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Thiele A, Klehr L, Strauß S, Angermaier A, Schminke U, Kronenbuerger M, Naegel S, Fleischmann R. Preventive treatment with CGRP monoclonal antibodies restores brain stem habituation deficits and excitability to painful stimuli in migraine: results from a prospective case-control study. J Headache Pain 2021; 22:149. [PMID: 34895133 PMCID: PMC8903683 DOI: 10.1186/s10194-021-01364-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background & Objectives Calcitonin gene-related peptide ligand/receptor (CGRP) antibodies effectively reduce headache frequency in migraine. It is understood that they act peripherally, which raises the question whether treatment merely interferes with the last stage of headache generation or, alternatively, causes secondary adaptations in the central nervous system and might thus possess disease modifying potential. This study addresses this question by investigating the nociceptive blink reflex (nBR), which is closely tied to central disease activity, before and after treatment with CGRP antibodies. Methods We enrolled 22 patients suffering episodic migraine (21 female, 46.2 ± 13.8 years of age) and 22 age-/gender-matched controls. Patients received assessments of the nBR (R2 component, 10 trials, 6 stimuli/trial) before (V0) and three months (V3) after treatment with CGRP antibodies started, controls were assessed once. The R2 area (R2a) and habituation (R2h; gradient of R2a against stimulus order) of the stimulated/non-stimulated side (_s/_ns) following repeated supraorbital stimulation provide a direct readout of brainstem excitability and habituation as key mechanisms in migraine. Results All patients showed a substantial reduction of headache days/month (V0: 12.4±3.3, V3: 6.6 ± 4.9). R2a_s (Fglobal=5.86, p<0.001; block 1: R2a_s: -28%, p<0.001) and R2a_ns (Fglobal=8.22, p<0.001, block 1: R2a_ns: -22%, p=0.003) were significantly decreased, and R2h_ns was significantly enhanced (Fglobal=3.07, p<0.001; block 6: R2h_ns: r=-1.36, p=0.007) from V0 to V3. The global test for changes of R2h_s was non-significant (Fglobal=1.46, p=0.095). Changes of R2h significantly correlated with improvement of headache frequency (R2h_s, r=0.56, p=0.010; R2h_ns: r=0.45, p=0.045). None of the nBR parameters assessed at baseline predicted treatment response. Discussion We provide evidence that three months of treatment with CGRP antibodies restores brain stem responses to painful stimuli and thus might be considered disease modifying. The nociceptive blink reflex may provide a biomarker to monitor central disease activity. Future studies should evaluate the blink reflex as a clinical biomarker to predict treatment response at baseline and to establish the risk of relapse after treatment discontinuation. Trial registration This trial was prospectively registered at clinicaltrials.gov (ID: NCT04019496, date of registration: July 15, 2019).
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Affiliation(s)
- Anne Thiele
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Lara Klehr
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Sebastian Strauß
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany.,University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Steffen Naegel
- Department of Neurology, Martin Luther University Halle- Wittenberg and University Hospital Halle, Halle (Saale), Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany.
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Gamain J, Herr T, Fleischmann R, Stenner A, Vollmer M, Willert C, Veit B, Lehnert B, Mueller JU, Steigerwald F, Tost F, Kronenbuerger M. Smell and taste in idiopathic blepharospasm. J Neural Transm (Vienna) 2021; 128:1215-1224. [PMID: 34184129 PMCID: PMC8237775 DOI: 10.1007/s00702-021-02366-4] [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: 01/09/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
The pathophysiology of blepharospasm is incompletely understood. Current concepts suggest that blepharospasm is a network disorder, involving basal ganglia, thalamus, cortex, and, possibly, the cerebellum. Tracing, imaging, and clinical studies revealed that these structures are also concerned with olfaction and taste. Because of this anatomical overlap, dysfunction of the chemical senses in blepharospasm is expected. Injections of botulinum toxin into the eyelid muscles are the first-line treatment of blepharospasm. Yet, the effects of botulinum toxin on the chemical senses have not been systematically assessed. To contribute to a better understanding of blepharospasm, olfactory and gustatory abilities were assessed in 17 subjects with blepharospasm and 17 age-/sex-matched healthy controls. Sniffin Sticks were used to assess odor threshold, odor discrimination, and odor identification. Results of these three Sniffin Sticks subtests were added to the composite olfactory score. The Taste Strips were applied to assess taste. In an adjacent study, we assessed the sense of smell and taste in eight subjects with blepharospasm before and 4 weeks after botulinum toxin treatment. Subjects with blepharospasm had significantly lower (= worse) scores for odor threshold and for the composite olfactory score than healthy controls, while odor discrimination, odor identification, and the composite taste score were not different between groups. The adjacent study revealed that botulinum toxin did not impact the chemical senses. In this study, subjects with blepharospasm had a lower (= worse) odor threshold than healthy controls. As olfaction is important in daily life, findings justify further research of olfaction in blepharospasm.
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Affiliation(s)
- Julie Gamain
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Thorsten Herr
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | | | - Andrea Stenner
- Department of Neurology, Paracelsus Clinic Zwickau, Zwickau, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University of Greifswald, Greifswald, Germany
| | | | - Birgitt Veit
- Neurology Group Practice, Neubrandenburg, Germany
| | - Bernhard Lehnert
- Department of Otorhinolaryngology, University of Greifswald, Greifswald, Germany
| | - Jan-Uwe Mueller
- Department of Neurosurgery, University of Greifswald, Greifswald, Germany
| | - Frank Steigerwald
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Frank Tost
- Department of Ophthalmology, University of Greifswald, Greifswald, Germany
| | - Martin Kronenbuerger
- Department of Neurology, University of Greifswald, Greifswald, Germany. .,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA. .,Department of Neurology, Medical School OWL, University of Bielefeld, Bielefeld, Germany.
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Thiele A, Strauß S, Angermaier A, Klehr L, Bartsch L, Kronenbuerger M, Schmidt S, Fleischmann R. Treatment Realities of Headache Disorders in Rural Germany by the Example of the Region of Western Pomerania. Brain Sci 2021; 11:brainsci11070839. [PMID: 34202861 PMCID: PMC8301947 DOI: 10.3390/brainsci11070839] [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: 05/17/2021] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Headache disorders are among the most disabling medical conditions but the supply with experienced providers is outpaced by the demand for service. It is unclear to what extent particularly patients in rural regions are affected by limited access to comprehensive care. Furthermore, it is unknown what role general practitioners (GPs) play in headache care. (2) Methods: First-time consultations to a specialised headache clinic at a tertiary care centre were asked to participate. Their socio-demographic background, general and headache-specific medical history, disability and quality of life (QoL) were assessed. Additionally, 176 GPs in neighbouring districts were contacted regarding headache management. (3) Results: We assessed 162 patients with first-time consultations (age 46.1 ± 17.0 years, 78.1% female), who suffered from migraine (72%), tension type, cluster and secondary headaches (each 5-10%). About 50% of patients received a new headache-diagnosis and 60% had treatment inconsistent with national guidelines. QoL was significantly worse in all domains compared to the general population. About 75% of GPs see headache patients at least several times per week, and mostly treat them by themself. (4) Conclusions: More than every second headache patient was neither correctly diagnosed nor received guideline adherent treatment. Headache-related disability is inferior to what is expected from previous studies. Access to specialised health care is more limited in rural than in urban regions in Germany and GPs request more training.
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Affiliation(s)
- Anne Thiele
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Sebastian Strauß
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Lara Klehr
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Luise Bartsch
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
- Medical School OWL, University of Bielefeld, 33615 Bielefeld, Germany
| | - Sein Schmidt
- Clinical Research Unit, Charité Campus Mitte, Berlin Institute of Health, 10117 Berlin, Germany;
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
- Correspondence:
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Herr T, Hummel T, Vollmer M, Willert C, Veit B, Gamain J, Fleischmann R, Lehnert B, Mueller JU, Stenner A, Kronenbuerger M. Correction to: Smell and taste in cervical dystonia. J Neural Transm (Vienna) 2021; 128:873. [PMID: 33956232 PMCID: PMC8206048 DOI: 10.1007/s00702-021-02340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Thorsten Herr
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | | | - Birgitt Veit
- Neurology Group Practice, Neubrandenburg, Germany
| | - Julie Gamain
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Bernhard Lehnert
- Department of Otorhinolaryngology, University Medicine Greifswald, Greifswald, Germany
| | - Jan-Uwe Mueller
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Andrea Stenner
- Outpatient Department of Neurology, Paracelsus Clinic Zwickau, Zwickau, Germany
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Klinkmueller P, Kronenbuerger M, Miao X, Bang J, Ultz KE, Paez A, Zhang X, Duan W, Margolis RL, van Zijl PCM, Ross CA, Hua J. Impaired response of cerebral oxygen metabolism to visual stimulation in Huntington's disease. J Cereb Blood Flow Metab 2021; 41:1119-1130. [PMID: 32807001 PMCID: PMC8054727 DOI: 10.1177/0271678x20949286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/30/2020] [Accepted: 07/15/2020] [Indexed: 01/29/2023]
Abstract
Huntington's disease (HD) is a neurodegenerative disease caused by a CAG triplet repeat expansion in the Huntingtin gene. Metabolic and microvascular abnormalities in the brain may contribute to early physiological changes that subserve the functional impairments in HD. This study is intended to investigate potential abnormality in dynamic changes in cerebral blood volume (CBV) and cerebral blood flow (CBF), and cerebral metabolic rate of oxygen (CMRO2) in the brain in response to functional stimulation in premanifest and early manifest HD patients. A recently developed 3-D-TRiple-acquisition-after-Inversion-Preparation magnetic resonance imaging (MRI) approach was used to measure dynamic responses in CBV, CBF, and CMRO2 during visual stimulation in one single MRI scan. Experiments were conducted in 23 HD patients and 16 healthy controls. Decreased occipital cortex CMRO2 responses were observed in premanifest and early manifest HD patients compared to controls (P < 0.001), correlating with the CAG-Age Product scores in these patients (R2 = 0.4, P = 0.001). The results suggest the potential value of this reduced CMRO2 response during visual stimulation as a biomarker for HD and may illuminate the role of metabolic alterations in the pathophysiology of HD.
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Affiliation(s)
- Peter Klinkmueller
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Neurosection, Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin Kronenbuerger
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Xinyuan Miao
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Neurosection, Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jee Bang
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kia E Ultz
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adrian Paez
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Neurosection, Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaoyu Zhang
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Neurosection, Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wenzhen Duan
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Departments of Neuroscience and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Russell L Margolis
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter CM van Zijl
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Neurosection, Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Departments of Neuroscience and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jun Hua
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Neurosection, Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Thiele A, Strauß S, Angermaier A, Kronenbuerger M, Fleischmann R. Translation and validation of an extended German version of ID Migraine™ as a migraine screening tool. Cephalalgia Reports 2020. [DOI: 10.1177/2515816320962773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and purpose: Diagnosing a patient with headache as a migraineur is critical for state-of-the-art migraine management. Screening tools are imperative means to improve the diagnostic yield in the primary care settings and specialized clinics. This study aims to translate and assess the diagnostic accuracy of a German version of the ID Migraine™ as a widely used and efficient screening instrument. Methods: The Functional Assessment of Chronic Illness Therapy translation methodology was used to translate the original three-item ID Migraine™, including a fourth question for aura, from the English language into the German language. Diagnostic accuracy of the German ID Migraine™ and predictors of false screening results were assessed among patients presenting to a headache outpatient clinic of a tertiary care center in Germany over a 6-month period. Results: The translation procedure yielded a harmonized German ID Migraine™ and its diagnostic accuracy was assessed in 105 patients (80 female, 46.5 ± 17.2 years of age), including 79 patients (75.2%) with migraine. The three-item German ID Migraine™ provides a sensitivity of 99%, specificity of 68%, and positive and negative predictive values of 90% and 95%, respectively, using a cutoff of ≥2. Positive and negative predictive values in a general headache population are estimated to be 74% and 98%, respectively. The aura question identified 18 out of 20 migraineurs with aura. Conclusions: The German ID Migraine™ is an accurate screening tool for migraine even in a challenging population of a specialized outpatient clinic. Its diagnostic accuracy indicates a potential utility for screening in primary health care.
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Affiliation(s)
- Anne Thiele
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian Strauß
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | | | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
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Herr T, Hummel T, Vollmer M, Willert C, Veit B, Gamain J, Fleischmann R, Lehnert B, Mueller JU, Stenner A, Kronenbuerger M. Smell and taste in cervical dystonia. J Neural Transm (Vienna) 2020; 127:347-354. [PMID: 32062706 PMCID: PMC8102446 DOI: 10.1007/s00702-020-02156-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
The pathophysiology of cervical dystonia is not completely understood. Current concepts of the pathophysiology propose that it is a network disorder involving the basal ganglia, cerebellum and sensorimotor cortex. These structures are primarily concerned with sensorimotor control but are also involved in non-motor functioning such as the processing of information related to the chemical senses. This overlap lets us hypothesize a link between cervical dystonia and altered sense of smell and taste. To prove this hypothesis and to contribute to the better understanding of cervical dystonia, we assessed olfactory and gustatory functioning in 40 adults with idiopathic cervical dystonia and 40 healthy controls. The Sniffin Sticks were used to assess odor threshold, discrimination and identification. Furthermore, the Taste Strips were applied to assess the combined taste score. Motor and non-motor deficits of cervical dystonia including neuropsychological and psychiatric alterations were assessed as cofactors for regression analyses. We found that cervical dystonia subjects had lower scores than healthy controls for odor threshold (5.8 ± 2.4 versus 8.0 ± 3.2; p = 0.001), odor identification (11.7 ± 2.3 versus 13.1 ± 1.3; p = 0.001) and the combined taste score (9.5 ± 2.2 versus 11.7 ± 2.7; p < 0.001), while no difference was found in odor discrimination (12.0 ± 2.5 versus 12.9 ± 1.8; p = 0.097). Regression analysis suggests that age is the main predictor for olfactory decline in subjects with cervical dystonia. Moreover, performance in the Montreal Cognitive Assessment is a predictor for gustatory decline in cervical dystonia subjects. Findings propose that cervical dystonia is associated with diminished olfactory and gustatory functioning.
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Affiliation(s)
- Thorsten Herr
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | | | - Birgitt Veit
- Neurology Group Practice, Neubrandenburg, Germany
| | - Julie Gamain
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Bernhard Lehnert
- Department of Otorhinolaryngology, University Medicine Greifswald, Greifswald, Germany
| | - Jan-Uwe Mueller
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Andrea Stenner
- Outpatient Department of Neurology, Paracelsus Clinic Zwickau, Zwickau, Germany
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Kronenbuerger M, Hua J, Bang JYA, Ultz KE, Miao X, Zhang X, Pekar JJ, van Zijl PCM, Duan W, Margolis RL, Ross CA. Differential Changes in Functional Connectivity of Striatum-Prefrontal and Striatum-Motor Circuits in Premanifest Huntington's Disease. NEURODEGENER DIS 2019; 19:78-87. [PMID: 31412344 DOI: 10.1159/000501616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is a progressive neurodegenerative disorder. The striatum is one of the first brain regions that show detectable atrophy in HD. Previous studies using functional magnetic resonance imaging (fMRI) at 3 tesla (3 T) revealed reduced functional connectivity between striatum and motor cortex in the prodromal period of HD. Neuroanatomical and neurophysiological studies have suggested segregated corticostriatal pathways with distinct loops involving different cortical regions, which may be investigated using fMRI at an ultra-high field (7 T) with enhanced sensitivity compared to lower fields. OBJECTIVES We performed fMRI at 7 T to assess functional connectivity between the striatum and several chosen cortical areas including the motor and prefrontal cortex, in order to better understand brain changes in the striatum-cortical pathways. METHOD 13 manifest subjects (age 51 ± 13 years, cytosine-adenine-guanine [CAG] repeat 45 ± 5, Unified Huntington's Disease Rating Scale [UHDRS] motor score 32 ± 17), 8 subjects in the close-to-onset premanifest period (age 38 ± 10 years, CAG repeat 44 ± 2, UHDRS motor score 8 ± 2), 11 subjects in the far-from-onset premanifest period (age 38 ± 11 years, CAG repeat 42 ± 2, UHDRS motor score 1 ± 2), and 16 healthy controls (age 44 ± 15 years) were studied. The functional connectivity between the striatum and several cortical areas was measured by resting state fMRI at 7 T and analyzed in all participants. RESULTS Compared to controls, functional connectivity between striatum and premotor area, supplementary motor area, inferior frontal as well as middle frontal regions was altered in HD (all p values <0.001). Specifically, decreased striatum-motor connectivity but increased striatum-prefrontal connectivity were found in premanifest HD subjects. Altered functional connectivity correlated consistently with genetic burden, but not with clinical scores. CONCLUSIONS Differential changes in functional connectivity of striatum-prefrontal and striatum-motor circuits can be found in early and premanifest HD. This may imply a compensatory mechanism, where additional cortical regions are recruited to subserve functions that have been impaired due to HD pathology. Our results suggest the potential value of functional connectivity as a marker for future clinical trials in HD.
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Affiliation(s)
- Martin Kronenbuerger
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, .,Department of Neurology, University Medicine Greifswald, Greifswald, Germany,
| | - Jun Hua
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jee Y A Bang
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kia E Ultz
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xinyuan Miao
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Xiaoyu Zhang
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - James J Pekar
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Peter C M van Zijl
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Wenzhen Duan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neuroscience and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Russell L Margolis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neuroscience and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher A Ross
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neuroscience and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lance EI, Kronenbuerger M, Cohen JS, Furmanski O, Singer HS, Fatemi A. Successful treatment of choreo-athetotic movements in a patient with an EEF1A2 gene variant. SAGE Open Med Case Rep 2018; 6:2050313X18807622. [PMID: 30377530 PMCID: PMC6202747 DOI: 10.1177/2050313x18807622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/25/2018] [Indexed: 01/26/2023] Open
Abstract
Pathogenic variants in EEF1A2, a gene encoding a eukaryotic translation elongation factor, have been previously reported in pediatric cases of epileptic encephalopathy and intellectual disability. We report a case of a 17-year-old male with a prior history of epilepsy, autism, intellectual disability, and the abrupt onset of choreo-athetotic movements. The patient was diagnosed with an EEF1A2 variant by whole exome sequencing. His movement disorder responded dramatically to treatment with tetrabenazine. To the best of our knowledge, this is the first report of successful treatment of a hyperkinetic movement disorder in the setting of EEF1A2 mutation. A trial with tetrabenazine should be considered in cases with significant choreoathetosis.
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Affiliation(s)
- Eboni I Lance
- Department of Neurology, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Martin Kronenbuerger
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Julie S Cohen
- Hugo W. Moser Research Institute at Kennedy Krieger, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Orion Furmanski
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, MD, USA.,Department of Anatomy, Physiology and Genetics, School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Harvey S Singer
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ali Fatemi
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Hugo W. Moser Research Institute at Kennedy Krieger, Kennedy Krieger Institute, Baltimore, MD, USA
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Kronenbuerger M, Belenghi P, Ilgner J, Freiherr J, Hummel T, Neuner I. Olfactory functioning in adults with Tourette syndrome. PLoS One 2018; 13:e0197598. [PMID: 29874283 PMCID: PMC5991349 DOI: 10.1371/journal.pone.0197598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/04/2018] [Indexed: 01/19/2023] Open
Abstract
Tourette syndrome is a chronic tic disorder characterized by motor and vocal tics. Comorbidities such as attention deficit hyperactivity disorder and obsessive compulsive disorder can be found. The overlap between neuroanatomical regions and neurotransmitter systems in the olfactory system and the pathophysiology of Tourette syndrome let us hypothesize altered olfactory performance in Tourette syndrome. The main objective of this study was to systematically assess olfactory functioning in subjects with Tourette syndrome and to compare it to healthy controls. We assessed 28 adults with Tourette syndrome (age 33.1±9.4 years, disease duration 23.7±9.7 years) and 28 healthy controls (age 32.9±9.0 years) matched in regard to age, sex, education and smoking habits. The “Sniffin Sticks” test battery was applied to assess odor threshold, discrimination, and identification. Additionally, the combined score of the odor threshold test, the odor discrimination test and the odor identification test of the “Sniffin Sticks” test battery was calculated. Although it was not the primary aim of this study, we assessed whether tics and comorbidity could contribute to olfactory alterations in adults with Tourette syndrome. Therefore, clinical scores were used to assess severity of tics and co-morbidity such as attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety and depression in subjects with Tourette syndrome. Pathology of the nasal cavities was excluded with rhinoendoscopy. Independent sample t-tests were applied to compare performance in olfactory tests. In the case of statistically significant differences (critical p-value: 0.05), multiple linear regression analysis was carried out to explore whether tic severity, social impairment, co-morbidity or medical treatment had an impact on the differences found. Descriptive values are reported as mean ± standard deviation. Tourette syndrome subjects showed lower combined scores (Tourette syndrome subjects 31.9 ± 5.1 versus healthy controls 35.0 ± 3.1; p = 0.007), odor identification scores (Tourette syndrome subjects 12.4 ± 2.0 versus healthy controls 13.7 ± 1.4; p = 0.008) and odor discrimination scores (Tourette syndrome subjects 12.1 ± 2.1 versus healthy controls 13.2 ± 1.6; p = 0.041) in comparison to healthy subjects, while there was no difference in odor threshold (Tourette syndrome subjects 7.3 ± 2.7 versus healthy controls 8.1 ± 2.2; p = 0.22). Seven out of 28 Tourette syndrome subjects (25%) scored in the range of the age- and sex-dependent combined score for hyposmia, while two of 28 healthy controls (7%) had a similar low combined score. None of the participants were found to have functional anosmia. Multiple linear regression analyses suggest that social impairment may a predictor for low combined score and odor identification score in Tourette syndrome subjects (p = 0.003). Compared to healthy controls, altered olfaction in adults with Tourette syndrome was found in this study. Normal odor threshold level but lower scores at tasks involving supra-threshold odor concentrations point towards a central-nervous alteration in the processing of olfactory information in Tourette syndrome.
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Affiliation(s)
- Martin Kronenbuerger
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Department of Neurology, University of Greifswald, Greifswald, Germany
- * E-mail:
| | - Patrizia Belenghi
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Justus Ilgner
- Department of Otorhinolaryngology and Plastic Head and Neck Surgery, RWTH Aachen University, Aachen, Germany
| | - Jessica Freiherr
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- JARA—Translational Brain Medicine, Aachen, Germany
- Institute of Neuroscience and Medicine 4, Forschungszentrum, Jülich, Germany
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Ross CA, Kronenbuerger M, Duan W, Margolis RL. Mechanisms underlying neurodegeneration in Huntington disease: applications to novel disease-modifying therapies. Handb Clin Neurol 2017; 144:15-28. [PMID: 28947113 DOI: 10.1016/b978-0-12-801893-4.00002-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The CAG repeat expansion mutation that causes Huntington Disease (HD) was discovered more than 20 years ago, yet no treatment has yet been developed to stop the relentless course of the disease. Nonetheless, substantial progress has been made in understanding HD pathogenesis. We review insights that have been gleaned from HD genetics, metabolism, and pathology; HD mouse and cell models; the structure, function and post-translational modification of normal and mutant huntingtin (htt) protein; gene expression profiles in HD cells and tissue; the neurotoxicy of mutant htt RNA; and the expression of an antisense transcript from the HD locus. We conclude that rationale therapeutics for HD is within sight, though many questions remain to be answered.
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Affiliation(s)
- Christopher A Ross
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Departments of Neuroscience and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Martin Kronenbuerger
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Wenzhen Duan
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Translational Neurobiology Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Russell L Margolis
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Translational Neurobiology Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Laboratory of Genetic Neurobiology and Johns Hopkins Schizophrenia Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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13
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Kalbe E, Rehberg SP, Heber I, Kronenbuerger M, Schulz JB, Storch A, Linse K, Schneider C, Gräber S, Liepelt-Scarfone I, Berg D, Dams J, Balzer-Geldsetzer M, Hilker R, Oberschmidt C, Witt K, Schmidt N, Mollenhauer B, Trenkwalder C, Spottke A, Roeske S, Wittchen HU, Riedel O, Dodel R. Subtypes of mild cognitive impairment in patients with Parkinson's disease: evidence from the LANDSCAPE study. J Neurol Neurosurg Psychiatry 2016; 87:1099-105. [PMID: 27401782 DOI: 10.1136/jnnp-2016-313838] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [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: 04/22/2016] [Accepted: 06/21/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Inconsistent results exist regarding the cognitive profile in patients with Parkinson's disease with mild cognitive impairment (PD-MCI). We aimed at providing data on this topic from a large cohort of patients with PD-MCI. METHODS Sociodemographic, clinical and neuropsychological baseline data from patients with PD-MCI recruited in the multicentre, prospective, observational DEMPARK/LANDSCAPE study were analysed. RESULTS 269 patients with PD-MCI (age 67.8±7.4, Unified Parkinson's Disease Rating Scale (UPDRS-III) scores 23.2±11.6) were included. PD-MCI subtypes were 39.4% non-amnestic single domain, 30.5% amnestic multiple domain, 23.4% non-amnestic multiple domain and 6.7% amnestic single domain. Executive functions were most frequently impaired. The most sensitive tests to detect cognitive dysfunctions were the Modified Card Sorting Test, digit span backwards and word list learning direct recall. Multiple stepwise regression analyses showed that global cognition, gender and age, but not education or disease-related parameters predicted PD-MCI subtypes. CONCLUSIONS This study with the so far largest number of prospectively recruited patients with PD-MCI indicates that non-amnestic PD-MCI is more frequent than amnestic PD-MCI; executive dysfunctions are the most typical cognitive symptom in PD-MCI; and age, gender and global cognition predict the PD-MCI subtype. Longitudinal data are needed to test the hypothesis that patients with PD-MCI with specific cognitive profiles have different risks to develop dementia.
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Affiliation(s)
- Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany
| | - Sarah Petra Rehberg
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany
| | - Ines Heber
- Department of Neurology, University Hospital, RWTH University Aachen, Aachen, Germany
| | - Martin Kronenbuerger
- Department of Neurology, University Hospital, RWTH University Aachen, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, University Hospital, RWTH University Aachen, Aachen, Germany JARA Brain Institute 2, RWTH University and Forschungszentrum Jülich, Germany
| | - Alexander Storch
- Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany Department of Neurology, University of Rostock, Rostock, Germany
| | - Katharina Linse
- Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Christine Schneider
- Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Susanne Gräber
- German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Inga Liepelt-Scarfone
- German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Daniela Berg
- German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, Tübingen, Germany Department of Neurology, Christian Albrecht University, Kiel, Germany
| | - Judith Dams
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | | | - Rüdiger Hilker
- Department of Neurology, J.W. Goethe University, Frankfurt/Main, Germany
| | - Carola Oberschmidt
- Department of Neurology, J.W. Goethe University, Frankfurt/Main, Germany
| | - Karsten Witt
- Department of Neurology, Christian Albrecht University, Kiel, Germany
| | - Nele Schmidt
- Department of Neurology, Christian Albrecht University, Kiel, Germany
| | - Brit Mollenhauer
- Paracelsus-Elena Clinic, Centre of Parkinsonism and Movement Disorders, Kassel, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena Clinic, Centre of Parkinsonism and Movement Disorders, Kassel, Germany
| | - Annika Spottke
- Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Sandra Roeske
- Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Oliver Riedel
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Richard Dodel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
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14
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Kronenbuerger M, Nolte KW, Coenen VA, Burgunder JM, Krauss JK, Weis J. Brain alterations with deep brain stimulation: New insight from a neuropathological case series. Mov Disord 2015; 30:1125-30. [PMID: 26011773 DOI: 10.1002/mds.26247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 03/20/2015] [Accepted: 03/26/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Previous studies on human brain tissue alterations caused by deep brain stimulation described glial and reactive inflammatory changes. In the current pathoanatomical study, we extended the analysis to signs of axonal changes and the influence of concomitant disease. METHODS Brains of 10 patients with Parkinson's disease or essential tremor and a total of 18 electrodes were systematically examined up to 7.5 y after surgery. RESULTS In general, tissue that had long-term contact with the electrode material exhibited astrogliosis in all, T-lymphocytes in 93%, and multinucleated giant cells in 68% of patients. Immunohistochemistry showed an increase in amyloid precursor protein immunoreactive axonal swellings in the brain at the electrically active parts of the electrodes. Patients who died of septicemia showed a more severe astrogliosis and giant cell reaction than patients who died of cardiovascular events. Parkinson's disease or essential tremor did not differentially produce histopathological changes around the electrodes. CONCLUSION Long-term electrical stimulation by deep brain stimulation causes minor axonal changes. The cause of death, but not the underlying neurological disease, affects the histopathological changes around the electrode. The findings need to be reproduced by examining larger patient subgroups.
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Affiliation(s)
- Martin Kronenbuerger
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
| | - Kay Wilhelm Nolte
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany
| | - Jean-Marc Burgunder
- Department of Neurology, University of Berne, Inselspital, Berne, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover (MHH), Hannover, Germany
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
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15
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Rottschy C, Kleiman A, Dogan I, Langner R, Mirzazade S, Kronenbuerger M, Werner C, Shah NJ, Schulz JB, Eickhoff SB, Reetz K. Diminished activation of motor working-memory networks in Parkinson's disease. PLoS One 2013; 8:e61786. [PMID: 23620791 PMCID: PMC3631252 DOI: 10.1371/journal.pone.0061786] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 09/20/2012] [Accepted: 03/13/2013] [Indexed: 11/19/2022] Open
Abstract
Parkinson's disease (PD) is characterized by typical extrapyramidal motor features and increasingly recognized non-motor symptoms such as working memory (WM) deficits. Using functional magnetic resonance imaging (fMRI), we investigated differences in neuronal activation during a motor WM task in 23 non-demented PD patients and 23 age- and gender-matched healthy controls. Participants had to memorize and retype variably long visuo-spatial stimulus sequences after short or long delays (immediate or delayed serial recall). PD patients showed deficient WM performance compared to controls, which was accompanied by reduced encoding-related activation in WM-related regions. Mirroring slower motor initiation and execution, reduced activation in motor structures such as the basal ganglia and superior parietal cortex was detected for both immediate and delayed recall. Increased activation in limbic, parietal and cerebellar regions was found during delayed recall only. Increased load-related activation for delayed recall was found in the posterior midline and the cerebellum. Overall, our results demonstrate that impairment of WM in PD is primarily associated with a widespread reduction of task-relevant activation, whereas additional parietal, limbic and cerebellar regions become more activated relative to matched controls. While the reduced WM-related activity mirrors the deficient WM performance, the additional recruitment may point to either dysfunctional compensatory strategies or detrimental crosstalk from “default-mode” regions, contributing to the observed impairment.
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Affiliation(s)
- Claudia Rottschy
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen, Germany
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Alexandra Kleiman
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen, Germany
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen, Germany
| | - Robert Langner
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Shahram Mirzazade
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen, Germany
| | | | - Cornelius Werner
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
| | - N. Jon Shah
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen, Germany
| | - Jörg B. Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen, Germany
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1, INM-4), Research Center Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen, Germany
- * E-mail:
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Zobel S, Hummel T, Ilgner J, Finkelmeyer A, Habel U, Timmann D, Schulz JB, Kronenbuerger M. Involvement of the human ventrolateral thalamus in olfaction. J Neurol 2010; 257:2037-43. [PMID: 20640578 DOI: 10.1007/s00415-010-5656-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 06/17/2010] [Accepted: 07/01/2010] [Indexed: 12/18/2022]
Abstract
It is widely assumed that the thalamus is not involved in olfaction. The ventrolateral thalamus is, however, closely connected to the contralateral cerebellum, which is involved in the sense of smell based on findings from functional imaging studies and findings of olfactory deficits in patients with cerebellar disease. We hypothesized that olfactory deficits following lesions of the ventrolateral thalamus may be similar to olfactory deficits following cerebellar lesions. Fifteen patients with a focal thalamic lesion involving the ventrolateral thalamus were examined and compared to 15 patients with a focal cerebellar lesion and 15 healthy controls. A detailed olfactory test ("Sniffin' Sticks") was used to assess different olfactory functions separately for each nostril. In the group of patients with a lesion of the ventrolateral thalamus, an impairment of the odor threshold was found at the ipsilateral nostril, consistent with the unilateral orientation of the olfactory system in the telencephalon. In the group of patients with a cerebellar lesion, an olfactory deficit at the contralesional nostril emerged. In controls, no significant side difference was found. The involvement of the ventrolateral thalamus in olfaction is comparable to that of the cerebellum in respect to odor threshold. Further study is needed to assess if these findings are related to an impairment of an olfactomotor loop. Present evidence for this hypothesis is indirect. Effects were subclinical as none of the patients reported olfactory disturbance. The results suggest that the cerebello-thalamic axis plays an adjuvant role in olfaction.
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Affiliation(s)
- S Zobel
- Department of Neurology, Medical Faculty, RWTH Aachen University, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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17
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Fimm B, Heber IA, Coenen VA, Fromm C, Noth J, Kronenbuerger M. Deep brain stimulation of the subthalamic nucleus improves intrinsic alertness in Parkinson's disease. Mov Disord 2010; 24:1613-20. [PMID: 19533754 DOI: 10.1002/mds.22580] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a treatment option for patients with Parkinson's disease (PD) in the advanced stage. Besides motor improvement, DBS of the STN may also modulate cognitive and attentional functions of the basal ganglia. In our study, 13 patients with PD and bilateral DBS of the STN were assessed with DBS switched on and off by the use of a wide range of neuropsychological tasks. This included reasoning, cognitive flexibility, phonemic and semantic word fluency, verbal and nonverbal short-term memory, learning, delayed verbal memory recall, and stimulus-response incompatibility. Special emphasis was put on basic attentional functions, in particular intrinsic and phasic alertness as well as visual search. DBS significantly improved intrinsic alertness, whereas phasic alertness and other neuropsychological domains were not affected. Additionally, the effects on intrinsic alertness were independent of motor improvements by DBS. The findings suggest that DBS modulates the fronto-parietal network of alertness.
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Affiliation(s)
- Bruno Fimm
- Department of Neurology, University Hospital RWTH Aachen, Germany.
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Zobel S, Ilgner J, Finkelmeyer A, Habel U, Hummel T, Schulz J, Kronenbuerger M. In wieweit sind Kleinhirn oder Thalamus an der Riechwahrnehmung beteiligt? Akt Neurol 2009. [DOI: 10.1055/s-0029-1238728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kronenbuerger M, Konczak J, Ziegler W, Buderath P, Frank B, Coenen VA, Kiening K, Reinacher P, Noth J, Timmann D. Balance and motor speech impairment in essential tremor. Cerebellum 2009; 8:389-98. [PMID: 19452239 DOI: 10.1007/s12311-009-0111-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 04/29/2009] [Indexed: 11/27/2022]
Abstract
The pathogenesis of essential tremor (ET) is still under debate. Several lines of evidence indicate that ET is associated with cerebellar dysfunction. The aim of the present study was to find corroborating evidence for this claim by investigating balance and speech impairments in patients with ET. In addition, the effect of deep brain stimulation (DBS) on balance and speech function was studied. A group of 25 ET patients including 18 with postural and/or simple kinetic tremor (ETpt) and seven ET patients with additional clinical signs of cerebellar dysfunction (ETc) was compared to 25 healthy controls. In addition, 12 ET patients with thalamic DBS participated in the study. Balance control was assessed during gait and stance including tandem gait performed on a treadmill as well as static and dynamic posturography. Motor speech control was analyzed through syllable repetition tasks. Signs of balance impairment were found in early stages and advanced stages of ET. During locomotion, ET patients exhibited an increased number of missteps and shortened stride length with tandem gait. ETc patients and, to a lesser extent, ETpt patients had increased postural instability in dynamic posturography conditions that are sensitive to vestibular or vestibulocerebellar dysfunction. ETc but not ETpt patients exhibited significantly increased syllable durations. DBS had no discernable effect on speech performance or balance control. We conclude that the deficits in balance as well as the subclinical signs of dysarthria in a subset of patients confirm and extend previous findings that ET is associated with an impairment of the cerebellum.
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Affiliation(s)
- Martin Kronenbuerger
- Department of Neurology, University Hospital Aachen, RWTH Aachen, Aachen 52074, Germany
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Kronenbuerger M, Nolte K, Coenen V, Burgunder J, Weis J, Krauss J. Deep brain stimulation and histopathological changes. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086542] [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: 10/21/2022]
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Kronenbuerger M, Tronnier V, Gerwig M, Fromm C, Coenen V, Reinacher P, Kiening K, Noth J, Timmann D. Thalamic deep brain stimulation improves eyeblink conditioning deficits in essential tremor. Exp Neurol 2008; 211:387-96. [DOI: 10.1016/j.expneurol.2008.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 01/06/2008] [Accepted: 02/08/2008] [Indexed: 11/16/2022]
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Abstract
Several lines of evidence point to an involvement of the olivo-cerebellar system in the pathogenesis of essential tremor (ET), with clinical signs of cerebellar dysfunction being present in some subjects in the advanced stage. Besides motor coordination, the cerebellum is critically involved in motor learning. Evidence of motor learning deficits would strengthen the hypothesis of olivo-cerebellar involvement in ET. Conditioning of the eyeblink reflex is a well-established paradigm to assess motor learning. Twenty-three ET subjects (13 males, 10 females; mean age 44.3 +/- 22.3 years, mean disease duration 17.4 +/- 17.3 years) and 23 age-matched healthy controls were studied on two consecutive days using a standard delay eyeblink conditioning protocol. Six ET subjects exhibited accompanying clinical signs of cerebellar dysfunction. Care was taken to examine subjects without medication affecting central nervous functioning. Seven ET subjects and three controls on low-dose beta-blocker treatments, which had no effect on eyeblink conditioning in animal studies, were allowed into the study. The ability to acquire conditioned eyeblink responses was significantly reduced in ET subjects compared with controls. Impairment of eyeblink conditioning was not due to low-dose beta-blocker medication. Additionally, acquisition of conditioned eyeblink response was reduced in ET subjects regardless of the presence of cerebellar signs in clinical examination. There were no differences in timing or extinction of conditioned responses between groups and conditioning deficits did not correlate with the degree of tremor or ataxia as rated by clinical scores. The findings of disordered eyeblink conditioning support the hypothesis that ET is caused by a functional disturbance of olivo-cerebellar circuits which may cause cerebellar dysfunction. In particular, results point to an involvement of the olivo-cerebellar system in early stages of ET.
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Affiliation(s)
- Martin Kronenbuerger
- Department of Neurology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Kronenbuerger M, Sharpe J, Lozano A, Moro E, Noth J, Hutchison W. Beteiligung des ventrolateralen Thalamus bei Blicksakkaden. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976422] [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: 10/21/2022]
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Hutchison W, Gonzales E, Steinbach M, Noth J, Moro E, Sharpe J, Lozano A, Kronenbuerger M. Einfluss der Tiefen Hirnstimulation des Thalamus auf Blicksakkaden. Akt Neurol 2007. [DOI: 10.1055/s-2007-987672] [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: 10/21/2022]
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Kronenbuerger M, Buderath P, Frank B, Timmann-Braun D. Sprechmotorik und posturale Kontrolle beim essentiellen Tremor. Akt Neurol 2007. [DOI: 10.1055/s-2007-987512] [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: 10/21/2022]
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Timmann-Braun D, Noth J, Kiening K, Coenen V, Tronnier V, Kronenbuerger M. Klassische Konditionierung des Blinkreflexes beim essentiellen Tremor. Akt Neurol 2007. [DOI: 10.1055/s-2007-987513] [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: 10/21/2022]
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Kronenbuerger M, Fromm C, Block F, Coenen VA, Rohde I, Rohde V, Noth J. On-demand deep brain stimulation for essential tremor: A report on four cases. Mov Disord 2005; 21:401-5. [PMID: 16211619 DOI: 10.1002/mds.20714] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [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: 11/09/2022] Open
Abstract
Deep brain stimulation (DBS) is an established therapy for essential tremor (ET), but loss of efficacy due to tolerance can occur. Our objective was to evaluate if it is feasible to use DBS only on-demand and if this would prevent tolerance. We report on the effects of left-side thalamic DBS in 4 ET patients who were instructed to switch on stimulation only when using their right hand for motor tasks and were followed-up to 30 months after surgery. The patients were capable of using DBS only on-demand (DBS use of 22.0+/-13.5%/day). DBS led to a stable suppression of right arm tremor throughout the follow-up. No problems associated with tolerance such as tremor rebound or late therapy failure occurred. In comparison to publications stating that ET patients had been using DBS continuously during the daytime, the use of on-demand DBS saves battery life, which delays surgical replacement of the stimulator. Thus, on-demand DBS saves money, may help to prevent tolerance, and should be adopted for the long-term treatment of ET patients.
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Capelle HH, Simpson RK, Kronenbuerger M, Michaelsen J, Tronnier V, Krauss JK. Long-term deep brain stimulation in elderly patients with cardiac pacemakers. J Neurosurg 2005; 102:53-9. [PMID: 15658096 DOI: 10.3171/jns.2005.102.1.0053] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Deep brain stimulation (DBS) has become an accepted therapy for movement disorders such as Parkinson disease (PD) and essential tremor (ET), when these conditions are refractory to medical treatment. The presence of a cardiac pacemaker is still considered a contraindication for DBS in functional neurosurgery. The goal of this study was to evaluate the technical and clinical management of DBS for the treatment of movement disorders in elderly patients with cardiac pacemakers.
Methods. Six patients with cardiac pacemakers underwent clinical and cardiac examinations to analyze the safety of DBS in the treatment of movement disorders. Four patients suffered from advanced PD and two patients had ET. The mean age of these patients at surgery was 69.5 years (range 63–79 years). The settings of the pacemakers were programmed in a manner considered to minimize the chance of interference between the two systems.
There were no adverse events during surgery. Four patients underwent stimulation of the thalamic ventralis intermedius nucleus (VIM), and two patients stimulation of the subthalamic nucleus. In general, bipolar sensing was chosen for the cardiac pacemakers. In all but one patient the quadripolar DBS electrodes were programmed for bipolar stimulation. Several control electrocardiography studies, including 24-hour monitoring, did not show any interference between the two systems. At the time this paper was written the patients had been followed up for a mean of 25.3 months (range 4–48 months).
Conclusions. In certain conditions it is safe for patients with cardiac pacemakers to receive DBS for treatment of concomitant movement disorders. Cardiac pacemakers should not be viewed as a general contraindication for DBS in patients with movement disorders.
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Kronenbuerger M, Fromm C, Dafotakis M, Block F, Coenen V, Rohde I, Rohde V. On demand deep brain stimulation for essential tremor: an approach to avoid tolerance? Akt Neurol 2004. [DOI: 10.1055/s-2004-833138] [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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Tronnier VM, Fogel W, Kronenbuerger M, Krause M, Steinvorth S. Is the medial globus pallidus a site for stimulation or lesioning in the treatment of Parkinson's disease? Stereotact Funct Neurosurg 1998; 69:62-8. [PMID: 9711735 DOI: 10.1159/000099853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
After the encouraging report on bilateral pallidal stimulation by Siegfried in 1994, we started this procedure in 1995 and will report our experience in 6 patients with a mean follow-up of 1 year. In contrast to the good results of pallidotomy reported in the literature improving the 'on' symptoms as dyskinesias as well as 'off' symptoms such as rigidity, bradykinesia and on-off fluctuations, our results indicate that pallidal stimulation improves the 'off' symptoms only to a minor extent and L-dopa-induced dyskinesias remain the main indication. Considering the overall functional outcome, the question arises whether the medial globus pallidus should be lesioned or stimulated.
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Affiliation(s)
- V M Tronnier
- Department of Neurological Surgery, University Hospital, Heidelberg College of Medicine, Germany.
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Abstract
A resurgence of interest in the surgical treatment of Parkinson's disease (PD) came with the rediscovery of posteroventral pallidotomy by Laitinen in 1985. Laitinen's procedure improved most symptoms in drug-resistant PD, which engendered wide interest in the neurosurgical community. Another lesioning procedure, ventrolateral thalamotomy, has become a powerful alternative to stimulate the nucleus ventralis intermedius, producing high long-term success rates and low morbidity rates. Pallidal stimulation has not met with the same success. According to the literature pallidotomy improves the "on" symptoms of PD, such as dyskinesias, as well as the "off" symptoms, such as rigidity, bradykinesia, and on-off fluctuations. Pallidal stimulation improves bradykinesia and rigidity to a minor extent; however, its strength seems to be in improving levodopa-induced dyskinesias. Stimulation often produces an improvement in the hyper- or dyskinetic upper limbs, but increases the "freezing" phenomenon in the lower limbs at the same time. Considering the small increase in the patient's independence, the high costs of bilateral implants, and the difficulty most patients experience in handling the devices, the question arises as to whether bilateral pallidal stimulation is a real alternative to pallidotomy.
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Affiliation(s)
- V M Tronnier
- Department of Neurological Surgery, University Hospital, Heidelberg College of Medicine, Germany.
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Abstract
A resurgence of interest in the surgical treatment of Parkinson's disease (PD) came with the rediscovery of posteroventral pallidotomy by Laitinen in 1985. Laitinen's procedure improved most symptoms in drug-resistant PD, which engendered wide interest in the neurosurgical community. Another lesioning procedure, ventrolateral thalamotomy, has become a powerful alternative to stimulate the nucleus ventralis intermedius, producing high long-term success rates and low morbidity rates. Pallidal stimulation has not met with the same success. According to the literature pallidotomy improves the "on" symptoms of PD, such as dyskinesias, as well as the "off" symptoms, such as rigidity, bradykinesia, and on-off fluctuations. Pallidal stimulation improves bradykinesia and rigidity to a minor extent; however, its strength seems to be in improving levodopa-induced dyskinesias. Stimulation often produces an improvement in the hyper- or dyskinetic upper limbs, but increases the "freezing" phenomenon in the lower limbs at the same time. Considering the small increase in the patient's independence, the high costs of bilateral implants, and the difficulty most patients experience in handling the devices, the question arises as to whether bilateral pallidal stimulation is a real alternative to pallidotomy.
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Affiliation(s)
- V M Tronnier
- Department of Neurological Surgery, University Hospital, Heidelberg College of Medicine, Heidelberg, Germany.
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Abstract
A resurgence of interest in the surgical treatment of Parkinson's disease (PD) came with the rediscovery of posteroventral pallidotomy by Laitinen in 1985. Laitinen's procedure improved most symptoms in drug-resistant PD, which engendered wide interest in the neurosurgical community. Another lesioning procedure, ventrolateral thalamotomy, has become a powerful alternative to stimulate the nucleus ventralis intermedius, producing high long-term success rates and low morbidity rates. Pallidal stimulation has not met with the same success. According to the literature pallidotomy improves the “on” symptoms of PD, such as dyskinesias, as well as the “off” symptoms, such as rigidity, bradykinesia, and on-off fluctuations. Pallidal stimulation improves bradykinesia and rigidity to a minor extent; however, its strength seems to be in improving levodopa-induced dyskinesias. Stimulation often produces an improvement in the hyper- or dyskinetic upper limbs, but increases the “freezing” phenomenon in the lower limbs at the same time. Considering the small increase in the patient's independence, the high costs of bilateral implants, and the difficulty most patients experience in handling the devices, the question arises as to whether bilateral pallidal stimulation is a real alternative to pallidotomy.
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