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Klein A, Aeschlimann SA, Zubler F, Scutelnic A, Riederer F, Ertl M, Schankin CJ. Alterations of the alpha rhythm in visual snow syndrome: a case-control study. J Headache Pain 2024; 25:53. [PMID: 38584260 PMCID: PMC11000394 DOI: 10.1186/s10194-024-01754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Visual snow syndrome is a disorder characterized by the combination of typical perceptual disturbances. The clinical picture suggests an impairment of visual filtering mechanisms and might involve primary and secondary visual brain areas, as well as higher-order attentional networks. On the level of cortical oscillations, the alpha rhythm is a prominent EEG pattern that is involved in the prioritisation of visual information. It can be regarded as a correlate of inhibitory modulation within the visual network. METHODS Twenty-one patients with visual snow syndrome were compared to 21 controls matched for age, sex, and migraine. We analysed the resting-state alpha rhythm by identifying the individual alpha peak frequency using a Fast Fourier Transform and then calculating the power spectral density around the individual alpha peak (+/- 1 Hz). We anticipated a reduced power spectral density in the alpha band over the primary visual cortex in participants with visual snow syndrome. RESULTS There were no significant differences in the power spectral density in the alpha band over the occipital electrodes (O1 and O2), leading to the rejection of our primary hypothesis. However, the power spectral density in the alpha band was significantly reduced over temporal and parietal electrodes. There was also a trend towards increased individual alpha peak frequency in the subgroup of participants without comorbid migraine. CONCLUSIONS Our main finding was a decreased power spectral density in the alpha band over parietal and temporal brain regions corresponding to areas of the secondary visual cortex. These findings complement previous functional and structural imaging data at a electrophysiological level. They underscore the involvement of higher-order visual brain areas, and potentially reflect a disturbance in inhibitory top-down modulation. The alpha rhythm alterations might represent a novel target for specific neuromodulation. TRIAL REGISTRATION we preregistered the study before preprocessing and data analysis on the platform osf.org (DOI: https://doi.org/10.17605/OSF.IO/XPQHF , date of registration: November 19th 2022).
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Affiliation(s)
- Antonia Klein
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Sarah A Aeschlimann
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Frederic Zubler
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Adrian Scutelnic
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Franz Riederer
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland
| | - Matthias Ertl
- Department of Psychology, University of Bern, Bern, CH 3010, Switzerland
- Neurocenter, Luzerner Kantonsspital, Lucerne, 6000, Switzerland
| | - Christoph J Schankin
- Department of Neurology Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 25, Bern, CH-3010, Switzerland.
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Fitze DC, Mast FW, Ertl M. Human vestibular perceptual thresholds - A systematic review of passive motion perception. Gait Posture 2024; 107:83-95. [PMID: 37778297 DOI: 10.1016/j.gaitpost.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The vestibular system detects head accelerations within 6 degrees of freedom. How well this is accomplished is described by vestibular perceptual thresholds. They are a measure of perceptual performance based on the conscious evaluation of sensory information. This review provides an integrative synthesis of the vestibular perceptual thresholds reported in the literature. The focus lies on the estimation of thresholds in healthy participants, used devices and stimulus profiles. The dependence of these thresholds on the participants clinical status and age is also reviewed. Furthermore, thresholds from primate studies are discussed. RESULTS Thresholds have been measured for frequencies ranging from 0.05 to 5 Hz. They decrease with increasing frequency for five of the six main degrees of freedom (inter-aural, head-vertical, naso-occipital, yaw, pitch). No consistent pattern is evident for roll rotations. For a frequency range beyond 5 Hz, a U-shaped relationship is suggested by a qualitative comparison to primate data. Where enough data is available, increasing thresholds with age and higher thresholds in patients compared to healthy controls can be observed. No effects related to gender or handedness are reported. SIGNIFICANCE Vestibular thresholds are essential for next generation screening tools in the clinical domain, for the assessment of athletic performance, and workplace safety alike. Knowledge about vestibular perceptual thresholds contributes to basic and applied research in fields such as perception, cognition, learning, and healthy aging. This review provides normative values for vestibular thresholds. Gaps in current knowledge are highlighted and attention is drawn to specific issues for improving the inter-study comparability in the future.
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Affiliation(s)
- Daniel C Fitze
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
| | - Fred W Mast
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
| | - Matthias Ertl
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
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Martarelli CS, Chiquet S, Ertl M. Keeping track of reality: embedding visual memory in natural behaviour. Memory 2023; 31:1295-1305. [PMID: 37727126 DOI: 10.1080/09658211.2023.2260148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/21/2023] [Indexed: 09/21/2023]
Abstract
Since immersive virtual reality (IVR) emerged as a research method in the 1980s, the focus has been on the similarities between IVR and actual reality. In this vein, it has been suggested that IVR methodology might fill the gap between laboratory studies and real life. IVR allows for high internal validity (i.e., a high degree of experimental control and experimental replicability), as well as high external validity by letting participants engage with the environment in an almost natural manner. Despite internal validity being crucial to experimental designs, external validity also matters in terms of the generalizability of results. In this paper, we first highlight and summarise the similarities and differences between IVR, desktop situations (both non-immersive VR and computer experiments), and reality. In the second step, we propose that IVR is a promising tool for visual memory research in terms of investigating the representation of visual information embedded in natural behaviour. We encourage researchers to carry out experiments on both two-dimensional computer screens and in immersive virtual environments to investigate visual memory and validate and replicate the findings. IVR is valuable because of its potential to improve theoretical understanding and increase the psychological relevance of the findings.
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Affiliation(s)
| | - Sandra Chiquet
- Faculty of Psychology, UniDistance Suisse, Brig, Switzerland
| | - Matthias Ertl
- Department of Psychology, University of Bern, Bern, Switzerland
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Rühl M, Kimmel R, Ertl M, Conrad J, Zu Eulenburg P. In Vivo Localization of the Human Velocity Storage Mechanism and Its Core Cerebellar Networks by Means of Galvanic-Vestibular Afternystagmus and fMRI. Cerebellum 2023; 22:194-205. [PMID: 35212978 PMCID: PMC9985569 DOI: 10.1007/s12311-022-01374-8] [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] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Humans are able to estimate head movements accurately despite the short half-life of information coming from our inner ear motion sensors. The observation that the central angular velocity estimate outlives the decaying signal of the semicircular canal afferents led to the concept of a velocity storage mechanism (VSM). The VSM can be activated via visual and vestibular modalities and becomes manifest in ocular motor responses after sustained stimulation like whole-body rotations, optokinetic or galvanic vestibular stimulation (GVS). The VSM has been the focus of many computational modelling approaches; little attention though has been paid to discover its actual structural correlates. Animal studies localized the VSM in the medial and superior vestibular nuclei. A significant modulation by cerebellar circuitries including the uvula and nodulus has been proposed. Nevertheless, the corresponding neuroanatomical structures in humans have not been identified so far. The aim of the present study was to delineate the neural substrates of the VSM using high-resolution infratentorial fMRI with a fast T2* sequence optimized for infratentorial neuroimaging and via video-oculography (VOG). The neuroimaging experiment (n=20) gave first in vivo evidence for an involvement of the vestibular nuclei in the VSM and substantiate a crucial role for cerebellar circuitries. Our results emphasize the importance of cerebellar feedback loops in VSM most likely represented by signal increases in vestibulo-cerebellar hubs like the uvula and nodulus and lobule VIIIA. The delineated activation maps give new insights regarding the function and embedment of Crus I, Crus II, and lobule VII and VIII in the human vestibular system.
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Affiliation(s)
- Maxine Rühl
- Department of Neurology, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.
| | - Rebecca Kimmel
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Matthias Ertl
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Julian Conrad
- Department of Neurology, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
- Institute for Neuroradiology, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
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Wyssen G, Morrison M, Korda A, Wimmer W, Otero-Millan J, Ertl M, Szukics AA, Wyss T, Wagner F, Caversaccio MD, Mantokoudis G, Mast FW. Measuring the Influence of Magnetic Vestibular Stimulation on Nystagmus, Self-Motion Perception, and Cognitive Performance in a 7T MRT. J Vis Exp 2023. [PMID: 36939227 DOI: 10.3791/64022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Strong magnetic fields induce dizziness, vertigo, and nystagmus due to Lorentz forces acting on the cupula in the semi-circular canals, an effect called magnetic vestibular stimulation (MVS). In this article, we present an experimental setup in a 7T MRT scanner (MRI scanner) that allows the investigation of the influence of strong magnetic fields on nystagmus as well as perceptual and cognitive responses. The strength of MVS is manipulated by altering the head positions of the participants. The orientation of the participants' semicircular canals with respect to the static magnetic field is assessed by combining a 3D magnetometer and 3D constructive interference in steady-state (3D-CISS) images. This approach allows to account for intra- and inter-individual differences in participants' responses to MVS. In the future, MVS can be useful for clinical research, for example, in the investigation of compensatory processes in vestibular disorders. Furthermore, it could foster insights into the interplay between vestibular information and cognitive processes in terms of spatial cognition and the emergence of self-motion percepts under conflicting sensory information. In fMRI studies, MVS can elicit a possible confounding effect, especially in tasks influenced by vestibular information or in studies comparing vestibular patients with healthy controls.
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Affiliation(s)
- Gerda Wyssen
- Department of Psychology, University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine;
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern; Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Jorge Otero-Millan
- Herbert Wertheim School of Optometry and Vision Science, University of California
| | | | - Andreas A Szukics
- Department of Psychology, University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine
| | - Thomas Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern
| | - Franca Wagner
- University Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern; Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine
| | - Fred W Mast
- Department of Psychology, University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine
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Ertl M, Zu Eulenburg P, Woller M, Mayadali Ü, Boegle R, Dieterich M. Vestibular mapping of the naturalistic head-centered motion spectrum. J Vestib Res 2023; 33:299-312. [PMID: 37458057 DOI: 10.3233/ves-210121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Naturalistic head accelerations can be used to elicit vestibular evoked potentials (VestEPs). These potentials allow for analysis of cortical vestibular processing and its multi-sensory integration with a high temporal resolution. METHODS We report the results of two experiments in which we compared the differential VestEPs elicited by randomized translations, rotations, and tilts in healthy subjects on a motion platform. RESULTS An event-related potential (ERP) analysis revealed that established VestEPs were verifiable in all three acceleration domains (translations, rotations, tilts). A further analysis of the VestEPs showed a significant correlation between rotation axes (yaw, pitch, roll) and the amplitude of the evoked potentials. We found increased amplitudes for rotations in the roll compared to the pitch and yaw plane. A distributed source localization analysis showed that the activity in the cingulate sulcus visual (CSv) area best explained direction-dependent amplitude modulations of the VestEPs, but that the same cortical network (posterior insular cortex, CSv) is involved in processing vestibular information, regardless of the motion direction. CONCLUSION The results provide evidence for an anisotropic, direction-dependent processing of vestibular input by cortical structures. The data also suggest that area CSv plays an integral role in ego-motion perception and interpretation of spatial features such as acceleration direction and intensity.
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Affiliation(s)
- Matthias Ertl
- Department of Psychology, University of Bern, Bern, Switzerland
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders (IFBLMU), Ludwig-Maximilians-Universität München, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marie Woller
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ümit Mayadali
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rainer Boegle
- German Center for Vertigo and Balance Disorders (IFBLMU), Ludwig-Maximilians-Universität München, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Vertigo and Balance Disorders (IFBLMU), Ludwig-Maximilians-Universität München, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Cluster for Neurology (SyNergy), Munich, Germany
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Ruehl RM, Flanagin VL, Ophey L, Raiser TM, Seiderer K, Ertl M, Conrad J, Zu Eulenburg P. The human egomotion network. Neuroimage 2022; 264:119715. [PMID: 36334557 DOI: 10.1016/j.neuroimage.2022.119715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
Abstract
All volitional movement in a three-dimensional space requires multisensory integration, in particular of visual and vestibular signals. Where and how the human brain processes and integrates self-motion signals remains enigmatic. Here, we applied visual and vestibular self-motion stimulation using fast and precise whole-brain neuroimaging to delineate and characterize the entire cortical and subcortical egomotion network in a substantial cohort (n=131). Our results identify a core egomotion network consisting of areas in the cingulate sulcus (CSv, PcM/pCi), the cerebellum (uvula), and the temporo-parietal cortex including area VPS and an unnamed region in the supramarginal gyrus. Based on its cerebral connectivity pattern and anatomical localization, we propose that this region represents the human homologue of macaque area 7a. Whole-brain connectivity and gradient analyses imply an essential role of the connections between the cingulate sulcus and the cerebellar uvula in egomotion perception. This could be via feedback loops involved updating visuo-spatial and vestibular information. The unique functional connectivity patterns of PcM/pCi hint at central role in multisensory integration essential for the perception of self-referential spatial awareness. All cortical egomotion hubs showed modular functional connectivity with other visual, vestibular, somatosensory and higher order motor areas, underlining their mutual function in general sensorimotor integration.
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Affiliation(s)
- Ria Maxine Ruehl
- Department of Neurology, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany; German Center for Vertigo and Balance Disorders, IFB-LMU, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany.
| | - Virginia L Flanagin
- Department of Neurology, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany; German Center for Vertigo and Balance Disorders, IFB-LMU, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany; Graduate School of Systemic Neurosciences, Department of Biology II and Neurobiology, Großhaderner Str. 2, 82151 Planegg-Martinsried, Ludwig-Maximilians-University Munich, Germany
| | - Leoni Ophey
- German Center for Vertigo and Balance Disorders, IFB-LMU, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany
| | - Theresa Marie Raiser
- Department of Neurology, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany; German Center for Vertigo and Balance Disorders, IFB-LMU, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany
| | - Katharina Seiderer
- German Center for Vertigo and Balance Disorders, IFB-LMU, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany
| | - Matthias Ertl
- Institute of Psychology and Inselspital, Fabrikstrasse 8, 3012 Bern, University of Bern, Switzerland
| | - Julian Conrad
- Department of Neurology, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany; German Center for Vertigo and Balance Disorders, IFB-LMU, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany; Department of Neurology, Theodor-Kutze Ufer 1-3, 68167 Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders, IFB-LMU, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchionini Str. 15, 81377 Munich, Germany; Graduate School of Systemic Neurosciences, Department of Biology II and Neurobiology, Großhaderner Str. 2, 82151 Planegg-Martinsried, Ludwig-Maximilians-University Munich, Germany; Institute for Neuroradiology, University Hospital Munich, Marchionini Str. 15, 81377 Munich, Ludwig-Maximilians-University Munich, Germany
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Ertl M, Fitze DC, Wyssen G, Mast FW. Estimating Vestibular Perceptual Thresholds using a Six-Degree-of-Freedom Motion Platform. J Vis Exp 2022. [DOI: 10.3791/63909] [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: 10/31/2022] Open
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Werner JM, Kupke P, Ertl M, Opitz S, Schlitt HJ, Hornung M. Timing of Closure of a Protective Loop-Ileostomy Can Be Crucial for Restoration of a Functional Digestion. Front Surg 2022; 9:821509. [PMID: 35419403 PMCID: PMC8999839 DOI: 10.3389/fsurg.2022.821509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/28/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Protective loop-ileostomy is one of the most common interventions in abdominal surgery to provide an alternative intestinal outlet until sufficient healing of a distal anastomosis has occurred. However, closure of a loop-ileostomy is also associated with complications. Thus, knowledge of the optimal time interval between primary and secondary surgery is crucial. Methods Data from 409 patients were retrospectively analyzed regarding complications and risk factors in closure-associated morbidity and mortality. A modified Clavien-Dindo classification of surgical complications was used to evaluate the severity of complications. Results A total of 96 (23.5%) patients suffered from postoperative complications after the closure of the loop-ileostomy. Early closure within 150 days from enterostomy (n = 229) was associated with less complications (p < 0.001**). Looking at the severity of complications, there were significantly more (p = 0.014*) mild postoperative complications in the late closure group (>150 days). Dysfunctional digestive problems—either (sub-) ileus (p = 0.004*), diarrhea or stool incontinence (p = 0.003*)—were the most frequent complications associated with late closure. Finally, we could validate in a multivariate analysis that “time to closure” (p = 0.002*) is independently associated with the development of complications after closure of a protective loop-ileostomy. Conclusion Late closure (>150 days) of a loop-ileostomy is an independent risk factor in post-closure complications in a multivariate analysis. Nevertheless, circumstances of disease and therapy need to be considered when scheduling the closure procedure.
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Conrad J, Habs M, Ruehl RM, Boegle R, Ertl M, Kirsch V, Eren O, Becker-Bense S, Stephan T, Wollenweber F, Duering M, Dieterich M, Zu Eulenburg P. Reorganization of sensory networks after subcortical vestibular infarcts - A longitudinal symptom-related VBM study. Eur J Neurol 2022; 29:1514-1523. [PMID: 35098611 DOI: 10.1111/ene.15263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to delineate common principles of reorganization after infarcts of the subcortical vestibular circuitry related to the clinical symptomatology. Our hypothesis was that the recovery of specific symptoms is associated with changes in distinct regions within the core vestibular, somatosensory and visual cortical and subcortical networks. METHODS We used voxel- and surface-based morphometry to investigate structural reorganization of subcortical and cortical brain areas in 42 patients with a unilateral, subcortical infarct with vestibular and ocular motor deficits in the acute phase. The patients received structural neuroimaging and clinical monitoring twice (acute phase and after 6 months) to detect within-subject changes over time. RESULTS In patients with vestibular signs such as tilts of the subjective visual vertical (SVV) and ocular torsion in the acute phase, significant volumetric increases in the superficial white matter around the parieto-(retro-)insular vestibular cortex (PIVC) were found at follow-up. In patients with SVV tilts, spontaneous nystagmus and rotatory vertigo in the acute phase gray matter volume decreases were located in the cerebellum and the visual cortex bilaterally at follow-up. Patients with saccade pathology demonstrated volumetric decreases in cerebellar, thalamic and cortical centers for ocular motor control. CONCLUSIONS The findings support the role of the PIVC as the key hub for vestibular processing and reorganization. The volumetric decreases represent the reciprocal interaction of the vestibular, visual and ocular motor systems during self-location and egomotion detection. A modulation in vestibular and ocular motor as well as visual networks was induced independent of the vestibular lesion site.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Maximilian Habs
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Ria Maxine Ruehl
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Rainer Boegle
- Department of Neurology, University Hospital, LMU Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany
| | - Matthias Ertl
- Department of Psychology, University of Bern, Switzerland
| | - Valerie Kirsch
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany
| | - Ozan Eren
- Department of Neurology, University Hospital, LMU Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Thomas Stephan
- Department of Neurology, University Hospital, LMU Munich, Germany
| | - Frank Wollenweber
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany.,Department of Neurology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany.,Medical Image Analysis Center (MIAC) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Marianne Dieterich
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany.,Institute for Neuroradiology LMU Munich, Germany
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Hebestreit H, Ullrich M, Graeßner H, Rashid A, Ertl M, Maisch T. Digitale Systeme für Konsile und Fallkonferenzen bei Seltenen Erkrankungen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01225-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Knowledge about the relevance and extent of human eye movement control in the cingulate cortex to date is very limited. Experiments in non-human primates brought about evidence for a potentially central role of the dorsal bank of the cingulate sulcus in saccadic eye movements. In humans, a putative cingulate eye field (CEF) in the same region has been proposed; however, its function and location still remain controversial. Another area in the posterior cingulate cortex, the cingulate sulcus visual area (CSv), has been shown to respond to visual motion cues and also ocular motor tasks. In this study we used multi-band neuroimaging (n = 46) to comprehensively characterize oculomotor responses along the entire cingulate cortex during the most common types of eye movements. We were able to robustly localize the CEF to the anterior portion of the midcingulate gyrus. The region gave responses during all oculomotor tasks and is embedded within the ventral attention network. Area CSv, which is located in the anterior portion of the posterior cingulate gyrus, on the other hand responded to smooth pursuit and optokinetic nystagmus only. It likewise represents a node within the ventral attention network but at the same time seems to be a distinctive part of the somatomotor network. Our findings support an executive role of the CEF, suggesting a cognitive control function in maintaining and adapting different kinds of eye movements. CSv on the other hand might be an interface for relaying oculomotor, visual motion and broad sensory signals related to self-motion.
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Affiliation(s)
- Ria Maxine Ruehl
- Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Leoni Ophey
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Ertl
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Munich, Germany; Institute for Neuroradiology, Ludwig-Maximilians-University Munich, Munich, Germany
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13
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Conrad J, Habs M, Ruehl M, Boegle R, Ertl M, Kirsch V, Eren O, Becker-Bense S, Stephan T, Wollenweber F, Duering M, Dieterich M, Eulenburg PZ. Structural reorganization of the cerebral cortex after vestibulo-cerebellar stroke. Neuroimage Clin 2021; 30:102603. [PMID: 33676164 PMCID: PMC7933782 DOI: 10.1016/j.nicl.2021.102603] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Structural reorganization following cerebellar infarcts is not yet known. This study aimed to demonstrate structural volumetric changes over time in the cortical vestibular and multisensory areas (i.e., brain plasticity) after acute cerebellar infarcts with vestibular and ocular motor symptoms. Additionally, we evaluated whether structural reorganization in the patients topographically correlates with cerebello-cortical connectivity that can be observed in healthy participants. METHODS We obtained high-resolution structural imaging in seven patients with midline cerebellar infarcts at two time points. These data were compared to structural imaging of a group of healthy age-matched controls using voxel-based morphometry (2×2 ANOVA approach). The maximum overlap of the infarcts was used as a seed region for a separate resting-state functional connectivity analysis in healthy volunteers. RESULTS Volumetric changes were detected in the multisensory cortical vestibular areas around the parieto-opercular and (retro-) insular cortex. Furthermore, structural reorganization was evident in parts of the frontal, temporal, parietal, limbic, and occipital lobes and reflected functional connections between the main infarct regions in the cerebellum and the cerebral cortex in healthy individuals. CONCLUSIONS This study demonstrates structural reorganization in the parieto-opercular insular vestibular cortex after acute vestibulo-cerebellar infarcts. Additionally, the widely distributed structural reorganization after midline cerebellar infarcts provides additional in vivo evidence for the multifaceted contribution of cerebellar processing to cortical functions that extend beyond vestibular or ocular motor function.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, University Hospital, LMU Munich, Germany; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany.
| | - Maximilian Habs
- Department of Neurology, University Hospital, LMU Munich, Germany; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Maxine Ruehl
- Department of Neurology, University Hospital, LMU Munich, Germany; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Rainer Boegle
- Department of Neurology, University Hospital, LMU Munich, Germany; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany; Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany
| | - Matthias Ertl
- Department of Psychology, University of Bern, Switzerland
| | - Valerie Kirsch
- Department of Neurology, University Hospital, LMU Munich, Germany; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Ozan Eren
- Department of Neurology, University Hospital, LMU Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Thomas Stephan
- Department of Neurology, University Hospital, LMU Munich, Germany
| | - Frank Wollenweber
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany; Department of Neurology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, LMU Munich, Germany; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany; Institute for Neuroradiology, University Hospital, LMU Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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14
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Ertl M, Zu Eulenburg P, Woller M, Dieterich M. The role of delta and theta oscillations during ego-motion in healthy adult volunteers. Exp Brain Res 2021; 239:1073-1083. [PMID: 33534022 PMCID: PMC8068649 DOI: 10.1007/s00221-020-06030-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
The successful cortical processing of multisensory input typically requires the integration of data represented in different reference systems to perform many fundamental tasks, such as bipedal locomotion. Animal studies have provided insights into the integration processes performed by the neocortex and have identified region specific tuning curves for different reference frames during ego-motion. Yet, there remains almost no data on this topic in humans. In this study, an experiment originally performed in animal research with the aim to identify brain regions modulated by the position of the head and eyes relative to a translational ego-motion was adapted for humans. Subjects sitting on a motion platform were accelerated along a translational pathway with either eyes and head aligned or a 20° yaw-plane offset relative to the motion direction while EEG was recorded. Using a distributed source localization approach, it was found that activity in area PFm, a part of Brodmann area 40, was modulated by the congruency of translational motion direction, eye, and head position. In addition, an asymmetry between the hemispheres in the opercular-insular region was observed during the cortical processing of the vestibular input. A frequency specific analysis revealed that low-frequency oscillations in the delta- and theta-band are modulated by vestibular stimulation. Source-localization estimated that the observed low-frequency oscillations are generated by vestibular core-regions, such as the parieto-opercular region and frontal areas like the mid-orbital gyrus and the medial frontal gyrus.
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Affiliation(s)
- M Ertl
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany.
| | - P Zu Eulenburg
- German Center for Vertigo and Balance Disorders (IFBLMU), Ludwig-Maximilians-Universität München, München, Germany
- Institute for Neuroradiology, Ludwig-Maximilians-Universität München, München, Germany
| | - M Woller
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - M Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
- German Center for Vertigo and Balance Disorders (IFBLMU), Ludwig-Maximilians-Universität München, München, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität München, München, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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15
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Conrad J, Habs M, Boegle R, Ertl M, Kirsch V, Stefanova-Brostek I, Eren O, Becker-Bense S, Stephan T, Wollenweber F, Duering M, Zu Eulenburg P, Dieterich M. Global multisensory reorganization after vestibular brain stem stroke. Ann Clin Transl Neurol 2020; 7:1788-1801. [PMID: 32856758 PMCID: PMC7545594 DOI: 10.1002/acn3.51161] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/25/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Patients with acute central vestibular syndrome suffer from vertigo, spontaneous nystagmus, postural instability with lateral falls, and tilts of visual vertical. Usually, these symptoms compensate within months. The mechanisms of compensation in vestibular infarcts are yet unclear. This study focused on structural changes in gray and white matter volume that accompany clinical compensation. METHODS We studied patients with acute unilateral brain stem infarcts prospectively over 6 months. Structural changes were compared between the acute phase and follow-up with a group of healthy controls using voxel-based morphometry. RESULTS Restitution of vestibular function following brain stem infarcts was accompanied by downstream structural changes in multisensory cortical areas. The changes depended on the location of the infarct along the vestibular pathways in patients with pathological tilts of the SVV and on the quality of the vestibular percept (rotatory vs graviceptive) in patients with pontomedullary infarcts. Patients with pontomedullary infarcts with vertigo or spontaneous nystagmus showed volumetric increases in vestibular parietal opercular multisensory and (retro-) insular areas with right-sided preference. Compensation of graviceptive deficits was accompanied by adaptive changes in multiple multisensory vestibular areas in both hemispheres in lower brain stem infarcts and by additional changes in the motor system in upper brain stem infarcts. INTERPRETATION This study demonstrates multisensory neuroplasticity in both hemispheres along with the clinical compensation of vestibular deficits following unilateral brain stem infarcts. The data further solidify the concept of a right-hemispheric specialization for core vestibular processing. The identification of cortical structures involved in central compensation could serve as a platform to launch novel rehabilitative treatments such as transcranial stimulations.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Habs
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany
| | - Rainer Boegle
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany
| | - Matthias Ertl
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Valerie Kirsch
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany
| | | | - Ozan Eren
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany
| | - Thomas Stephan
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Frank Wollenweber
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany.,Institute for Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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16
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Ertl M, Klaus M, Mast FW, Brandt T, Dieterich M. Spectral fingerprints of correct vestibular discrimination of the intensity of body accelerations. Neuroimage 2020; 219:117015. [PMID: 32505699 DOI: 10.1016/j.neuroimage.2020.117015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
Perceptual decision-making is a complex task that requires multiple processing steps performed by spatially distinct brain regions interacting in order to optimize perception and motor response. Most of our knowledge on these processes and interactions were derived from unimodal stimulations of the visual system which identified the lateral intraparietal area and the posterior parietal cortex as critical regions. Unlike the visual system, the vestibular system has no primary cortical areas and it is associated with separate multisensory areas within the temporo-parietal cortex with the parieto-insular vestibular cortex, PIVC, being the core region. The aim of the presented experiment was to investigate the transition from sensation to perception and to reveal the main structures of the cortical vestibular system involved in perceptual decision-making. Therefore, an EEG analysis was performed in 35 healthy subjects during linear whole-body accelerations of different intensities on a motor-driven motion platform (hexapod). We used a discrimination task in order to judge the intensity of the accelerations. Furthermore, we manipulated the expectation of the upcoming stimulus by indicating the probability (25%, 50%, 75%, 100%) of the motion direction. The analysis of the vestibular evoked potentials (VestEPs) showed that the decision-making process leads to a second positive peak (P2b) which was not observed in previous task-free experiments. The comparison of the estimated neural generators of the P2a and P2b components showed significant activity differences in the anterior cingulus, the parahippocampal and the middle temporal gyri. Taking into account the time courses of the P2 components, the physical properties of the stimuli, and the responses given by the subjects we conclude that the P2b likely reflects the transition from the processing of sensory information to perceptual evaluation. Analyzing the decision-uncertainty reported by the subjects, a persistent divergence of the time courses starting at 188 ms after the acceleration was found at electrode Pz. This finding demonstrated that meta-cognition by means of confidence estimation starts in parallel with the decision-making process itself. Further analyses in the time-frequency domain revealed that a correct classification of acceleration intensities correlated with an inter-trial phase clustering at electrode Cz and an inter-site phase clustering of theta oscillations over frontal, central, and parietal cortical areas. The sites where the phase clustering was observed corresponded to core decision-making brain areas known from neuroimaging studies in the visual domain.
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Affiliation(s)
- M Ertl
- Department of Psychology, University Bern, Switzerland; Department of Neurology, Ludwig-Maximilians-Universität München, Germany.
| | - M Klaus
- Department of Psychology, University Bern, Switzerland
| | - F W Mast
- Department of Psychology, University Bern, Switzerland
| | - T Brandt
- German Center for Vertigo and Balance Disorders-IFBLMU (DSGZ), Ludwig-Maximilians-Universität München, Germany; Hertie Senior Research Professor for Clinical Neuroscience, Ludwig-Maximilians-Universität München, Germany
| | - M Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany; German Center for Vertigo and Balance Disorders-IFBLMU (DSGZ), Ludwig-Maximilians-Universität München, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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17
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Ertl M, Schulte M, Dieterich M. EEG microstate architecture does not change during passive whole-body accelerations. J Neurol 2020; 267:76-78. [PMID: 32468117 PMCID: PMC7718187 DOI: 10.1007/s00415-020-09794-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/24/2022]
Affiliation(s)
- M Ertl
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany. .,Department of Psychology, University of Bern, Bern, Switzerland.
| | - M Schulte
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany
| | - M Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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18
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Conrad J, Ertl M, Oltmanns MH, Zu Eulenburg P. Prediction contribution of the cranial collateral circulation to the clinical and radiological outcome of ischemic stroke. J Neurol 2020; 267:2013-2021. [PMID: 32206898 PMCID: PMC7320948 DOI: 10.1007/s00415-020-09798-0] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND AIM The extent of penumbra tissue and outcome in stroke patients depend on the collateral cranial vasculature. To provide optimal individualized care for stroke patients in the emergency room setting we investigated the predictive capability of a stringent evaluation of the collateral vessels in ischemic stroke on clinical outcome and infarct size. METHODS We retrospectively studied uniform clinical and radiological data of 686 consecutive patients admitted to the emergency department with suspected acute ischemic stroke. Cranial collateral vasculature status was graded using the initial CT-angiography. Outcome was measured by mRS, NIHSS and final infarct size at hospital discharge. All data were used to build a linear regression model to predict the patients´ outcome. RESULTS Univariate and multivariate analyses showed significant effects of the whole brain collateral vessel score on all outcome variables. Atherosclerosis and piale collateral status were associated with the final infarct volume (FIV). Atherosclerosis and age were associated with the NIHSS at discharge. The presence of atherosclerosis, glucose level on admission and age were associated with the mRS at discharge. The multivariate models were able to predict 29% of the variance of the mRS at discharge, 24% of the variance in FIV and 17% of the variance of the NIHSS at discharge. The whole brain collateral status and the presence of atherosclerosis were the most relevant predictors for the clinical and radiological outcome. CONCLUSION The whole brain collateral vasculature status is clearly associated with clinical and radiological outcome but in a multivariate model seems not sufficiently predictive for FIV, mRS and NIHSS outcome at discharge in non-preselected patients admitted to the emergency department with ischemic stroke.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, LMU Munich, Marchioninistr.15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), LMU Munich, Munich, Germany.
| | - Matthias Ertl
- German Center for Vertigo and Balance Disorders (DSGZ), LMU Munich, Munich, Germany.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Meret H Oltmanns
- Department of Neuroradiology, Johannes Gutenberg-University, Mainz, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders (DSGZ), LMU Munich, Munich, Germany.,Institute for Neuroradiology, LMU Munich, Munich, Germany
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19
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Sahiti F, Morbach C, Henneges C, Hanke M, Ludwig R, Breunig M, Cejka V, Christa M, Scholz N, Ertl M, Kaspar M, Ertl G, Frantz S, Angermann C, Stoerk S. P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
OnBehalf
AHF Registry
Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF <40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF).
Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates.
Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF <40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table).
Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF.
Abstract P803 Figure.
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Affiliation(s)
- F Sahiti
- Comprehensive Heart Failure Center (CHFC), Department for Medicine I, Interdisciplinary Center for Clinical Research (IZKF), University and University Hospital Würzburg, Würzburg, Germany
| | - C Morbach
- Comprehensive Heart Failure Center (CHFC), Department for Medicine I, University and University Hospital Wurzburg, Wurzburg, Germany
| | - C Henneges
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - M Hanke
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - R Ludwig
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - M Breunig
- Comprehensive Heart Failure Center (CHFC), Department for Medicine I, University and University Hospital Wurzburg, Wurzburg, Germany
| | - V Cejka
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - M Christa
- Comprehensive Heart Failure Center (CHFC), Department for Medicine I, University and University Hospital Wurzburg, Wurzburg, Germany
| | - N Scholz
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - M Ertl
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - M Kaspar
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - G Ertl
- Comprehensive Heart Failure Center (CHFC), Department for Medicine I, University and University Hospital Wurzburg, Wurzburg, Germany
| | - S Frantz
- Comprehensive Heart Failure Center (CHFC), Department for Medicine I, University and University Hospital Wurzburg, Wurzburg, Germany
| | - C Angermann
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - S Stoerk
- Comprehensive Heart Failure Center (CHFC), Department for Medicine I, University and University Hospital Wurzburg, Wurzburg, Germany
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20
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Ertl M, Klaus M, Brandt T, Dieterich M, Mast FW. Distorted mental spatial representation of multi-level buildings - Humans are biased towards equilateral shapes of height and width. Sci Rep 2019; 9:15046. [PMID: 31636281 PMCID: PMC6803710 DOI: 10.1038/s41598-019-50992-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
Abstract
A distorted model of a familiar multi-level building with a systematic overestimation of the height was demonstrated earlier in psychophysical and real world navigational tasks. In the current study we further investigated this phenomenon with a tablet-based application. Participants were asked to adjust height and width of the presented buildings to best match their memory of the dimensional ratio. The estimation errors between adjusted and true height-width ratios were analyzed. Additionally, familiarity with respect to in- and outside of the building as well as demographic data were acquired. A total of 142 subjects aged 21 to 90 years from the cities of Bern and Munich were tested. Major results were: (1) a median overestimation of the height of the multi-level buildings of 11%; (2) estimation errors were significantly less if the particular building was unknown to participants; (3) in contrast, the height of tower-like buildings was underestimated; (4) the height of long, flat shaped buildings was overestimated. (5) Further features, such as the architectonical complexity were critical. Overall, our internal models of large multi-level buildings are distorted due to multiple factors including geometric features and memory effects demonstrating that such individual models are not rigid but plastic with consequences for spatial orientation and navigation.
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Affiliation(s)
- M Ertl
- Department of Psychology, University Bern, Bern, Switzerland.
- Department of Neurology, Inselspital Bern, Bern, Switzerland.
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany.
| | - M Klaus
- Department of Psychology, University Bern, Bern, Switzerland
| | - T Brandt
- Hertie Senior Professor for Clinical Neuroscience, Ludwig-Maximilians- Universität München, München, Germany
- German Center for Vertigo and Balance Disorders-IFBLMU (DSGZ), Ludwig-Maximilians-Universität München, München, Germany
| | - M Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
- German Center for Vertigo and Balance Disorders-IFBLMU (DSGZ), Ludwig-Maximilians-Universität München, München, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - F W Mast
- Department of Psychology, University Bern, Bern, Switzerland
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21
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Ertl M, Boegle R. Investigating the vestibular system using modern imaging techniques-A review on the available stimulation and imaging methods. J Neurosci Methods 2019; 326:108363. [PMID: 31351972 DOI: 10.1016/j.jneumeth.2019.108363] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 05/07/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023]
Abstract
The vestibular organs, located in the inner ear, sense linear and rotational acceleration of the head and its position relative to the gravitational field of the earth. These signals are essential for many fundamental skills such as the coordination of eye and head movements in the three-dimensional space or the bipedal locomotion of humans. Furthermore, the vestibular signals have been shown to contribute to higher cognitive functions such as navigation. As the main aim of the vestibular system is the sensation of motion it is a challenging system to be studied in combination with modern imaging methods. Over the last years various different methods were used for stimulating the vestibular system. These methods range from artificial approaches like galvanic or caloric vestibular stimulation to passive full body accelerations using hexapod motion platforms, or rotatory chairs. In the first section of this review we provide an overview over all methods used in vestibular stimulation in combination with imaging methods (fMRI, PET, E/MEG, fNIRS). The advantages and disadvantages of every method are discussed, and we summarize typical settings and parameters used in previous studies. In the second section the role of the four imaging techniques are discussed in the context of vestibular research and their potential strengths and interactions with the presented stimulation methods are outlined.
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Affiliation(s)
- Matthias Ertl
- Department of Psychology, University of Bern, Switzerland; Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital (Inselspital) Bern, Switzerland.
| | - Rainer Boegle
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany; German Center for Vertigo and Balance Disorders, IFB-LMU, Ludwig-Maximilians Universität, Munich, Germany
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Ertl M, Raasch N, Hammel G, Harter K, Lang C. P3. Transtemporal investigation of brain parenchyma elasticity using 2-D shear wave elastography: Definition of age-matched normal values. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Conrad J, Boegle R, Ertl M, Brandt T, Dieterich M. Recovery from Spatial Neglect with Intra- and Transhemispheric Functional Connectivity Changes in Vestibular and Visual Cortex Areas-A Case Study. Front Neurol 2018; 9:112. [PMID: 29551990 PMCID: PMC5840167 DOI: 10.3389/fneur.2018.00112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/14/2018] [Indexed: 01/24/2023] Open
Abstract
Objective Vestibular signals are involved in higher cortical functions like spatial orientation and its disorders. Vestibular dysfunction contributes, for example, to spatial neglect which can be transiently improved by caloric stimulation. The exact roles and mechanisms of the vestibular and visual systems for the recovery of neglect are not yet known. Methods Resting-state functional connectivity (fc) magnetic resonance imaging was recorded in a patient with hemispatial neglect during the acute phase and after recovery 6 months later following a right middle cerebral artery infarction before and after caloric vestibular stimulation. Seeds in the vestibular [parietal operculum (OP2)], the parietal [posterior parietal cortex (PPC); 7A, hIP3], and the visual cortex (VC) were used for the analysis. Results During the acute stage after caloric stimulation the fc of the right OP2 to the left OP2, the anterior cingulum, and the para/hippocampus was increased bilaterally (i.e., the vestibular network), while the interhemispheric fc was reduced between homologous regions in the VC. After 6 months, similar fc increases in the vestibular network were found without stimulation. In addition, fc increases of the OP2 to the PPC and the VC were seen; interhemispherically this was true for both PPCs and for the right PPC to both VCs. Conclusion Improvement of neglect after caloric stimulation in the acute phase was associated with increased fc of vestibular cortex areas in both hemispheres to the para-hippocampus and the dorsal anterior cingulum, but simultaneously with reduced interhemispheric VC connectivity. This disclosed a, to some extent, similar but also distinct short-term mechanism (vestibular stimulation) of an improvement of spatial orientation compared to the long-term recovery of neglect.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders - IFBLMU (DSGZ), Ludwig-Maximilians-Universität, Munich, Germany
| | - Rainer Boegle
- German Center for Vertigo and Balance Disorders - IFBLMU (DSGZ), Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Matthias Ertl
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders - IFBLMU (DSGZ), Ludwig-Maximilians-Universität, Munich, Germany.,Clinical Neuroscience, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders - IFBLMU (DSGZ), Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Oh SY, Shin HJ, Boegle R, Ertl M, Eulenburg PZ, Kim JS, Dieterich M. Simultaneous recording of cervical and ocular vestibular-evoked myogenic potentials. Neurology 2017; 90:e230-e238. [DOI: 10.1212/wnl.0000000000004835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/29/2017] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo increase clinical application of vestibular-evoked myogenic potentials (VEMPs) by reducing the testing time by evaluating whether a simultaneous recording of ocular and cervical VEMPs can be achieved without a loss in diagnostic sensitivity and specificity.MethodsSimultaneous recording of ocular and cervical VEMPs on each side during monaural stimulation, bilateral simultaneous recording of ocular VEMPs and cervical VEMPs during binaural stimulation, and conventional sequential recording of ocular and cervical VEMPs on each side using air-conducted sound (500 Hz, 5-millisecond tone burst) were compared in 40 healthy participants (HPs) and 20 patients with acute vestibular neuritis.ResultsEither simultaneous recording during monaural and binaural stimulation effectively reduced the recording time by ≈55% of that for conventional sequential recordings in both the HP and patient groups. The simultaneous recording with monaural stimulation resulted in latencies and thresholds of both VEMPs and the amplitude of cervical VEMPs similar to those found during the conventional recordings but larger ocular VEMP amplitudes (156%) in both groups. In contrast, compared to the conventional recording, simultaneous recording of each VEMP during binaural stimulation showed reduced amplitudes (31%) and increased thresholds for cervical VEMPs in both groups.ConclusionsThe results of simultaneous recording of cervical and ocular VEMPs during monaural stimulation were comparable to those obtained from the conventional recording while reducing the time to record both VEMPs on each side.ClinicalTrials.gov identifierNCT03049683.
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Feldmann C, Kaspar M, Mittenzwei K, Mohrbach C, Ertl M, Fette G, Puppe F, Ertl G, Angermann C, Stoerk S. P6191Patients not consenting in registry participation- another black box in acute heart failure registries. Results from AHF Registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6191] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C. Feldmann
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - M. Kaspar
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - K. Mittenzwei
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - C. Mohrbach
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - M. Ertl
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - G. Fette
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - F. Puppe
- University of Wuerzburg, Chair of Computer Science VI, Wurzburg, Germany
| | - G. Ertl
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - C.E. Angermann
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - S. Stoerk
- University of Würzburg, Department of Internal Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
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Ertl M, Moser M, Boegle R, Conrad J, zu Eulenburg P, Dieterich M. The cortical spatiotemporal correlate of otolith stimulation: Vestibular evoked potentials by body translations. Neuroimage 2017; 155:50-59. [DOI: 10.1016/j.neuroimage.2017.02.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 12/01/2022] Open
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Boegle R, Ertl M, Stephan T, Dieterich M. Magnetic vestibular stimulation influences resting-state fluctuations and induces visual-vestibular biases. J Neurol 2017; 264:999-1001. [PMID: 28271404 DOI: 10.1007/s00415-017-8447-6] [Citation(s) in RCA: 8] [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] [Received: 01/10/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
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Oh SY, Boegle R, Eulenburg PZ, Ertl M, Kim JS, Dieterich M. Longitudinal multi-modal neuroimaging in opsoclonus–myoclonus syndrome. J Neurol 2017; 264:512-519. [DOI: 10.1007/s00415-016-8389-4] [Citation(s) in RCA: 8] [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] [Received: 11/10/2016] [Revised: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
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Salzl S, Ertl M, Knör G. Evidence for photosensitised hydrogen production from water in the absence of precious metals, redox-mediators and co-catalysts. Phys Chem Chem Phys 2017; 19:8141-8147. [DOI: 10.1039/c6cp07725k] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
New approaches for sunlight-powered proton reduction and photocatalytic hydrogen evolution from aqueous salt solutions using earth-abundant components and molecular photosensitisers.
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Affiliation(s)
- S. Salzl
- Johannes Kepler University Linz (JKU)
- Institute of Inorganic Chemistry
- A-4040 Linz
- Austria
| | - M. Ertl
- Johannes Kepler University Linz (JKU)
- Institute of Inorganic Chemistry
- A-4040 Linz
- Austria
| | - G. Knör
- Johannes Kepler University Linz (JKU)
- Institute of Inorganic Chemistry
- A-4040 Linz
- Austria
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Ertl M, Aigner R, Krost M, Karnasová Z, Müller K, Naumann M, Schlachetzki F. Measuring changes in the optic nerve sheath diameter in patients with idiopathic normal-pressure hydrocephalus: a useful diagnostic supplement to spinal tap tests. Eur J Neurol 2016; 24:461-467. [DOI: 10.1111/ene.13225] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- M. Ertl
- Clinic for Neurology and Neurophysiology; Klinikum Augsburg; Augsburg Germany
| | - R. Aigner
- Clinic for Neurology and Neurophysiology; Klinikum Augsburg; Augsburg Germany
| | - M. Krost
- Clinic for Neurology and Neurophysiology; Klinikum Augsburg; Augsburg Germany
| | - Z. Karnasová
- Clinic for Neurology and Neurophysiology; Klinikum Augsburg; Augsburg Germany
| | - K. Müller
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
| | - M. Naumann
- Clinic for Neurology and Neurophysiology; Klinikum Augsburg; Augsburg Germany
| | - F. Schlachetzki
- Department of Neurology; Clinic for Neurological Rehabiliation II; University of Regensburg; Regensburg Germany
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Von Heyking K, Roth L, Ertl M, Schmidt O, Calzada-Wack J, Neff F, Lawlor E, Burdach S, Richter G. The posterior HOXD locus: Its contribution to phenotype and malignancy of Ewing sarcoma. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pfadenhauer K, Ertl M, Berlis A, Hittinger M. Zerebrale Ischämie bei aktiver Riesenzellarteriitis: Klinische und diagnostische Besonderheiten bei 36 Patienten. Akt Neurol 2016. [DOI: 10.1055/s-0042-109048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - M. Ertl
- Neurologie, Klinikum Augsburg, Augsburg
| | - A. Berlis
- Institut für diagnostische Radiologie und Neuroradiologie, Augsburg
| | - M. Hittinger
- Institut für diagnostische Radiologie und Neuroradiologie, Augsburg
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Pfadenhauer K, Ertl M, Hittinger M, Berlis A. Cerebral Ischemia in Active Giant Cell Arteritis: Clinical and Diagnostic Aspects in 36 Patients. Akt Neurol 2016. [DOI: 10.1055/s-0042-119566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Background: Cerebral ischemia (CI) is an uncommon, sometimes life-threatening complication of active giant cell arteritis (aGCA) due to affection of the precerebral arteries.
Aim of the Study: To analyze and describe clinical findings and results of multimodal vascular imaging of the craniocervical arteries.
Patients and Methods: Out of 317 aGCA patients, 36 (11%) presented with CI. All patients underwent vascular imaging including ultrasonography (US) of the temporal arteries (TA) and precerebral arteries, biopsies were taken in 27, CTA/MRA were performed in 21 and FDG-PET in 18 patients.
Results: In 72% of patients, CI was located in the posterior circulation and in14% of patients, it occurred after beginning of steroid therapy. TA were normal on clinical and US examination in 10 patients (with normal biopsies in 5) but PET demonstrated GCA of the precerebral arteries in 9 of them. Abnormalities of the precerebral arteries typical of GCA were demonstrated by US as halos in 67% (in 61% halos of the vertebral arteries), CTA/MRA in 43% and PET in 72% of patients. Concurrent etiologies for CI were evident in 19% of patients (including >50% ICA stenosis in 3 and atrial fibrillation in 4 patients).
Conclusions: Awareness for GCA as a cause of CI requiring specific diagnostic and therapeutic steps is important. US, CTA, MRA and PET are valuable diagnostic tools for rapid detection of GCA involving the precerebral arteries in different stages of the disease even if the TA look normal.
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Affiliation(s)
| | - M. Ertl
- Department of Neurology, Klinikum Augsburg, Germany
| | - M. Hittinger
- Institute for Diagnostic Radiology and Neuroradiology, Klinikum Augsburg, Germany
| | - A. Berlis
- Institute for Diagnostic Radiology and Neuroradiology, Klinikum Augsburg, Germany
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Ertl M, Moser M, Boegle R, Conrad J, Dieterich M. ID 383 – On the impact of stimulus intensity on vestibular evoked potentials (VestEPs). Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Boegle R, Stephan T, Ertl M, Glasauer S, Dieterich M. Magnetic vestibular stimulation modulates default mode network fluctuations. Neuroimage 2016; 127:409-421. [PMID: 26666898 DOI: 10.1016/j.neuroimage.2015.11.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022] Open
Abstract
Strong magnetic fields (>1 Tesla) can cause dizziness and it was recently shown that healthy subjects (resting in total darkness) developed a persistent nystagmus even when remaining completely motionless within a MR tomograph. Consequently, it was speculated that this magnetic vestibular stimulation (MVS) might influence fMRI results, as nystagmus is indicative of an imbalance in the vestibular system, potentially influencing other systems via multisensory vestibular interactions. The objective of our study was to investigate whether MVS does indeed modulate BOLD signal fluctuations. We recorded eye movements, as well as, resting-state fMRI of 30 volunteers in darkness at 1.5 T and 3.0 T to answer the question whether MVS modulated parts of the default mode resting-state network (DMN) in accordance with the Lorentz-force model for MVS, while distinguishing this from the known signal increase due to field strength related imaging effects. Our results showed that modulation of the default mode network occurred mainly in areas associated with vestibular and ocular motor function, and was in accordance with the Lorentz-force model, i.e., double than the expected signal scaling due to field strength alone. We discuss the implications of our findings for the interpretation of studies using resting-state fMRI, especially those concerning vestibular research. We conclude that MVS needs to be considered in vestibular research to avoid biased results, but it might also offer the possibility of manipulating network dynamics and may thus help in studying the brain as a dynamical system.
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Affiliation(s)
- Rainer Boegle
- German Center for Vertigo and Balance Disorders (DSGZ-IFB(LMU)), Ludwig-Maximilians-University Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Germany.
| | - Thomas Stephan
- German Center for Vertigo and Balance Disorders (DSGZ-IFB(LMU)), Ludwig-Maximilians-University Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Germany; Department of Neurology, Ludwig-Maximilians-University Munich, Germany
| | - Matthias Ertl
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Germany; Department of Neurology, Ludwig-Maximilians-University Munich, Germany
| | - Stefan Glasauer
- German Center for Vertigo and Balance Disorders (DSGZ-IFB(LMU)), Ludwig-Maximilians-University Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Germany; Center for Sensorimotor Research, Ludwig-Maximilians-University Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders (DSGZ-IFB(LMU)), Ludwig-Maximilians-University Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Germany; Department of Neurology, Ludwig-Maximilians-University Munich, Germany; SyNergy: Cluster for Systems Neurology, Munich, Germany
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Bremova T, Caushaj A, Ertl M, Strobl R, Böttcher N, Strupp M, MacNeilage PR. Comparison of linear motion perception thresholds in vestibular migraine and Menière's disease. Eur Arch Otorhinolaryngol 2016; 273:2931-9. [PMID: 26728484 PMCID: PMC5014886 DOI: 10.1007/s00405-015-3835-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/09/2015] [Indexed: 12/28/2022]
Abstract
Linear motion perceptual thresholds (PTs) were compared between patients with Menière’s disease (MD) and vestibular migraine (VM). Twenty patients with VM, 27 patients with MD and 34 healthy controls (HC) were examined. PTs for linear motion along the inter-aural (IA), naso-occipital axes (NO), and head-vertical (HV) axis were measured using a multi-axis motion platform. Ocular and cervical vestibular evoked myogenic potentials (o/c VEMP) were performed and the dizziness handicap inventory (DHI) administered. In order to discriminate between VM and MD, we also evaluated the diagnostic accuracy of applied methods. PTs depended significantly on the group tested (VM, MD and HC), as revealed by ANCOVA with group as the factor and age as the covariate. This was true for all motion axes (IA, HV and NO). Thresholds were highest for MD patients, significantly higher than for all other groups for all motion axes, except for the IA axis when compared with HC group suggesting decreased otolith sensitivity in MD patients. VM patients had thresholds that were not different from those of HC, but were significantly lower than those of the MD group for all motion axes. The cVEMP p13 latencies differed significantly across groups being lowest in VM. There was a statistically significant association between HV and NO thresholds and cVEMP PP amplitudes. Diagnostic accuracy was highest for the IA axis, followed by cVEMP PP amplitudes, NO and HV axes. To conclude, patients with MD had significantly higher linear motion perception thresholds compared to patients with VM and controls. Except for reduced cVEMP latency, there were no differences in c/oVEMP between MD, VM and controls.
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Affiliation(s)
- Tatiana Bremova
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,Graduate School of Systemic Neurosciences, Ludwig-Maximilians University Munich, Grosshaderner Strasse 2, 82152, Munich, Germany.
| | - Arla Caushaj
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Matthias Ertl
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians University Munich, Grosshaderner Strasse 2, 82152, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians University Munich, Marchioninistrasse 17, 81377, Munich, Germany
| | - Nicolina Böttcher
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Department of Neurology, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Department of Neurology, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Paul R MacNeilage
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians University Munich, Grosshaderner Strasse 2, 82152, Munich, Germany
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Gassner R, Zsifkovits C, Steinkuhler J, Ertl M, Ertl P, Kapferer W, Lepperdinger G. Implants: science meets technology. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.559] [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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Ertl M, Moser M, Dieterich M. V19. Neural correlates of otolith stimulation: Results of an EEG study. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ertl M, Schierling W, Kasprzak P, Schömig B, Brückl C, Schlachetzki F, Pfister K. P6. Optic nerve sheath diameter measurement – A tool to identify high risk patients for spinal ischemia after endovascular thoracoabdominal aortic aneurysm repair? Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ertl M, Kirsch V, Gerb J, Boegle R, Krafczyk S, Dieterich M. Appraisal of the signal-to-noise-ratio of uni- and bipolar recordings of ocular vestibular evoked myogenic potentials. ACTA ACUST UNITED AC 2015; 25:9-14. [DOI: 10.3233/ves-150545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ocular vestibular evoked myogenic potentials (oVEMPs) are a non-invasive method to investigate otolith function mediated via the superior vestibular nerve. However, the herein used recordings and protocols may alter within different studies. In particular the diverging use of electrode configuration regarding polarity or even electrode position varies across studies. Therefore, a systematic analysis and appraisal of the different electrode configuration seems mandatory. In this study we compared the quality of uni- and bipolar recordings based on the signal to noise ratio (SNR). We recoded oVEMPs using a uni- and bipolar electrode configuration simultaneously and compared the recorded amplitudes and latencies and calculated the SNR. The amplitudes recorded by the unipolar configurations were significantly (p < 0.01) increased compared to the bipolar configuration. However, the SNR of the bipolar setup was significantly better (p < 0.05) when compared to the unipolar setup. Additionally, we estimated a transfer function that enabled a comparison of uni- and bipolar recordings. To conclude, the variety of setups used for oVEMP recording hinder a comparison of results and unipolar electrode configurations have clear disadvantages.
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Affiliation(s)
- M. Ertl
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
| | - V. Kirsch
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders (IFB ), Ludwig-Maximilians University, Munich, Germany
| | - J. Gerb
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
| | - R. Boegle
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders (IFB ), Ludwig-Maximilians University, Munich, Germany
| | - S. Krafczyk
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders (IFB ), Ludwig-Maximilians University, Munich, Germany
| | - M. Dieterich
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders (IFB ), Ludwig-Maximilians University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Ertl M, Boegle R, Kirsch V, Dieterich M. On the impact of examiners on latencies and amplitudes in cervical and ocular vestibular-evoked myogenic potentials evaluated over a large sample (N = 1,038). Eur Arch Otorhinolaryngol 2015; 273:317-23. [PMID: 25628238 DOI: 10.1007/s00405-015-3510-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/14/2015] [Indexed: 11/26/2022]
Abstract
Vestibular-evoked myogenic potentials (VEMPs) are frequently used in the clinical diagnosis and research of vertigo syndromes. Altered latencies or amplitudes are typically interpreted as an indication of disturbance in the processing of vestibular stimuli along the otolithic pathways. Correct interpretation, however, can be difficult as VEMP amplitudes can vary greatly across subjects and across laboratories, likely because they are very sensitive to measurement conditions. Here, we attempted to quantify the impact of examiner differences on VEMP data. We collected data from 1,038 people using eight different experimental examiners, and investigated the effect of examiner on VEMP latencies and amplitudes. We found that the examiner collecting the data had a strong effect on outcome measures with significant differences (p < 0.001) in cVEMP and oVEMP latencies and in oVEMP amplitudes. No significant differences between examiners were found for the cVEMP amplitudes. When we compared the healthy and pathological sides of patients with a clinically diagnosed unilateral disease, no significant differences between sides were found. Given our results and the results reported in the literature, we conclude that the signal features of VEMPs are very sensitive to variables that may be influenced by the examiner. The field should therefore work on a better standard for VEMP recordings.
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Affiliation(s)
- Matthias Ertl
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany.
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany.
| | - R Boegle
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders (IFB-LMU), Ludwig-Maximilians University, Munich, Germany
| | - V Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders (IFB-LMU), Ludwig-Maximilians University, Munich, Germany
| | - M Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders (IFB-LMU), Ludwig-Maximilians University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Ertl M, Wöβ E, Knör G. Antimony porphyrins as red-light powered photocatalysts for solar fuel production from halide solutions in the presence of air. Photochem Photobiol Sci 2015; 14:1826-30. [DOI: 10.1039/c5pp00238a] [Citation(s) in RCA: 16] [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] [Indexed: 01/12/2023]
Abstract
Stable light-harvesting sensitizers for the two-electron oxidation of halide ions are reported. Photocatalysis is studied in solution, in aqueous micellar medium and with surface immobilized samples for convenient photocatalyst recycling.
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Affiliation(s)
- M. Ertl
- Johannes Kepler University (JKU)
- Institute of Inorganic Chemistry
- A-4040 Linz
- Austria
| | - E. Wöβ
- Johannes Kepler University (JKU)
- Institute of Inorganic Chemistry
- A-4040 Linz
- Austria
| | - G. Knör
- Johannes Kepler University (JKU)
- Institute of Inorganic Chemistry
- A-4040 Linz
- Austria
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Ertl M, Barinka F, Torka E, Altmann M, Pfister K, Helbig H, Bogdahn U, Gamulescu MA, Schlachetzki F. Ocular color-coded sonography - a promising tool for neurologists and intensive care physicians. Ultraschall Med 2014; 35:422-431. [PMID: 24647767 DOI: 10.1055/s-0034-1366113] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Ocular color-coded duplex sonography (OCCS), when performed within the safety limits of diagnostic ultrasonography, is an easy noninvasive technique with high potential for diagnosis and therapy in diseases with raised intracranial pressure and vascular diseases affecting the eye. Despite the capabilities of modern ultrasound systems and its scientific validation, OCCS has not gained widespread use in neurological practice. In this review, the authors describe the technique and main parameter settings of OCCS systems to reduce potential risks as thermal or cavitational effects for sensitive orbital structures. Applications of OCCS are the determination of intracranial pressure in emergency medicine, and follow-up evaluations of idiopathic intracranial hypertension and ventricular shunting by measuring the optic nerve sheath diameter. A diameter of 5.7 - 6.0 mm corresponds well with symptomatically increased intracranial pressure (> 20 cmH2O). OCCS also helps to discriminate between different etiologies of central retinal artery occlusion - by visualization of a "spot sign" and Doppler flow analysis of the central retinal artery - and aids the differential diagnosis of papilledema. At the end perspectives are illustrated that combine established ultrasound methods such as transcranial color-coded sonography with OCCS.
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Affiliation(s)
- M Ertl
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg
| | - F Barinka
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg
| | - E Torka
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg
| | - M Altmann
- Department of Opthalmology, University of Regensburg
| | - K Pfister
- Department of Surgery, Vascular Surgery and Endovascular Surgery, University of Regensburg
| | - H Helbig
- Department of Opthalmology, University of Regensburg
| | - U Bogdahn
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg
| | - M A Gamulescu
- Department of Opthalmology, University of Regensburg
| | - F Schlachetzki
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg
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Steinmann S, Leicht G, Ertl M, Andreou C, Polomac N, Westerhausen R, Friederici AD, Mulert C. Conscious auditory perception related to long-range synchrony of gamma oscillations. Neuroimage 2014; 100:435-43. [PMID: 24945670 DOI: 10.1016/j.neuroimage.2014.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/08/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022] Open
Abstract
While the role of synchronized oscillatory activity in the gamma-band frequency range for conscious perception is well established in the visual domain, there is limited evidence concerning neurophysiological mechanisms in conscious auditory perception. In the current study, we addressed this issue with 64-channel EEG and a dichotic listening (DL) task in twenty-five healthy participants. The typical finding of DL is a more frequent conscious perception of the speech syllable presented to the right ear (RE), which is attributed to the supremacy of the contralateral pathways running from the RE to the speech-dominant left hemisphere. In contrast, the left ear (LE) input initially accesses the right hemisphere and needs additional transfer via interhemispheric pathways before it is processed in the left hemisphere. Using lagged phase synchronization (LPS) analysis and eLORETA source estimation we examined the functional connectivity between right and left primary and secondary auditory cortices in the main frequency bands (delta, theta, alpha, beta, gamma) during RE/LE-reports. Interhemispheric LPS between right and left primary and secondary auditory cortices was specifically increased in the gamma-band range, when participants consciously perceived the syllable presented to the LE. Our results suggest that synchronous gamma oscillations are involved in interhemispheric transfer of auditory information.
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Affiliation(s)
- Saskia Steinmann
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Matthias Ertl
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Christina Andreou
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Nenad Polomac
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - René Westerhausen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland Hospital, Bergen, Norway
| | - Angela D Friederici
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neuropsychology, Leipzig, Germany
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
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Ertl M, Kirsch V, Gerb J, Krafczyk S, Dieterich M. P125: Appraisal of the signal-to-noise-ratio of uni- and bipolar recordings of ocular vestibular evoked myogenic potentials. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Karch S, Voelker JM, Thalmeier T, Ertl M, Leicht G, Pogarell O, Mulert C. Deficits during Voluntary Selection in Adult Patients with ADHD: New Insights from Single-Trial Coupling of Simultaneous EEG/fMRI. Front Psychiatry 2014; 5:41. [PMID: 24795657 PMCID: PMC4001047 DOI: 10.3389/fpsyt.2014.00041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/02/2014] [Indexed: 11/13/2022] Open
Abstract
Deficits in executive functions, including voluntary decisions are among the core symptoms of attention deficit/hyperactivity disorder (ADHD) patients. In order to clarify the spatiotemporal characteristics of these deficits, a simultaneous EEG/functional MRI (fMRI) study was performed. Single-trial coupling was used to integrate temporal EEG information in the fMRI analyses and to correlate the trial by trial variation in the different event-related potential amplitudes with fMRI BOLD responses. The results demonstrated that during voluntary selection early electrophysiological responses (N2) were associated with responses in similar brain regions in healthy participants as well as in ADHD patients, e.g., in the medial-frontal cortex and the inferior parietal gyrus. However, ADHD patients presented significantly reduced N2-related BOLD responses compared to healthy controls especially in frontal areas. These results support the hypothesis that in ADHD patients executive deficits are accompanied by early dysfunctions, especially in frontal brain areas.
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Affiliation(s)
- Susanne Karch
- Neurophysiology and Functional Neuroimaging, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University , Munich , Germany
| | - Julia Madeleine Voelker
- Neurophysiology and Functional Neuroimaging, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University , Munich , Germany
| | - Tobias Thalmeier
- Neurophysiology and Functional Neuroimaging, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University , Munich , Germany
| | - Matthias Ertl
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Gregor Leicht
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Oliver Pogarell
- Neurophysiology and Functional Neuroimaging, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University , Munich , Germany
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Leicht G, Troschütz S, Andreou C, Karamatskos E, Ertl M, Naber D, Mulert C. Relationship between oscillatory neuronal activity during reward processing and trait impulsivity and sensation seeking. PLoS One 2013; 8:e83414. [PMID: 24376698 PMCID: PMC3869783 DOI: 10.1371/journal.pone.0083414] [Citation(s) in RCA: 33] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/13/2013] [Indexed: 11/25/2022] Open
Abstract
Background The processing of reward and punishment stimuli in humans appears to involve brain oscillatory activity of several frequencies, probably each with a distinct function. The exact nature of associations of these electrophysiological measures with impulsive or risk-seeking personality traits is not completely clear. Thus, the aim of the present study was to investigate event-related oscillatory activity during reward processing across a wide spectrum of frequencies, and its associations with impulsivity and sensation seeking in healthy subjects. Methods During recording of a 32-channel EEG 22 healthy volunteers were characterized with the Barratt Impulsiveness and the Sensation Seeking Scale and performed a computerized two-choice gambling task comprising different feedback options with positive vs. negative valence (gain or loss) and high or low magnitude (5 vs. 25 points). Results We observed greater increases of amplitudes of the feedback-related negativity and of activity in the theta, alpha and low-beta frequency range following loss feedback and, in contrast, greater increase of activity in the high-beta frequency range following gain feedback. Significant magnitude effects were observed for theta and delta oscillations, indicating greater amplitudes upon feedback concerning large stakes. The theta amplitude changes during loss were negatively correlated with motor impulsivity scores, whereas alpha and low-beta increase upon loss and high-beta increase upon gain were positively correlated with various dimensions of sensation seeking. Conclusions The findings suggest that the processing of feedback information involves several distinct processes, which are subserved by oscillations of different frequencies and are associated with different personality traits.
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Affiliation(s)
- Gregor Leicht
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Stefan Troschütz
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evangelos Karamatskos
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Ertl
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
- Graduate school of systemic neuroscience, Ludwig-Maximilians-University, Munich, Germany
| | - Dieter Naber
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ertl M, Hildebrandt M, Ourina K, Leicht G, Mulert C. Emotion regulation by cognitive reappraisal — The role of frontal theta oscillations. Neuroimage 2013; 81:412-421. [DOI: 10.1016/j.neuroimage.2013.05.044] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 04/16/2013] [Accepted: 05/07/2013] [Indexed: 11/26/2022] Open
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Leicht G, Mulert C, Eser D, Sämann PG, Ertl M, Laenger A, Karch S, Pogarell O, Meindl T, Czisch M, Rupprecht R. Benzodiazepines counteract rostral anterior cingulate cortex activation induced by cholecystokinin-tetrapeptide in humans. Biol Psychiatry 2013; 73:337-44. [PMID: 23059050 DOI: 10.1016/j.biopsych.2012.09.004] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 09/04/2012] [Accepted: 09/04/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Benzodiazepines modulate γ-aminobutyric acid type A (GABA(A)) receptors throughout the brain. However, it is not fully understood which brain regions within anxiety-related brain circuits are really responsible for their anxiolytic effects and how these regions interact. METHODS We investigated whether the benzodiazepine alprazolam affects activity in distinct brain regions within anxiety-related circuits during an experimental anxiety paradigm by means of functional magnetic resonance imaging (fMRI). Panic symptoms were elicited by a bolus injection of the neuropeptide cholecystokinin-tetrapeptide (CCK-4) in 16 healthy male subjects in a double-blind, placebo-controlled design. Functional brain activation patterns were determined before and during the CCK-4-challenge without pretreatment and after treatment with either placebo or 1 mg alprazolam. RESULTS The CCK-4 induced anxiety and elicited widely distributed activation patterns in anxiety-related brain circuits, especially in the rostral anterior cingulate cortex (rACC), which was attenuated after alprazolam treatment. In contrast to placebo, alprazolam abolished the activation of the rACC after challenge with CCK-4 (p<.005, corrected for multiple comparisons) and increased functional connectivity between the rACC and other anxiety-related brain regions such as amygdala and prefrontal cortex. Moreover, the reduction in the CCK-4 induced activation of the rACC correlated with the anxiolytic effect of alprazolam (r(p) = .52; p = .04). CONCLUSIONS These findings put forward the rACC as a target for benzodiazepines and suggest that the CCK-4/fMRI paradigm might represent a human translational model for the investigation of anxiolytic drugs.
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Affiliation(s)
- Gregor Leicht
- Psychiatry Neuroimaging Branch, University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Psychiatry Neuroimiaging Branch, Hamburg, Germany.
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