel FM, Nijveldt R, Kamsteeg EJ, Dittrich AT, Draaisma JM, Janssen MC, van Engelen BG, Erasmus CE, Voermans NC. SELENON-Related Myopathy Across the Life Span, a Cross-Sectional Study for Preparing Trial Readiness. J Neuromuscul Dis 2023; 10:1055-1074. [PMID: 37807786 PMCID: PMC10657684 DOI: 10.3233/jnd-221673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 09/11/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND SELENON(SEPN1)-related myopathy (SELENON-RM) is a rare congenital neuromuscular disease characterized by proximal and axial muscle weakness, spinal rigidity, scoliosis and respiratory impairment. No curative treatment options exist, but promising preclinical studies are ongoing. Currently, natural history data are lacking, while selection of appropriate clinical and functional outcome measures is needed to reach trial readiness. OBJECTIVE We aim to identify all Dutch and Dutch-speaking Belgian SELENON-RM patients, deep clinical phenotyping, trial readiness and optimization of clinical care. METHODS This cross-sectional, single-center, observational study comprised neurological examination, functional measurements including Motor Function Measurement 20/32 (MFM-20/32) and accelerometry, questionnaires, muscle ultrasound, respiratory function tests, electro- and echocardiography, and dual-energy X-ray absorptiometry. RESULTS Eleven patients with genetically confirmed SELENON-RM were included (20±13 (3-42) years, 73% male). Axial and proximal muscle weakness were most pronounced. The mean MFM-20/32 score was 71.2±15.1%, with domain 1 (standing and transfers) being most severely affected. Accelerometry showed a strong correlation with MFM-20/32. Questionnaires revealed impaired quality of life, pain and problematic fatigue. Muscle ultrasound showed symmetrically increased echogenicity in all muscles. Respiratory function, and particularly diaphragm function, was impaired in all patients, irrespective of the age. Cardiac assessment showed normal left ventricular systolic function in all patients but abnormal left ventricular global longitudinal strain in 43% of patients and QRS fragmentation in 80%. Further, 80% of patients showed decreased bone mineral density on dual-energy X-ray absorptiometry scan and 55% of patients retrospectively experienced fragility long bone fractures. CONCLUSIONS We recommend cardiorespiratory follow-up as a part of routine clinical care in all patients. Furthermore, we advise vitamin D supplementation and optimization of calcium intake to improve bone quality. We recommend management interventions to reduce pain and fatigue. For future clinical trials, we propose MFM-20/32, accelerometry and muscle ultrasound to capture disease severity and possibly disease progression.
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Affiliation(s)
- Karlijn Bouman
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Floris E.A. Udink ten Cate
- Department of Pediatric cardiology, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Anne T.M. Dittrich
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Jos M.T. Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Mirian C.H. Janssen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Corrie E. Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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10
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van Kleef ES, Langer D, van Engelen BG, Ottenheijm CA, Voermans NC, Doorduin J. Inspiratory Muscle Training in Nemaline Myopathy. J Neuromuscul Dis 2023; 10:825-834. [PMID: 37458044 PMCID: PMC10578271 DOI: 10.3233/jnd-221665] [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] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Respiratory muscle weakness is a common feature in nemaline myopathy. Inspiratory muscle training (IMT) is an intervention that aims to improve inspiratory muscle strength. OBJECTIVE The aim of this controlled before-and-after pilot study was to investigate if IMT improves respiratory muscle strength in patients with nemaline myopathy. METHODS Nine patients (7 females; 2 males, age 36.6±20.5 years) with respiratory muscle weakness and different clinical phenotypes and genotypes were included. Patients performed eight weeks of sham IMT followed by eight weeks of active threshold IMT. The patients trained twice a day five days a week for 15 minutes at home. The intensity was constant during the training after a gradual increase to 30% of maximal inspiratory pressure (MIP). RESULTS Active IMT significantly improved MIP from 43±15.9 to 47±16.6 cmH2O (p = 0.019). The effect size was 1.22. There was no significant effect of sham IMT. Sniff nasal inspiratory pressure, maximal expiratory pressure, spirometry, and diaphragm thickness and thickening showed no significant improvements. CONCLUSIONS This pilot study shows that threshold IMT is feasible in patients with nemaline myopathy and improves inspiratory muscle strength. Our findings provide valuable preliminary data for the design of a larger, more comprehensive trial.
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Affiliation(s)
- Esmee S.B. van Kleef
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Cardiovascular and Respiratory Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
- Respiratory Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coen A.C. Ottenheijm
- Department of Physiology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Molenaar JP, van Zandvoort E, van Engelen BG, Voermans NC, Doorduin J. Reproducibility and robustness of motor cortical stimulation to assess muscle relaxation kinetics. Physiol Rep 2022; 10:e15491. [PMID: 36267028 PMCID: PMC9585355 DOI: 10.14814/phy2.15491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) of the motor cortex can be used during a voluntary contraction to inhibit corticospinal drive to the muscle and consequently induce involuntary muscle relaxation. Our aim was to evaluate the reproducibility and the effect of varying experimental conditions (robustness) of TMS‐induced muscle relaxation. Relaxation of deep finger flexors was assessed in 10 healthy subjects (5 M, 5 F) using handgrip dynamometry with normalized peak relaxation rate as main outcome measure, that is, peak relaxation rate divided by (voluntary plus TMS‐evoked)force prior to relaxation. Both interday and interrater reliability of relaxation rate were high with intraclass correlation coefficient of 0.88 and 0.92 and coefficient of variation of 3.8 and 3.7%, respectively. Target forces of 37.5% of maximal voluntary force or higher resulted in similar relaxation rate. From 50% of maximal stimulator output and higher relaxation rate remained the same. Only the most lateral position (>2 cm from the vertex) rendered lower relaxation rate (mean ± SD: 11.1 ± 3.0 s−1, 95% CI: 9.0–13.3 s−1) compared to stimulation at the vertex (12.8 ± 1.89 s−1, 95% CI: 11.6–14.1 s−1). Within the range of baseline skin temperatures, an average change of 0.5 ± 0.2 s−1 in normalized peak relaxation rate was measured per 1°C change in skin temperature. In conclusion, interday and interrater reproducibility and reliability of TMS‐induced muscle relaxation of the finger flexors were high. Furthermore, this technique is robust with limited effect of target force, stimulation intensity, and coil position. Muscle relaxation is strongly affected by skin temperature; however, this effect is marginal within the normal skin temperature range. We deem this technique well suited for clinical and scientific assessment of muscle relaxation.
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Affiliation(s)
- Joery P. Molenaar
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands,Department of NeurologyRijnstateArnhemThe Netherlands
| | - Elianne van Zandvoort
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Baziel G. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
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12
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Stoffels AAF, van Voorthuizen EL, van Hees HWH, Peters JB, van Helvoort HAC, Voermans NC, Doorduin J, van den Borst B. Longitudinal Analysis of Quadriceps Muscle Strength in Patients with Previous COVID-19 Hospitalization and in Patients with Post-Acute Sequelae following Mild COVID-19. Nutrients 2022; 14:nu14204319. [PMID: 36297002 PMCID: PMC9608500 DOI: 10.3390/nu14204319] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Muscle weakness is a prominent symptom in post-acute sequelae of COVID-19 (PASC). However, few studies have objectively and longitudinally assessed muscle strength after varying COVID-19 severity grades. This observational study aimed to explore the prevalence, determinants, and 1.5 years change of quadriceps muscle weakness in 98 patients discharged from COVID-19 hospitalization and in 50 patients with PASC following mild COVID-19. Isometric quadriceps maximal voluntary contraction (MVC) was assessed on a computerized dynamometer at three visits. Also, in a subgroup of 14 post-COVID-19 patients with quadriceps muscle weakness, muscle thickness and echo intensity were determined by muscle ultrasound of nine upper and lower extremity muscles. Muscle weakness was found in 59% of post-hospitalized patients and in 65% of those with PASC following mild COVID-19 at ~14 weeks after acute COVID-19. Whereas during ~1.5 years follow-up MVC modestly improved, muscle weakness prevalence remained unchanged. Hospital length of stay and diabetes mellitus were identified as possible predictors of muscle weakness following COVID-19 hospitalization. No predictors could be identified in those with PASC following mild COVID-19. Ultrasound outcomes revealed no large structural abnormalities. In conclusion, clinically relevant muscle weakness is common after COVID-19 and its long-term improvement is poor. Future studies with relevant control groups are warranted to confirm our data.
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Affiliation(s)
- Anouk A. F. Stoffels
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Correspondence:
| | - Esther L. van Voorthuizen
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hieronymus W. H. van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Jeannette B. Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | | | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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13
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Kroon RHMJM, Kalf JG, Meijers RL, de Swart BJM, Cameron IGM, Doorduin J, van Alfen N, van Engelen BGM, Horlings CGC. Muscle ultrasound is a sensitive biomarker in oculopharyngeal muscular dystrophy. Muscle Nerve 2022; 66:453-461. [PMID: 35859342 DOI: 10.1002/mus.27679] [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: 04/18/2021] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION/AIMS Oculopharyngeal muscular dystrophy (OPMD) is a late-onset, progressive muscle disease. Quantitative muscle ultrasound (QMUS) assesses structural changes in muscles and is a sensitive biomarker in neuromuscular disorders. Our aim of this study was to determine whether QMUS can detect muscle pathology and can be used as longitudinal imaging biomarker in OPMD. METHODS Genetically confirmed OPMD patients, recruited by their treating physicians or from the national neuromuscular database, were examined twice, 20 months apart, using QMUS of orofacial and limb muscles, and measurements of functional capacity and muscle strength. Absolute echo intensity (AEI) and muscle thickness of all muscles were analyzed and correlated with clinical data. RESULTS The tongue, deltoid, iliopsoas, rectus femoris, and soleus muscles showed increased AEI at baseline compared with normal values in 43 OPMD patients, with the rectus femoris being most often affected (51%).The AEI and muscle thickness of 9 of 11 muscles correlated significantly with the motor function measure, 10-step stair test, swallowing capacity, dynamometry, Medical Research Council grade, tongue strength, and bite force (r = 0.302 to -0.711). Between baseline and follow-up, deterioration in AEI was found for the temporalis, tongue, and deltoid muscles, and decreased muscle thickness was detected for the temporalis, masseter, digastric, tongue, deltoid, iliopsoas, and soleus muscles (P < .05). No relation was found between the change in AEI and repeat length or disease duration. DISCUSSION QMUS detected muscle pathology and disease progression in OPMD over 20 months. We conclude that QMUS should be considered as a biomarker in treatment trials.
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Affiliation(s)
- Rosemarie H M J M Kroon
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Johanna G Kalf
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Rutger L Meijers
- Radboud university medical center, Donders Institute of Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Bert J M de Swart
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Ian G M Cameron
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands.,University of Twente, Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer, Science, Enschede, The Netherlands
| | - Jonne Doorduin
- Radboud university medical center, Donders Institute of Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Nens van Alfen
- Radboud university medical center, Donders Institute of Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- Radboud university medical center, Donders Institute of Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Corinne G C Horlings
- Radboud university medical center, Donders Institute of Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands.,Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
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14
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Wijntjes J, van der Hoeven J, Saris CGJ, Doorduin J, van Alfen N. Visual versus quantitative analysis of muscle ultrasound in neuromuscular disease. Muscle Nerve 2022; 66:253-261. [PMID: 35765226 PMCID: PMC9545111 DOI: 10.1002/mus.27669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022]
Abstract
Introduction/Aims Visual and quantitative muscle ultrasound are both valid diagnostic tools in neuromuscular diseases. To optimize muscle ultrasound evaluation and facilitate its use in neuromuscular disease, we examined the correlation between visual and quantitative muscle ultrasound analysis and their pitfalls. Methods Retrospective data from 994 patients with 13,562 muscle ultrasound images were analyzed. Differences in echogenicity z‐score distribution per Heckmatt grade and corresponding correlation coefficients were calculated. Results Overall, there was a correlation of 0.60 between the two scoring systems, with a gradual increase in z‐score with increasing Heckmatt grades and vice versa. Patients with a neuromuscular disorder had higher Heckmatt grades (p < 0.001) and z‐scores (median z‐score = 0.30, p < 0.001) than patients without. The highest Heckmatt grades and z‐scores were found in patients with either a dystrophy or inflammatory myopathy (both median Heckmatt grade of 2 and median z score of 0.74 and 1.20, respectively). Discrepant scores were infrequent (<2%), but revealed important pitfalls in both grading systems. Discussion Visual and quantitative muscle ultrasound are complementary techniques to evaluate neuromuscular disease and have a moderate positive correlation. Importantly, we identified specific pitfalls for visual and quantitative muscle ultrasound and how to overcome them in clinical practice.
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Affiliation(s)
- Juerd Wijntjes
- Radboud university medical center, Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Joris van der Hoeven
- Radboud university medical center, Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Christiaan G J Saris
- Radboud university medical center, Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Jonne Doorduin
- Radboud university medical center, Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Nens van Alfen
- Radboud university medical center, Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
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15
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van Kleef ES, van Doorn JL, Gaytant MA, de Weerd W, Vosse BA, Wallgren-Pettersson C, van Engelen BG, Ottenheijm CA, Voermans NC, Doorduin J. Respiratory muscle function in patients with nemaline myopathy. Neuromuscul Disord 2022; 32:654-663. [DOI: 10.1016/j.nmd.2022.06.009] [Citation(s) in RCA: 1] [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: 01/20/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
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van Doorn JLM, Wijntjes J, Saris CGJ, Ottenheijm CAC, van Alfen N, Doorduin J. Association of diaphragm thickness and echogenicity with age, sex, and body mass index in healthy subjects. Muscle Nerve 2022; 66:197-202. [PMID: 35583147 PMCID: PMC9543748 DOI: 10.1002/mus.27639] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 09/15/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022]
Abstract
Introduction/Aims Diaphragm ultrasound is increasingly used in the diagnosis of diaphragm dysfunction and to guide respiratory management in patients with neuromuscular disorders and those who are critically ill. However, the association between diaphragm ultrasound variables and demographic factors like age, sex, and body mass index (BMI) are understudied. Such relationships are important for correct interpretation of normative values and comparison with selected patients groups. The aim of this study was to determine the associations between diaphragm ultrasound variables and subject characteristics. Methods B‐mode ultrasound was used to image the diaphragm at the zone of apposition in 83 healthy subjects. Diaphragm thickness at resting end‐expiration (Tend‐exp), diaphragm thickness at maximal end‐inspiration (Tmax‐insp), diaphragm thickening ratio (Tmax‐insp/Tend‐exp), and diaphragm echogenicity were measured. Multivariate linear regression was used to explore the associations between diaphragm ultrasound variables and subject characteristics. Results Tend‐exp, Tmax‐insp, and thickening ratio do not change with age whereas diaphragm echogenicity increases with age. The thickening ratio had a weak negative association with BMI, while Tend‐exp was positively associated with BMI. Men had a larger Tend‐exp and Tmax‐insp than women (Tend‐exp 1.6 ± 0.5 and 1.4 ± 0.3 mm; p = .011, Tmax‐insp 3.8 ± 1.0 and 3.2 ± 0.9 mm; p = .004), but similar thickening ratios. Discussion Diaphragm thickness, thickening, and echogenicity measured with ultrasound are associated with factors such as age, BMI, and sex. Therefore, subject characteristics should be considered when interpreting diaphragm ultrasound measurements. In the absence of normative values, matched control groups are a prerequisite for research and in clinical practice.
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Affiliation(s)
- Jeroen L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juerd Wijntjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan G J Saris
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coen A C Ottenheijm
- Department of Physiology, Amsterdam University Medical Center, VUmc, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Ruijter BJ, Keijzer HM, Tjepkema-Cloostermans MC, Blans MJ, Beishuizen A, Tromp SC, Scholten E, Horn J, van Rootselaar AF, Admiraal MM, van den Bergh WM, Elting JWJ, Foudraine NA, Kornips FHM, van Kranen-Mastenbroek VHJM, Rouhl RPW, Thomeer EC, Moudrous W, Nijhuis FAP, Booij SJ, Hoedemaekers CWE, Doorduin J, Taccone FS, van der Palen J, van Putten MJAM, Hofmeijer J. Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest. N Engl J Med 2022; 386:724-734. [PMID: 35196426 DOI: 10.1056/nejmoa2115998] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether the treatment of rhythmic and periodic electroencephalographic (EEG) patterns in comatose survivors of cardiac arrest improves outcomes is uncertain. METHODS We conducted an open-label trial of suppressing rhythmic and periodic EEG patterns detected on continuous EEG monitoring in comatose survivors of cardiac arrest. Patients were randomly assigned in a 1:1 ratio to a stepwise strategy of antiseizure medications to suppress this activity for at least 48 consecutive hours plus standard care (antiseizure-treatment group) or to standard care alone (control group); standard care included targeted temperature management in both groups. The primary outcome was neurologic outcome according to the score on the Cerebral Performance Category (CPC) scale at 3 months, dichotomized as a good outcome (CPC score indicating no, mild, or moderate disability) or a poor outcome (CPC score indicating severe disability, coma, or death). Secondary outcomes were mortality, length of stay in the intensive care unit (ICU), and duration of mechanical ventilation. RESULTS We enrolled 172 patients, with 88 assigned to the antiseizure-treatment group and 84 to the control group. Rhythmic or periodic EEG activity was detected a median of 35 hours after cardiac arrest; 98 of 157 patients (62%) with available data had myoclonus. Complete suppression of rhythmic and periodic EEG activity for 48 consecutive hours occurred in 49 of 88 patients (56%) in the antiseizure-treatment group and in 2 of 83 patients (2%) in the control group. At 3 months, 79 of 88 patients (90%) in the antiseizure-treatment group and 77 of 84 patients (92%) in the control group had a poor outcome (difference, 2 percentage points; 95% confidence interval, -7 to 11; P = 0.68). Mortality at 3 months was 80% in the antiseizure-treatment group and 82% in the control group. The mean length of stay in the ICU and mean duration of mechanical ventilation were slightly longer in the antiseizure-treatment group than in the control group. CONCLUSIONS In comatose survivors of cardiac arrest, the incidence of a poor neurologic outcome at 3 months did not differ significantly between a strategy of suppressing rhythmic and periodic EEG activity with the use of antiseizure medication for at least 48 hours plus standard care and standard care alone. (Funded by the Dutch Epilepsy Foundation; TELSTAR ClinicalTrials.gov number, NCT02056236.).
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Affiliation(s)
- Barry J Ruijter
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Hanneke M Keijzer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Marleen C Tjepkema-Cloostermans
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Michiel J Blans
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Albertus Beishuizen
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Selma C Tromp
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Erik Scholten
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Janneke Horn
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Anne-Fleur van Rootselaar
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Marjolein M Admiraal
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Walter M van den Bergh
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jan-Willem J Elting
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Norbert A Foudraine
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Francois H M Kornips
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Vivianne H J M van Kranen-Mastenbroek
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Rob P W Rouhl
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Elsbeth C Thomeer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Walid Moudrous
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Frouke A P Nijhuis
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Suzanne J Booij
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Cornelia W E Hoedemaekers
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jonne Doorduin
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Fabio S Taccone
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Job van der Palen
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Michel J A M van Putten
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jeannette Hofmeijer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
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Teeselink S, Vincenten SCC, Voermans NC, Groothuis JT, Doorduin J, Wijkstra PJ, Horlings CGC, van Engelen BGM, Mul K. Long-term follow-up of respiratory function in facioscapulohumeral muscular dystrophy. J Neurol 2022; 269:3682-3689. [PMID: 35147730 PMCID: PMC8831680 DOI: 10.1007/s00415-022-10990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/25/2022]
Abstract
Objective To evaluate the 5-year change in respiratory function in patients with facioscapulohumeral muscular dystrophy (FSHD). Methods Genetically confirmed patients with FSHD aged ≥ 18 years were examined twice over five years. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured using hand-held spirometry with a face mask. Several clinical outcome measures were correlated to respiratory function. Results Ninety-two patients were included (57% male, age 18–75 years). At baseline, the spirometry outcomes of 41 patients showed a restrictive ventilatory pattern (FVC < 80% and FEV1/FVC ≥ 70% of predicted) and of 48 patients at follow-up. The mean FVC decreased from baseline to follow-up from 79.0 to 76.7% predicted (p = 0.021). This decrease was driven by a subgroup of 15 patients who had a deterioration of FVC of > 10% predicted. The subgroup of 15 patients was more severely affected at baseline (p = 0.002 for FSHD clinical score and 0.007 for Ricci score). They developed more frequently spinal and thorax deformities (p < 0.001 for kyphoscoliosis and 0.012 for pectus excavatum) and had a larger decline in axial muscle function (p = 0.020). Only weak correlations were found between the change in FVC% predicted and the change in clinical scores between baseline and follow-up. Interpretation Respiratory function remained stable in most patients with FSHD, but a subgroup of patients showed a pronounced deterioration. They showed more severe muscle weakness including the leg muscles at baseline (Ricci score ≥ 6), had spinal and thorax deformities and a relatively fast decline in axial muscle function at follow-up.
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Affiliation(s)
- Sjan Teeselink
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Sanne C C Vincenten
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Vinke RS, Selvaraj AK, Geerlings M, Georgiev D, Sadikov A, Kubben PL, Doorduin J, Praamstra P, Bloem BR, Bartels RH, Esselink RA. The Role of Microelectrode Recording and Stereotactic Computed Tomography in Verifying Lead Placement During Awake MRI-Guided Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease. J Parkinsons Dis 2022; 12:1269-1278. [PMID: 35367970 PMCID: PMC9198756 DOI: 10.3233/jpd-223149] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) has become a cornerstone in the advanced treatment of Parkinson's disease (PD). Despite its well-established clinical benefit, there is a significant variation in the way surgery is performed. Most centers operate with the patient awake to allow for microelectrode recording (MER) and intraoperative clinical testing. However, technical advances in MR imaging and MRI-guided surgery raise the question whether MER and intraoperative clinical testing still have added value in DBS-surgery. OBJECTIVE To evaluate the added value of MER and intraoperative clinical testing to determine final lead position in awake MRI-guided and stereotactic CT-verified STN-DBS surgery for PD. METHODS 29 consecutive patients were analyzed retrospectively. Patients underwent awake bilateral STN-DBS with MER and intraoperative clinical testing. The role of MER and clinical testing in determining final lead position was evaluated. Furthermore, interobserver variability in determining the MRI-defined STN along the planned trajectory was investigated. Clinical improvement was evaluated at 12 months follow-up and adverse events were recorded. RESULTS 98% of final leads were placed in the central MER-track with an accuracy of 0.88±0.45 mm. Interobserver variability of the MRI-defined STN was 0.84±0.09. Compared to baseline, mean improvement in MDS-UPDRS-III, PDQ-39 and LEDD were 26.7±16.0 points (54%) (p < 0.001), 9.0±20.0 points (19%) (p = 0.025), and 794±434 mg/day (59%) (p < 0.001) respectively. There were 19 adverse events in 11 patients, one of which (lead malposition requiring immediate postoperative revision) was a serious adverse event. CONCLUSION MER and intraoperative clinical testing had no additional value in determining final lead position. These results changed our daily clinical practice to an asleep MRI-guided and stereotactic CT-verified approach.
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Affiliation(s)
- R. Saman Vinke
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ashok K. Selvaraj
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Geerlings
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dejan Georgiev
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Aleksander Sadikov
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Pieter L. Kubben
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jonne Doorduin
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Praamstra
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald H.M.A. Bartels
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rianne A.J. Esselink
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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Roesthuis LH, van der Hoeven JG, Guérin C, Doorduin J, Heunks LMA. Three bedside techniques to quantify dynamic pulmonary hyperinflation in mechanically ventilated patients with chronic obstructive pulmonary disease. Ann Intensive Care 2021; 11:167. [PMID: 34862945 PMCID: PMC8643378 DOI: 10.1186/s13613-021-00948-9] [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: 07/30/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Dynamic pulmonary hyperinflation may develop in patients with chronic obstructive pulmonary disease (COPD) due to dynamic airway collapse and/or increased airway resistance, increasing the risk of volutrauma and hemodynamic compromise. The reference standard to quantify dynamic pulmonary hyperinflation is the measurement of the volume at end-inspiration (Vei). As this is cumbersome, the aim of this study was to evaluate if methods that are easier to perform at the bedside can accurately reflect Vei. METHODS Vei was assessed in COPD patients under controlled protective mechanical ventilation (7 ± mL/kg) on zero end-expiratory pressure, using three techniques in a fixed order: (1) reference standard (Veireference): passive exhalation to atmosphere from end-inspiration in a calibrated glass burette; (2) ventilator maneuver (Veimaneuver): measuring the expired volume during a passive exhalation of 45s using the ventilator flow sensor; (3) formula (Veiformula): (Vt × Pplateau)/(Pplateau - PEEPi), with Vt tidal volume, Pplateau is plateau pressure after an end-inspiratory occlusion, and PEEPi is intrinsic positive end-expiratory pressure after an end-expiratory occlusion. A convenience sample of 17 patients was recruited. RESULTS Veireference was 1030 ± 380 mL and had no significant correlation with Pplateau (r2 = 0.06; P = 0.3710) or PEEPi (r2 = 0.11; P = 0.2156), and was inversely related with Pdrive (calculated as Pplateau -PEEPi) (r2 = 0.49; P = 0.0024). A low bias but rather wide limits of agreement and fairly good correlations were found when comparing Veimaneuver and Veiformula to Veireference. Vei remained stable during the study period (low bias 15 mL with high agreement (95% limits of agreement from - 100 to 130 mL) and high correlation (r2 = 0.98; P < 0.0001) between both measurements of Veireference). CONCLUSIONS In patients with COPD, airway pressures are not a valid representation of Vei. The three techniques to quantify Vei show low bias, but wide limits of agreement.
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Affiliation(s)
- L H Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - J G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - C Guérin
- Service de Medicine Intensive Réanimation, Hôpital Edouard Herriot, Lyon, France
| | - J Doorduin
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M A Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
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Teeselink S, Vincenten S, Voermans N, Groothuis J, Doorduin J, Wijkstra P, Horlings C, van Engelen B, Mul K. FSHD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.191] [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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Bouman K, Groothuis J, Doorduin J, van Alfen N, ten Cate FU, van den Heuvel F, Nijveldt R, van Tilburg W, Buckens S, Dittrich A, Draaisma J, Janssen M, Kamsteeg E, van Kleef E, Smeitink J, van Tienen F, Smeets H, van Engelen B, Erasmus C, Voermans N. CONGENITAL MUSCULAR DYSTROPHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.094] [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: 11/25/2022]
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Bouman K, Groothuis JT, Doorduin J, van Alfen N, Udink Ten Cate FEA, van den Heuvel FMA, Nijveldt R, van Tilburg WCM, Buckens SCFM, Dittrich ATM, Draaisma JMT, Janssen MCH, Kamsteeg EJ, van Kleef ESB, Koene S, Smeitink JAM, Küsters B, van Tienen FHJ, Smeets HJM, van Engelen BGM, Erasmus CE, Voermans NC. Natural history, outcome measures and trial readiness in LAMA2-related muscular dystrophy and SELENON-related myopathy in children and adults: protocol of the LAST STRONG study. BMC Neurol 2021; 21:313. [PMID: 34384384 PMCID: PMC8357962 DOI: 10.1186/s12883-021-02336-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND SELENON (SEPN1)-related myopathy (SELENON-RM) is a rare congenital myopathy characterized by slowly progressive proximal muscle weakness, early onset spine rigidity and respiratory insufficiency. A muscular dystrophy caused by mutations in the LAMA2 gene (LAMA2-related muscular dystrophy, LAMA2-MD) has a similar clinical phenotype, with either a severe, early-onset due to complete Laminin subunit α2 deficiency (merosin-deficient congenital muscular dystrophy type 1A (MDC1A)), or a mild, childhood- or adult-onset due to partial Laminin subunit α2 deficiency. For both muscle diseases, no curative treatment options exist, yet promising preclinical studies are ongoing. Currently, there is a paucity on natural history data and appropriate clinical and functional outcome measures are needed to reach trial readiness. METHODS LAST STRONG is a natural history study in Dutch-speaking patients of all ages diagnosed with SELENON-RM or LAMA2-MD, starting August 2020. Patients have four visits at our hospital over a period of 1.5 year. At all visits, they undergo standardized neurological examination, hand-held dynamometry (age ≥ 5 years), functional measurements, questionnaires (patient report and/or parent proxy; age ≥ 2 years), muscle ultrasound including diaphragm, pulmonary function tests (spirometry, maximal inspiratory and expiratory pressure, sniff nasal inspiratory pressure; age ≥ 5 years), and accelerometry for 8 days (age ≥ 2 years); at visit one and three, they undergo cardiac evaluation (electrocardiogram, echocardiography; age ≥ 2 years), spine X-ray (age ≥ 2 years), dual-energy X-ray absorptiometry (DEXA-)scan (age ≥ 2 years) and full body magnetic resonance imaging (MRI) (age ≥ 10 years). All examinations are adapted to the patient's age and functional abilities. Correlation between key parameters within and between subsequent visits will be assessed. DISCUSSION Our study will describe the natural history of patients diagnosed with SELENON-RM or LAMA2-MD, enabling us to select relevant clinical and functional outcome measures for reaching clinical trial-readiness. Moreover, our detailed description (deep phenotyping) of the clinical features will optimize clinical management and will establish a well-characterized baseline cohort for prospective follow-up. CONCLUSION Our natural history study is an essential step for reaching trial readiness in SELENON-RM and LAMA2-MD. TRIAL REGISTRATION This study has been approved by medical ethical reviewing committee Region Arnhem-Nijmegen (NL64269.091.17, 2017-3911) and is registered at ClinicalTrial.gov ( NCT04478981 ).
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Affiliation(s)
- Karlijn Bouman
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands.
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Floris E A Udink Ten Cate
- Department of Pediatric cardiology, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Stan C F M Buckens
- Department of Radiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Anne T M Dittrich
- Department of Pediatrics, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Mirian C H Janssen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Esmee S B van Kleef
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Saskia Koene
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Benno Küsters
- Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Hubert J M Smeets
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
- School for Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, the Netherlands
- School for Developmental Biology and Oncology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Marzola F, van Alfen N, Doorduin J, Meiburger KM. Deep learning segmentation of transverse musculoskeletal ultrasound images for neuromuscular disease assessment. Comput Biol Med 2021; 135:104623. [PMID: 34252683 DOI: 10.1016/j.compbiomed.2021.104623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022]
Abstract
Ultrasound imaging is a patient-friendly and robust technique for studying physiological and pathological muscles. An automatic deep learning (DL) system for the analysis of ultrasound images could be useful to support an expert operator, allowing the study of large datasets requiring less human interaction. The purpose of this study is to present a deep learning algorithm for the cross-sectional area (CSA) segmentation in transverse musculoskeletal ultrasound images, providing a quantitative grayscale analysis which is useful for studying muscles, and to validate the results in a large dataset. The dataset included 3917 images of biceps brachii, tibialis anterior and gastrocnemius medialis acquired on 1283 subjects (mean age 50 ± 21 years, 729 male). The algorithm was based on multiple deep-learning architectures, and its performance was compared to a manual expert segmentation. We compared the mean grayscale value inside the automatic and manual CSA using Bland-Altman plots and a correlation analysis. Classification in healthy and abnormal muscles between automatic and manual segmentation were compared using the grayscale value z-scores. In the test set, a Precision of 0.88 ± 0.12 and a Recall of 0.92 ± 0.09 was achieved. The network segmentation performance was slightly less in abnormal muscles, without a loss of discrimination between healthy and abnormal muscle images. Bland-Altman plots showed no clear trend in the error distribution and the two readings have a 0.99 Pearson's correlation coefficient (p < 0.001, test set). The ICC(A, 1) calculated between the z-score readings was 0.99. The algorithm achieves robust CSA segmentation performance and gives mean grayscale level information comparable to a manual operator. This could provide a helpful tool for clinicians in neuromuscular disease diagnosis and follow-up. The entire dataset and code are made available for the research community.
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Affiliation(s)
- Francesco Marzola
- Biolab, Polito(BIO)MedLab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kristen M Meiburger
- Biolab, Polito(BIO)MedLab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.
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25
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Maas RPPWM, Toni I, Doorduin J, Klockgether T, Schutter DJLG, van de Warrenburg BPC. Correction to: Cerebellar transcranial direct current stimulation in spinocerebellar ataxia type 3 (SCA3-tDCS): rationale and protocol of a randomized, double-blind, sham-controlled study. BMC Neurol 2021; 21:250. [PMID: 34187386 PMCID: PMC8240312 DOI: 10.1186/s12883-021-02278-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Roderick P P W M Maas
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525, GC, Nijmegen, The Netherlands.
| | - Ivan Toni
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525, GC, Nijmegen, The Netherlands
| | - Thomas Klockgether
- Department of Neurology, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Dennis J L G Schutter
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525, GC, Nijmegen, The Netherlands
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26
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van Doorn JLM, Pennati F, Hansen HHG, van Engelen BGM, Aliverti A, Doorduin J. Respiratory muscle imaging by ultrasound and MRI in neuromuscular disorders. Eur Respir J 2021; 58:13993003.00137-2021. [PMID: 33863737 DOI: 10.1183/13993003.00137-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 11/05/2022]
Abstract
Respiratory muscle weakness is common in neuromuscular disorders and leads to significant respiratory difficulties. Therefore, reliable and easy assessment of respiratory muscle structure and function in neuromuscular disorders is crucial. In the last decade, ultrasound and MRI emerged as promising imaging techniques to assess respiratory muscle structure and function. Respiratory muscle imaging directly measures the respiratory muscles and, in contrast to pulmonary function testing, is independent of patient effort. This makes respiratory muscle imaging suitable to use as tool in clinical respiratory management and as outcome parameter in upcoming drug trials for neuromuscular disorders, particularly in children. In this narrative review, we discuss the latest studies and technological developments in imaging of the respiratory muscles by US and MR, and its clinical application and limitations. We aim to increase understanding of respiratory muscle imaging and facilitate its use as outcome measure in daily practice and clinical trials.
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Affiliation(s)
- Jeroen L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Hendrik H G Hansen
- Department of Medical Imaging, Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
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de Jongh FHC, de Vries HJ, Warnaar RSP, Oppersma E, Verdaasdonk R, Heunks LMA, Doorduin J. Ventilating two patients with one ventilator: technical setup and laboratory testing. ERJ Open Res 2020; 6:00256-2020. [PMID: 32665947 PMCID: PMC7335837 DOI: 10.1183/23120541.00256-2020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
During health crises, including terrorist attacks or pandemics like coronavirus disease 2019 (COVID-19), the number of mechanical ventilators might fall short of the number of patients with severe respiratory failure [1–3]. A possible emergency solution is to ventilate multiple patients with one ventilator. Sharing ventilators was applied anecdotally during the 2017 Las Vegas (USA) shootings and has raised interest in lay media with the current COVID-19 pandemic [4]. However, ventilating two patients with one ventilator can be dangerous when incorrectly applied. Different setups have been published online, but none have reported any technical safety testing. With a modified circuit, it is feasible to ventilate two patients with one ventilator over a relevant range of compliances. Adding inspiratory resistance allows individual titration of tidal volume, and incorporating one-way valves prevents pendelluft.https://bit.ly/3ex8SYP
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Affiliation(s)
- Frans H C de Jongh
- Dept of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands.,TechMed Centre, University of Twente, Enschede, The Netherlands.,Dept of Neonatal Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,These authors contributed equally
| | - Heder J de Vries
- Dept of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,These authors contributed equally
| | - Rob S P Warnaar
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Eline Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Rudolf Verdaasdonk
- Health Technology Implementation, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Leo M A Heunks
- Dept of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jonne Doorduin
- Dept of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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28
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Marzola F, Alfen NV, Salvi M, Santi BD, Doorduin J, Meiburger KM. Automatic segmentation of ultrasound images of gastrocnemius medialis with different echogenicity levels using convolutional neural networks. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:2113-2116. [PMID: 33018423 DOI: 10.1109/embc44109.2020.9176343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to develop an automatic method for the segmentation of muscle cross-sectional area on transverse B-mode ultrasound images of gastrocnemius medialis using a convolutional neural network(CNN). In the provided dataset images with both normal and increased echogenicity are present. The manually annotated dataset consisted of 591 images, from 200 subjects, 400 relative to subjects with normal echogenicity and 191 to subjects with augmented echogenicity. From the DICOM files, the image has been extracted and processed using the CNN, then the output has been post-processed to obtain a finer segmentation. Final results have been compared to the manual segmentations. Precision and Recall scores as mean ± standard deviation for training, validation, and test sets are 0.96 ± 0.05, 0.90 ± 0.18, 0.89 ± 0.15 and 0.97 ±0.03, 0.89± 0.17, 0.90 ± 0.14 respectively. The CNN approach has also been compared to another automatic algorithm, showing better performances. The proposed automatic method provides an accurate estimation of muscle cross-sectional area in muscles with different echogenicity levels.
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29
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Roesthuis LH, van der Hoeven JG, van Hees HWH, Schellekens WJM, Doorduin J, Heunks LMA. Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support. Ann Intensive Care 2020; 10:67. [PMID: 32472272 PMCID: PMC7256918 DOI: 10.1186/s13613-020-00684-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/18/2019] [Accepted: 05/16/2020] [Indexed: 01/16/2023] Open
Abstract
Background Inappropriate ventilator assist plays an important role in the development of diaphragm dysfunction. Ventilator under-assist may lead to muscle injury, while over-assist may result in muscle atrophy. This provides a good rationale to monitor respiratory drive in ventilated patients. Respiratory drive can be monitored by a nasogastric catheter, either with esophageal balloon to determine muscular pressure (gold standard) or with electrodes to measure electrical activity of the diaphragm. A disadvantage is that both techniques are invasive. Therefore, it is interesting to investigate the role of surrogate markers for respiratory dive, such as extradiaphragmatic inspiratory muscle activity. The aim of the current study was to investigate the effect of different inspiratory support levels on the recruitment pattern of extradiaphragmatic inspiratory muscles with respect to the diaphragm and to evaluate agreement between activity of extradiaphragmatic inspiratory muscles and the diaphragm. Methods Activity from the alae nasi, genioglossus, scalene, sternocleidomastoid and parasternal intercostals was recorded using surface electrodes. Electrical activity of the diaphragm was measured using a multi-electrode nasogastric catheter. Pressure support (PS) levels were reduced from 15 to 3 cmH2O every 5 min with steps of 3 cmH2O. The magnitude and timing of respiratory muscle activity were assessed. Results We included 17 ventilated patients. Diaphragm and extradiaphragmatic inspiratory muscle activity increased in response to lower PS levels (36 ± 6% increase for the diaphragm, 30 ± 6% parasternal intercostals, 41 ± 6% scalene, 40 ± 8% sternocleidomastoid, 43 ± 6% alae nasi and 30 ± 6% genioglossus). Changes in diaphragm activity correlated best with changes in alae nasi activity (r2 = 0.49; P < 0.001), while there was no correlation between diaphragm and sternocleidomastoid activity. The agreement between diaphragm and extradiaphragmatic inspiratory muscle activity was low due to a high individual variability. Onset of alae nasi activity preceded the onset of all other muscles. Conclusions Extradiaphragmatic inspiratory muscle activity increases in response to lower inspiratory support levels. However, there is a poor correlation and agreement with the change in diaphragm activity, limiting the use of surface electromyography (EMG) recordings of extradiaphragmatic inspiratory muscles as a surrogate for electrical activity of the diaphragm.
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Affiliation(s)
- L H Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H W H van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - J Doorduin
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M A Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB, Amsterdam, The Netherlands.
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30
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Hendriks T, Kunst HPM, Huppelschoten M, Doorduin J, Ter Laan M. TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery. Acta Neurochir (Wien) 2020; 162:1197-1203. [PMID: 32146526 PMCID: PMC7156349 DOI: 10.1007/s00701-020-04275-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Abstract
Object Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. This study compares these two methods and correlates them to House-Brackmann (HB) scores post-op in patients with tumours in the cerebellopontine angle. Method Forty-three patients (one was operated twice) with large CPA tumours treated surgically in the Radboud University Medical Center between 2015 and 2019 were included in this study. During surgery, TcMEP threshold increases and A-train activity were measured. Because our treatment paradigm aims at facial nerve preservation (accepting residual tumour), TcMEP threshold increase of over 20 mA or occurrence of A-trains were considered as warning signs and used as a guide for terminating surgery. HB scores were measured post-op, at 6 weeks, 6 months and 1 year after surgery. Spearman’s correlation was calculated between the IOM-values and the HB scores for a homogeneous subgroup of 30 patients with vestibular schwannoma (VS) without neurofibromatosis type II (NF-II) and all patients collectively. Results TcMEP threshold was successfully measured in 39 (90.7%) procedures. In the homogeneous VS non-NFII group, we found a statistically significant moderate-to-strong correlation between TcMEP threshold increase and House Brackmann score immediately post-op, at 6 weeks, 6 months and 1 year after surgery (Spearman’s rho of 0.79 (p < 0.001), 0.74 (p < 0.001), 0.64 (p < 0.001) and 0.58 (p = 0.002), respectively). For A-trains, no correlation was found. Similar results were found when including all patients with CPA tumours. A threshold increase of < 20 mA was a predictor of good facial nerve outcome. Conclusion These results show that TcMEP threshold increases are strongly correlated to post-operative HB scores, while A-trains are not. This suggests TcMEP threshold increases can be a valuable predictor for facial nerve outcome in patients with large tumours when facial nerve preservation is prioritized over total resection. In this study, we found no use for A-trains to prevent facial nerve deficits.
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Affiliation(s)
- Tom Hendriks
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otorhinolaryngology, Medical Center, Maastricht, Netherlands
| | - Maarten Huppelschoten
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Ter Laan
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
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Khayum MA, Moraga-Amaro R, Buwalda B, Koole M, den Boer JA, Dierckx RAJO, Doorduin J, de Vries EFJ. Ovariectomy-induced depressive-like behavior and brain glucose metabolism changes in female rats are not affected by chronic mild stress. Psychoneuroendocrinology 2020; 115:104610. [PMID: 32088632 DOI: 10.1016/j.psyneuen.2020.104610] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/23/2019] [Accepted: 01/29/2020] [Indexed: 01/11/2023]
Abstract
The increased incidence of depression in women going through peri-menopause suggests that fluctuations in estrogen levels may increase the risk of developing depression. Nonetheless, this psychiatric disorder is likely to be multifactorial and consequently an additional trigger may be needed to induce depression in this population. Stress could be such a trigger. We therefore investigated the effect of ovarian estrogen depletion and chronic mild stress (CMS) on depressive-like behavior and brain metabolism in female rats. Approximately 2 and 9 weeks after estrogen depletion by ovariectomy, behavioral changes were assessed in the open-field test and the forced swim test, and brain metabolism was measured with [18F]FDG PET imaging. A subset of animals was subjected to a 6-weeks CMS protocol starting 17 days after ovariectomy. Short-term estrogen depletion had a significant effect on brain metabolism in subcortical areas, but not on behavior. Differences in depressive-like behavior were only found after prolonged estrogen depletion, leading to an increased immobility time in the forced swim test. Prolonged estrogen depletion also resulted in an increase in glucose metabolism in frontal cortical areas and hippocampus, whereas a decrease glucose metabolism was found in temporal cortical areas, hypothalamus and brainstem. Neither short-term nor prolonged estrogen depletion caused anxiety-like behavior. Changes in body weight, behavior and brain glucose metabolism were not significantly affected by CMS. In conclusion, ovarian estrogen depletion resulted in changes in brain metabolism and depressive-like behavior, but these changes were not enhanced by CMS.
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Affiliation(s)
- M A Khayum
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - R Moraga-Amaro
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands; Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B Buwalda
- Behavioral Physiology, University of Groningen, Nijenborgh 7, 9747 AG, Groningen, the Netherlands
| | - M Koole
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - J A den Boer
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands; PRA-Health Sciences, Van Swietenlaan, 9728 NZ, Groningen, the Netherlands
| | - R A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - J Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - E F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
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Leeuwenberg KE, van Alfen N, Christopher-Stine L, Paik JJ, Tiniakou E, Mecoli C, Doorduin J, Saris CGJ, Albayda J. Ultrasound can differentiate inclusion body myositis from disease mimics. Muscle Nerve 2020; 61:783-788. [PMID: 32239702 PMCID: PMC7317807 DOI: 10.1002/mus.26875] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 10/14/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022]
Abstract
Introduction The diagnosis of inclusion body myositis (IBM) can be challenging, and its presentation can be confused with other forms of myositis or neuromuscular disorders. In this study we evaluate the ability of quantitative muscle ultrasound to differentiate between IBM and mimicking diseases. Methods Patients 50 years of age and older were included from two specialty centers. Muscle echogenicity and muscle thickness of four characteristically involved muscles in IBM were measured and compared with polymyositis (PM)/dermatomyositis (DM), other neuromuscular disorders, and healthy controls. Results Echogenicity was higher and muscle thickness generally lower in all four muscles in IBM compared with PM/DM and normal controls. When comparing IBM with the comparator groups, the flexor digitorum profundus was the most discriminative muscle. Discussion Ultrasound appears to be a good test to differentiate established IBM from PM/DM and neuromuscular controls, with value as a diagnostic tool for IBM.
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Affiliation(s)
- Kristofoor E Leeuwenberg
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Lisa Christopher-Stine
- School of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland
| | - Julie J Paik
- School of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland
| | - Eleni Tiniakou
- School of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland
| | - Christopher Mecoli
- School of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland
| | - Jonne Doorduin
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Christiaan G J Saris
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jemima Albayda
- School of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland
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Gouw S, Frowein A, Braem C, de Wijer A, Creugers NHJ, Pasman JW, Doorduin J, Kalaykova SI. Coherence of jaw and neck muscle activity during sleep bruxism. J Oral Rehabil 2020; 47:432-440. [PMID: 31926031 PMCID: PMC7079051 DOI: 10.1111/joor.12932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/05/2019] [Accepted: 12/31/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Studies have shown co-contraction of jaw and neck muscles in healthy subjects during (sub) maximum voluntary jaw clenching, indicating functional inter-relation between these muscles during awake bruxism. So far, coherence of jaw and neck muscles has not been evaluated during either awake or sleep bruxism. OBJECTIVE The objective of this study was to evaluate the coherence between jaw and neck muscle activity during sleep bruxism. METHODS In a cross-sectional observational design, the electromyographic activity of jaw (masseter, temporalis) and neck (sternocleidomastoid, trapezius) muscles in individuals with "definite" sleep bruxism was measured using ambulatory polysomnography (PSG). Coherence for masseter-temporalis, masseter-sternocleidomastoid and masseter-trapezius was measured during phasic and mixed rhythmic masticatory muscle activity episodes using coherence-analysing software. Outcome measures were as follows: presence or absence of significant coherence per episode (in percentages), frequency of peak coherence (FPC) per episode and sleep stage. RESULTS A total of 632 episodes within 16 PSGs of eight individuals were analysed. Significant coherence was found between the jaw and neck muscles in 84.9% of the episodes. FPCs of masseter-temporalis were significantly positively correlated with those of masseter-sternocleidomastoid or masseter-trapezius (P < .001). Sleep stages did not significantly influence coherence of these muscular couples. CONCLUSION During sleep bruxism, jaw and neck muscle activation is significantly coherent. Coherence occurs independently of sleep stage. These results support the hypothesis of bruxism being a centrally regulated phenomenon.
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Affiliation(s)
- Simone Gouw
- Department of Oral Function and Prosthetic DentistryCollege of Dental SciencesRadboud University Medical CenterNijmegenThe Netherlands
- Academic InstituteUtrechtThe Netherlands
| | - Angela Frowein
- Department of Oral Function and Prosthetic DentistryCollege of Dental SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Carlijn Braem
- Department of NeurologyRadboud University Medical CenterNijmegenThe Netherlands
- Technical MedicineUniversity of TwenteEnschedeThe Netherlands
| | - Anton de Wijer
- Department of Oral Function and Prosthetic DentistryCollege of Dental SciencesRadboud University Medical CenterNijmegenThe Netherlands
- Academic InstituteUtrechtThe Netherlands
| | - Nico H. J. Creugers
- Department of Oral Function and Prosthetic DentistryCollege of Dental SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Jaco W. Pasman
- Department of NeurologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Jonne Doorduin
- Department of NeurologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Stanimira I. Kalaykova
- Department of Oral Function and Prosthetic DentistryCollege of Dental SciencesRadboud University Medical CenterNijmegenThe Netherlands
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Oppersma E, Doorduin J, Roesthuis LH, van der Hoeven JG, Veltink PH, Heunks LM. Patient-Ventilator Interaction During Noninvasive Ventilation in Subjects With Exacerbation of COPD: Effect of Support Level and Ventilator Mode. Respir Care 2020; 65:1315-1322. [PMID: 32156788 DOI: 10.4187/respcare.07159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patient-ventilator synchrony in patients with COPD is at risk during noninvasive ventilation (NIV). NIV in neurally-adjusted ventilatory assist (NAVA) mode improves synchrony compared to pressure support ventilation (PSV). The current study investigated patient-ventilator interaction at 2 levels of NAVA and PSV mode in subjects with COPD exacerbation. METHODS NIV was randomly applied at 2 levels (5 and 15 cm H2O) of PSV and NAVA. Patient-ventilator interaction was evaluated by comparing airway pressure and electrical activity of the diaphragm waveforms with automated computer algorithms. RESULTS 8 subjects were included. Trigger delay was longer in PSV high (268 ± 112 ms) than in PSV low (161 ± 118 ms, P = .043), and trigger delay during NAVA was shorter than PSV for both low support (49 ± 24 ms for NAVA, P = .035) and high support (79 ± 276 ms for NAVA, P = .003). No difference in cycling error for low and high levels of PSV (PSV low -100 ± 114 ms and PSV high 56 ± 315 ms) or NAVA (NAVA low -5 ± 18 ms, NAVA high 12 ± 36 ms) and no difference between PSV and NAVA was found. CONCLUSIONS Increasing PSV levels during NIV caused a progressive mismatch between neural effort and pneumatic timing. Patient-ventilator interaction during NAVA was more synchronous than during PSV, independent of inspiratory support level. (ClinicalTrials.gov registration NCT01791335.).
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Affiliation(s)
- Eline Oppersma
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands. .,Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands.,Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisanne H Roesthuis
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Peter H Veltink
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - Leo Ma Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
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35
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de Winter JM, Molenaar JP, Yuen M, van der Pijl R, Shen S, Conijn S, van de Locht M, Willigenburg M, Bogaards SJ, van Kleef ES, Lassche S, Persson M, Rassier DE, Sztal TE, Ruparelia AA, Oorschot V, Ramm G, Hall TE, Xiong Z, Johnson CN, Li F, Kiss B, Lozano-Vidal N, Boon RA, Marabita M, Nogara L, Blaauw B, Rodenburg RJ, Küsters B, Doorduin J, Beggs AH, Granzier H, Campbell K, Ma W, Irving T, Malfatti E, Romero NB, Bryson-Richardson RJ, van Engelen BG, Voermans NC, Ottenheijm CA. KBTBD13 is an actin-binding protein that modulates muscle kinetics. J Clin Invest 2020; 130:754-767. [PMID: 31671076 PMCID: PMC6994151 DOI: 10.1172/jci124000] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 08/16/2018] [Accepted: 10/24/2019] [Indexed: 11/17/2022] Open
Abstract
The mechanisms that modulate the kinetics of muscle relaxation are critically important for muscle function. A prime example of the impact of impaired relaxation kinetics is nemaline myopathy caused by mutations in KBTBD13 (NEM6). In addition to weakness, NEM6 patients have slow muscle relaxation, compromising contractility and daily life activities. The role of KBTBD13 in muscle is unknown, and the pathomechanism underlying NEM6 is undetermined. A combination of transcranial magnetic stimulation-induced muscle relaxation, muscle fiber- and sarcomere-contractility assays, low-angle x-ray diffraction, and superresolution microscopy revealed that the impaired muscle-relaxation kinetics in NEM6 patients are caused by structural changes in the thin filament, a sarcomeric microstructure. Using homology modeling and binding and contractility assays with recombinant KBTBD13, Kbtbd13-knockout and Kbtbd13R408C-knockin mouse models, and a GFP-labeled Kbtbd13-transgenic zebrafish model, we discovered that KBTBD13 binds to actin - a major constituent of the thin filament - and that mutations in KBTBD13 cause structural changes impairing muscle-relaxation kinetics. We propose that this actin-based impaired relaxation is central to NEM6 pathology.
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Affiliation(s)
| | - Joery P. Molenaar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, Netherlands
| | - Michaela Yuen
- Department of Physiology, Amsterdam University Medical Center, Netherlands
- Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Australia
| | - Robbert van der Pijl
- Department of Physiology, Amsterdam University Medical Center, Netherlands
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Shengyi Shen
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Stefan Conijn
- Department of Physiology, Amsterdam University Medical Center, Netherlands
| | | | - Menne Willigenburg
- Department of Physiology, Amsterdam University Medical Center, Netherlands
| | | | - Esmee S.B. van Kleef
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Saskia Lassche
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Malin Persson
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Dilson E. Rassier
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Tamar E. Sztal
- School of Biological Sciences, Monash University, Melbourne, Australia
| | | | - Viola Oorschot
- Monash Ramaciotti Centre for Structural Cryo-Electron Microscopy, Monash University, Melbourne, Australia
| | - Georg Ramm
- Monash Ramaciotti Centre for Structural Cryo-Electron Microscopy, Monash University, Melbourne, Australia
- Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Thomas E. Hall
- Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Zherui Xiong
- Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Christopher N. Johnson
- Division of Clinical Pharmacology, Center for Arrhythmia Research and Therapeutics and Center for Structural Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Frank Li
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Balazs Kiss
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Reinier A. Boon
- Department of Physiology, Amsterdam University Medical Center, Netherlands
| | - Manuela Marabita
- Venetian Institute of Molecular Medicine, Department of Biomedical Sciences, University of Padova, Italy
| | - Leonardo Nogara
- Venetian Institute of Molecular Medicine, Department of Biomedical Sciences, University of Padova, Italy
| | - Bert Blaauw
- Venetian Institute of Molecular Medicine, Department of Biomedical Sciences, University of Padova, Italy
| | - Richard J. Rodenburg
- Department of Pediatrics, Radboud University Medical Centre, Translational Metabolic Laboratory, Nijmegen, Netherlands
| | - Benno Küsters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alan H. Beggs
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Ken Campbell
- Department of Physiology and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Weikang Ma
- BioCAT, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Thomas Irving
- BioCAT, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Edoardo Malfatti
- Service Neurologie Médicale, Centre de Référence Maladies Neuromusculaire Paris-Nord CHU Raymond-Poincaré, U1179 UVSQ-INSERM Handicap Neuromusculaire: Physiologie, Biothérapie et Pharmacologie Appliquées, UFR des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - Norma B. Romero
- Sorbonne Université, Myology Institute, Neuromuscular Morphology Unit, Center for Research in Myology, GH Pitié-Salpêtrière Paris, France
- Centre de Référence de Pathologie Neuromusculaire Paris-Est, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Coen A.C. Ottenheijm
- Department of Physiology, Amsterdam University Medical Center, Netherlands
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
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Leeuwenberg K, Christopher-Stine L, Paik J, Tiniakou E, Mecoli C, van Alfen N, Doorduin J, Saris C, Albayda J. P.06Muscle ultrasound in patients with inclusion body myositis: differentiating from mimics. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Roesthuis L, van der Hoeven H, Sinderby C, Frenzel T, Ottenheijm C, Brochard L, Doorduin J, Heunks L. Effects of levosimendan on respiratory muscle function in patients weaning from mechanical ventilation. Intensive Care Med 2019; 45:1372-1381. [PMID: 31576436 PMCID: PMC6773912 DOI: 10.1007/s00134-019-05767-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/08/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Abstract
Purpose Respiratory muscle weakness frequently develops in critically ill patients and is associated with adverse outcome, including difficult weaning from mechanical ventilation. Today, no drug is approved to improve respiratory muscle function in these patients. Previously, we have shown that the calcium sensitizer levosimendan improves calcium sensitivity of human diaphragm muscle fibers in vitro and contractile efficiency of the diaphragm in healthy subjects. The main purpose of this study is to investigate the effects of levosimendan on diaphragm contractile efficiency in mechanically ventilated patients. Methods In a double-blind randomized placebo-controlled trial, mechanically ventilated patients performed two 30-min continuous positive airway pressure (CPAP) trials with 5-h interval. After the first CPAP trial, study medication (levosimendan 0.2 µg/kg/min continuous infusion or placebo) was administered. During the CPAP trials, electrical activity of the diaphragm (EAdi), transdiaphragmatic pressure (Pdi), and flow were measured. Neuromechanical efficiency (primary outcome parameter) was calculated. Results Thirty-nine patients were included in the study. Neuromechanical efficiency was not different during the CPAP trial after levosimendan administration compared to the CPAP trial before study medication. Tidal volume and minute ventilation were higher after levosimendan administration (11 and 21%, respectively), whereas EAdi and Pdi were higher in both groups in the CPAP trial after study medication compared to the CPAP trial before study medication. Conclusions Levosimendan does not improve diaphragm contractile efficiency. Electronic supplementary material The online version of this article (10.1007/s00134-019-05767-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisanne Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christer Sinderby
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute for Biomedical Engineering and Science Technology (iBEST), Ryerson University and St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coen Ottenheijm
- Department of Physiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, USA
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leo Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, location VUmc, Postbox 7057, 1007 MB, Amsterdam, The Netherlands.
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Hop H, de Boer SA, Reijrink M, Kamphuisen PW, de Borst MH, Pol RA, Zeebregts CJ, Hillebrands JL, Slart RHJA, Boersma HH, Doorduin J, Mulder DJ. 18F-sodium fluoride positron emission tomography assessed microcalcifications in culprit and non-culprit human carotid plaques. J Nucl Cardiol 2019; 26:1064-1075. [PMID: 29943142 PMCID: PMC6660502 DOI: 10.1007/s12350-018-1325-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/15/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND 18F-NaF positron emission tomography (PET) targets microcalcifications. We compared in vitro microPET assessed 18F-NaF uptake between culprit and non-culprit human carotid plaques. Furthermore, we compared 18F-NaF uptake with calcification visualized on microcomputed tomography (microCT). METHODS Carotid plaques from stroke patients undergoing surgery were incubated in 18F-NaF and scanned using a microPET and a microCT scan. The average PET assessed 18F-NaF uptake was expressed as percentage of the incubation dose per gram (%Inc/g). 18F-NaF PET volume of interest (VOI) was compared with CT calcification VOI. RESULTS 23 carotid plaques (17 culprit, 6 non-culprit) were included. The average 18F-NaF uptake in culprit carotid plaques was comparable with the uptake in non-culprit carotid plaques (median 2.32 %Inc/g [IQR 1.98 to 2.81] vs. median 2.35 %Inc/g [IQR 1.77 to 3.00], P = 0.916). Only a median of 10% (IQR 4 to 25) of CT calcification VOI showed increased 18F-NaF uptake, while merely a median of 35% (IQR 6 to 42) of 18F-NaF PET VOI showed calcification on CT. CONCLUSIONS 18F-NaF PET represents a different stage in the calcification process than CT. We observed a similar PET assessed 18F-NaF uptake and pattern in culprit and non-culprit plaques of high-risk patients, indicating that this method may be of more value in early atherosclerotic stenosis development.
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Affiliation(s)
- H Hop
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - S A de Boer
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M Reijrink
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - P W Kamphuisen
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M H de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R A Pol
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J L Hillebrands
- Division of Pathology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - H H Boersma
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J Mulder
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Maas RPPWM, Toni I, Doorduin J, Klockgether T, Schutter DJLG, van de Warrenburg BPC. Cerebellar transcranial direct current stimulation in spinocerebellar ataxia type 3 (SCA3-tDCS): rationale and protocol of a randomized, double-blind, sham-controlled study. BMC Neurol 2019; 19:149. [PMID: 31272408 PMCID: PMC6610834 DOI: 10.1186/s12883-019-1379-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Spinocerebellar ataxia type 3 (SCA3) is the most common subtype among the autosomal dominant cerebellar ataxias, a group of neurodegenerative disorders for which currently no disease-specific therapy is available. Evidence-based options for symptomatic treatment of ataxia are also limited. Recent investigations in a heterogeneous group of hereditary and acquired ataxias showed promising, prolonged effects of a two-week course with daily sessions of cerebellar anodal transcranial direct current stimulation (tDCS) on ataxia severity, gait speed, and upper limb dexterity. The aim of the SCA3-tDCS study is to further examine whether tDCS improves ataxia severity and various (cerebellar) non-motor symptoms in a homogeneous cohort of SCA3 patients and to explore the time course of these effects. METHODS/DESIGN An investigator-initiated, double-blind, randomized, sham-controlled, single-center trial will be conducted. Twenty mildly to moderately affected SCA3 patients (Scale for the Assessment and Rating of Ataxia score between 3 and 20) will be included and randomly assigned in a 1:1 ratio to either cerebellar anodal tDCS or sham cerebellar tDCS. Patients, investigators, and outcome assessors are unaware of treatment allocation. Cerebellar tDCS (20 min, 2 mA, ramp-up and down periods of 30 s each) will be delivered over ten sessions, distributed in two groups of five consecutive days with a two-day break in between. Outcomes are assessed after a single session of tDCS, after the tenth stimulation (T1), and after three, six, and twelve months. The primary outcome measure is the absolute change of the SARA score between baseline and T1. In addition, effects on a variety of other motor and neuropsychological functions in which the cerebellum is known to be involved will be evaluated using quantitative motor tests, static posturography, neurophysiological measurements, cognitive assessment, and questionnaires. DISCUSSION The results of this study will inform us whether repeated sessions of cerebellar anodal tDCS benefit SCA3 patients and whether this form of non-invasive stimulation might be a novel therapeutic approach to consider in a neurorehabilitation setting. Combined with two earlier controlled trials, a positive effect of the SCA3-tDCS study will encourage implementation of this intervention and stimulate further research in other SCAs and heredodegenerative ataxias. TRIAL REGISTRATION NL7321 , registered October 8, 2018.
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Affiliation(s)
- Roderick P. P. W. M. Maas
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Thomas Klockgether
- Department of Neurology, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Dennis J. L. G. Schutter
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Bart P. C. van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
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Piai V, Vos SH, Idelberger R, Gans P, Doorduin J, Ter Laan M. Awake Surgery for a Violin Player: Monitoring Motor and Music Performance, A Case Report. Arch Clin Neuropsychol 2019; 34:132-137. [PMID: 29490011 DOI: 10.1093/arclin/acy009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/29/2018] [Indexed: 11/12/2022] Open
Abstract
Objective We report the case of a professional violin player who underwent an awake craniotomy to resect a tumor in the left supplementary motor area, an area involved in motor planning. Method A careful pre- and intraoperative monitoring plan for music performance and complex motor function was established that could be used in combination with cortical stimulation. Results The patient suffered an epileptic seizure during cortical stimulation. The monitoring of complex motor and musical functions was implemented with the patient playing the violin while the resection was performed. Almost complete resection was achieved with no notable postoperative deficits contributing to functional impairment. Conclusions The multidisciplinary approach, involving neurosurgery, neuropsychology, anesthesiology, and clinical neurophysiology, allowed us to successfully cope with the theoretical and practical challenges associated with tailored care for a professional musician. The music and motor monitoring plan is reported in detail to enable other sites to reproduce and adapt it accordingly.
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Affiliation(s)
- Vitória Piai
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Medical Psychology, Nijmegen, The Netherlands.,Radboud University, Donders Centre for Cognition, Nijmegen, The Netherlands
| | - Sandra H Vos
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Medical Psychology, Nijmegen, The Netherlands
| | - Reinhard Idelberger
- Radboud University Medical Center, Department of Anesthesiology, Pain and Palliative Medicine, Nijmegen, The Netherlands
| | - Pauline Gans
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Mark Ter Laan
- Radboud University Medical Center, Department of Neurosurgery, Nijmegen, The Netherlands
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Bachasson D, Dres M, Niérat MC, Gennisson JL, Hogrel JY, Doorduin J, Similowski T. Diaphragm shear modulus reflects transdiaphragmatic pressure during isovolumetric inspiratory efforts and ventilation against inspiratory loading. J Appl Physiol (1985) 2019; 126:699-707. [DOI: 10.1152/japplphysiol.01060.2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The reference method for the assessment of diaphragm function relies on the measurement of transdiaphragmatic pressure (Pdi). Local muscle stiffness measured using ultrafast shear wave elastography (SWE) provides reliable estimates of muscle force in locomotor muscles. This study aimed at investigating whether SWE could be used as a surrogate of Pdi to evaluate diaphragm function. Fifteen healthy volunteers underwent a randomized stepwise inspiratory loading protocol of 0–60% of maximal isovolumetric inspiratory pressure during closed-airways maneuvers and 0–50% during ventilation against an external inspiratory threshold load. During all tasks, Pdi was measured and SWE was used to assess shear modulus of the right hemidiaphragm (SMdi) at the zone of apposition. Pearson correlation coefficients ( r) and repeated-measures correlation coefficients ( R) were computed to determine within-individual and overall relationships between Pdi and SMdi, respectively. During closed-airways maneuvers, mean Pdi correlated to mean SMdi in all participants [ r ranged from 0.77 to 0.96, all P < 0.01; R = 0.82, 95% confidence intervals (0.76, 0.86), P < 0.01]. During ventilation against inspiratory threshold loading, Pdi swing correlated to maximal SMdi in all participants [ r ranged from 0.40 to 0.90, all P < 0.01; R = 0.70, 95% confidence intervals (0.66, 0.73), P < 0.001]. Changes in diaphragm stiffness as assessed by SWE reflect changes in transdiaphragmatic pressure. SWE provides a new opportunity for direct and noninvasive assessment of diaphragm function. NEW & NOTEWORTHY Accurate and specific estimation of diaphragm effort is critical for evaluating and monitoring diaphragm dysfunction. The measurement of transdiaphragmatic pressure requires the use of invasive gastric and esophageal probes. In the present work, we demonstrate that changes in diaphragm stiffness assessed with ultrasound shear wave elastography reflect changes in transdiaphragmatic pressure, therefore offering a new noninvasive method for gauging diaphragm effort.
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Affiliation(s)
- Damien Bachasson
- Neuromuscular Physiology Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Martin Dres
- Service de Pneumologie, Médecine Intensive et Réanimation (Département “R3S”), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Marie-Cécile Niérat
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Jean-Luc Gennisson
- Imagerie par Résonance Magnétique Médicale et Multi-Modalités, Centre National de la Recherche Scientifique UMR8081, Université Paris-Saclay, Orsay, France
| | - Jean-Yves Hogrel
- Neuromuscular Physiology Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Similowski
- Service de Pneumologie, Médecine Intensive et Réanimation (Département “R3S”), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Paris, France
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42
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Heuvel SASVD, Doorduin J, Steegers MAH, Bronkhorst EM, Radema SA, Vissers KCP, Wal SEIVD, Alfen NV. Simple surface EMG recording as a noninvasive screening method for the detection of acute oxaliplatin-induced neurotoxicity: a feasibility pilot study. Neurosci Lett 2019; 699:184-188. [PMID: 30753911 DOI: 10.1016/j.neulet.2019.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/22/2018] [Revised: 01/30/2019] [Accepted: 02/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Oxaliplatin-induced neurotoxicity can be a dose-limiting side effect to effective chemotherapy. Acute hyperexcitability causes cold-evoked sensory and motor symptoms, which resemble neuromyotonia. An accessible and non-invasive technique for early detection could help select patients for potential treatments. We assessed the use of a simple surface electromyography (sEMG) in patients directly after oxaliplatin infusion. METHODS In patients with colorectal cancer, acute neurotoxicity was evaluated by means of a physical examination, a questionnaire, and sEMG directly after the second and fourth cycle of oxaliplatin. Questionnaires were also assessed 1 day after infusion. RESULTS 14 patients were measured after the second cycle and 8 patients were also measured after the fourth cycle of oxaliplatin. All patients reported to a variable degree oxaliplatin induced neurotoxicity symptoms: sensitivity to touching cold or swallowing cold items were reported as most severe. Clinical signs of hyperexcitability were observed in 55% of the measurements. Spontaneous activity compatible with neuromyotonia was observed in 82% of the sEMG recordings. CONCLUSIONS Patient reported symptoms, physical examination and simple sEMG are complementary measurements to detect acute oxaliplatin induced neurotoxicity. After further validation, sEMG recording can be used as a simple objective screenings tool to detect nerve hyperexcitability directly after oxaliplatin administration.
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Affiliation(s)
- Sandra A S van den Heuvel
- Expertise center for Pain and Palliative Medicine, Department of Anesthesiology and Pain Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Donders Institute for Brain Cognition and Behavior, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique A H Steegers
- Expertise center for Pain and Palliative Medicine, Department of Anesthesiology and Pain Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sandra A Radema
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Expertise center for Pain and Palliative Medicine, Department of Anesthesiology and Pain Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Selina E I van der Wal
- Expertise center for Pain and Palliative Medicine, Department of Anesthesiology and Pain Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Donders Institute for Brain Cognition and Behavior, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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Tilanus T, Groothuis J, ten Broek-Pastoor J, Doorduin J, van Engelen B, Kampelmacher M, Raaphorst J. Respiratory Assessment of ALS Patients: A Nationwide Survey of Current Dutch Practice. J Neuromuscul Dis 2018; 5:431-438. [DOI: 10.3233/jnd-180302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- T.B.M. Tilanus
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J.T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J.M.C. ten Broek-Pastoor
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Doorduin
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B.G.M. van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M.J. Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J. Raaphorst
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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Jansen D, Jonkman AH, Roesthuis L, Gadgil S, van der Hoeven JG, Scheffer GJJ, Girbes A, Doorduin J, Sinderby CS, Heunks LMA. Estimation of the diaphragm neuromuscular efficiency index in mechanically ventilated critically ill patients. Crit Care 2018; 22:238. [PMID: 30261920 PMCID: PMC6161422 DOI: 10.1186/s13054-018-2172-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/28/2018] [Indexed: 12/27/2022]
Abstract
Background Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain respiratory muscle activity within physiological limits. Diaphragm electromyography is used to quantify breathing effort and has been correlated with transdiaphragmatic pressure and esophageal pressure. The neuromuscular efficiency index (NME) can be used to estimate inspiratory effort, however its repeatability has not been investigated yet. Our goal is to evaluate NME repeatability during an end-expiratory occlusion (NMEoccl) and its use to estimate the pressure generated by the inspiratory muscles (Pmus). Methods This is a prospective cohort study, performed in a medical-surgical ICU. A total of 31 adult patients were included, all ventilated in neurally adjusted ventilator assist (NAVA) mode with an electrical activity of the diaphragm (EAdi) catheter in situ. At four time points within 72 h five repeated end-expiratory occlusion maneuvers were performed. NMEoccl was calculated by delta airway pressure (ΔPaw)/ΔEAdi and was used to estimate Pmus. The repeatability coefficient (RC) was calculated to investigate the NMEoccl variability. Results A total number of 459 maneuvers were obtained. At time T = 0 mean NMEoccl was 1.22 ± 0.86 cmH2O/μV with a RC of 82.6%. This implies that when NMEoccl is 1.22 cmH2O/μV, it is expected with a probability of 95% that the subsequent measured NMEoccl will be between 2.22 and 0.22 cmH2O/μV. Additional EAdi waveform analysis to correct for non-physiological appearing waveforms, did not improve NMEoccl variability. Selecting three out of five occlusions with the lowest variability reduced the RC to 29.8%. Conclusions Repeated measurements of NMEoccl exhibit high variability, limiting the ability of a single NMEoccl maneuver to estimate neuromuscular efficiency and therefore the pressure generated by the inspiratory muscles based on EAdi. Electronic supplementary material The online version of this article (10.1186/s13054-018-2172-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diana Jansen
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annemijn H Jonkman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Postbox 7057, 1007, MB, Amsterdam, The Netherlands
| | - Lisanne Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suvarna Gadgil
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Gert-Jan J Scheffer
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Armand Girbes
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Postbox 7057, 1007, MB, Amsterdam, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christer S Sinderby
- Department of Critical Care Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Postbox 7057, 1007, MB, Amsterdam, The Netherlands.
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Tilanus TBM, Groothuis JT, Ten Broek-Pastoor JMC, Doorduin J, van Engelen BGM, Kampelmacher MJ, Raaphorst J. Respiratory Assessment of ALS Patients: A Nationwide Survey of Current Dutch Practice. J Neuromuscul Dis 2018:JND18302. [PMID: 30175982 DOI: 10.3233/jnd-18302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Non-invasive ventilation (NIV) is an established treatment for respiratory failure in patients with amyotrophic lateral sclerosis (ALS). Several studies have shown room for improvement with regard to respiratory care for ALS patients, including latency of referral. These studies focused on the time period starting at the moment of referral to a home ventilation service (HVS) onwards. In the current study we performed a nationwide survey to gain insight in the trajectory before referral. We questioned the assessment of respiratory impairment by ALS physicians/care teams, including criteria for referral to an HVS. METHODS We requested 40 ALS care teams in the Netherlands to fill in an online questionnaire on respiratory management in ALS patients. RESULTS Thirty-two ALS care teams (80%) responded. Forced vital capacity was the most frequently used test at each outpatient visit (72%) and often served as a criterion (78%) for referral to an HVS. Other respiratory function measurements that were performed less often included peak cough flow (50%), maximum inspiratory/expiratory pressure (31% /28%) and sniff nasal inspiratory pressure (13%). Morning headache was the most frequently questioned complaint (94%), followed by daytime sleepiness (91%). Dyspnoea and orthopnoea were reported by 38% and 59% as important complaints. Out of all patients under the care of the ALS care teams, the mean estimated proportion of patients that was referred to an HVS was 69% (range 20-100%). When physicians refrained from referral, the most often cited reasons were patient's decision to withhold NIV (94%) and cognitive impairment (50%). Sixteen percent of the respondents stated bulbar impairment as a reason to refrain from referral. CONCLUSION Despite findings in previous studies on the superiority of SNIP and PCF as compared to FVC, our study shows that a majority of ALS care teams still prefers to use FVC for the assessment of respiratory dysfunction and for the timing of referral to an HVS. Another finding is that bulbar impairment is not an obstacle for referral for NIV.
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Affiliation(s)
- T B M Tilanus
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J M C Ten Broek-Pastoor
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Doorduin
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Raaphorst
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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46
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van Alfen N, Doorduin J, van Rosmalen MHJ, van Eijk JJJ, Heijdra Y, Boon AJ, Gaytant MA, van den Biggelaar RJM, Sprooten RTM, Wijkstra PJ, Groothuis JT. Phrenic neuropathy and diaphragm dysfunction in neuralgic amyotrophy. Neurology 2018; 91:e843-e849. [PMID: 30054437 DOI: 10.1212/wnl.0000000000006076] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/25/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical phenotype and recovery of diaphragm dysfunction caused by neuralgic amyotrophy in a large cohort of patients, to improve accurate awareness of this entity, and to encourage adoption of a standardized approach for diagnosis and treatment. METHODS This observational cohort study recruited adult patients with neuralgic amyotrophy and symptoms of idiopathic phrenic neuropathy from the database of the Dutch expert center for neuralgic amyotrophy and the Dutch centers for home mechanical ventilation. Demographic and clinical information on diagnosis, symptoms, and recovery was obtained from chart review. We attempted to contact all patients for a follow-up interview. RESULTS Phrenic neuropathy occurs in 7.6% of patients with neuralgic amyotrophy. Unilateral diaphragmatic dysfunction and bilateral diaphragmatic dysfunction are frequently symptomatic, causing exertional dyspnea, orthopnea, disturbed sleep, and excessive fatigue. Diagnostic practices varied widely and were often not optimally targeted. The majority of patients experienced at least moderate recovery within 2 years. CONCLUSION We recommend screening every patient with neuralgic amyotrophy for diaphragm dysfunction by asking about orthopnea and by performing upright and supine vital capacity screening and diaphragm ultrasound in cases of suspected phrenic neuropathy to optimize diagnosis and care.
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Affiliation(s)
- Nens van Alfen
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands.
| | - Jonne Doorduin
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Marieke H J van Rosmalen
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Jeroen J J van Eijk
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Yvonne Heijdra
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Andrea J Boon
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Michael A Gaytant
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Ries J M van den Biggelaar
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Roy T M Sprooten
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Peter J Wijkstra
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Jan T Groothuis
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
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Oppersma E, Doorduin J, Gooskens PJ, Roesthuis LH, van der Heijden EHFM, van der Hoeven JG, Veltink PH, Heunks LMA. Glottic patency during noninvasive ventilation in patients with chronic obstructive pulmonary disease. Respir Physiol Neurobiol 2018; 259:53-57. [PMID: 30026086 DOI: 10.1016/j.resp.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-invasive ventilation (NIV) provides ventilatory support for patients with respiratory failure. However, the glottis can act as a closing valve, limiting effectiveness of NIV. This study investigates the patency of the glottis during NIV in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). METHODS Electrical activity of the diaphragm, flow, pressure and videolaryngoscopy were acquired. NIV was randomly applied in pressure support (PSV) and neurally adjusted ventilatory assist (NAVA) mode with two levels of support. The angle formed by the vocal cords represented glottis patency. RESULTS Eight COPD patients with acute exacerbation requiring NIV were included. No differences were found in median glottis angle during inspiration or peak inspiratory effort between PSV and NAVA at low and high support levels. CONCLUSIONS The present study showed that glottis patency during inspiration in patients with an acute exacerbation of COPD is not affected by mode (PSV or NAVA) or level of assist (5 or 15 cm H2O) during NIV.
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Affiliation(s)
- Eline Oppersma
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Jonne Doorduin
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Petra J Gooskens
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Lisanne H Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Erik H F M van der Heijden
- Department of Pulmonology, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Peter H Veltink
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands.
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands; Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007MB, Amsterdam, The Netherlands.
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Molenaar JP, Voermans NC, de Jong LA, Stegeman DF, Doorduin J, van Engelen BG. Repeatability and reliability of muscle relaxation properties induced by motor cortical stimulation. J Appl Physiol (1985) 2018. [PMID: 29543137 DOI: 10.1152/japplphysiol.00455.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Impaired muscle relaxation is a feature of many neuromuscular disorders. However, few tests are available to quantify muscle relaxation. Transcranial magnetic stimulation (TMS) of the motor cortex can induce muscle relaxation by abruptly inhibiting corticospinal drive. The aim of our study was to investigate whether repeatability and reliability of TMS-induced relaxation are greater than voluntary relaxation. Furthermore, effects of sex, cooling, and fatigue on muscle relaxation properties were studied. Muscle relaxation of deep finger flexors was assessed in 25 healthy subjects (14 men and 11 women, age 39.1 ± 12.7 and 45.3 ± 8.7 yr, respectively) with handgrip dynamometry. All outcome measures showed greater repeatability and reliability in TMS-induced relaxation compared with voluntary relaxation. The within-subject coefficient of variability of normalized peak relaxation rate was lower in TMS-induced relaxation than in voluntary relaxation (3.0% vs. 19.7% in men and 6.1% vs. 14.3% in women). The repeatability coefficient was lower (1.3 vs. 6.1 s-1 in men and 2.3 vs. 3.1 s-1 in women) and the intraclass correlation coefficient was higher (0.95 vs. 0.53 in men and 0.78 vs. 0.69 in women) for TMS-induced relaxation compared with voluntary relaxation. TMS enabled demonstration of slowing effects of sex, muscle cooling, and muscle fatigue on relaxation properties that voluntary relaxation could not. In conclusion, repeatability and reliability of TMS-induced muscle relaxation were greater compared with voluntary muscle relaxation. TMS-induced muscle relaxation has the potential to be used in clinical practice for diagnostic purposes and therapy effect monitoring in patients with impaired muscle relaxation. NEW & NOTEWORTHY Transcranial magnetic stimulation (TMS)-induced muscle relaxation demonstrates greater repeatability and reliability compared with voluntary relaxation, represented by the ability to demonstrate typical effects of sex, cooling, and fatigue on muscle relaxation properties that were not seen in voluntary relaxation. In clinical practice, TMS-induced muscle relaxation could be used for diagnostic purposes and therapy effect monitoring. Furthermore, fewer subjects will be needed for future studies when using TMS to demonstrate differences in muscle relaxation properties.
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Affiliation(s)
- J P Molenaar
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - N C Voermans
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - L A de Jong
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - D F Stegeman
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - J Doorduin
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - B G van Engelen
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
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Moraga‐Amaro R, van Waarde A, Doorduin J, de Vries EFJ. Sex steroid hormones and brain function: PET imaging as a tool for research. J Neuroendocrinol 2018; 30:e12565. [PMID: 29237239 PMCID: PMC5838537 DOI: 10.1111/jne.12565] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/26/2017] [Accepted: 12/06/2017] [Indexed: 12/15/2022]
Abstract
Sex steroid hormones are major regulators of sexual characteristic among species. These hormones, however, are also produced in the brain. Steroidal hormone-mediated signalling via the corresponding hormone receptors can influence brain function at the cellular level and thus affect behaviour and higher brain functions. Altered steroid hormone signalling has been associated with psychiatric disorders, such as anxiety and depression. Neurosteroids are also considered to have a neuroprotective effect in neurodegenerative diseases. So far, the role of steroid hormone receptors in physiological and pathological conditions has mainly been investigated post mortem on animal or human brain tissues. To study the dynamic interplay between sex steroids, their receptors, brain function and behaviour in psychiatric and neurological disorders in a longitudinal manner, however, non-invasive techniques are needed. Positron emission tomography (PET) is a non-invasive imaging tool that is used to quantitatively investigate a variety of physiological and biochemical parameters in vivo. PET uses radiotracers aimed at a specific target (eg, receptor, enzyme, transporter) to visualise the processes of interest. In this review, we discuss the current status of the use of PET imaging for studying sex steroid hormones in the brain. So far, PET has mainly been investigated as a tool to measure (changes in) sex hormone receptor expression in the brain, to measure a key enzyme in the steroid synthesis pathway (aromatase) and to evaluate the effects of hormonal treatment by imaging specific downstream processes in the brain. Although validated radiotracers for a number of targets are still warranted, PET can already be a useful technique for steroid hormone research and facilitate the translation of interesting findings in animal studies to clinical trials in patients.
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Affiliation(s)
- R. Moraga‐Amaro
- Department of Nuclear Medicine and Molecular ImagingUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - A. van Waarde
- Department of Nuclear Medicine and Molecular ImagingUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - J. Doorduin
- Department of Nuclear Medicine and Molecular ImagingUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - E. F. J. de Vries
- Department of Nuclear Medicine and Molecular ImagingUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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50
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Oppersma E, Doorduin J, van der Hoeven JG, Veltink PH, van Hees HWH, Heunks LMA. The effect of metabolic alkalosis on the ventilatory response in healthy subjects. Respir Physiol Neurobiol 2018; 249:47-53. [PMID: 29307724 DOI: 10.1016/j.resp.2018.01.002] [Citation(s) in RCA: 11] [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: 09/29/2017] [Revised: 12/07/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with acute respiratory failure may develop respiratory acidosis. Metabolic compensation by bicarbonate production or retention results in posthypercapnic alkalosis with an increased arterial bicarbonate concentration. The hypothesis of this study was that elevated plasma bicarbonate levels decrease respiratory drive and minute ventilation. METHODS In an intervention study in 10 healthy subjects the ventilatory response using a hypercapnic ventilatory response (HCVR) test was assessed, before and after administration of high dose sodium bicarbonate. Total dose of sodiumbicarbonate was 1000 ml 8.4% in 3 days. RESULTS Plasma bicarbonate increased from 25.2 ± 2.2 to 29.2 ± 1.9 mmol/L. With increasing inspiratory CO2 pressure during the HCVR test, RR, Vt, Pdi, EAdi and VE increased. The clinical ratio ΔVE/ΔPetCO2 remained unchanged, but Pdi, EAdi and VE were significantly lower after bicarbonate administration for similar levels of inspired CO2. CONCLUSION This study demonstrates that in healthy subjects metabolic alkalosis decreases the neural respiratory drive and minute ventilation, as a response to inspiratory CO2.
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Affiliation(s)
- E Oppersma
- MIRA - Institute for Biomedical Technology & Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Critical Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Doorduin
- Department of Critical Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J G van der Hoeven
- Department of Critical Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P H Veltink
- MIRA - Institute for Biomedical Technology & Technical Medicine, University of Twente, Enschede, The Netherlands
| | - H W H van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M A Heunks
- Department of Critical Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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