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Schroeder J, Schlesinger A, Burghaus L, Pape P, Balke M. Think TB! A rare case of influenza and rapid progressive Neurotuberculosis coinfection. J Travel Med 2024:taae025. [PMID: 38340321 DOI: 10.1093/jtm/taae025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/29/2024] [Indexed: 02/12/2024]
Abstract
An Indian migrant presented with increasing neurological symptoms after an acute influenza B infection. We diagnosed progressive neurotuberculosis—a rare and difficult case of tuberculosis and influenza co-infection. It highlights the importance of broad-based diagnostics in people from low- and middle-income countries, taking into account unusual manifestations of tuberculosis.
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Affiliation(s)
- J Schroeder
- Division of Infectious Diseases, Travel- and Tropical Medicine, Clinic for Internal Medicine, St. Marien Hospital, Cologne, Germany
| | - A Schlesinger
- Division of Infectious Diseases, Travel- and Tropical Medicine, Clinic for Internal Medicine, St. Marien Hospital, Cologne, Germany
| | - L Burghaus
- Clinic for Neurology, Heilig-Geist Hospital, Cologne, Germany
| | - P Pape
- Clinic for Neurological Early Rehabilitation, St. Marien Hospital, Cologne, Germany
| | - M Balke
- Clinic for Neurological Early Rehabilitation, St. Marien Hospital, Cologne, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
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Burghaus L, Madlener M, Kohle F, Bruno EF, Limmroth V, Fink GR, Malter MP. Prehospital Levetiracetam Use in Adults With Status Epilepticus: Results of a Multicenter Registry. J Clin Neurol 2023; 19:365-370. [PMID: 37417432 DOI: 10.3988/jcn.2022.0302] [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] [Received: 08/16/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Status epilepticus (SE) is a neurological emergency due to prolonged seizure activity or multiple seizures without full recovery in between them. Prehospital SE management is crucial since its duration is correlated with higher morbidity and mortality rates. We examined the impact of different therapeutic strategies in the prehospital setting with a focus on levetiracetam. METHODS We initiated the Project for SE in Cologne, a scientific association of all neurological departments of Cologne, the fourth-largest city in Germany with around 1,000,000 inhabitants. All patients with an SE diagnosis were evaluated over 2 years (from March 2019 to February 2021) to determine whether prehospital levetiracetam use had a significant effect on SE parameters. RESULTS We identified 145 patients who received initial drug therapy in the prehospital setting by professional medical staff. Various benzodiazepine (BZD) derivatives were used as first-line treatments, which were mostly used in line with the recommended guidelines. Levetiracetam was regularly used (n=42) and mostly in combination with BZDs, but no significant additional effect was observed for intravenous levetiracetam. However, it appeared that the administered doses tended to be low. CONCLUSIONS Levetiracetam can be applied to adults with SE in prehospital settings with little effort. Nevertheless, the prehospital treatment regimen described here for the first time did not significantly improve the preclinical cessation rate of SE. Future therapy concepts should be based on this, and the effects of higher doses should in particular be reexamined.
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Affiliation(s)
- Lothar Burghaus
- Department of Neurology, Heilig Geist-Hospital, Cologne, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Marie Madlener
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Felix Kohle
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emanuel F Bruno
- Department of Neurology, Cologne City Hospitals, Cologne, Germany
| | - Volker Limmroth
- Department of Neurology, Cologne City Hospitals, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Michael P Malter
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Kohle F, Madlener M, Bruno EF, Fink GR, Limmroth V, Burghaus L, Malter MP. Status epilepticus and benzodiazepine treatment: Use, underdosing and outcome - insights from a retrospective, multicentre registry. Seizure 2023; 107:114-120. [PMID: 37004393 DOI: 10.1016/j.seizure.2023.03.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE To explore the reasons for and outcomes of non- or undertreatment with benzodiazepines (BZDs) in status epilepticus (SE). METHODS We retrospectively analysed all SE patients from the urban area of Cologne over two years. RESULTS 328 SE patients were eligible, and only 72% were initially treated with BZDs. Of these, only 21.6% were treated sufficiently with BZDs according to current guidelines. SE patients not initially treated with BZDs were significantly older, had less often known epilepsy, had a prolonged arrival time to the emergency room, and presented more often with a non-generalised convulsive semiology. Regarding adequate dosages, patients with a generalised convulsive SE seemed to benefit from a sufficient BZD dosing with significantly shortened mean ventilation duration (37.1 to 208 h), decreased mean intensive care unit (1.7 to 5 days) and in-hospital stay (4.1 to 8.8 days). In contrary, aggressive BZD treatment in non-generalised convulsive SE resulted in a longer inpatient stay (9.2 to 5.8 days) and lower favourable outcome rates at discharge (16% to 63%). CONCLUSIONS The current SE treatment guidelines for first-line BZD therapy in SE were violated in most patients. Sufficient BZD dosing was beneficial in generalised convulsive SE, but not in other forms of SE. SE semiology might be crucial for treatment decisions with BZDs. Further treatment evidence especially in non-generalised convulsive SE is urgently needed.
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Affiliation(s)
- Felix Kohle
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany.
| | - Marie Madlener
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Emanuel F Bruno
- Department of Neurology & Palliative Medicine, Cologne City Hospitals, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Germany
| | - Volker Limmroth
- Department of Neurology & Palliative Medicine, Cologne City Hospitals, Cologne, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist Krankenhaus, Cologne, Germany
| | - Michael P Malter
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
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Winter Y, Mayer G, Kotterba S, Benes H, Burghaus L, Koch A, Girfoglio D, Setanoians M, Kallweit U. Solriamfetol real world experience study (SURWEY): Initiation, titration, safety, effectiveness, and experience during follow-up for patients with narcolepsy from Germany. Sleep Med 2023; 103:138-143. [PMID: 36796288 DOI: 10.1016/j.sleep.2023.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/14/2022] [Revised: 12/22/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a core narcolepsy symptom, for which solriamfetol (Sunosi®) was recently approved in the European Union. SURWEY characterises real-world strategies used by physicians when initiating solriamfetol, and patient outcomes after follow-up. METHODS SURWEY is an ongoing retrospective chart review conducted by physicians in Germany/France/Italy. Here, data are reported from 70 German patients with EDS and narcolepsy. Eligibility included age ≥18 years, reached a stable solriamfetol dose, and completed ≥6 weeks of treatment. Patients were classified (based on existing EDS treatment) into changeover, add-on, or new-to-therapy subgroups. RESULTS Patients' mean ± SD age was 36.9 ± 13.9 years. Changeover from prior EDS medication was the most common initiation strategy. Initial solriamfetol dose was typically 75 mg/day (69%). In 30 patients (43%), solriamfetol was titrated; 27/30 (90%) completed titration as prescribed, most within 7 days. Mean ± SD Epworth Sleepiness Scale (ESS) score was 17.6 ± 3.1 at initiation (n = 61) and 13.6 ± 3.8 at follow-up (n = 51). Slight/strong improvements in EDS were perceived for >90% of patients (patient and physician report). Sixty-two percent reported an effect duration of 6 to <10 h; 72% reported no change in perceived nighttime sleep quality. Common adverse events included headache (9%), decreased appetite (6%), and insomnia (6%); no cardiovascular events were reported. CONCLUSIONS Most patients in this study were switched from a prior EDS medication to solriamfetol. Solriamfetol was typically initiated at 75 mg/day; titration was common. ESS scores improved after initiation, and most patients perceived improvement in EDS. Common adverse events were consistent with those reported in clinical trials. CLINICALTRIALS GOV REGISTRATION N/A.
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Affiliation(s)
- Yaroslav Winter
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany; Department of Neurology, Philipps-University, Biegenstraße 10, 35037, Marburg, Germany.
| | - Geert Mayer
- Hephata Klinik, Schimmelpfengstraße 6, 34613, Schwalmstadt, Germany; Philipps University, Biegenstraße 10, 35037, Marburg, Germany
| | - Sylvia Kotterba
- Klinikum Leer gGmbH, Augustenstraße 35, 26789, Leer (Ostfriesland), Lower Saxony, Germany
| | - Heike Benes
- Somni bene GmbH Institut für Medizinische Forschung and Schlafmedizin Schwerin GmbH, Goethestraße 1, 19053, Schwerin, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist-Hospital, Graseggerstr. 105, 50737, Cologne-Longerich, Germany
| | - Andreas Koch
- Jazz Pharmaceuticals, Einsteinstrasse 174, 81677, München, Munich, Germany
| | - Daniela Girfoglio
- Jazz Pharmaceuticals, Wing B, Building 5700, Spires House, John Smith Drive, Oxford Business Park South, Oxford, OX4 2RW, United Kingdom
| | - Melinda Setanoians
- Jazz Pharmaceuticals, Wing B, Building 5700, Spires House, John Smith Drive, Oxford Business Park South, Oxford, OX4 2RW, United Kingdom
| | - Ulf Kallweit
- Institute of Immunology and Center for Biomedical Education and Research, University Witten/Herdecke, Stockumer Str. 10, 58453, Witten, Germany
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Votteler S, Knaack L, Janicki J, Fink GR, Burghaus L. Sex differences in polysomnographic findings in patients with obstructive sleep apnea. Sleep Med 2023; 101:429-436. [PMID: 36516599 DOI: 10.1016/j.sleep.2022.11.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Sex differences in the clinical findings and the polysomnographic presentation of patients with obstructive sleep apnea (OSA) are compelling current research issues. For example, patients suffering from obstructive sleep apnea are predominantly male. While women are older than men and tend to have a higher body mass index, men typically present with a more severe form of obstructive sleep apnea. Using polysomnography, we investigated a German cohort, subdivided per severity levels of obstructive sleep apnea (apnea-hypopnea index: ≥5 to < 15/h (mild), ≥15 to < 30/h (moderate), and ≥30/h (severe)) to provide a detailed analysis of breathing and sleep parameters, accounting for body position effects and severity of illness. A deeper understanding of sex differences may allow targeted diagnosis and treatment adjustment. PATIENTS AND METHODS This retrospective study included a cohort of 1242 German patients (940 male, 302 female) who underwent overnight polysomnography at the private sleep laboratory "Intersom Köln", Center for Sleep Medicine and Sleep Research. In 1125 subjects (878 male, 247 female), obstructive sleep apnea was diagnosed. All patients were examined between January 01, 2018 and December 31, 2020, comparing anthropometric, sleep morphological, and respiratory polysomnographic findings. RESULTS Female patients with obstructive sleep apnea were significantly older than male patients (60.9 ± 12.3 vs. 56.9 ± 12.5 years, P < .001), also among OSA subgroups per OSA severity. The body mass index was similar in male and female patients (29.6 ± 5.1 vs. 29.2 ± 7.3 kg/m2, P > .05), including the three subgroups. Men were more likely to have severe obstructive sleep apnea (46.9%) than women (35.2%). Women exhibited a higher proportion of slow-wave sleep than men (129.4 ± 52.8 vs. 104.2 ± 53.2 min; P < .001). The apnea-hypopnea index of total sleep time was significantly greater in male than female patients (32.9 ± 21.2 vs. 27.2 ± 20.2 per hour; P < .001). Female patients had a higher apnea-hypopnea index during rapid-eye-movement (REM) sleep (34.0 ± 23.8 vs. 31.8 ± 22.3 per hour; P = .171). A statistically significant difference in the apnea-hypopnea index during REM sleep between sexes was found when the obstructive sleep apnea severity was considered. Women had a lower apnea-hypopnea index in non-rapid eye-movement (NREM) sleep than men (25.7 ± 21.1 vs. 32.7 ± 22.3 per hour; P < .001). The oxygen desaturation index (29.9 ± 20.3 vs. 22.4 ± 19.4%; P < .001) and an oxygen desaturation below 90% (9.4 ± 14.0 vs. 6.8 ± 11.7%; P = .003) was greater in men than in women. In severe obstructive sleep apnea, the oxygen desaturation index was similar between the sexes (45.0 ± 17.8 vs. 41.1 ± 20.9%; P = .077). Male patients showed a higher supine apnea-hypopnea-index than female patients. (45.7 ± 26.7 vs 36.1 ± 22.7 per hour; P < .001). CONCLUSION The present noninvasive, retrospective registry study is the first to examine sex differences in OSA in such a large German population in terms of respiratory and sleep parameters, taking into account the effects of body position and severity of the disease. We could confirm and extend observations from previous studies. Female patients were significantly older than the male patients. The apnea-hypopnea index was higher in male than in female patients. Women showed a higher apnea-hypopnea index in REM sleep and a lower one in NREM sleep. Men were desaturated more often and were more affected by supine-dependent obstructive sleep apnea than women. Contrary to the literature, there were no significant differences in body mass index (BMI) between the sexes. With increasing age and BMI, the gender differences become less significant.
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Affiliation(s)
- Sinje Votteler
- Sleep Laboratory "Intersom Köln" Center for Sleep Medicine and Sleep Research, Im Mediapark 4D, Cologne, 50670, Germany; Department of Neurology, Faculty of Medicine and University Hospital, Cologne, 50937, Germany.
| | - Lennart Knaack
- Sleep Laboratory "Intersom Köln" Center for Sleep Medicine and Sleep Research, Im Mediapark 4D, Cologne, 50670, Germany.
| | - Jaroslaw Janicki
- Sleep Laboratory "Intersom Köln" Center for Sleep Medicine and Sleep Research, Im Mediapark 4D, Cologne, 50670, Germany.
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital, Cologne, 50937, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, 52428, Germany.
| | - Lothar Burghaus
- Department of Neurology, Faculty of Medicine and University Hospital, Cologne, 50937, Germany; Department of Neurology, Heilig-Geist-Hospital, Graseggerstraße 105, Cologne, Germany.
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Kallweit U, Winter Y, Kotterba S, Benes H, Burghaus L, Koch A, Girfoglio D, Setanoians M, Mayer G. 039 Solriamfetol real world experience study (SURWEY): safety and effectiveness for patients with narcolepsy from Germany. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionSolriamfetol is a dopamine/norepinephrine reuptake inhibitor approved in the EU for excessive daytime sleepiness (EDS) associated with narcolepsy. This real-world study characterises outcomes following solriamfetol initiation.MethodsSURWEY is an ongoing retrospective chart review (Germany, France, Italy). Patients (≥18 years old, EDS due to narcolepsy, stable solriamfetol dose, ≥6 weeks of treatment) were classified by solriamfe- tol initiation: changeover (from existing EDS medications), add-on (to current EDS medication), or new- to-therapy (no current/prior EDS medication). Epworth Sleepiness Scale (ESS) scores, patient/physician impressions of improvement, and adverse events (AEs) were assessed.ResultsAmong 78 German patients (36.9±13.9 years old; 56% female, 57% with cataplexy), changeo- ver was most common (n=43), followed by add-on (n=19) and new-to-therapy (n=8). Final follow-up was 15.9±7.0 weeks after initiation. Overall, ESS scores were 17.6±3.1 (n=61) at initiation and 13.6±3.8 at follow-up (n=51), indicating improvement of EDS (improvements similar across subgroups). Most patients perceived slight/strong improvements in their condition (physician report, 94%; patient report, 91%; results similar across subgroups). Common AEs: headache (9%), decreased appetite (6%), insomnia (6%).ConclusionIn this real-world cohort of German patients with narcolepsy, EDS improved across all subgroups with solriamfetol treatment. AEs were consistent with those reported in clinical trials.SupportJazz Pharmaceuticals.
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Kohle F, Madlener M, Bruno EF, Fink GR, Limmroth V, Burghaus L, Malter MP. Status epilepticus during the COVID-19 pandemic in Cologne, Germany: data from a retrospective, multicentre registry. J Neurol 2022; 269:5710-5719. [PMID: 35802201 PMCID: PMC9266085 DOI: 10.1007/s00415-022-11260-2] [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: 05/06/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
Background The “coronavirus disease 2019” (COVID-19) pandemic, caused by the “severe-acute-respiratory-syndrome-coronavirus 2” (SARS-CoV-2), challenges healthcare systems worldwide and impacts not only COVID-19 patients but also other emergencies. To date, data are scarce on the extent to which the COVID-19 pandemic impacted status epilepticus (SE) and its treatment. Objective To assess the influence of the COVID-19 pandemic on the incidence, management and outcome of SE patients. Study design This is a retrospective, multicentre trial, approved by the University of Cologne (21-1443-retro). Methods All SE patients from the urban area of Cologne transmitted to all acute neurological departments in Cologne between 03/2019 and 02/2021 were retrospectively analysed and assessed for patient characteristics, SE characteristics, management, and outcome in the first pandemic year compared to the last pre-pandemic year. Results 157 pre-pandemic (03/2019–02/2020) and 171 pandemic (from 03/2020 to 02/2021) SE patients were included in the analyses. Acute SARS-CoV-2 infections were rarely detected. Patient characteristics, management, and outcome did not reveal significant groupwise differences. In contrast, regarding prehospital management, a prolonged patient transfer to the hospital and variations in SE aetiologies compared to the last pre-pandemic year were observed with less chronic vascular and more cryptogenic and anoxic SE cases. No infections with SARS-CoV-2 occurred during inpatient stays. Conclusions SARS-CoV-2 infections did not directly affect SE patients, but the transfer of SE patients to emergency departments was delayed. Interestingly, SE aetiology rates shifted, which warrants further exploration. Fears of contracting an in-hospital SARS-CoV-2-infection were unfounded due to consequent containment measures. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11260-2.
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Affiliation(s)
- Felix Kohle
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Kerpener Strasse, 62, 50937, Cologne, Germany.
| | - Marie Madlener
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Kerpener Strasse, 62, 50937, Cologne, Germany
| | | | - Gereon Rudolf Fink
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Kerpener Strasse, 62, 50937, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Volker Limmroth
- Department of Neurology and Palliative Medicine, Cologne City Hospitals, Cologne, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist Krankenhaus, Cologne, Germany
| | - Michael Peter Malter
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Kerpener Strasse, 62, 50937, Cologne, Germany.
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Madlener M, Onur OA, Müller-Ehmsen J, Fink GR, Burghaus L. [Acute Aortic Dissection: A Life-Threatening Disease Also in Neurological Emergency Medicine]. Fortschr Neurol Psychiatr 2022; 90:571-579. [PMID: 35508194 DOI: 10.1055/a-1802-3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acute aortic dissection is rare but life-threatening. The symptoms depend on the localization and reduced perfusion of the downstream organs or limbs and are therefore variable. Neurological symptoms may occur that do not immediately lead to a diagnosis and thus delay the necessary therapy. Knowing the early symptoms and warning signs of aortic dissection is therefore also crucial in neurological emergency care for quickly identifying the affected patients and for providing acute therapy. A misdiagnosis with delayed initiation of therapy can significantly worsen the patient's outcome. This study aims to establish a standardized diagnostic and therapeutic algorithm for suspected acute aortic dissection in neurological emergency care. Close interdisciplinary cooperation is mandatory.
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Affiliation(s)
- Marie Madlener
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Germany
| | - Oezguer A Onur
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Germany
| | | | - Gereon R Fink
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Germany.,Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Lothar Burghaus
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Germany.,Klinik für Neurologie, Heilig Geist-Krankenhaus Köln, Köln, Germany
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9
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Golla H, Dillen K, Hellmich M, Dojan T, Ungeheuer S, Schmalz P, Staß A, Mildenberger V, Goereci Y, Dunkl V, Strupp J, Fink GR, Voltz R, Stock S, Cornely O, Stahmann A, Müller A, Löcherbach P, Burghaus L, Limmroth V, Bonmann E, Gerbershagen K, Nelles G, Joist T, Haas J, Temmes H, Warnke C. Communication, Coordination, and Security for People with Multiple Sclerosis (COCOS-MS): a randomised phase II clinical trial protocol. BMJ Open 2022; 12:e049300. [PMID: 35078833 PMCID: PMC8796263 DOI: 10.1136/bmjopen-2021-049300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patients with multiple sclerosis (MS) have complex needs that range from organising one's everyday life to measures of disease-specific therapy monitoring to palliative care. Patients with MS are likely to depend on multiple healthcare providers and various authorities, which are often difficult to coordinate. Thus, they will probably benefit from comprehensive cross-sectoral coordination of services provided by care and case management (CCM). Though studies have shown that case management improves quality of life (QoL), functional status and reduces service use, such benefits have not yet been investigated in severely affected patients with MS. In this explorative phase ll clinical trial, we evaluated a CCM with long-term, cross-sectoral and outreaching services and, in addition, considered the unit of care (patients and caregivers). METHODS AND ANALYSIS Eighty patients with MS and their caregivers will be randomly assigned to either the control (standard care) or the intervention group (standard care plus CCM (for 12 months)). Regular data assessments will be done at baseline and then at 3-month intervals. As primary outcome, we will evaluate patients' QoL. Secondary outcomes are patients' treatment-related risk perception, palliative care needs, anxiety/depression, use of healthcare services, caregivers' burden and QoL, meeting patients' and caregivers' needs, and evaluating the CCM intervention. We will also evaluate CCM through individual interviews and focus groups. The sample size calculation is based on a standardised effect of 0.5, and one baseline and four follow-up assessments (with correlation 0.5). Linear mixed models for repeated measures will be applied to analyse changes in quantitative outcomes over time. Multiple imputation approaches are taken to assess the robustness of the results. The explorative approach (phase ll clinical trial) with embedded qualitative research will allow for the development of a final design for a confirmative phase lll trial. ETHICS AND DISSEMINATION The trial will be conducted under the Declaration of Helsinki and has been approved by the Ethics Commission of Cologne University's Faculty of Medicine. Trial results will be published in an open-access scientific journal and presented at conferences. TRIAL REGISTRATION NUMBER German Register for Clinical Studies (DRKS) (DRKS00022771).
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Affiliation(s)
- Heidrun Golla
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Kim Dillen
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Solveig Ungeheuer
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Petra Schmalz
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Angelika Staß
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Vanessa Mildenberger
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
- Cognitive Neuroscience, Institute of Neurosciences and Medicine, Jülich, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Oliver Cornely
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Alexander Stahmann
- MS-Registry by the German MS-Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Anne Müller
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Peter Löcherbach
- German Society for Care and Case Management (DGCC), Mainz, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist-Krankenhaus Köln, Cologne, Germany
| | | | | | | | - Gereon Nelles
- NeuroMed Campus, MedCampus Hohenlind, Cologne, Germany
| | - Thomas Joist
- Academic Teaching Practice, University of Cologne, Cologne, Germany
| | - Judith Haas
- German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
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10
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Kermer P, Eschenfelder CC, Diener HC, Grond M, Abdalla Y, Abraham A, Althaus K, Becks G, Berrouschot J, Berthel J, Bode FJ, Burghaus L, Cangür H, Daffertshofer M, Edelbusch S, Eggers J, Gerlach R, Gröschel K, Große-Dresselhaus F, Günther A, Haase CG, Haensch CA, Harloff A, Heckmann JG, Held V, Hieber M, Kauert A, Kern R, Kerz T, Köhrmann M, Kraft P, Kühnlein P, Latta J, Leinisch E, Lenz A, Leithner C, Neumann-Haefelin T, Mäurer M, Müllges W, Nolte CH, Obermann M, Partowi S, Patzschke P, Poli S, Pulkowski U, Purrucker J, Rehfeldt T, Ringleb PA, Röther J, Rossi R, El-Sabassy H, Sauer O, Schackert G, Schäfer N, Schellinger PD, Schneider A, Schuppner R, Schwab S, Schwarte O, Seitz RJ, Senger S, Shah YP, Sindern E, Sparenberg P, Steiner T, Szabo K, Urbanek C, Sarnowksi BV, Weissenborn K, Wienecke P, Witt K, Wruck R, Wunderlich S. Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany-Updated series of 120 cases. Int J Stroke 2020; 15:609-618. [PMID: 31955706 DOI: 10.1177/1747493019895654] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Thereby, patients with acute ischemic stroke who are on dabigatran treatment may become eligible for thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth. AIMS To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of acute ischemic stroke or intracranial hemorrhage. METHODS Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January 2016 to August 2018 were used. RESULTS One-hundred and twenty stroke patients received idarucizumab in 61 stroke centers. Eighty patients treated with dabigatran presented with ischemic stroke and 40 patients suffered intracranial bleeding (intracerebral hemorrhage (ICH) in n = 27). In patients receiving intravenous thrombolysis with rt-PA following idarucizumab, 78% showed a median improvement of 7 points in National Institutes of Health Stroke Scale. No bleeding complications were reported. Hematoma growth was observed in 3 out of 27 patients with ICH. Outcome was favorable with a median National Institutes of Health Stroke Scale improvement of 4 points and modified Rankin score 0-3 in 61%. Six out of 40 individuals (15%) with intracranial bleeding died during hospital stay. CONCLUSION Administration of rt-PA after reversal of dabigatran activity with idarucizumab in case of acute ischemic stroke seems feasible, effective, and safe. In dabigatran-associated intracranial hemorrhage, idarucizumab appears to prevent hematoma growth and to improve outcome.
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Affiliation(s)
- Pawel Kermer
- Department of Neurology, Nordwestkrankenhaus Sanderbusch, Sande and Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | | | | | | | - Yasser Abdalla
- Department of Neurosurgery, Nordwestkrankenhaus Sanderbusch, Sande, Germany
| | - Alexej Abraham
- Department of Neurology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | | | - Gebhard Becks
- Department of Neurology, Klinikum Itzehoe, Itzehoe, Germany
| | - Jörg Berrouschot
- Department of Neurology, Klinikum Altenburger Land GmbH, Altenburg, Germany
| | - Jörg Berthel
- Department of Neurology, Klinikum Fulda, Fulda, Germany
| | - Felix J Bode
- Department of Neurology, University Bonn, Bonn, Germany.,Department of Neurology, German Center for Neurodegenerative Disease, Bonn, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist-Krankenhaus, Köln, Germany
| | - Hakan Cangür
- Department of Neurology, Klinikum Wolfsburg, Wolfsburg, Germany
| | | | | | - Jürgen Eggers
- Department of Neurology, Sana Kliniken Lübeck, Lübeck, Germany
| | - Rüdiger Gerlach
- Department of Neurosurgery, Helios Klinikum Erfurt, Erfurt, Germany
| | - Klaus Gröschel
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Claus G Haase
- Department of Neurology and clinical Neurophysiology, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Germany
| | | | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Valentin Held
- Department of Neurology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Maren Hieber
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Andreas Kauert
- Department of Neurology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Rolf Kern
- Department of Neurology, Klinikverbund Kempten-Oberallgäu, Kempten, Germany
| | - Thomas Kerz
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Martin Köhrmann
- Department of Neurology, University Hospital, Essen, Germany
| | - Peter Kraft
- Department of Neurology, Klinikum Main-Spessart, Lohr, Germany.,Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Peter Kühnlein
- Department of Neurology, Regiomed-Kliniken, Coburg, Germany
| | - Jan Latta
- Department of Neurology, Helios Klinik, Hildburghausen, Germany
| | - Elke Leinisch
- Department of Neurology, Helios Klinikum, Erfurt, Germany
| | - Arne Lenz
- Department of Neurology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Christoph Leithner
- Department of Neurology, Campus Virchow-Klinikum, Charité, Berlin, Germany
| | | | - Mathias Mäurer
- Department of Neurology, Klinikum Würzburg Mitte, Würzburg, Germany
| | - Wolfgang Müllges
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Christian H Nolte
- Department of Neurology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Someieh Partowi
- Stroke Unit, Marienhaus Klinikum, Kreis Ahrweiler, Bad Neuenahr-Ahrweiler, Germany
| | | | - Sven Poli
- Department of Neurology with Focus on Neurovascular Diseases and Neurooncology and Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Tübingen, Germany
| | | | - Jan Purrucker
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Torsten Rehfeldt
- Department of Neurology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
| | - Raluca Rossi
- Department of Neurology, Main-Kinzig-Kliniken, Gelnhausen, Germany
| | | | - Oliver Sauer
- Department of Neurology, Diakonie-Klinikum, Schwäbisch-Hall
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Dresden, Dresden, Germany
| | | | - Peter D Schellinger
- Department of Neurology and Neurogeriatry, Johannes Wesling Klinikum Minden, University Hospital, Minden, Germany
| | - Andreas Schneider
- Department of Neurology and clinical Neurophysiology, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Olav Schwarte
- Department of Neurology, Kreiskliniken Altötting-Burghausen, Altötting, Germany
| | - Rüdiger J Seitz
- Department of Neurology, Centre of Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sebastian Senger
- Department for Neurosurgery, Saarland University Hospital, Homburg, Germany
| | - Yogesh P Shah
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - Eckhart Sindern
- Department for Neurology, Diakovere Friederikenstift, Hannover, Germany
| | - Paul Sparenberg
- Department for Neurology, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Kristina Szabo
- Department of Neurology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Christian Urbanek
- Department for Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | | | | | - Peter Wienecke
- Department for Neurology, Asklepios Fachklinik Teupitz, Teupitz, Germany
| | - Karsten Witt
- Department for Neurology and Research Center Neurosensory Science, Carl von Ossietzky-University, Oldenburg, Germany
| | - Robert Wruck
- Department of Neurology, Klinikum Mittelbaden, Rastatt, Germany
| | - Silke Wunderlich
- Department for Neurology, Klinikum rechts der Isar, TU München, München, Germany
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11
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Burghaus L, Dohmen C, Malter M. [Status epilepticus]. Fortschr Neurol Psychiatr 2018; 86:279-286. [PMID: 29843177 DOI: 10.1055/a-0576-6950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Status epilepticus is a neurologic emergency manifested by prolonged seizure activity or multiple seizures without full recovery of previous condition in between. The most important aim of treatment is early seizure termination, because duration of status epilepticus correlates with a higher rate of morbidity and mortality. Based on evidence from clinical trials and guidelines strategies for management of status epilepticus are provided.
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12
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Friedemann M, Doberauer C, Fink GR, Burghaus L. [Ciguatera or why you should enquire about fish consumption in cases of cold allodynia]. Fortschr Neurol Psychiatr 2017; 85:611-615. [PMID: 29017199 DOI: 10.1055/s-0043-118336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ciguatoxine sind potente, von Mikroalgen produzierte, marine Biotoxine, die sich in tropischen Raubfischen, lokal und saisonal unterschiedlich stark, anreichern können. Kurze Zeit nach dem Fischverzehr treten gastrointestinale, neurologische und/oder kardiovaskuläre Vergiftungssymptome auf. Durch die hohe Affinität der Toxine zu neuronalen Natriumkanälen sind neurologische Symptome für Ciguatera-Vergiftungen charakteristisch. Nahezu pathognomonisch ist dabei die Kälteallodynie, bei der kalte Oberflächen als heiß, schmerzhaft oder extrem unangenehm empfunden werden. Durch Importe von Tropenfisch tritt Ciguatera zunehmend auch in gemäßigten Klimazonen auf. Wir erläutern anhand zweier Fälle die Besonderheiten dieser Fischvergiftung.
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Affiliation(s)
| | | | - Gereon R Fink
- Klinik und Poliklinik fur Neurologie, Uniklinik Köln.,Institut für Neurowissenschaften und Medizin (INM 3), Forschungszentrum Jülich
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13
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Malter MP, Nass RD, Kaluschke T, Fink GR, Burghaus L, Dohmen C. New onset status epilepticus in older patients: Clinical characteristics and outcome. Seizure 2017; 51:114-120. [PMID: 28843069 DOI: 10.1016/j.seizure.2017.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/09/2017] [Accepted: 08/13/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE We here evaluated (1) the differential characteristics of status epilepticus (SE) in older (≥60 years) compared to younger adults (18-59 years). In particular, we were interested in (2) the proportion and characteristics of new onset SE in patients with no history of epilepsy (NOSE) in older compared to younger adults, and (3) predictive parameters for clinical outcome in older subjects with NOSE. METHODS We performed a monocentric retrospective analysis of all adult patients (≥18years) admitted with SE to our tertiary care centre over a period of 10 years (2006-2015) to evaluate clinical characteristics and short-time outcome at discharge. RESULTS One-hundred-thirty-five patients with SE were included in the study. Mean age at onset was 64 years (range 21-90), eighty-seven of the patients (64%) were older than 60 years. In 76 patients (56%), SE occurred as NOSE, sixty-seven percent of them were aged ≥60 years. There was no age-dependent predominance for NOSE. NOSE was not a relevant outcome predictor, especially regarding age-related subgroups. Older patients with NOSE had less frequently general tonic clonic SE (GTCSE; p=0.001) and were more often female (p=0.01). Regarding outcome parameters and risk factors in older patients with NOSE, unfavourable outcome was associated with infections during in-hospital treatment (0.04), extended stay in ICU (p=0.001), and generally in hospital (p<0.001). CONCLUSION In our cohort, older patients represented the predominant subgroup in patients with SE. Older patients suffered more often from non-convulsive semiology and had a less favourable short-time outcome. NOSE was not a predictive outcome parameter in older patients. Data suggest that avoiding infections should have a priority because higher infection rates were associated with unfavourable outcome.
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Affiliation(s)
- M P Malter
- Department of Neurology, University of Cologne, Germany.
| | - R D Nass
- Department of Neurology, University of Cologne, Germany; Department of Epileptology, University of Bonn, Germany
| | - T Kaluschke
- Department of Neurology, University of Cologne, Germany
| | - G R Fink
- Department of Neurology, University of Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - L Burghaus
- Department of Neurology, University of Cologne, Germany; Heilig Geist Krankenhaus, Cologne, Germany
| | - C Dohmen
- Department of Neurology, University of Cologne, Germany
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14
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Pelzer EA, Nelles C, Pedrosa DJ, Eggers C, Burghaus L, Melzer C, Tittgemeyer M, Timmermann L. Structural differences in impaired verbal fluency in essential tremor patients compared to healthy controls. Brain Behav 2017; 7:e00722. [PMID: 28729930 PMCID: PMC5516598 DOI: 10.1002/brb3.722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 02/23/2017] [Accepted: 03/28/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE We wanted to identify differences in grey and white matter in essential tremor patients compared to controls in the non-motor domain, using the example of impaired verbal fluency. BACKGROUND A disturbance of verbal fluency in essential tremor patients compared to healthy controls is behaviorally well described. METHODS Voxel-based morphometry and tract-based spatial statistics were used to analyze structural differences in grey and white matter in 19 essential tremor patients compared to 23 age- and gender-matched controls. RESULTS Several significant observations were made. (I) There was less grey matter in the predominantly right precuneus in the essential tremor group compared to controls [p < .001]. (II) In ET patients mean, axial, and radial diffusivity values broadly correlated with the tremor rating scale, pronounced in fronto-parietal regions [p < .05]. (III) In ET patients there was a significant decline in fractional anisotropy values in the corpus callosum in the correlation with verbal fluency results [p < .05]; by inclusion of the tremor rating scale as covariate of no interest this significance was however diminished to a tendency (p < .1). No significant results were found in these within-group correlations in grey matter analyses for ET patients (p > .05). CONCLUSION The present results indicate that non-motor symptoms such as verbal fluency (VBF) in ET have a structural substrate; their reproduction requires the integration of potential environmental plasticity effects, differentiation into individual clinical subtypes and a careful handling with methodological peculiarities of structural MR imaging.
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Affiliation(s)
- Esther A Pelzer
- Max Planck Institute for Metabolism Research Cologne Cologne Germany
| | - Christian Nelles
- Department of Neurology University Hospital Cologne Cologne Germany
| | - David J Pedrosa
- Department of Neurology University Hospital Cologne Cologne Germany
| | - Carsten Eggers
- Department of Neurology University Hospital Cologne Cologne Germany
| | - Lothar Burghaus
- Department of Neurology University Hospital Cologne Cologne Germany
| | - Corina Melzer
- Max Planck Institute for Metabolism Research Cologne Cologne Germany
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research Cologne Cologne Germany
| | - Lars Timmermann
- Department of Neurology University Hospital Cologne Cologne Germany
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15
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Schneider C, Danek A, Hostmann A, Fink GR, Burghaus L. [Early Diagnosis of Chorea-Acanthocytosis: Orofacial Dyskinesia, Epileptic Seizures, and HyperCKemia]. Fortschr Neurol Psychiatr 2017; 85:270-273. [PMID: 28561176 DOI: 10.1055/s-0042-123042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chorea-acanthocytosis is an uncommon neurodegenerative disorder. Early diagnosis is often challenging. The triad of orofacial dyskinesia, epileptic seizures, and hyperCKemia should alert neurologists of a neuroacanthocytosis syndrome. The diagnosis can be confirmed by detection of chorein deficiency or through molecular genetics (VPS13A mutation).
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Affiliation(s)
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München
| | | | - Gereon R Fink
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
- Institut für Neurowissenschaften und Medizin (INM 3), Forschungszentrum Jülich
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16
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Pedrosa DJ, Nelles C, Maier F, Eggers C, Burghaus L, Fink GR, Wittmann M, Timmermann L. Variance of essential tremor patients' time reproduction deficits. Mov Disord 2016; 31:1428-9. [PMID: 27501132 DOI: 10.1002/mds.26736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 06/17/2016] [Accepted: 06/19/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- David J Pedrosa
- Department of Neurology, University Hospital Cologne, Cologne, Germany. .,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Christian Nelles
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Franziska Maier
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Jülich, Jülich, Germany
| | - Marc Wittmann
- Institute for Frontier Areas of Psychology and Mental Health, Department of Empirical and Analytical Psychophysics, Freiburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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17
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Leuenhagen S, Burghaus L, Kukolja J, Rosenkranz S, Kabbasch C, Fink GR, Onur OA. [The Therapeutic Dilemma in Treatment of Intracranial Infectious Aneurysm in Patients with Infective Endocarditis: Proposal for a Patient-Centered, Interdisciplinary Treatment Concept]. Fortschr Neurol Psychiatr 2016; 84:411-8. [PMID: 27471999 DOI: 10.1055/s-0042-110850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intracranial infectious aneurysms are rare but hazardous complications of an infective endocarditis. To date, there are no evidence-based recommendations for the treatment of patients with this condition. Therefore, it remains an interdisciplinary challenge to decide which treatment steps are required and in which order they should be carried out. To illustrate the interdisciplinary dilemma in the treatment of these patients, we here present a case of a 23-year-old, drug-addicted woman with infectious endocarditis. While antibiotic treatment of the streptococcus-mitis-induced endocarditis stabilized the overall status of the patient, rupture of a basilar artery aneurysm caused her sudden death. We discuss the decision-making processes of the treatment, potential difficulties and dilemmas when dealing with patients suffering from infectious endocarditis and infectious intracranial aneurysm. Based upon case reports, studies and reviews, we present the options and risks of conservative, neurosurgical, endovascular, and cardiosurgical treatment of intracranial infectious aneurysms, and propose a patient-centered, interdisciplinary treatment concept.
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Affiliation(s)
- S Leuenhagen
- Uniklinik Köln, Klinik und Poliklinik für Neurologie, Köln
| | - L Burghaus
- Heilig Geist-Krankenhaus Köln, Klinik für Neurologie, Köln
| | - J Kukolja
- Uniklinik Köln, Klinik und Poliklinik für Neurologie, Köln
| | - S Rosenkranz
- Uniklinik Köln, Klinik III für Innere Medizin und Zentrum für Molekulare Medizin Köln (ZMMK), Herzzentrum, Köln
| | - C Kabbasch
- Uniklinik Köln, Institut und Poliklinik für Radiologische Diagnostik, Köln
| | - G R Fink
- Uniklinik Köln, Klinik und Poliklinik für Neurologie, Köln
| | - O A Onur
- Uniklinik Köln, Klinik und Poliklinik für Neurologie, Köln
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18
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Lehnhardt FG, Scheid C, Holtik U, Burghaus L, Neveling M, Impekoven P, Rüger A, Hallek M, Jacobs AH, Rubbert A. Autologous blood stem cell transplantation in refractory systemic lupus erythematodes with recurrent longitudinal myelitis and cerebral infarction. Lupus 2016; 15:240-3. [PMID: 16686265 DOI: 10.1191/0961203306lu2269cr] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Autologous hematopoietic stem cell transplantation (ASCT) has the potential to eliminate autoreactive lymphocytes and may represent a therapeutic option for patients with refractory autoimmune diseases. We describe a 19-year old woman with neuropsychiatric systemic lupus erythematodes (NPSLE) presenting with acute longitudinal myelitis and aseptic meningitis. Despite therapy with methylprednisolone and cyclophosphamide (CYC), recurrence of longitudinal myelitis and a disabling stroke-like relapse occurred. Hematopoietic stem cells were mobilized by CYC at 2 g/m2 and G-CSF. The patient was conditioned by CYC at 200 mg/kg and anti-thymocyte globulin and 3.6 = 106 CD34+ cells/kg were infused. Hematopoietic regeneration was observed on day 12 after ASCT. Currently, 18 months after ASCT, the patient is in clinical remission with no evidence for residual serological or neuroradiological activity of SLE. Although a longer follow-up will be needed to reliably assess the efficacy of ASCT in this patient, the present case demonstrates that ASCT may represent a therapeutic option for patients with severe NPSLE.
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Affiliation(s)
- F G Lehnhardt
- Department of Neurology, University of Cologne, Germany
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19
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Pedrosa DJ, Nelles C, Maier F, Eggers C, Burghaus L, Fink GR, Wittmann M, Timmermann L. Time reproduction deficits in essential tremor patients. Mov Disord 2016; 31:1234-40. [PMID: 27091412 DOI: 10.1002/mds.26630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although motor symptoms predominate in essential tremor, increasing evidence indicates additional cognitive deficits. According to the pivotal role of cognitive functioning for temporal information processing and acknowledging the relevance of temporal information processing for movement coordination, we investigated whether essential tremor patients exhibit time reproduction deficits. METHODS A total of 24 essential tremor patients and 24 healthy controls performed sub- and suprasecond visual duration reproduction tasks of 500 to 900 milliseconds and 1.6 to 2.4 seconds, respectively. To differentiate deficient time processing from motor or other cognitive dysfunctions, the average temporal reproduction errors were correlated with tremor severity, immediate and delayed word-list recall performance, and verbal fluency. RESULTS Essential tremor patients significantly underreproduced sub- and suprasecond time intervals longer than 800 milliseconds. Moreover, time compression correlated significantly with semantic verbal fluency and word-list retrieval performance, but not with tremor severity. CONCLUSION Data suggest impaired temporal processing in essential tremor, corroborating evidence for specific cognitive deficits. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- David J Pedrosa
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christian Nelles
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Franziska Maier
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine, Cognitive Neuroscience, Research Centre Jülich, Jülich, Germany
| | - Marc Wittmann
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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20
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Krämer J, Burghaus L, Schlesinger A. Atempumpenschwäche und Hops, wie passt das zusammen? – ein interdisziplinärer Fallbericht. Pneumologie 2016. [DOI: 10.1055/s-0036-1572095] [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: 10/22/2022]
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21
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Lang N, Lange M, Schmitt FC, Bös M, Weber Y, Evers S, Burghaus L, Kellinghaus C, Schubert-Bast S, Bösel J, Lammers T, Sabolek M, van Baalen A, Dziewas R, Kraft A, Ruf S, Stephani U. Intravenous lacosamide in clinical practice-Results from an independent registry. Seizure 2016; 39:5-9. [PMID: 27161669 DOI: 10.1016/j.seizure.2016.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 01/24/2023] Open
Abstract
PURPOSE This non-interventional study was conducted to evaluate the efficacy and tolerability of intravenous lacosamide (LCM-iv) under routine conditions in daily clinical practice as a prospective registry. METHODS Patients with any type of seizure or epilepsy syndrome were recruited in 16 neurological and neuropediatric centers in Germany if the treating physician decided to administer LCM-iv for any reason. Observation time per patient was 10 days with daily documentation of LCM-iv administration, type and frequency of seizures, currently used drugs and doses, and adverse events. Treatment efficacy, tolerability, and handling of LCM-iv were assessed using a five-step scale. RESULTS In 119 patients treating physicians classified epilepsies as focal in 66.1% and generalized in 17.4% (16.5% unclassifiable). Most common etiologies of seizures were tumors (36.1%) and cerebrovascular diseases (21.8%). Reasons for LCM-iv treatment included preparation for surgery (25.2%), convulsive (24.4%) and non-convulsive (18.5%) status epilepticus (SE), series of seizures (16.0%), gastrointestinal causes (5.9%), and acute seizures (4.2%). The median dose of LCM-iv was 300mg per day. In 45 of 64 patients (70.3%) with SE or series of seizures, epileptic activity ceased during observation time. Five patients showed abnormalities in ECG prior to the infusion and one patient afterwards, but during infusion no abnormalities were reported. Treating physicians rated efficacy and tolerability as very good or good in 77.6% and 93.1% of patients, respectively. CONCLUSIONS This large and independent multicenter registry on the use of LCM-iv in clinical practice demonstrates that LCM-iv is well-tolerated and highly efficacious when given in emergency situations, including patients experiencing SE. It is advisable to perform an electrocardiogram prior to LCM-iv administration.
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Affiliation(s)
- Nicolas Lang
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Max Lange
- Department of Neurosurgery, University Hospital Regensburg, Germany
| | | | - Monika Bös
- Department of Neurology, St. Johannes Hospital, Troisdorf, Germany
| | - Yvonne Weber
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Stefan Evers
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital Cologne, Germany
| | | | | | - Julian Bösel
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Thorsten Lammers
- Department of Neurology, Johanna-Etienne-Hospital, Neuss, Germany
| | - Michael Sabolek
- Neurology Specialist Hospital Dietenbronn, Schwendi, Germany
| | - Andreas van Baalen
- Department of Neuropediatrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Germany
| | - Andrea Kraft
- Department of Neurology, Martha-Maria Hospital, Halle (Saale), Germany
| | - Susanne Ruf
- Department of Neuropediatrics, University Hospital Tübingen, Germany
| | - Ulrich Stephani
- Department of Neuropediatrics, University Hospital Schleswig-Holstein, Kiel, Germany
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22
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Tok A, Eminaga O, Burghaus L, Herden J, Akbarov I, Engelmann U, Wille S. Age-stratified cut-off points for the nocturnal penile tumescence measurement using Nocturnal Electrobioimpedance Volumetric Assessment (NEVA(®) ) in sexually active healthy men. Andrologia 2015; 48:631-6. [PMID: 26498135 DOI: 10.1111/and.12492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 11/29/2022] Open
Abstract
The current nocturnal penile tumescence (NPT) measurement is based on standard cut-off levels defined regardless of age. This study was conducted to provide age-stratified cut-off points for NPT measurement. Forty sexually active healthy men between 20 and 60 years old were enrolled and divided equally into four groups defined by age (20-29, 30-39, 40-49 and 50-60 years.). None of the candidates had sexual dysfunction or sleep disturbance or used supportive medication to enhance sexual function. Erectile function was evaluated by using the 5-item version of the international index of erectile function (IIEF-5). NPT was observed using the nocturnal electrobioimpedance volumetric assessment (NEVA(®) ). The NPT values of healthy men aged 20-60 years varied from 268.7% to 202.3%. The NPT differed significantly between age groups (P < 0.0009); however, no significant differences between men aged 30-39 and 40-49 (P = 0.593) were observed. Age was weakly associated with IIEF-5 scores (P = 0.004), whereas a strong and negative correlation between age and NPT (P < 0.0001) was found. IEF-5 scores were not significantly associated with NPT (P = 0.95). Therefore, the standard values for NPT testing should be considered in the evaluation of the nocturnal penile activity of men of all ages.
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Affiliation(s)
- A Tok
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - O Eminaga
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - L Burghaus
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - J Herden
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - I Akbarov
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - U Engelmann
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - S Wille
- Department of Urology, University Hospital of Cologne, Cologne, Germany
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23
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Tscherpel C, Gottschalk A, Meyding-Lamadé U, Fink GR, Burghaus L. [Neurocysticercosis]. Fortschr Neurol Psychiatr 2015; 83:451-455. [PMID: 26327477 DOI: 10.1055/s-0035-1553472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Neurocysticercosis is a leading cause of acquired epilepsy worldwide and endemic in underdeveloped and developing regions. As a result of increased migration and traveling, cases of neurocysticercosis reach Europe more frequently. Neurological symptoms are multifarious and often nonspecific, so that neurocysticercosis poses a diagnostic challenge. We report a case of a patient in whom the diagnosis of neurocysticercosis was achieved quickly via the patient's history, neuroimaging and serology.
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Affiliation(s)
- C Tscherpel
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
| | - A Gottschalk
- Neuroradiologie, Krankenhaus Nordwest, Frankfurt am Main
| | | | - G R Fink
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
| | - L Burghaus
- Neurologie, Heilig Geist-Krankenhaus Köln
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24
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Markser A, Maier F, Lewis CJ, Dembek TA, Pedrosa D, Eggers C, Timmermann L, Kalbe E, Fink GR, Burghaus L. Deep brain stimulation and cognitive decline in Parkinson's disease: The predictive value of electroencephalography. J Neurol 2015; 262:2275-84. [PMID: 26159102 DOI: 10.1007/s00415-015-7839-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
Some Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) develop new-onset cognitive decline. We examined whether clinical EEG recordings can be used to predict cognitive deterioration in PD patients undergoing STN-DBS. In this retrospective study, we used the Grand Total EEG (GTE)-score (short and total) to evaluate pre- and postoperative EEGs. In PD patients undergoing STN-DBS (N = 30), cognitive functioning was measured using Mini-Mental State Test and DemTect before and after surgery. Severity of motor impairment was assessed using the Unified Parkinson's Disease Rating Scale-III. Patients were classified into patients with or without cognitive decline after STN-DBS surgery. Epidemiological data, pre- and postoperative EEG recordings as well as neuropsychological and neurological data, electrode positions and the third ventricle width were compared. A logistic regression model was used to identify predictors of cognitive decline. Motor deficits significantly improved from pre- to post-surgery, while the mean GTE-scores increased significantly. Six patients developed cognitive deterioration 4-12 months postoperatively. These patients had significantly higher preoperative GTE-scores than patients without cognitive deterioration, although preoperative cognitive functioning was comparable. Electrode positions, brain atrophy and neurological data did not differ between groups. Logistic regression analysis identified the GTE-score as a significant predictor of postoperative cognitive deterioration. Data suggest that the preoperative GTE-score can be used to identify PD patients that are at high risk for developing cognitive deterioration after STN-DBS surgery even though their preoperative cognitive state was normal.
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Affiliation(s)
- A Markser
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - Franziska Maier
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.
| | - C J Lewis
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - T A Dembek
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - D Pedrosa
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - C Eggers
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - L Timmermann
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - E Kalbe
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.,Institute of Gerontology, Psychological Gerontology and Center for Neuropsychological Diagnostics and Intervention, University of Vechta, Vechta, Germany
| | - G R Fink
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Juelich, Juelich, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
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25
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Lang N, Esser W, Evers S, Kellinghaus C, Nguento A, Schlegel U, Gaida B, Gburek-Augustat J, Altenmüller DM, Burghaus L, Hoffmann F, Fiedler B, Bast T, Rehfeld T, Happe S, Seitz RJ, Boor R, Stephani U. Intravenous levetiracetam in clinical practice--Results from an independent registry. Seizure 2015; 29:109-13. [PMID: 26076852 DOI: 10.1016/j.seizure.2015.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/06/2015] [Accepted: 03/26/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Most common clinical studies with antiepileptic drugs do not reflect medical everyday practice due to their strict in- and exclusion criteria and specifications of treatment regimens. Here we present a large non-interventional registry with the intention to evaluate the spectrum of applications in daily use and the efficacy and tolerability of intravenously given levetiracetam (LEV-iv). METHODS In a prospective approach of 17 neurological and neuropediatric centres in Germany LEV-iv treated patients of all ages were included over a period of 10 months. The observational period was 10 days with daily documentation of LEV-iv administration, type and frequency of seizures, currently used drugs and doses, and adverse events (AEs). In addition, treatment efficacy and tolerability were assessed by patients and physicians at study end as well as practicability of LEV-iv using a five-step scale. RESULTS In 95 patients LEV-iv was administered, 93 were included into the analysis. The median LEV-iv dose was 1500 mg (range 110-6000 mg) per day. Median age was 66 years (range 0.7-90.3 years). The majority of patients (n=70, 75%) suffered from status epilepticus (SE, n=55, 59%) and acute seizure clusters (n=15, 16%). Of those with SE, 41 patients (75%) had SE for the first time. Acute seizure clusters and SE terminated in 83% after LEV-iv administration. A total of 29 adverse events were reported in 17 of the 95 patients from the safety set. Ten of these were at least possibly related to LEV-iv treatment. Slight decrease of blood pressure during the infusion (3 patients each) was captured most frequently. No serious side effect was observed. Physicians rated the efficacy and tolerability of LEV-iv treatment as good or very good in 78% and 82% of the cases, respectively. CONCLUSION In this large observational study of everyday practise the use of LEV-iv exhibited a remarkable good response and tolerability in patients with acute onset seizures (mostly SE). Further randomized controlled studies, like the established status epilepticus trial (ESET) are needed to confirm these findings.
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Affiliation(s)
- N Lang
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - W Esser
- Department of Neurology, Städtisches Klinikum, Karlsruhe, Germany
| | - S Evers
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
| | - C Kellinghaus
- Department of Neurology, Klinikum, Osnabrück, Germany
| | - A Nguento
- Department of Neurology, Asklepios Klinikum Uckermark, Schwedt, Germany
| | - U Schlegel
- Department of Neurology, Ruhr University, Bochum, Germany
| | - B Gaida
- Department of Neurology, University Hospital, Greifswald, Germany
| | - J Gburek-Augustat
- Department of Neuropediatrics, University Hospital, Tübingen, Germany
| | | | - L Burghaus
- Department of Neurology, University Hospital, Köln, Germany
| | - F Hoffmann
- Department of Neurology, Krankenhaus Martha-Maria, Halle, Germany
| | - B Fiedler
- Department of Neuropediatrics, University Hospital, Münster, Germany
| | - T Bast
- University Children's Hopsital, Heidelberg, Germany
| | - T Rehfeld
- Department of Neurology, Dietrich Bonhoeffer Klinikum, Neubrandenburg, Germany
| | - S Happe
- Department of Neurology, Klinik Maria Frieden, Telgte, Germany
| | - R J Seitz
- Department of Neurology, University Hospital, Düsseldorf, Germany
| | - R Boor
- Northern German Epilepsy Centre for Children and Adolescents, Raisdorf, Germany
| | - U Stephani
- Department of Neuropediatrics, University Hospital Schleswig-Holstein, Kiel, Germany.
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26
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Klein G, Burghaus L, Vaillant M, Pieri V, Fink GR, Diederich N. Dysautonomia in narcolepsy: evidence by questionnaire assessment. J Clin Neurol 2014; 10:314-9. [PMID: 25324880 PMCID: PMC4198712 DOI: 10.3988/jcn.2014.10.4.314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose Excessive daytime sleepiness and sudden sleep attacks are the main features of narcolepsy, but rapid-eye-movement sleep behavior disorder (RBD), hyposmia, and depression can also occur. The latter symptoms are nonmotor features in idiopathic Parkinson's disease (IPD). In the present study, IPD-proven diagnostic tools were tested to determine whether they are also applicable in the assessment of narcolepsy. Methods This was a case-control study comparing 15 patients with narcolepsy (PN) and 15 control subjects (CS) using the Scales for Outcomes in Parkinson's Autonomic Test (SCOPA-AUT), Parkinson's Disease Nonmotor Symptoms (PDNMS), University of Pennsylvania Smell Test, Farnsworth-Munsell 100 Hue test, Beck Depression Inventory, and the RBD screening questionnaire. Results Both the PN and CS exhibited mild hyposmia and no deficits in visual tests. Frequent dysautonomia in all domains except sexuality was found for the PN. The total SCOPA-AUT score was higher for the PN (18.47±10.08, mean±SD) than for the CS (4.40±3.09), as was the PDNMS score (10.53±4.78 and 1.80±2.31, respectively). RBD was present in 87% of the PN and 0% of the CS. The PN were more depressed than the CS. The differences between the PN and CS for all of these variables were statistically significant (all p<0.05). Conclusions The results of this study provide evidence for the presence of dysautonomia and confirm the comorbidities of depression and RBD in narcolepsy patients. The spectrum, which is comparable to the nonmotor complex in IPD, suggests wide-ranging, clinically detectable dysfunction beyond the narcoleptic core syndrome.
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Affiliation(s)
- Gilles Klein
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg. ; Department of Internal Medicine, Brothers of Charity Hospital, Trier, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Michel Vaillant
- Competences Center for Methodology and Statistics, CRP Santé, Strassen, Luxembourg
| | - Vannina Pieri
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg
| | - Gereon R Fink
- Department of Neurology, University Hospital of Cologne, Cologne, Germany. ; Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Juelich, Juelich, Germany
| | - Nico Diederich
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg. ; Department of Neurology, University Hospital of Cologne, Cologne, Germany
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27
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Stetefeld HR, Lehmann HC, Fink GR, Burghaus L. Posterior reversible encephalopathy syndrome and stroke after intravenous immunoglobulin treatment in Miller-Fisher syndrome/Bickerstaff brain stem encephalitis overlap syndrome. J Stroke Cerebrovasc Dis 2014; 23:e423-5. [PMID: 25149206 DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.034] [Citation(s) in RCA: 15] [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: 04/10/2014] [Revised: 04/30/2014] [Accepted: 05/08/2014] [Indexed: 10/24/2022] Open
Abstract
The association of a posterior reversible encephalopathy syndrome (PRES) without arterial hypertension with autoimmune-mediated inflammatory neuropathies such as Guillain-Barré syndrome (GBS) is a rare and poorly understood phenomenon. To date, PRES has been described as initial manifestation, coincidental finding, or adverse event subsequent to immunomodulatory treatment with intravenous immunoglobulin (IVIG) in cases of axonal and demyelinating GBS as well as in Miller-Fisher syndrome (MFS). We here report a case of MFS/Bickerstaff brain stem encephalitis (BBE)-overlap syndrome and nonhypertensive PRES that occurred in close temporal association with IVIG treatment and caused stroke. Immunoadsorption ameliorated the disease course. Our case supports the notion that in severe cases, immunoadsorption should be considered as first-line therapy instead of IVIG for rapid removal of IgG and thus to hasten recovery and improve functional outcome.
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Affiliation(s)
| | - Helmar C Lehmann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Department of Cognitive Neuroscience, Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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28
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Miquel M, Spampinato U, Latxague C, Aviles-Olmos I, Bader B, Bertram K, Bhatia K, Burbaud P, Burghaus L, Cho JW, Cuny E, Danek A, Foltynie T, Garcia Ruiz PJ, Giménez-Roldán S, Guehl D, Guridi J, Hariz M, Jarman P, Kefalopoulou ZM, Limousin P, Lipsman N, Lozano AM, Moro E, Ngy D, Rodriguez-Oroz MC, Shang H, Shin H, Walker RH, Yokochi F, Zrinzo L, Tison F. Short and long term outcome of bilateral pallidal stimulation in chorea-acanthocytosis. PLoS One 2013; 8:e79241. [PMID: 24223913 PMCID: PMC3818425 DOI: 10.1371/journal.pone.0079241] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/19/2013] [Indexed: 11/28/2022] Open
Abstract
Background Chorea-acanthocytosis (ChAc) is a neuroacanthocytosis syndrome presenting with severe movement disorders poorly responsive to drug therapy. Case reports suggest that bilateral deep brain stimulation (DBS) of the ventro-postero-lateral internal globus pallidus (GPi) may benefit these patients. To explore this issue, the present multicentre (n=12) retrospective study collected the short and long term outcome of 15 patients who underwent DBS. Methods Data were collected in a standardized way 2-6 months preoperatively, 1-5 months (early) and 6 months or more (late) after surgery at the last follow-up visit (mean follow-up: 29.5 months). Results Motor severity, assessed by the Unified Huntington’s Disease Rating Scale-Motor Score, UHDRS-MS), was significantly reduced at both early and late post-surgery time points (mean improvement 54.3% and 44.1%, respectively). Functional capacity (UHDRS-Functional Capacity Score) was also significantly improved at both post-surgery time points (mean 75.5% and 73.3%, respectively), whereas incapacity (UHDRS-Independence Score) improvement reached significance at early post-surgery only (mean 37.3%). Long term significant improvement of motor symptom severity (≥20 % from baseline) was observed in 61.5 % of the patients. Chorea and dystonia improved, whereas effects on dysarthria and swallowing were variable. Parkinsonism did not improve. Linear regression analysis showed that preoperative motor severity predicted motor improvement at both post-surgery time points. The most serious adverse event was device infection and cerebral abscess, and one patient died suddenly of unclear cause, 4 years after surgery. Conclusion This study shows that bilateral DBS of the GPi effectively reduces the severity of drug-resistant hyperkinetic movement disorders such as present in ChAc.
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Affiliation(s)
- Marie Miquel
- Service de Neurologie, CHU Bordeaux, Bordeaux, France
- Service de Neurologie, CH François Mitterrand, Pau, France
| | - Umberto Spampinato
- Service de Neurologie, CHU Bordeaux, Bordeaux, France
- Univ.Bordeaux-INSERM U862, Neurocentre Magendie, Bordeaux, France
- * E-mail:
| | | | - Iciar Aviles-Olmos
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Benedikt Bader
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kelly Bertram
- Neurosciences, Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
- Van Cleef Roet Centre for Nervous Diseases, Monash University, Melbourne, Victoria, Australia
| | - Kailash Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Pierre Burbaud
- Service de Neurophysiologie Clinique, CHU Bordeaux, Bordeaux, France
| | - Lothar Burghaus
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Centre, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Emmanuel Cuny
- Service de Neurochirurgie, CHU Bordeaux, Bordeaux, France
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | | | | | - Dominique Guehl
- Service de Neurophysiologie Clinique, CHU Bordeaux, Bordeaux, France
| | - Jorge Guridi
- Neurology and Neurosurgical Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Marwan Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Paul Jarman
- National Hospital of Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Zinovia Maria Kefalopoulou
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Nir Lipsman
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Elena Moro
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
- Movement Disorders Center, Department of Psychiatry and Neurology, University Hospital Centre of Grenoble, Grenoble, France
| | - Dhita Ngy
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, United States of America
- Avicenna Medical Center, New York, New York, United States of America
| | - Maria Cruz Rodriguez-Oroz
- Department of Neurology, University Hospital Donostia, Neuroscience Unit, BioDonostia Research Institute, San Sebastian, Spain
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hyeeun Shin
- Department of Neurology, Samsung Medical Centre, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ruth H. Walker
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, United States of America
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States of America
| | - Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - François Tison
- Service de Neurologie, CHU Bordeaux, Bordeaux, France
- Université Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
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Abstract
Patients with neurodegenerative disease frequently experience hallucinations and illusionary perceptions. As early symptoms, hallucinations may even have diagnostic relevance (i.e., for the diagnosis of Lewy Body Dementia). In the later course of the disease, hallucinations may appear as characteristic symptoms and often constitute a particular challenge for therapeutic endeavors. Here, the distinction of disease-inherent hallucinations from medication-associated perceptual disturbances is particularly relevant. Synucleinopathies and tauopathies have different risk profiles for hallucinations. In synucleinopathies hallucinations are much more frequent and phenomenology is characterized by visual, short-lived hallucinations, with insight preserved for a long time. A “double hit” theory proposes that dysfunctionality of both associative visual areas and changes of limbic areas or the ventral striatum are required. In contrast, in tauopathies the hallucinations are more rare and mostly embedded in confusional states with agitation and with poorly defined or rapidly changing paranoia. The occurrence of hallucinations has even been proposed as an exclusion criterion for tauopathies with Parkinsonian features such as progressive supranuclear palsy. To date, treatment remains largely empirical, except the use of clozapine and cholinesterase inhibitors in synucleinopathies, which is evidence-based. The risk of increased neuroleptic sensitivity further restricts the treatment options in patients with Lewy Body Dementia. Coping Strategies and improvement of visual acuity and sleep quality may be useful therapeutic complements.
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Affiliation(s)
- Lothar Burghaus
- Department of Neurology, University of Cologne, Cologne, Germany.
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Klein G, Burghaus L, Diederich N. [Pathogenesis of narcolepsy: from HLA association to hypocretin deficiency]. Fortschr Neurol Psychiatr 2012; 80:627-34. [PMID: 22696207 DOI: 10.1055/s-0031-1299447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Narcolepsy is a rare and chronic sleep disorder, characterised by excessive daytime sleepiness. Frequently associated signs are cataplexy, sleep paralysis and hypnagogic or hypnopompic hallucinations. Advances in understanding the pathogenesis of the disease have essentially been elucidated during the last fifteen years. The most significant finding has been the discovery of hypocretin-1 and -2 in 1998. Hypocretin-containing cells have widespread projections throughout the entire CNS and play a crucial role in the regulation of the sleep-wake cycle. They also contribute to olefaction and to the regulation of food intake. Animal models and human studies concordantly show that the disturbed hypocretin system is the probable cause of narcolepsy. However, it remains unclear why there is neuronal death of hypocretin-producing cells in the lateral hypothalamus. As the HLA-allele DQB1*0602 is associated with narcolepsy and hypocretin deficiency, an autoimmune reaction against hypocretin-producing neurons has been vigorously discussed. Newly discovered gene polymorphisms as well as previously unknown pathogenetic mechanisms, linking the sleep-wake cycle with the immune system, may also contribute to the pathogenetic cascade. Worthy of mention in this context is, e.g., the "insulin-like growth factor"-binding protein 3 (IGFBP3), whose overexpression causes a down-regulation of the hypocretin production. Substitution of the deficient neuropeptides by hypocretin agonists may become the causal treatment strategy of the future, if an adequate administration route can be found. Presently, animal trials, including genetic therapy, cell transplantations or the administration of hypocretin receptor agonists, are underway.
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Affiliation(s)
- G Klein
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Germany
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31
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Burghaus L, Liu WC, Dohmen C, Haupt WF, Fink GR, Eggers C. Prognostic value of electroencephalography and evoked potentials in the early course of malignant middle cerebral artery infarction. Neurol Sci 2012; 34:671-8. [PMID: 22538759 DOI: 10.1007/s10072-012-1102-1] [Citation(s) in RCA: 21] [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: 01/04/2012] [Accepted: 04/14/2012] [Indexed: 11/24/2022]
Abstract
Space-occupying brain edema may lead to a malignant course in patients with large middle cerebral artery infarction. Decompressive hemicraniectomy has to be initiated early to prevent further tissue damage. In this retrospective study, we analyzed electroencephalography (EEG) and evoked potentials (EPs), obtained within 24 h after onset of stroke, in 22 patients suffering from a large middle cerebral artery infarction. Our findings indicate a prognostic value of EEG and brainstem auditory EP (BAEP): the absence of delta activity and the presence of theta and fast beta frequencies within EEG-focus predicted a non-malignant course. In contrast, diffuse generalized slowing and slow delta activity in the ischemic hemisphere pointed to a malignant course. Likewise, pathological BAEP were correlated with a malignant course. The coexistence of background slowing and pathological BAEP showed the highest level of significance. In conclusion, our findings implicate an additional early application of electrophysiological methods in stroke patients. EEG and EP deliver useful information to select those patients who develop malignant edema.
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Affiliation(s)
- Lothar Burghaus
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50924 Cologne, Germany.
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32
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Diels A, Fink G, Faust M, Burghaus L. Akute Neuropathie mit Tetraparese und Ateminsuffizienz bei akuter intermittierender Porphyrie. Fortschr Neurol Psychiatr 2012; 80:221-6. [DOI: 10.1055/s-0031-1281793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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33
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Burghaus L, Liu WC, Eggers C, Dohmen C, Haupt WF, Fink GR. Prognostic value of electroencephalography and evoked potentials in the early course of malignant middle cerebral artery infarction. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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34
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Pedrosa DJ, Geyer C, Klosterkötter J, Fink GR, Burghaus L. [Anti-NMDA receptor encephalitis: a neurological and psychiatric emergency]. Fortschr Neurol Psychiatr 2012; 80:29-35. [PMID: 22173967 DOI: 10.1055/s-0031-1281961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Anti-NMDA receptor encephalitis is a severe autoimmune disease, first described in 2007. Since then a number of cases have been published, suggesting that to date the disease is a considerably underdiagnosed entity. The clinical picture develops over a relatively long period of time and is initially characterised by psychiatric symptoms such as decreased levels of consciousness and hallucinations as well as paranoid behaviour. In the course of the disease neurological symptoms occur, in particular, seizures, autonomic dysfunction and dyskinesias. Due to the young age of many patients, the symptoms are often mistaken as to result from drug-induced psychosis. Anti-NMDA receptor Encephalitis was first described in young women with teratomas. In the past few years the disorder has also been reported in men and children and without any detectable neoplasia. The diagnosis is based on the characteristic clinical picture and supportive findings in MRI, EEG and the cerebrospinal fluid. Hereby, highly specific autoantibodies directed against the NR1 subunit of the NMDA-type glutamate receptors in the CSF (or serum) play an important role and should be sought specifically in any case of an "encephalitis of unknown cause". The prognosis of the disease is favourable, even when autonomic disorders entail ventilation and/or prolonged intensive care treatment is necessary. Nonetheless, the clinical outcome is highly dependent on an early diagnosis and immunotherapy without delay. In the case of a malignancy, tumour removal is also crucial. Taken together, an interdisciplinary approach including neurologists, psychiatrists, oncologists and gynaecologists is essential in order to detect and effectively treat this disorder.
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Affiliation(s)
- D J Pedrosa
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln.
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35
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Nass R, Elger C, Fink G, Burghaus L. Kommotionelle Konvulsionen: Epileptischer Anfall oder nicht? Fortschr Neurol Psychiatr 2011; 79:655-9. [DOI: 10.1055/s-0031-1281688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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36
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Galldiks N, Burghaus L, Dohmen C, Teschner S, Pollok M, Leebmann J, Frischmuth N, Hollinger P, Nazli N, Fassbender C, Klingel R, Benzing T, Fink GR, Haupt WF. Immunoadsorption in patients with chronic inflammatory demyelinating polyradiculoneuropathy with unsatisfactory response to first-line treatment. Eur Neurol 2011; 66:183-9. [PMID: 21912134 DOI: 10.1159/000331011] [Citation(s) in RCA: 24] [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: 02/28/2011] [Accepted: 07/04/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS First-line treatment options for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are corticosteroids, intravenous immunoglobulin, and plasma exchange. In a significant number of patients, first-line therapy fails, and long-term maintenance treatment still remains a therapeutic challenge. Immunoadsorption (IA) may be an alternative to classical plasma exchange in the therapy of immune-mediated neurologic diseases. The aim of this investigation was to evaluate efficacy and safety of IA in patients with CIDP with unsatisfactory response to first-line treatment options. METHODS CIDP patients received adjunct IA treatment using tryptophan-immune adsorbers. The inflammatory neuropathy cause and treatment disability (INCAT) score was used to grade disability and monitor treatment effects. RESULTS In total, 14 CIDP patients were analyzed. Ten patients were treated in hospital. After one IA treatment series, the INCAT score decreased significantly in all 10 patients. Four of these 14 patients were treated in outpatient clinics using long-term maintenance IA with 1-2 treatments per week. In these 4 patients, effects of long-term maintenance IA resulted in an improvement of overall disability. In all patients, IA was safe, well tolerated, and no severe adverse effects occurred. CONCLUSION IA could be an effective and safe option for CIDP patients with unsatisfactory response to first-line treatment options and for long-term maintenance treatment.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany.
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37
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Diels A, Pfeifenbring S, Eggers C, Galldiks N, Fink GR, Burghaus L. [Diagnostic work-up in Whipple's disease with cerebral involvement]. Fortschr Neurol Psychiatr 2011; 79:298-303. [PMID: 21544762 DOI: 10.1055/s-0031-1273232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The diagnostic work-up in the case of a suspected cerebral involvement of Whipple's disease involves neuroimaging and analysis of cerebrospinal fluid (CSF) including polymerase chain reaction (PCR) assays for Tropheryma whipplei. As neurological findings may be complex and unspecific, extracerebral symptoms often lead to the suspicion of Whipple's disease. We report the cases of two patients in whom the suspected diagnosis of Whipple's disease could not be proved either by endoscopy or by the analysis of CSF. Only by means of a cerebral biopsy was the diagnosis assumed and specific therapy was initiated.
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Affiliation(s)
- A Diels
- Klinik und Poliklinik für Neurologie, Uniklinik Köln.
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38
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39
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Eggers C, Liu W, Brinker G, Fink GR, Burghaus L. Do negative CCT and CSF findings exclude a subarachnoid haemorrhage? A retrospective analysis of 220 patients with subarachnoid haemorrhage. Eur J Neurol 2011; 18:300-305. [DOI: 10.1111/j.1468-1331.2010.03168.x] [Citation(s) in RCA: 9] [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: 01/23/2023]
Affiliation(s)
- C. Eggers
- Department of Neurology, University Hospital Cologne, Cologne
| | - W. Liu
- Department of Neurology, University Hospital Cologne, Cologne
| | - G. Brinker
- Department of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - G. R. Fink
- Department of Neurology, University Hospital Cologne, Cologne
| | - L. Burghaus
- Department of Neurology, University Hospital Cologne, Cologne
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40
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Michels G, Haupt W, Dohmen C, Liu WC, Burghaus L. Neurologie. Repetitorium Internistische Intensivmedizin 2011. [PMCID: PMC7123860 DOI: 10.1007/978-3-642-16841-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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41
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Burghaus L, Liu W, Fink GR, Eggers C. [Acute headache: limitations of cerebral computed tomography and analysis of cerebrospinal fluid in the diagnosis of subarachnoid haemorrhage]. Fortschr Neurol Psychiatr 2010; 79:41-5. [PMID: 21128197 DOI: 10.1055/s-0029-1245780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Subarachnoid haemorrhage constitutes a neurological emergency. In most cases the diagnosis is easy to establish by cerebral computed tomography or cerebrospinal fluid tap. However, in rare cases verification of the diagnosis is more difficult and a residual uncertainty remains. We describe three patients supposed to have a subarachnoid haemorrhage without pathological findings in both cerebral computed tomography and cerebrospinal fluid. In these cases vasospasm or cerebral aneurysm were detected by means of transcranial Doppler sonography and/or conventional angiography. We comment on the special features of this rare presentation of a severe acute neurological emergency, and we discuss diagnostic work-up and differential diagnoses.
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Affiliation(s)
- L Burghaus
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln, Kerpener Strasse 62, Köln.
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42
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Burghaus L, Kuhn J, Liu W, Eggers C, Fink GR, Dohmen C. [Thrombolytic therapy in conversion disorder with sensorimotor hemisyndrome]. Fortschr Neurol Psychiatr 2010; 78:414-418. [PMID: 20514605 DOI: 10.1055/s-0029-1245403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We here report on a 43-year-old man who was repeatedly admitted to our stroke unit with acute onset of sensorimotor hemisyndrome of acute onset. In most cases symptoms ceased shortly after admission, but twice when symptoms persisted thrombolytic therapy was applied. This case demonstrates that in emergency situations a rare differential diagnosis like conversion disorder with sensorimotor deficits may be hard to establish even if the patient presents to the same emergency unit.
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Affiliation(s)
- L Burghaus
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln, Kerpener Strasse 62, Köln.
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43
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Burghaus L, Liu W, Eggers C, Müller-Ehmsen J, Fink GR. [Mistaking a long QT syndrome for epilepsy: does every seizure call for an ECG?]. Fortschr Neurol Psychiatr 2010; 78:419-24. [PMID: 20533164 DOI: 10.1055/s-0029-1245443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Syncope is a common and difficult differential diagnosis for epilepsy. One possible cause for a cardiac syncope is a long QT syndrome (LQTS). LQTS with torsade de pointes tachycardia can lead to lethal ventricular fibrillation and cardiac arrest. Patients with LQTS when first diagnosed as suffering from epileptic fits often experience a particularly long diagnostic delay which may even take years. In some cases, the diagnosis of LQTS is not made until the patient needs resuscitation due to a cardiac arrest. Therefore, ECG recording should be performed for every patient presenting with a seizure considered to be of epileptic origin not only at the beginning of the disease but also when fits occur in spite of antiepileptic treatment in order to prevent an incorrect diagnosis and delay in making the correct diagnosis.
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Affiliation(s)
- L Burghaus
- Klinik und Poliklinik für Neurologie, Uniklinik Köln, Kerpener Strasse 62, Köln.
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44
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Burghaus L, Lie CH, Dohmen C, Hackenbroch M, Fink GR. [Detection of aneurysm by 3 Tesla MRA in third cranial nerve palsy]. Fortschr Neurol Psychiatr 2010; 78:230-1. [PMID: 20213590 DOI: 10.1055/s-0029-1245259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The diagnostic work-up of patients with third cranial nerve palsy includes neuroimaging because the lesion of the oculomotor nerve may result from compression due to an aneurysm. The advantages and disadvantages of different neuroimaging techniques, i. e. magnetic resonance angiography (MRA), computed tomography angiography (CTA) and intra-arterial digital subtraction angiography (DSA), are still under debate. In this context, the present case report demonstrates that the application of 3 Tesla-MRA may help to detect an aneurysm of the internal carotid artery which had remained undetected by non-invasive standard methods applied before. Therefore 3 Tesla-MRA may help to fill a gap in diagnostic approaches between non-invasive (MRA, CTA) and invasive (DSA) neuroimaging techniques.
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Affiliation(s)
- L Burghaus
- Klinik und Poliklinik für Neurologie, Klinikum der Universität zu Köln, Köln, Germany.
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45
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Galldiks N, Kracht LW, Burghaus L, Ullrich RT, Backes H, Brunn A, Heiss WD, Jacobs AH. Patient-tailored, imaging-guided, long-term temozolomide chemotherapy in patients with glioblastoma. Mol Imaging 2010; 9:40-46. [PMID: 20128997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We present two patients with glioblastoma with an unusually stable clinical course and long-term survival who were treated after surgery and radiotherapy with adjuvant temozolomide (TMZ) chemotherapy for 17 and 20 cycles, respectively. Afterward, adjuvant TMZ chemotherapy was discontinued in one patient and the dosage of TMZ was reduced in the other. In addition to clinical status and magnetic resonance imaging, the biologic activity of the tumors was monitored by repeated methyl-11C-l-methionine (MET) and 3'-deoxy-3'-18F-fluorothymidine (FLT) positron emission tomography (PET) studies in these patients. In these patients, repeated MET- and FLT-PET imaging documented complete response to the initial treatment regimen, including resection, radiation, and TMZ, and during the course of the disease, recurrent, uncontrollable tumor activity. Continuation or dose escalation of TMZ in both patients was shown to be ineffective to overcome the metabolic activity of the tumor. Our data suggest that repeated MET- and FLT-PET imaging provide information on the biologic activity of a tumor that is highly useful to monitor and detect changes in activity.
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Affiliation(s)
- Norbert Galldiks
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany
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46
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Galldiks N, Kracht LW, Burghaus L, Ullrich RT, Backes H, Brunn A, Heiss WD, Jacobs AH. Patient-Tailored, Imaging-Guided, Long-Term Temozolomide Chemotherapy in Patients with Glioblastoma. Mol Imaging 2010. [DOI: 10.2310/7290.2010.00002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Norbert Galldiks
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Lutz W. Kracht
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Lothar Burghaus
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Roland T. Ullrich
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Heiko Backes
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Anna Brunn
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Wolf-Dieter Heiss
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Andreas H. Jacobs
- Laboratory for Gene Therapy and Molecular Imaging at the Max-Planck-Institute for Neurological Research, Cologne, Germany; Center for Molecular Medicine (ZMMK), University of Cologne, Germany; Department of Neurology, University of Cologne, Germany; Department of Neuropathology, University of Cologne, Germany; Department of Neurology, Klinikum Fulda, Germany; and European Institute of Molecular Imaging (EIMI), University of Münster, Münster, Germany
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Eggers C, Burghaus L, Fink GR, Dohmen C. Epilepsia partialis continua responsive to intravenous levetiracetam. Seizure 2009; 18:716-8. [DOI: 10.1016/j.seizure.2009.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 08/05/2009] [Accepted: 09/18/2009] [Indexed: 11/30/2022] Open
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Eggers C, Hilker R, Burghaus L, Schumacher B, Heiss W. High resolution positron emission tomography demonstrates basal ganglia dysfunction in early Parkinson's disease. J Neurol Sci 2009; 276:27-30. [DOI: 10.1016/j.jns.2008.08.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 08/14/2008] [Accepted: 08/19/2008] [Indexed: 11/28/2022]
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Burghaus L, Liu WC, Dohmen C, Bosche B, Haupt WF. Evoked Potentials in Acute Ischemic Stroke within the First 24 h: Possible Predictor of a Malignant Course. Neurocrit Care 2007; 9:13-6. [DOI: 10.1007/s12028-007-9025-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Burghaus L, Liu W, Haupt WF. [Cerebrotendinous xanthomatosis]. Dtsch Med Wochenschr 2007; 132:1463-6. [PMID: 17583829 DOI: 10.1055/s-2007-982053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 43-year-old woman had since childhood suffered from progressive dementia. Gait ataxia and mild polyneuropathy were noted in the neurological examination. She also had painful xanthomas of the achilles tendons. A bilateral cataract operation had been performed during adolescence. INVESTIGATIONS An elevated concentration of cholestanol and a normal cholesterol level were found in the blood samples. The cerebral computed tomography revealed slight cerebral atrophy, predominantly affecting the cerebellum. Neurophysiological tests detected a sensory polyneuropathy in the legs. In addition the electroencephalogram showed a generalized slowing of electrical activity. DIAGNOSIS, TREATMENT AND COURSE Clinical findings and laboratory values indicated the diagnosis of a cerebrotendinous xanthomatosis. After initiation of a drug therapy, based on a combination of an HMG-CoA-reductase inhibitor (simvastatin 20 mg/day) and a bile acid, chenodeoxycholic acid (15 mg/kg/day), further progression of the disease was prevented. CONCLUSION The diagnosis of cerebrotendinous xanthomatosis is easily made in patients presenting all clinical symptoms expected in the disease. However, up to 30% of the patients do not show severe xanthomas. Especially in early stages of the disease the diagnosis may be difficult. Treatment can be efficacious and should be started as early as possible to prevent irreversible damage, particularly in the nervous system.
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Affiliation(s)
- L Burghaus
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Köln, Germany.
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