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Kanner AM, Shankar R, Margraf NG, Schmitz B, Ben-Menachem E, Sander JW. Mood disorders in adults with epilepsy: a review of unrecognized facts and common misconceptions. Ann Gen Psychiatry 2024; 23:11. [PMID: 38433207 PMCID: PMC10910742 DOI: 10.1186/s12991-024-00493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/03/2024] [Indexed: 03/05/2024] Open
Abstract
Epilepsy is one of the most common neurologic conditions. Its clinical manifestations are not restricted to seizures but often include cognitive disturbances and psychiatric disorders. Prospective population-based studies have shown that people with epilepsy have an increased risk of developing mood disorders, and people with a primary mood disorder have an increased risk of developing epilepsy. The existence of common pathogenic mechanisms in epilepsy and mood disorders may explain the bidirectional relation between these two conditions. Recognition of a personal and family psychiatric history at the time of evaluation of people for a seizure disorder is critical in the selection of antiseizure medications: those with mood-stabilizing properties (e.g., lamotrigine, oxcarbazepine) should be favoured as a first option in those with a positive history while those with negative psychotropic properties (e.g., levetiracetam, topiramate) avoided. While mood disorders may be clinically identical in people with epilepsy, they often present with atypical manifestations that do not meet ICD or DSM diagnostic criteria. Failure to treat mood disorders in epilepsy may have a negative impact, increasing suicide risk and iatrogenic effects of antiseizure medications and worsening quality of life. Treating mood disorders in epilepsy is identical to those with primary mood disorders. Yet, there is a common misconception that antidepressants have proconvulsant properties. Most antidepressants are safe when prescribed at therapeutic doses. The incidence of seizures is lower in people randomized to antidepressants than placebo in multicenter randomized placebo-controlled trials of people treated for a primary mood disorder. Thus, there is no excuse not to prescribe antidepressant medications to people with epilepsy.
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Affiliation(s)
- Andres M Kanner
- Epilepsy Division and Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA.
| | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Nils G Margraf
- Department of Neurology, Christian-Albrechts University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Elinor Ben-Menachem
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, 2103SW, The Netherlands
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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2
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Dargvainiene J, Jensen-Kondering U, Bender B, Berg D, Brüggemann N, Flüh C, Markewitz R, Neumann A, Röben B, Röcken C, Royl G, Schulte C, Wandinger KP, Weiler C, Margraf NG, Kuhlenbäumer G. Aβ38 and Aβ43 do not differentiate between Alzheimer's disease and cerebral amyloid angiopathy. Ann Clin Transl Neurol 2024; 11:806-811. [PMID: 38186185 DOI: 10.1002/acn3.51987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024] Open
Abstract
Differential diagnosis between Alzheimer's disease (AD) and cerebral amyloid angiopathy (CAA) using cerebrospinal fluid (CSF) biomarkers is challenging. A recent study suggested that the addition of Aβ38 and Aβ43 to a standard AD biomarker panel (Aβ40, Aβ42, t-tau, p-tau) to improve the differential diagnosis. We tested this hypothesis in an independent German cohort of CAA and AD patients and controls using the same analytical techniques. We found excellent discrimination between AD and controls and between CAA and controls, but not between AD and CAA. Adding Aβ38 and Aβ43 to the panel did not improve the discrimination between AD and CAA.
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Affiliation(s)
- Justina Dargvainiene
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulf Jensen-Kondering
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Benjamin Bender
- Department of Radiology, Diagnostical and Interventional Neuroradiology, University Hospital of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Norbert Brüggemann
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Robert Markewitz
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Alexander Neumann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Benjamin Röben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Pathology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Georg Royl
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Klaus-Peter Wandinger
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Caroline Weiler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Nils G Margraf
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
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Jensen-Kondering U, Heß K, Flüh C, Kuhlenbäumer G, Margraf NG. A Rare Case of Iatrogenic Prion-like Pathogenesis of Cerebral Amyloid Angiopathy. Dtsch Arztebl Int 2024; 121:68-69. [PMID: 38427943 PMCID: PMC10979434 DOI: 10.3238/arztebl.m2023.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 03/03/2024]
Affiliation(s)
- Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology / University Medical Center Schleswig-Holstein (UKSH), Lübeck and Institute of Neuroradiology / University Medical Center Schleswig-Holstein (UKSH), Kiel,
| | - Katharina Heß
- Department of Pathology / University Medical Center Schleswig-Holstein (UKSH), Kiel
| | - Charlotte Flüh
- Department of Neurosurgery / University Medical Center Schleswig-Holstein (UKSH), Kiel
| | | | - Nils G. Margraf
- Department of Neurology, Epilepsy Center for Adults / University Medical Center Schleswig-Holstein (UKSH), Kiel
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Huhndorf M, Peters S, Cordt J, Margraf NG, Salehi Ravesh M, Jansen O, Synowitz M, Cohrs G. Venous 3D Phase Contrast Magnetic Resonance Angiography Increases Diagnostic Certainty in Children with Ventriculoperitoneal Shunt and Suspected Shunt Failure. Clin Neuroradiol 2023; 33:1067-1074. [PMID: 37395788 PMCID: PMC10654158 DOI: 10.1007/s00062-023-01310-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Clinical symptoms in children with suspected malfunction of ventriculoperitoneal shunt may not be specific and difficult to interpret. The presence or absence of ventricular enlargement on magnetic resonance imaging (MRI) does not reliably predict raised intracranial pressure (ICP) in these patients. Therefore, the aim was to investigate the diagnostic utility of 3D venous phase-contrast MR angiography (vPCA) in these patients. MATERIALS The MR studies of two groups of patients at two different examination dates were retrospectively analyzed; one group without clinical symptoms on both examinations and one with symptoms of shunt dysfunction on one examination receiving surgery. Both MRI examinations had to have been performed including axial T2 weighted (T2-w) images and 3D vPCA. Two (neuro)radiologists evaluated T2-w images alone and in combination with 3D vPCA in terms of suspected elevated ICP. Interrater reliability, sensitivity and specificity were assessed. RESULTS Compression of venous sinuses was seen significantly more often in patients with shunt failure (p = 0.00003). Consequently, evaluation of 3D vPCA and T2-w images increases sensitivity to 0.92/1.0 compared to T2-w images alone with 0.69/0.77, the interrater agreement for the diagnosis of shunt failure rises from κ = 0.71 to κ = 0.837. Concerning imaging markers, three groups could be identified in children with shunt failure. CONCLUSION In accordance with the literature, the results show that ventricular morphology alone is an unreliable marker for elevated ICP in children with shunt malfunction. The findings confirmed 3D vPCA as a valuable supplemental diagnostic tool improving diagnostic certainty for children with unchanged ventricular size in cases of shunt failure.
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Affiliation(s)
- M Huhndorf
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - S Peters
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Cordt
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - N G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Salehi Ravesh
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - O Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Synowitz
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - G Cohrs
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
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Artusi CA, Geroin C, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al‐Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M. Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review. Mov Disord Clin Pract 2023; 10:1585-1596. [PMID: 38026508 PMCID: PMC10654876 DOI: 10.1002/mdc3.13879] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Postural abnormalities involving the trunk are referred to as axial postural abnormalities and can be observed in over 20% of patients with Parkinson's disease (PD) and in atypical parkinsonism. These symptoms are highly disabling and frequently associated with back pain and a worse quality of life in PD. Despite their frequency, little is known about the pathophysiology of these symptoms and scant data are reported about their clinical predictors, making it difficult to prompt prevention strategies. Objectives We conducted a scoping literature review of clinical predictors and pathophysiology of axial postural abnormalities in patients with parkinsonism to identify key concepts, theories and evidence on this topic. Methods We applied a systematic approach to identify studies, appraise quality of evidence, summarize main findings, and highlight knowledge gaps. Results Ninety-two articles were reviewed: 25% reported on clinical predictors and 75% on pathophysiology. Most studies identified advanced disease stage and greater motor symptoms severity as independent clinical predictors in both PD and multiple system atrophy. Discrepant pathophysiology data suggested different potential central and peripheral pathogenic mechanisms. Conclusions The recognition of clinical predictors and pathophysiology of axial postural abnormalities in parkinsonism is far from being elucidated due to literature bias, encompassing different inclusion criteria and measurement tools and heterogeneity of patient samples. Most studies identified advanced disease stage and higher burden of motor symptoms as possible clinical predictors. Pathophysiology data point toward many different (possibly non-mutually exclusive) mechanisms, including dystonia, rigidity, proprioceptive and vestibular impairment, and higher cognitive deficits.
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Affiliation(s)
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourDepartment of RehabilitationNijmegenThe Netherlands
| | - Camila Aquino
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, and Department of Community Health SciencesUniversity of CalgaryCalgaryABCanada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India. Department of NeurologyVardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
| | - Marian L. Dale
- Oregon Health & Science UniversityDepartment of NeurologyPortlandORUSA
| | - Darbe Schlosser
- Graduate Student in the Motor Learning Program at Teachers CollegeColumbia UniversityNew YorkNYUSA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional NeurosurgeryRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mohammad Al‐Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Mehri Salari
- Department of NeurologyShahid Beheshti University of Medical SciencesTehranIran
| | - Robin Wolke
- Department of NeurologyUKSH, Christian‐Albrechts‐UniversityKielGermany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi MontalciniUniversity of TurinTorinoItaly
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Marcelo Merello
- Movement Disorders ServiceFLENI, CONICETBuenos AiresArgentina
| | - Bastiaan R. Bloem
- Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Tamine Capato
- Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
- University of São PauloDepartment of Neurology, Movement Disorders CenterSão PauloBrazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva; Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Karen Doherty
- Department of NeurologyRoyal Victoria HospitalBelfastUnited Kingdom
- Centre for Medical EducationQueens University BelfastBelfastUnited Kingdom
| | - Alfonso Fasano
- Division of NeurologyUniversity of TorontoTorontoONCanada
- Krembil Brain InstituteTorontoONCanada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria ShulmanMovement Disorders Clinic, Toronto Western Hospital, UHNTorontoONCanada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO‐Neuro‐OphtalmologiqueIbn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of RabatRabatMorocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi MontalciniUniversity of TurinTorinoItaly
| | - Nils G. Margraf
- Department of NeurologyUKSH, Christian‐Albrechts‐UniversityKielGermany
| | - Caroline Moreau
- Expert Center for Parkinson's Disease, Neurological Department, Inserm UMR 1172Lille University HospitalLilleFrance
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of MedicineFukushima Medical UniversityFukushimaJapan
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
- The Academy of ScienceThe Royal Society of ThailandBangkokThailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
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Hobert MA, Dargvainiene J, Margraf NG. Generalized Polyspike Pattern in EEG Due to Aseptic Meningoencephalitis. Diagnostics (Basel) 2023; 13:2569. [PMID: 37568932 PMCID: PMC10417272 DOI: 10.3390/diagnostics13152569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
We report the electroencephalography (EEG) showing an intermittent generalized polyspike pattern in EEG due to an aseptic meningoencephalitis in a 71-year-old soporous patient. Initially, she presented with word-finding disturbances and later with generalized tonic-clonic seizures. The cerebrospinal fluid (CSF) showed pleocytosis of 99 leukocytes/μL (primarily neutrophils) and an increased protein level of 1240 mg/L (CSF/serum glucose ratio and lactate unremarkable). Pathogens and autoimmune antibodies in CSF were not found. Brain imaging was unremarkable. After antibiotic, antiviral and anticonvulsive therapy, the pattern in the EEG was no longer detectable. The patient was discharged to go home due to absence of any residues.
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Affiliation(s)
- Markus A. Hobert
- Department of Neurology, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany;
| | - Justina Dargvainiene
- Institute of Clinical Chemistry, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany;
| | - Nils G. Margraf
- Department of Neurology, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany;
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Jensen-Kondering U, Maurer CJ, Brudermann HCB, Ernst M, Sedaghat S, Margraf NG, Bahmer T, Jansen O, Nawabi J, Vogt E, Büttner L, Siebert E, Bartl M, Maus V, Werding G, Schlamann M, Abdullayev N, Bender B, Richter V, Mengel A, Göpel S, Berlis A, Grams A, Ladenhauf V, Gizewski ER, Kindl P, Schulze-Zachau V, Psychogios M, König IR, Sondermann S, Wallis S, Brüggemann N, Schramm P, Neumann A. Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19 : Results of a retrospective multicenter neuroimaging-based study from three central European countries. J Neurol 2023; 270:2349-2359. [PMID: 36820915 PMCID: PMC9947908 DOI: 10.1007/s00415-023-11608-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19. MATERIALS AND METHODS Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay. RESULTS 442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH. DISCUSSION AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.
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Affiliation(s)
- Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany.
- Department of Neuroradiology, UKSH, Campus Lübeck, Lübeck, Germany.
| | - Christoph J Maurer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Hanna C B Brudermann
- Institute of Medical Biometry and Statistics (IMBS), UKSH, Campus Lübeck, Lübeck, Germany
| | - Marielle Ernst
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center, Göttingen, Germany
| | - Sam Sedaghat
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany
- Department of Radiology, University of California San Diego, San Diego, USA
| | - Nils G Margraf
- Department of Neurology, UKSH, Campus Kiel, Kiel, Germany
| | - Thomas Bahmer
- Department of Internal Medicine, UKSH, Campus Kiel, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
| | - Estelle Vogt
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Laura Büttner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Bartl
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Medical Center Knappschaftskrankenhaus, Bochum, Germany
| | - Gregor Werding
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Medical Center Knappschaftskrankenhaus, Bochum, Germany
| | - Marc Schlamann
- Department of Radiology, Neuroradiology Division, University of Cologne, Cologne, Germany
| | - Nuran Abdullayev
- Department of Radiology, Neuroradiology Division, University of Cologne, Cologne, Germany
- GFO Clinics Troisdorf, Radiology and Neuroradiologie, Troisdorf, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Vivien Richter
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany
| | - Siri Göpel
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Valentin Ladenhauf
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Kindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Inke R König
- Institute of Medical Biometry and Statistics (IMBS), UKSH, Campus Lübeck, Lübeck, Germany
| | | | - Sönke Wallis
- Department of Internal Medicine, UKSH, Campus Lübeck, Lübeck, Germany
| | | | - Peter Schramm
- Department of Neuroradiology, UKSH, Campus Lübeck, Lübeck, Germany
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8
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Geroin C, Artusi CA, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al-Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M. Axial Postural Abnormalities in Parkinsonism: Gaps in Predictors, Pathophysiology, and Management. Mov Disord 2023; 38:732-739. [PMID: 37081741 DOI: 10.1002/mds.29377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Camila Aquino
- Department of Clinical Neurosciences, and Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Marian L Dale
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Darbe Schlosser
- Motor Learning Program, Teachers College, Columbia University, New York, New York, USA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mehri Salari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marcelo Merello
- Movement Disorders Service, FLENI, CONICET, Buenos Aires, Argentina
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tamine Capato
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Neurology, Movement Disorders Center, University of São Paulo, São Paulo, Brazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Doherty
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- Centre for Medical Education, Queens University Belfast, Belfast, UK
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO-Neuro-Ophtalmologique, Ibn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Nils G Margraf
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Caroline Moreau
- Neurological Department, Expert Center for Parkinson's Disease, Inserm UMR 1172, Lille University Hospital, Lille, France
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Kuhlenbäumer G, Jensen-Kondering U, Margraf NG. Letter for: Decreased cerebrospinal fluid Aβ 38, 40, 42, and 43 levels in sporadic and hereditary cerebral amyloid angiopathy. Ann Neurol 2023. [PMID: 37186313 DOI: 10.1002/ana.26671] [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] [Received: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Gregor Kuhlenbäumer
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Germany
| | - Ulf Jensen-Kondering
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübck, Germany
| | - Nils G Margraf
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Germany
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10
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Margraf NG, Dargvainiene J, Theel E, Leypoldt F, Lieb W, Franke A, Berger K, Kuhle J, Kuhlenbaeumer G. Neurofilament light (NfL) as biomarker in serum and CSF in status epilepticus. J Neurol 2023; 270:2128-2138. [PMID: 36624182 PMCID: PMC10025237 DOI: 10.1007/s00415-022-11547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We explored the potential of neurofilament light chain (NfL) in serum and cerebrospinal fluid as a biomarker for neurodestruction in status epilepticus. METHODS In a retrospective analysis, we measured NfL in serum and cerebrospinal fluid samples of patients with status epilepticus using a highly sensitive single-molecule array technique (Simoa). Status epilepticus was diagnosed according to ILAE criteria. Additionally, we employed an alternative classification with more emphasis on the course of status epilepticus. We used data from three large control groups to compare NfL in status epilepticus versus neurologically healthy controls. RESULTS We included 28 patients (mean age: 69.4 years, SD: 15 years) with a median status duration of 44 h (IQR: 80 h). Twenty-one patients (75%) suffered from convulsive status epilepticus and seven (25%) from non-convulsive status epilepticus. Six patients died (21%). Cerebrospinal fluid and serum NfL concentrations showed a high correlation (r = 0.73, p < 0.001, Pearson). The main determinant of NfL concentration was the status duration. NfL concentrations did not differ between convulsive status epilepticus and convulsive status epilepticus classified according to the ILAE or to the alternative classification without and with adjusting for status duration and time between status onset and sampling. We found no association of NfL concentration with death, treatment refractoriness, or prognostic scores. CONCLUSION The results suggest that neurodestruction in status epilepticus measured by NfL is mainly determined by status duration, not status type nor therapy refractoriness. Therefore, our results suggest that regarding neurodestruction convulsive and non-convulsive status epilepticus are both neurological emergencies of comparable urgency.
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Affiliation(s)
- Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University (CAU), Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Justina Dargvainiene
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University (CAU), Kiel, Germany
| | - Emily Theel
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University (CAU), Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University (CAU), Arnold-Heller-Str. 3, 24105, Kiel, Germany
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University (CAU), Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology and Biobank PopGen, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University (CAU), Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Jens Kuhle
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Basel, Switzerland
| | - Gregor Kuhlenbaeumer
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University (CAU), Arnold-Heller-Str. 3, 24105, Kiel, Germany
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11
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Wolke R, Gavriliuc O, Granert O, Deuschl G, Margraf NG. Three-Dimensional Mesh Recovery from Common 2-Dimensional Pictures for Automated Assessment of Body Posture in Camptocormia. Mov Disord Clin Pract 2023; 10:472-476. [PMID: 36949782 PMCID: PMC10026267 DOI: 10.1002/mdc3.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/08/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
Background Three-dimensional (3D) human body estimation from common photographs is an evolving method in the field of computer vision. It has not yet been evaluated on postural disorders. We generated 3D models from 2-dimensional pictures of camptocormia patients to measure the bending angle of the trunk according to recommendations in the literature. Methods We used the Part Attention Regressor algorithm to generate 3D models from photographs of camptocormia patients' posture and validated the resulting angles against the gold standard. A total of 2 virtual human models with camptocormia were generated to evaluate the performance depending on the camera angle. Results The bending angle assessment using the 3D mesh correlated highly with the gold standard (R = 0.97, P < 0.05) and is robust to deviations of the camera angle. Conclusions The generation of 3D models offers a new method for assessing postural disorders. It is automated and robust to nonperfect pictures, and the result offers a comprehensive analysis beyond the bending angle.
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Affiliation(s)
- Robin Wolke
- Department of NeurologyKiel University, Universitätskrankenhaus Schleswig‐Holstein, Campus KielKielGermany
| | - Olga Gavriliuc
- Department of NeurologyState University of Medicine and Pharmacy "Nicolae Testemitanu"ChisinauMoldova
| | - Oliver Granert
- Department of NeurologyKiel University, Universitätskrankenhaus Schleswig‐Holstein, Campus KielKielGermany
| | - Günther Deuschl
- Department of NeurologyKiel University, Universitätskrankenhaus Schleswig‐Holstein, Campus KielKielGermany
| | - Nils G. Margraf
- Department of NeurologyKiel University, Universitätskrankenhaus Schleswig‐Holstein, Campus KielKielGermany
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Jensen-Kondering U, Margraf NG, Weiler C, Maetzler W, Dargvainiene J, Falk K, Philippen S, Bartsch T, Flüh C, Röcken C, Möller B, Royl G, Neumann A, Brüggemann N, Roeben B, Schulte C, Bender B, Berg D, Kuhlenbäumer G. Characterizing mixed location hemorrhages/microbleeds with CSF markers. Int J Stroke 2023:17474930231152124. [PMID: 36622021 DOI: 10.1177/17474930231152124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Cerebral amyloid angiopathy (CAA) is a common cause of lobar and subarachnoid hemorrhages in the elderly. A diagnosis of CAA requires multiple lobar hemorrhagic lesions (intracerebral hemorrhage and/or cerebral microbleeds) and/or cortical superficial siderosis (cSS). In contrast, hemorrhagic lesions located in the deep structures are the hallmark of hypertensive arteriopathy (HTN-A). They are an exclusion criterion for CAA, and when present with lobar hemorrhagic lesions considered a separate entity: mixed location hemorrhages/microbleeds (MLHs). We compared clinical, radiological, and cerebrospinal fluid (CSF) marker data in patients with CAA, MLH, and Alzheimer's disease (AD), and healthy controls (HCs) and used it to position MLH in the disease spectrum. PATIENTS AND METHODS Retrospective cohort study of consecutive patients with CAA (n = 31), MLH (n = 31), AD (n = 28), and HC (n = 30). Analysis of clinical, radiological, CSF biomarker (Aß42, Aß40, t-tau, and p-tau), and histopathological data in patients each group. RESULTS cSS was significantly more common in CAA than MLH (45% vs 13%, p = 0.011), and cSS in MLH was associated with intracerebral hemorrhage (ICH) (p = 0.037). Aß42 levels and the Aß42/Aß40 ratio, diagnostic groups followed the order HC > MLH > CAA > AD and the opposite order for t-tau and p-tau. No clear order was apparent forAß40. Aß40 and Aß42 levels as well as the Aß42/Aß40 ratio were lower in both CAA and MLH patients with cSS than in patients without cSS. Aß40 and Aß42 levels were higher in CAA and MLH patients with lacunar infarcts than in those without. CONCLUSION Our data suggest that MLH and CAA are mutually not exclusive diagnoses, and are part of a spectrum with variable contributions of both CAA and HTN-A.
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Affiliation(s)
- Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Nils G Margraf
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Caroline Weiler
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Justina Dargvainiene
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Kim Falk
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Sarah Philippen
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Möller
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Georg Royl
- Department of Neurology, University Medical Center Schleswig Holstein, Lübeck, Germany
| | - Alexander Neumann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University Medical Center Schleswig Holstein, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Benjamin Roeben
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Yilmaz R, Wolke R, Puls N, Sorgun MH, Deuschl G, Berg D, Margraf NG. Characterizing Camptocormia in Parkinson's Disease Using Muscle Ultrasonography. J Parkinsons Dis 2023; 13:819-827. [PMID: 37334619 PMCID: PMC10473098 DOI: 10.3233/jpd-230037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Camptocormia (CC) is the forward-bending of the spine of more than 30 degrees that can be found in Parkinson's disease (PD) as a disabling complication. Detection of changes in paraspinal lumbar musculature in CC is of value for choosing treatment strategies. OBJECTIVE To investigate whether these changes can be detected using muscle ultrasonography (mUSG). METHODS Age and sex-matched groups comprised 17 PD patients with CC (seven acute, PD-aCC; 10 chronic PD-cCC), 19 PD patients with no CC, and 18 healthy controls (HC). Lumbar paravertebral muscles (LPM) on both sides were assessed using mUSG by two different raters blinded to the group assignment. Groups were compared with regard to the linear measurements of the muscle thickness as well as semi-quantitative and quantitative (grayscale) analyses of muscle echogenicity using a univariate general linear model. RESULTS All assessments showed substantial interrater reliability. The PD-cCC group had significantly thinner LPM compared to groups with no CC (PD and HC). Groups of PD-aCC and PD-cCC differed from the groups of no CC in quantitative and semi-quantitative analyses of LPM echogenicity, respectively. CONCLUSION Assessment of LPM in PD patients with CC can be reliably performed using mUSG. Also, mUSG may be used as a screening tool to detect CC-related changes in thickness and echogenicity of the LPM in patients with PD.
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Affiliation(s)
- Rezzak Yilmaz
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Robin Wolke
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Nina Puls
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Mine Hayriye Sorgun
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Nils G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
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14
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Huhndorf M, Röcken C, Flüh C, Weiler C, Kuhlenbäumer G, Tegeler N, Schacht H, Neumann A, Margraf NG, Jensen-Kondering U. Frequency of deep-seated cerebral microbleeds in patients with lobar hemorrhages and histopathological evidence for cerebral amyloid angiopathy. Front Neurol 2023; 14:1146737. [PMID: 37122304 PMCID: PMC10130449 DOI: 10.3389/fneur.2023.1146737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/08/2023] [Indexed: 05/02/2023] Open
Abstract
Background Cerebral amyloid angiopathy (CAA) is a common disease and the most common cause of lobar hemorrhages in the elderly. Usually, deep-seated microhemorrhages preclude the diagnosis of CAA. In this study, we sought to estimate the frequency of deep-seated microbleeds on MRI in patients with lobar hemorrhages and histopathological evidence for cerebral amyloid angiopathy. In addition, we describe a cohort of patients with cortical and deep-seated microbleeds on MRI and a histopathological specimen available from lobar hematoma evacuation. Methods Retrospective database search for histopathological specimens from lobar hematoma evacuation and review of imaging findings (CT and MRI) and patient charts was performed. Results Between 1 January 2012 and 31 December 2020, 88 specimens from 88 patients were available. A total of 56 specimens were excluded (no brain tissue in the specimen n = 4, other diagnosis n = 8, no MRI n = 43, and no BOLD-based sequence n = 1). Of the remaining 32 patients, 25 patients (78%) did not harbor deep-seated lesions on MRI, of which 17 patients had histopathological features of CAA. A total of seven patients harbored deep-seated CMB. Of these seven patients, three (3/20, 15%) had histopathological features of CAA. Conclusion Approximately 15% of patients with histopathologically diagnosed CAA harbor deep-seated microbleeds. This finding may add to the discussion on how to identify patients with CAA and deep-seated CMB.
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Affiliation(s)
- Monika Huhndorf
- Department of Radiology and Neuroradiology, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Caroline Weiler
- Department of Neurology, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Nora Tegeler
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Hannes Schacht
- Department of Neuroradiology, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Germany
| | - Alexander Neumann
- Department of Neuroradiology, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Germany
| | - Nils G. Margraf
- Department of Neurology, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
- Department of Neuroradiology, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Germany
- *Correspondence: Ulf Jensen-Kondering
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15
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Pongmala C, Fabbri M, Zibetti M, Pitakpatapee Y, Wangthumrong T, Sangpeamsook T, Srikajon J, Srivanitchapoom P, Youn J, Cho JW, Kim M, Zamil Shinawi HM, Obaid MT, Baumann A, Margraf NG, Pona-Ferreira F, Leitão M, Lobo T, Ferreira JJ, Lopiano L, Artusi CA. Gait and axial postural abnormalities correlations in Parkinson's disease: A multicenter quantitative study. Parkinsonism Relat Disord 2022; 105:19-23. [PMID: 36332288 DOI: 10.1016/j.parkreldis.2022.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/16/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Gait and axial postural abnormalities (PA) are common and disabling symptoms of Parkinson's disease (PD). The interplay between them has been poorly explored. METHODS A standardized protocol encompassing videos and photos for posture and gait analysis of PD patients with a clinically defined PA (MDS-UPDRS-III item 3.13 > 0) was used in 6 movement disorder centers. A comprehensive evaluation was performed to clarify the association between gait performance and the presence and severity of PA. RESULTS 225 PD patients were enrolled: 57 had severe PA, 149 mild PA, and 19 did not meet criteria for PA, according to a recent consensus agreement on PA definition. PD patients with severe PA were significantly older (p:0.001), with longer disease duration (p:0.007), worse MDS-UPDRS-II and -III scores and axial sub-scores (p < 0.0005), higher LEDD (p:0.002) and HY stage (p < 0.0005), and a significantly lower velocity (p < 0.001) and cadence (p:0.021), if compared to mild PA patients. The multiple regression analysis evaluating gait parameters and degrees of trunk/neck flexion showed that higher degrees of lumbar anterior trunk flexion were correlated with lower step length (OR -0.244; p:0.014) and lower velocity (OR -0.005; p:0.028). CONCLUSIONS Our results highlight the possible impact of severe anterior trunk flection on PD patients' gait, with a specific detrimental effect on gait velocity and step length. Personalized rehabilitation strategies should be elaborated based on the different features of PA, aiming to target a combined treatment of postural and specifically related gait pattern alterations.
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Affiliation(s)
- Chatkaew Pongmala
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy; Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Margherita Fabbri
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy
| | - Yuvadee Pitakpatapee
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Takarn Wangthumrong
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanita Sangpeamsook
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jindapa Srikajon
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prachaya Srivanitchapoom
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jinyoung Youn
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jin Whan Cho
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | | | - Mona Talib Obaid
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alexander Baumann
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | | | - Teresa Lobo
- CNS-Campus Neurológico, Torres Vedras, Portugal
| | - Joaquim J Ferreira
- CNS-Campus Neurológico, Torres Vedras, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Instituto Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy.
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16
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Stolz-Klingenberg C, Bünzen C, Coors M, Flüh C, Margraf NG, Wehkamp K, Clayman ML, Scheibler F, Wehking F, Rüffer JU, Schüttig W, Sundmacher L, Synowitz M, Berg D, Geiger F. Sustainability of large-scale implementation of shared decision making with the SHARE TO CARE program. Front Neurol 2022; 13:1037447. [PMID: 36504657 PMCID: PMC9726727 DOI: 10.3389/fneur.2022.1037447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction SHARE TO CARE (S2C) is a comprehensive implementation program for shared decision making (SDM). It is run at the University Hospital Schleswig-Holstein (UKSH) in Kiel, Germany, and consists of four combined intervention modules addressing healthcare professionals and patients: (1) multimodal training of physicians (2) patient activation campaign including the ASK3 method, (3) online evidence-based patient decision aids (4) SDM support by nurses. This study examines the sustainability of the hospital wide SDM implementation by means of the Neuromedical Center comprising the Departments of Neurology and Neurosurgery. Methods Between 2018 and 2020, the S2C program was applied initially within the Neuromedical Center: We implemented the patient activation campaign, trained 89% of physicians (N = 56), developed 12 patient decision aids and educated two decision coaches. Physicians adjusted the patients' pathways to facilitate the use of decision aids. To maintain the initial implementation, the departments took care that new staff members received training and decision aids were updated. The patient activation campaign was continued. To determine the sustainability of the initial intervention, the SDM level after a maintenance phase of 6-18 months was compared to the baseline level before implementation. Therefore, in- and outpatients received a questionnaire via mail after discharge. The primary endpoint was the "Patient Decision Making" subscale of the Perceived Involvement in Care Scale (PICSPDM). Secondary endpoints were an additional scale measuring SDM (CollaboRATE), and the PrepDM scale, which determines patients' perceived health literacy while preparing for decision making. Mean scale scores were compared using t-tests. Results Patients reported a significantly increased SDM level (PICSPDM p = 0.02; Hedges' g = 0.33; CollaboRATE p = 0.05; Hedges' g = 0.26) and improved preparation for decision making (PrepDM p = 0.001; Hedges' g = 0.34) 6-18 months after initial implementation of S2C. Discussion The S2C program demonstrated its sustainability within the Neuromedical Center at UKSH Kiel in terms of increased SDM and health literacy. Maintaining the SDM implementation required a fraction of the initial intensity. The departments took on the responsibility for maintenance. Meanwhile, an additional health insurance-based reimbursement for S2C secures the continued application of the program. Conclusion SHARE TO CARE promises to be suitable for long-lasting implementation of SDM in hospitals.
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Affiliation(s)
- Constanze Stolz-Klingenberg
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany,*Correspondence: Constanze Stolz-Klingenberg
| | - Claudia Bünzen
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Marie Coors
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nils G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany,Department of Medical Management, MSH Medical School Hamburg, Hamburg, Germany
| | - Marla L. Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, MA, United States,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Fueloep Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Felix Wehking
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | | | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Friedemann Geiger
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany,Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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Beni KN, Wolke R, Finck MJ, Elfrath E, Margraf NG, Rieger R. Acquisition and Automated Segmentation of Inertia Sensor Data for Mobile Camptocormia Assessment. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:105-108. [PMID: 36086086 DOI: 10.1109/embc48229.2022.9871886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The camptocormia angle has been established as a strong indicator for evaluating the progress of Parkinson's disease and the efficacy of therapeutical approaches. A wearable setup is proposed to measure the camptocormia angle with the perpendicular method using five inertial sensors. This study identifies suitable inertial measurement unit sensors for mobile long-term measurement. Moreover, a machine-learning approach is presented for segmenting the recorded data into periods with different dominant activities. An artificial neural network was the better classifier compared to a support vector machine to recognize certain common activities in patients with camptocormia. The artificial neural network's accuracy, sensitivity, and F1-score were 92.4 %, 82.9 %, and 82.1 %, respectively. Clinical Relevance- The presented approach is expected to lead to a wearable system for long-term monitoring of the progress of camptocormia, yielding improved parameters compared to the conventional static photo method.
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18
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Tinazzi M, Geroin C, Bhidayasiri R, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Merello M, Moreau C, Ugawa Y, Artusi CA. Task force consensus on nosology and Cut‐Off values for axial postural abnormalities in parkinsonism. Mov Disord Clin Pract 2022; 9:594-603. [PMID: 35844289 PMCID: PMC9274349 DOI: 10.1002/mdc3.13460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is no consensus with regard to the nosology and cut‐off values for postural abnormalities in parkinsonism. Objective To reach a consensus regarding the nosology and cut‐off values. Methods Using a modified Delphi panel method, multiple rounds of questionnaires were conducted by movement disorder experts to define nosology and cut‐offs of postural abnormalities. Results After separating axial from appendicular postural deformities, a full agreement was found for the following terms and cut‐offs: camptocormia, with thoracic fulcrum (>45°) or lumbar fulcrum (>30°), Pisa syndrome (>10°), and antecollis (>45°). “Anterior trunk flexion,” with thoracic (≥25° to ≤45°) or lumbar fulcrum (>15° to ≤30°), “lateral trunk flexion” (≥5° to ≤10°), and “anterior neck flexion” (>35° to ≤45°) were chosen for milder postural abnormalities. Conclusions For axial postural abnormalities, we recommend the use of proposed cut‐offs and six unique terms, namely camptocormia, Pisa syndrome, antecollis, anterior trunk flexion, lateral trunk flexion, anterior neck flexion, to harmonize clinical practice and future research.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok 10330 Thailand
- The Academy of Science, The Royal Society of Thailand Bangkok 10330 Thailand
| | - Bastiaan R. Bloem
- Department of Neurology Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands
| | - Tamine Capato
- Department of Neurology Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands
- University of São Paulo, Department of Neurology, Movement Disorders Center São Paulo Brazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100; Sackler Faculty of Medicine Tel Aviv University, P.O. Box 39040 Tel Aviv 6997801 Israel
| | - Karen Doherty
- Department of Neurology Royal Victoria Hospital Belfast, N Ireland
- Centre for Medical Education Queens University Belfast, N Ireland
| | - Alfonso Fasano
- Division of Neurology University of Toronto Toronto ON Canada
- Krembil Brain Institute Toronto ON Canada
- Edmond J. Safra Program in Parkinson’s Disease and Morton and Gloria Shulman. Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des spécialités OTO‐Neuro‐Ophtalmologique. Ibn Sina University hospital, Medical school of Rabat Mohamed 5 University of Rabat Morocco
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini” University of Turin, Via Cherasco 15 10126 Torino Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Torino Italy
| | - Nils G. Margraf
- Department of Neurology UKSH, Christian‐Albrechts‐University Kiel Germany
| | - Marcelo Merello
- Movement Disorders Service. FLENI. CONICET. Buenos Aires. Argentina
| | - Caroline Moreau
- Expert center for Parkinson's disease, Neurological department, Inserm UMR 1171 Lille University Hospital Lille France
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine Fukushima Medical University Fukushima Japan
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini” University of Turin, Via Cherasco 15 10126 Torino Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Torino Italy
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19
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Pongmala C, Artusi CA, Zibetti M, Pitakpatapee Y, Wangthumrong T, Sangpeamsook T, Srikajon J, Srivanitchapoom P, Youn J, Cho JW, Kim M, Zamil Shinawi HM, Obaid MT, Baumann A, Margraf NG, Pona-Ferreira F, Leitão M, Lobo T, Ferreira JJ, Fabbri M, Lopiano L. Postural abnormalities in Asian and Caucasian Parkinson's disease patients: A multicenter study. Parkinsonism Relat Disord 2022; 97:91-98. [PMID: 35378428 DOI: 10.1016/j.parkreldis.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Postural abnormalities (PA) are disabling features of Parkinson's disease (PD). Indirect analyses suggested a higher prevalence of PA among Asian patients compared to Caucasian ones, but no direct comparisons have been performed so far. METHODS An international, multicenter, cross-sectional study was performed in 6 European and Asian movement disorders centers with the aim to clarify differences and similarities of prevalence and characteristics of PA in Asian vs. Caucasian PD patients. Axial PA, encompassing antecollis (AC), camptocormia (CC), and Pisa syndrome (PS), and appendicular PA (appPA) were systematically searched and analysed in consecutive patients. RESULTS 88 (27%) of 326 PD patients had PA (29.1% in Asians and 24.3% in Caucasians, p: 0.331). Prevalence of axial PA was 23.6% in Asians and 24.3% in Caucasians (p = 0.886), in spite of a longer disease duration among Caucasians, but a longer PA duration among Asians. No differences in prevalence between AC, CC, and PS were found between the two ethnicities. The prevalence of appPA was higher in Asians (p = 0.036), but the regression analysis did not confirm a significant difference related to ethnicity. Considering the whole population, male gender (OR, 4.036; 95% CI, 1.926-8.456; p < 0.005), a longer disease duration (OR, 2.61; 95% CI, 1.024-6.653; p = 0.044), and a higher axial score (OR, 1.242; 95% CI, 1.122-1.375; p < 0.0005) were the factors associated with axial PA. CONCLUSION The prevalence of axial PA in PD patients is not influenced by ethnicity. However, Asian PD patients tend to develop PA earlier in the disease course, particularly AC.
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Affiliation(s)
- Chatkaew Pongmala
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy.
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy
| | - Yuvadee Pitakpatapee
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Takarn Wangthumrong
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanita Sangpeamsook
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jindapa Srikajon
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prachaya Srivanitchapoom
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jinyoung Youn
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Jin Whan Cho
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, South Korea
| | | | - Mona Talib Obaid
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alexander Baumann
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | | | - Teresa Lobo
- CNS-Campus Neurológico, Torres Vedras, Portugal
| | - Joaquim J Ferreira
- CNS-Campus Neurológico, Torres Vedras, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Instituto Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - Margherita Fabbri
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center; Toulouse University Hospital; INSERM; University of Toulouse 3; Toulouse, France
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy
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Nydahl P, Baumgarte F, Berg D, Bergjan M, Borzikowsky C, Franke C, Green D, Hannig A, Hansen HC, Hauss A, Hansen U, Istel R, Krämer N, Krause K, Lohrmann R, Mohammadzadeh-Vazifeh M, Osterbrink J, Palm F, Petersen T, Schöller B, Stolze H, Zilezinski M, Meyne J, Margraf NG. Delirium on stroke units: a prospective, multicentric quality-improvement project. J Neurol 2022; 269:3735-3744. [PMID: 35157137 PMCID: PMC9217833 DOI: 10.1007/s00415-022-11000-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/24/2022]
Abstract
Background Post-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management. Methods Multicentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison. Primary outcome was severity of POD, assessed with the Nursing Delirium Screening Scale (Nu-DESC). Secondary outcome parameters were POD incidence, duration, modified Rankin Scale (mRS), length of stay in SU and hospital, mortality, and others. Results Out of a total of 799 patients, 59.4% (n = 475) could be included with 9.5% (n = 45) being delirious. Implementation of a delirium-management led to reduced POD severity; Nu-DESC median: pre: 3.5 (interquartile range 2.6–4.7) vs. post 3.0 (2.2–4.0), albeit not significant (p = 0.154). Other outcome parameters were not meaningful different. In the post-period, delirium-management could be delivered to 75% (n = 18) of delirious patients, and only 24 (53.3%) of delirious patients required pharmacological treatments. Patients with a more severe stroke and POD remained on their disability levels, compared to similar affected, non-delirious patients who improved. Conclusions Implementation of delirium-management on SU is feasible and can be delivered to most patients, but with limited effects. Nursing interventions as first choice could be delivered to the majority of patients, and only the half required pharmacological treatments. Delirium-management may lead to reduced severity of POD but had only partial effects on duration of POD or length of stay. POD hampers rehabilitation, especially in patients with more severe stroke. Registry DRKS, DRKS00021436. Registered 04/17/2020, www.drks.de/DRKS00021436. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11000-6.
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Affiliation(s)
- Peter Nydahl
- Nursing Science and development, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany
| | | | - Daniela Berg
- Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Manuela Bergjan
- Business Division Nursing Directorate, Nursing Science, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics und Statistics, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Christiana Franke
- Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Diana Green
- Christian Albrechts University Kiel, Kiel, Germany
| | - Anisa Hannig
- Department of Neurology, Friedrich-Ebert-Krankenhaus, Neumünster, Germany
| | | | - Armin Hauss
- Business Division Nursing Directorate, Nursing Science, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Uta Hansen
- Department of Neurology, Diako Flensburg, Flensburg, Germany
| | - Rahel Istel
- Christian Albrechts University Kiel, Kiel, Germany
| | - Norma Krämer
- Department of Neurology, Friedrich-Ebert-Krankenhaus, Neumünster, Germany
| | | | - Renée Lohrmann
- Business Division Nursing Directorate, Nursing Science, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Jürgen Osterbrink
- Institut für Pflegewissenschaft und-praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
- Brooks College of Health, University of North Florida, Jacksonville, USA
| | - Frederick Palm
- Department of Neurology, Heliosklinikum Schleswig, Schleswig, Germany
| | | | - Bernd Schöller
- Department of Neurology, Heliosklinikum Schleswig, Schleswig, Germany
| | - Henning Stolze
- Department of Neurology, Diako Flensburg, Flensburg, Germany
| | - Max Zilezinski
- Business Division Nursing Directorate, Nursing Science, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- University Medicine Halle (Saale), Health Service Research Working Group | Acute Care, Department of Internal Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Johannes Meyne
- Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Nils G. Margraf
- Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
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21
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Margraf NG, Jensen-Kondering U, Weiler C, Leypoldt F, Maetzler W, Philippen S, Bartsch T, Flüh C, Röcken C, Möller B, Royl G, Neumann A, Brüggemann N, Roeben B, Schulte C, Bender B, Berg D, Kuhlenbäumer G. Cerebrospinal Fluid Biomarkers in Cerebral Amyloid Angiopathy: New Data and Quantitative Meta-Analysis. Front Aging Neurosci 2022; 14:783996. [PMID: 35237145 PMCID: PMC8884145 DOI: 10.3389/fnagi.2022.783996] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/03/2022] [Indexed: 01/31/2023] Open
Abstract
Background To evaluate the diagnostic accuracy of cerebrospinal fluid (CSF) biomarkers in patients with probable cerebral amyloid angiopathy (CAA) according to the modified Boston criteria in a retrospective multicentric cohort. Methods Beta-amyloid 1-40 (Aβ40), beta-amyloid 1-42 (Aβ42), total tau (t-tau), and phosphorylated tau 181 (p-tau181) were measured in 31 patients with probable CAA, 28 patients with Alzheimer’s disease (AD), and 30 controls. Receiver-operating characteristics (ROC) analyses were performed for the measured parameters as well as the Aβ42/40 ratio to estimate diagnostic parameters. A meta-analysis of all amenable published studies was conducted. Results In our data Aβ42/40 (AUC 0.88) discriminated best between CAA and controls while Aβ40 did not perform well (AUC 0.63). Differentiating between CAA and AD, p-tau181 (AUC 0.75) discriminated best in this study while Aβ40 (AUC 0.58) and Aβ42 (AUC 0.54) provided no discrimination. In the meta-analysis, Aβ42/40 (AUC 0.90) showed the best discrimination between CAA and controls followed by t-tau (AUC 0.79), Aβ40 (AUC 0.76), and p-tau181 (AUC 0.71). P-tau181 (AUC 0.76), Aβ40 (AUC 0.73), and t-tau (AUC 0.71) differentiated comparably between AD and CAA while Aβ42 (AUC 0.54) did not. In agreement with studies examining AD biomarkers, Aβ42/40 discriminated excellently between AD and controls (AUC 0.92–0.96) in this study as well as the meta-analysis. Conclusion The analyzed parameters differentiate between controls and CAA with clinically useful accuracy (AUC > ∼0.85) but not between CAA and AD. Since there is a neuropathological, clinical and diagnostic continuum between CAA and AD, other diagnostic markers, e.g., novel CSF biomarkers or other parameters might be more successful.
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Affiliation(s)
- Nils G. Margraf
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- *Correspondence: Nils G. Margraf,
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Caroline Weiler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Sarah Philippen
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Bettina Möller
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Georg Royl
- Department of Neurology, University Medical Center Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Alexander Neumann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University Medical Center Schleswig Holstein, Campus Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, Diagnostical and Interventional Neuroradiology, University Hospital of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
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22
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Nydahl P, Meyne J, Osterbrink J, Margraf NG. Nurse staffing levels are not associated with appearance, duration or solution of delirium in stroke patients. Intensive Crit Care Nurs 2021; 68:103159. [PMID: 34836770 DOI: 10.1016/j.iccn.2021.103159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Nydahl
- Nursing Research, Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Haus V40, Arnold-Heller-Str. 3, 24105 Kiel, Germany.
| | - Johannes Meyne
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany.
| | - Jürgen Osterbrink
- Institut für Pflegewissenschaft und-praxis, Paracelsus Medizinische Privatuniversität, Strubergasse 21, 5020 A-Salzburg, Austria; Brooks College of Health, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA.
| | - Nils G Margraf
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany.
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Scharf A, Margraf NG, Tode J, Jensen-Kondering U. Multiple retinal aneurysms in probable cerebral amyloid angiopathy. J Neurol Sci 2021; 430:120005. [PMID: 34619621 DOI: 10.1016/j.jns.2021.120005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Amelie Scharf
- Department of Ophthalmology, UKSH Campus Kiel, Germany
| | | | - Jan Tode
- Department for Ophthalmology, Hannover Medical School (MHH), Hanover, Germany
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, UKSH Campus Kiel, Germany; Institute of Neuroradiology, UKSH Campus Lübeck, Germany.
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Nydahl P, Günther U, Hansen HC, Meyne J, Osterbrink J, Margraf NG. [Pitfalls in the diagnosis of delirium]. Med Klin Intensivmed Notfmed 2021; 117:615-622. [PMID: 34383103 DOI: 10.1007/s00063-021-00846-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/09/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The diagnosis of delirium is challenging and requires precise definitions in both clinical routine and in studies. AIM To point out various pitfalls in the clinical diagnosis of delirium and discuss solutions. METHODS Review. RESULTS Common problems include (a) clinical judgment of staff vs. the use of valid assessment tools, (b) different lists of criteria for delirium that may consider the symptoms of delirium differently and thus lead to inclusion or exclusion of patients, (c) different assessment tools that test the symptoms of delirium to different extents and thus have different accuracy, (d) patients with limited communication abilities, such as aphasia, where common tests often fail and alternative procedures may be more effective; (e) the decision whether to test delirium once, twice, three times, or more frequently in 24 h has consequences on the incidence and duration of delirium, (f) the end of delirium, often defined retrospectively as a delirium-free interval or prospectively as the time of transfer or occurrence of an exclusion criterion, can lead to considerable measurement inaccuracies. CONCLUSIONS Although not all problems can be definitively answered, transparent definition, performance, and documentation of diagnostic procedures are recommended.
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Affiliation(s)
- Peter Nydahl
- Pflegeforschung, Abteilung für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Brunswiker Str. 10, 24105, Kiel, Deutschland.
| | - Ulf Günther
- Universitätsklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Klinikum Oldenburg AöR, Oldenburg, Deutschland.,Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Fakultät VI - Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität, Oldenburg, Deutschland
| | - Hans-Christian Hansen
- Klinik für Neurologie, Friedrich-Ebert-Krankenhaus GmbH Neumünster/Universität Hamburg, Neumünster, Deutschland
| | - Johannes Meyne
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Jürgen Osterbrink
- Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.,Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Nils G Margraf
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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Cossais F, Schaeffer E, Heinzel S, Zimmermann J, Niesler B, Röth R, Rappold G, Scharf A, Zorenkov D, Lange C, Barrenschee M, Margraf NG, Ellrichmann M, Berg D, Böttner M, Wedel T. Expression Profiling of Rectal Biopsies Suggests Altered Enteric Neuropathological Traits in Parkinson's Disease Patients. J Parkinsons Dis 2020; 11:171-176. [PMID: 33337386 DOI: 10.3233/jpd-202258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Still little is known about the nature of the gastrointestinal pathological alterations occurring in Parkinson's disease (PD). Here, we used multiplexed mRNA profiling to measure the expression of a panel of 770 genes related to neuropathological processes in deep submucosal rectal biopsies of PD patients and healthy controls. Altered enteric neuropathological traits based on the expression of 22 genes related to neuroglial and mitochondrial functions, vesicle trafficking and inflammation was observed in 9 out of 12 PD patients in comparison to healthy controls. These results provide new evidences that intestinal neuropathological alterations may occur in a large proportion of PD patients.
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Affiliation(s)
- François Cossais
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jessica Zimmermann
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Ralph Röth
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gudrun Rappold
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Amelie Scharf
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Dmitri Zorenkov
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christina Lange
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Mark Ellrichmann
- Interdisciplinary Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Martina Böttner
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
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Jensen-Kondering U, Neumann A, Margraf NG, Gövert F, Brüggemann N, Schunk D, Bahmer T, Schramm P, Schreiber S, Jansen O. Cerebral Imaging in Patients with COVID-19 and Neurological Symptoms: First Experience from two University Hospitals in Northern Germany. ROFO-FORTSCHR RONTG 2020; 193:667-671. [PMID: 33212537 DOI: 10.1055/a-1265-7209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To describe findings on cerebral imaging in patients with COVID-19 and neurological symptoms at two German university hospitals. MATERIALS AND METHODS Patients with COVID-19 and neurological symptoms and cerebral imaging (CT or MRI) were included. A chart review regarding neurological symptoms, COVID-19 and imaging findings was conducted. RESULTS 12 patients (4 females, age 68 ± 12 years) could be included. Three patients had acute findings. Two patients had acute and subacute cerebral ischemia, one patient had additional intracranial hemorrhages and presumed central pontine myelinolysis. One patient had presumed COVID-19-associated pansinusitis. CONCLUSION Findings on cerebral imaging in patients with COVID-19 are uncommon and nonspecific. However, cerebral ischemia is regularly encountered and patients should be evaluated for stroke symptoms. KEY POINTS · Approx. 20 % of patients with COVID-19 develop neurological symptoms.. · Findings on cerebral imaging in patients with COVID-19 are heterogeneous and nonspecific.. · The most common findings are cerebral ischemia and hemorrhages.. CITATION FORMAT · Jensen-Kondering U, Neumann A, Margraf N et al. Cerebral Imaging in Patients with COVID-19 and Neurological Symptoms: First Experience from two University Hospitals in Northern Germany. Fortschr Röntgenstr 2021; 193: 667 - 671.
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Affiliation(s)
- Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Alexander Neumann
- Institute of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Norbert Brüggemann
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Domagoj Schunk
- Emergency Department, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Thomas Bahmer
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Peter Schramm
- Institute of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Wolke R, Kuhtz-Buschbeck JP, Deuschl G, Margraf NG. Insufficiency of trunk extension and impaired control of muscle force in Parkinson's disease with camptocormia. Clin Neurophysiol 2020; 131:2621-2629. [PMID: 32932021 DOI: 10.1016/j.clinph.2020.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/04/2020] [Accepted: 07/12/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the aetiology of parkinsonian camptocormia, a non-fixed pathological forward bending of the trunk, by measuring trunk muscle activation and force regulation in Parkinson patients with (PD + CC) and without (PD) camptocormia matched for disease severity, and in age- and sex-matched healthy controls (HC). METHODS The isometric forces of trunk extension and flexion were measured in PD + CC, PD and HC. Neuromuscular efficiency (increase of extension force per increase of paravertebral muscle surface electromyography signal) and the ability to maintain a constant submaximal trunk extension force were examined. RESULTS Peak trunk extension force was significantly lower in PD + CC and PD than in HC, with PD + CC non-significantly weaker than PD. Compared with HC and with PD, the neuromuscular efficiency of trunk extension was significantly reduced in PD + CC. The variability of the force output (coefficient of variation) was significantly larger for PD + CC than for HC or PD. CONCLUSION The reduced neuromuscular efficiency of trunk extension separates PD + CC from PD. Moreover, control of the trunk extensor force is impaired in PD + CC. SIGNIFICANCE There is weakness and a force control deficit in parkinsonian camptocormia suggesting a disturbed sensory-motor integration, which may contribute to myopathic changes in the trunk extensor muscles.
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Affiliation(s)
- R Wolke
- Department of Neurology, Kiel University, UKSH, Germany
| | | | - G Deuschl
- Department of Neurology, Kiel University, UKSH, Germany.
| | - N G Margraf
- Department of Neurology, Kiel University, UKSH, Germany
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Jensen-Kondering UR, Weiler C, Langguth P, Larsen N, Flüh C, Kuhlenbäumer G, Jansen O, Margraf NG. Clinical and radiological differences between patients with probable cerebral amyloid angiopathy and mixed cerebral microbleeds. J Neurol 2020; 267:3602-3608. [PMID: 32638111 PMCID: PMC7674181 DOI: 10.1007/s00415-020-10038-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The key imaging features of cerebral amyloid angiopathy (CAA) are lobar, cortical, or cortico-subcortical microbleeds, macrohaemorrhages and cortical superficial siderosis (cSS). In contrast, hypertensive angiopathy is characterized by (micro) haemorrhages in the basal ganglia, thalami, periventricular white matter or the brain stem. Another distinct form of haemorrhagic microangiopathy is mixed cerebral microbleeds (mixed CMB) with features of both CAA and hypertensive angiopathy. The distinction between the two entities (CAA and mixed CMB) is clinically relevant because the risk of haemorrhage and stroke should be well balanced if oral anticoagulation is indicated in CAA patients. We aimed to comprehensively compare these two entities. METHODS Patients with probable CAA according to the modified Boston criteria and mixed CMB without macrohaemorrhage were retrospectively identified from our database. Comprehensive comparison regarding clinical and radiological parameters was performed between the two cohorts. RESULTS Patients with CAA were older (78 ± 8 vs. 74 ± 9 years, p = 0.036) and had a higher prevalence of cSS (19% vs. 4%, p = 0.027) but a lower prevalence of lacunes (73% vs. 50%, p = 0.018) and deep lacunes (23% vs. 51%, p = 0.0003) compared to patients with mixed CMB. Logistic regression revealed an association between the presence of deep lacunes and mixed CMB. The other collected parameters did not reveal a significant difference between the two groups. CONCLUSIONS CAA and mixed CMB demonstrate radiological differences in the absence of macrohaemorrhages. However, more clinically available biomarkers are needed to elucidate the contribution of CAA and hypertensive angiopathy in mixed CMB patients.
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Affiliation(s)
- Ulf R Jensen-Kondering
- Department of Radiology and Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Caroline Weiler
- Department of Neurology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Patrick Langguth
- Department of Radiology and Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Nils G Margraf
- Department of Neurology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
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Schlenstedt C, Boße K, Gavriliuc O, Wolke R, Granert O, Deuschl G, Margraf NG. Quantitative assessment of posture in healthy controls and patients with Parkinson's disease. Parkinsonism Relat Disord 2020; 76:85-90. [PMID: 32033879 DOI: 10.1016/j.parkreldis.2020.01.012] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION A stooped posture is a main clinical feature of Parkinson's disease (PD). The assessment of posture is important to measure treatment effects. The aim of this study was to investigate the reliability of a standardized postural rating tool, to calculate minimal detectable change scores and to assess the role of gender and age. METHODS Two independent raters assessed total camptocormia (TCC), upper camptocormia (UCC) and Pisa angles of 192 PD patients and 78 healthy controls (HC) with the free NeuroPostureApp©(http://www.neuroimaging.uni-kiel.de/NeuroPostureApp). Reliabilities and linear models were calculated for different effects. Three subgroups were defined based on two thresholds (mean+2SD of HC and PD): A) normal, B) presumed stooped/lateral bended posture and C) postural disorder. RESULTS Intraclass correlation coefficients ranged between 0.71 and 0.95 for the interrater and test-retest reliability of the three angles. The minimal detectable change values in the PD patients were 3.7°, 6.7° and 2.1° for the TCC, UCC and Pisa angles, respectively. Men had a more stooped posture than women (p < 0.05). Patients with PD had a worse posture than HC (p < 0.001) in all three angles. For the TCC angle, 39.1% of the patients had a normal posture (<17.4°), 47.9% a presumed stooped posture (>17.4°, <30.2°) and 6.3° had camptocormia (>30.2°). CONCLUSIONS The NeuroPostureApp© is reliable. Our results confirmed gender differences and the progression of postural deviation in PD patients with age and empirically support the ≥30° TCC angle as a defining criterium for camptocormia. Diagnostic criteria for UCC and Pisa syndrome should be further explored in future studies.
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Affiliation(s)
| | - Kathrin Boße
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Olga Gavriliuc
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany; Department of Neurology, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany.
| | - Nils G Margraf
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
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30
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Schlenstedt C, Gavriliuc O, Boße K, Wolke R, Granert O, Deuschl G, Margraf NG. The Effect of Medication and Deep Brain Stimulation on Posture in Parkinson's Disease. Front Neurol 2019; 10:1254. [PMID: 31849818 PMCID: PMC6901659 DOI: 10.3389/fneur.2019.01254] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Postural abnormalities are common in Parkinson's disease (PD) and increasing with disease progression. While many studies focus on balance and gait, postural alignment is only infrequently studied. Purpose: The aim of the present study was to examine the immediate and long-term effects of medication and deep brain stimulation (DBS) in the subthalamic nucleus on postural alignment in PD. Materials and Methods: PD patients (n = 192) in an advanced stage of disease were videotaped during a standardized l-dopa trial before and after DBS. The patients were tested with and without medication pre-surgical and retested post-surgical (6–24 months) in all treatment combinations of medication and DBS regarding the on and off conditions. The forward bending as total camptocormia (TCC) and upper camptocormia (UCC) angles and lateral bending as Pisa angle were assessed with the free downloadable NeuroPostureApp (http://www.neuroimaging.uni-kiel.de/NeuroPostureApp/). Three subgroups were defined according to normative values of healthy controls and according to clinical criteria: patients with normal posture, with stooped posture, and with postural disorders. Results: A stooped posture was found in 82% of the patients with regard to the TCC angle and in 54% for the UCC angle. Sixty-two percent had an abnormal Pisa angle. Camptocormia was diagnosed in ~7% and a Pisa syndrome in 1% of the patients. Medication and DBS both significantly improved postural alignment in the entire cohort. Female and male patients benefit similarly by medication and stimulation. Subgroup analyses revealed that the effects were also significant for patients with stooped posture, and the effects were strongest for patients with camptocormia: they led to angles below the diagnostical criterion for camptocormia for 13 of 14 patients with TCC and 11 of 26 patients with UCC. DBS had an additional effect to medication over time for the Pisa angle. Conclusion: Medication and DBS both improved postural alignment in PD patients, but effects were small for the entire cohort. Patients with camptocormia according to the TCC angle benefit strongest. The large differences of the treatment effects may indicate distinct pathological mechanisms for stooped posture and postural disorders. The TCC angle was shown to be sensitive to change. The UCC angle was less sensitive but may be a useful assessment tool for a subgroup.
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Affiliation(s)
| | - Olga Gavriliuc
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany.,Department of Neurology, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Moldova
| | - Kathrin Boße
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Nils G Margraf
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
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Wolframm H, Margraf NG, Deuschl G, Wolke R, Rieger R. Measurement of camptocormia trunk flexion using a dual-sensor measurement setup. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2019:3275-3278. [PMID: 31946583 DOI: 10.1109/embc.2019.8857212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Assessing the flexion of the trunk of patients with camptocormia is a key factor in developing therapies for camptocormia and monitoring their success. Currently used methods to measure this camptocormia angle are based on photographs or short videos. Both methods are not able to take the ability of patients into account to compensate their symptoms for short amounts of time. We propose a simple two sensor measurement setup based on two accelerometers to measure the angle in accordance with the established perpendicular measurement method [1]. We show that our method yields an average deviation of -1.74° with a maximum deviation of +2° and -6° compared to visual assessment with a motion capturing system.
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Bernhard FP, Sartor J, Bettecken K, Hobert MA, Arnold C, Weber YG, Poli S, Margraf NG, Schlenstedt C, Hansen C, Maetzler W. Wearables for gait and balance assessment in the neurological ward - study design and first results of a prospective cross-sectional feasibility study with 384 inpatients. BMC Neurol 2018; 18:114. [PMID: 30115021 PMCID: PMC6094895 DOI: 10.1186/s12883-018-1111-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 04/23/2018] [Accepted: 07/26/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Deficits in gait and balance are common among neurological inpatients. Currently, assessment of these patients is mainly subjective. New assessment options using wearables may provide complementary and more objective information. METHODS In this prospective cross-sectional feasibility study performed over a four-month period, all patients referred to a normal neurology ward of a university hospital and aged between 40 and 89 years were asked to participate. Gait and balance deficits were assessed with wearables at the ankles and the lower back. Frailty, sarcopenia, Parkinsonism, depression, quality of life, fall history, fear of falling, physical activity, and cognition were evaluated with questionnaires and surveys. RESULTS Eighty-two percent (n = 384) of all eligible patients participated. Of those, 39% (n = 151) had no gait and balance deficit, 21% (n = 79) had gait deficits, 11% (n = 44) had balance deficits and 29% (n = 110) had gait and balance deficits. Parkinson's disease, stroke, epilepsy, pain syndromes, and multiple sclerosis were the most common diseases. The assessment was well accepted. CONCLUSIONS Our study suggests that the use of wearables for the assessment of gait and balance features in a clinical setting is feasible. Moreover, preliminary results confirm previous epidemiological data about gait and balance deficits among neurological inpatients. Evaluation of neurological inpatients with novel wearable technology opens new opportunities for the assessment of predictive, progression and treatment response markers.
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Affiliation(s)
- Felix P. Bernhard
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jennifer Sartor
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Kristina Bettecken
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Markus A. Hobert
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
| | - Carina Arnold
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Yvonne G. Weber
- Department of Neurology and Epileptology, University Tübingen, 72076 Tübingen, Germany
| | - Sven Poli
- Department of Neurology & Stroke, University Hospital Tübingen, Tübingen, Germany
| | - Nils G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
| | - Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
| | - Walter Maetzler
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
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Margraf NG, Wolke R, Granert O, Berardelli A, Bloem BR, Djaldetti R, Espay AJ, Fasano A, Furusawa Y, Giladi N, Hallett M, Jankovic J, Murata M, Tinazzi M, Volkmann J, Berg D, Deuschl G. Consensus for the measurement of the camptocormia angle in the standing patient. Parkinsonism Relat Disord 2018; 52:1-5. [DOI: 10.1016/j.parkreldis.2018.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/02/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
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Rothkirch I, Wolff S, Margraf NG, Pedersen A, Witt K. Does Post-task Declarative Learning Have an Influence on Early Motor Memory Consolidation Over Day? An fMRI Study. Front Neurosci 2018; 12:280. [PMID: 29755315 PMCID: PMC5932143 DOI: 10.3389/fnins.2018.00280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/10/2018] [Indexed: 12/02/2022] Open
Abstract
Previous studies demonstrated the influence of the post-learning period on procedural motor memory consolidation. In an early period after the acquisition, motor skills are vulnerable to modifications during wakefulness. Indeed, specific interventions such as world-list learning within this early phase of motor memory consolidation seem to enhance motor performance as an indicator for successful consolidation. This finding highlights the idea that manipulations of procedural and declarative memory systems during the early phase of memory consolidation over wakefulness may influence off-line consolidation. Using functional magnetic resonance imaging (fMRI) during initial motor sequence learning and motor sequence recall, we indirectly assess the influence of a secondary task taken place in the early phase of memory consolidation. All participants were scanned using fMRI during the learning phase of a serial reaction time task (SRTT) at 8 a.m. Afterwards, they were randomly assigned to one of five conditions. One group performed a declarative verbal, one a declarative nonverbal learning task. Two groups worked on attention tasks. A control group passed a resting condition. Participants stayed awake the whole day and performed the SRTT in the MRI scanner 12 h later at 8 p.m. At the behavioral level, the analysis of the reaction times failed to show a significant group difference. The primary analysis assessing fMRI data based on the contrast (sequence – random) between learning and retrieval also did not show any significant group differences. Therefore, our main analysis do not support the hypothesis that a secondary task influences the retrieval of the SRTT. In a more liberal fMRI analysis, we compared only the sequence blocks of the SRTT from learning to recall. BOLD signal decreased in the ipsilateral cerebellum and the supplementary motor area solely in the verbal learning group. Although our primary analysis failed to show significant changes between our groups, results of the secondary analysis could be an indication for a beneficial effect of the verbal declarative task in the early post-learning phase. A nonverbal learning task did not affect the activation within the motor network. Further studies are needed to replicate this finding and to assess the usefulness of this manipulation.
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Affiliation(s)
- Inken Rothkirch
- Department of Neurology, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Stephan Wolff
- Department of Radiology, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nils G Margraf
- Department of Neurology, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anya Pedersen
- Department of Psychology, Kiel University, Kiel, Germany
| | - Karsten Witt
- Department of Neurology, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany.,European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Juhász J, Lindner T, Riedel C, Margraf NG, Jansen O, Rohr A. Quantitative Phase-Contrast MR Angiography to Measure Hemodynamic Changes in Idiopathic Intracranial Hypertension. AJNR Am J Neuroradiol 2018. [PMID: 29519787 DOI: 10.3174/ajnr.a5571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Idiopathic intracranial hypertension is a syndrome of raised intracranial pressure of unknown etiology. Few MR imaging-based studies have investigated arterial and venous blood flow in these patients. Results are inconclusive, and to our knowledge, no comparison of the hemodynamic parameters before and after CSF pressure reduction has been published. The aim of this study was to assess the short-term effects of normalizing CSF pressure on intracranial flow to better understand the pathophysiology of idiopathic intracranial hypertension. MATERIALS AND METHODS In this study, we performed quantitative MR imaging-derived flow measurements of brain-supplying arteries and draining veins/dural sinuses to visualize hemodynamic changes in patients with idiopathic intracranial hypertension before and after therapy by lumbar puncture in comparison with a healthy control group. RESULTS We found differences in patients before and after lumbar puncture in the calculated resistance and pulsatility indices in the superior sagittal sinus. Venous pulsatility showed a negative correlation with CSF pressure in untreated patients. Additionally, there was a trend toward lower flow in the superior sagittal sinus in patients compared with healthy controls. Flow in the internal jugular veins was significantly reduced by lumbar puncture, and the resistance and pulsatility indices differed in patients and controls. The arterial flow was not influenced by pressure normalization. CONCLUSIONS The results of the present study indicate that venous but not arterial blood flow differs in patients compared with controls and that calculating resistance and pulsatility indices may contribute to assessing short-term hemodynamic changes in patients with diagnosed idiopathic intracranial hypertension before and after CSF diversion.
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Affiliation(s)
- J Juhász
- From the Clinic for Radiology and Neuroradiology (J.J., T.L., C.R., O.J., A.R.)
| | - T Lindner
- From the Clinic for Radiology and Neuroradiology (J.J., T.L., C.R., O.J., A.R.)
| | - C Riedel
- From the Clinic for Radiology and Neuroradiology (J.J., T.L., C.R., O.J., A.R.)
| | - N G Margraf
- Clinic for Neurology (N.G.M.), University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - O Jansen
- From the Clinic for Radiology and Neuroradiology (J.J., T.L., C.R., O.J., A.R.)
| | - A Rohr
- From the Clinic for Radiology and Neuroradiology (J.J., T.L., C.R., O.J., A.R.).,Neuroradiology Section (A.R.), Vancouver General Hospital, Vancouver, British Columbia, Canada
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Nydahl P, Bartoszek G, Binder A, Paschen L, Margraf NG, Witt K, Ewers A. Prevalence for delirium in stroke patients: A prospective controlled study. Brain Behav 2017; 7:e00748. [PMID: 28828209 PMCID: PMC5561309 DOI: 10.1002/brb3.748] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/12/2017] [Accepted: 05/14/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE This study investigates the prevalence of delirium in acute stroke patients on a primary stroke unit (SU) analyzing associated risk factors and clinical outcomes. METHOD Prospective, 4-month observational study from 2015 to 2016 on patients aged ≥18 years with stroke at a German university hospital's SU. The presence of delirium as first outcome was rated at three times daily using the Confusion Assessment Method (CAM). Secondary outcome measures were duration of delirium, rehabilitation in SU, length of stay in SU and hospital, complications, and mortality. Significant risk factors were used to conduct a confounder-matched case-control analysis. RESULTS 309 patients were included. The overall prevalence of delirium was 10.7% (33 patients) mostly on the first and second hospital day. Duration of delirium on SU was in median 1.0 day (Interquartile range: 0.3-2 days). In 39.4% of patients delirium was present in a short time interval (≤8 hr) and in 24% of patients delirium was diagnosed during nightshifts exclusively. Significant risk factors for delirium were dementia, age ≥72 years, severe neurological disability on admission, and increased C-reactive protein on admission. The case-control analysis showed that delirious patients had more complications and a trend toward a worse rehabilitation. CONCLUSIONS These results underline the importance of delirium screening in stroke patients specifically during the night. Since even short delirious episodes are associated with more complications and increased disability, future studies are needed to find delirium prevention strategies.
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Affiliation(s)
- Peter Nydahl
- Nursing research Campus Kiel University Hospital of Schleswig-Holstein Kiel Germany
| | - Gabriele Bartoszek
- Faculty of Health School of Nursing Science Witten/Herdecke University Witten Germany
| | - Andreas Binder
- Department of Neurology University Medical Center Schleswig-Holstein Christian-Albrechts University Kiel Kiel Germany
| | - Laura Paschen
- Department of Neurology University Medical Center Schleswig-Holstein Christian-Albrechts University Kiel Kiel Germany
| | - Nils G Margraf
- Department of Neurology University Medical Center Schleswig-Holstein Christian-Albrechts University Kiel Kiel Germany
| | - Karsten Witt
- Department of Neurology University Medical Center Schleswig-Holstein Christian-Albrechts University Kiel Kiel Germany.,School of Medicine and Health Sciences - European Medical School University Hospital of Neurology Medical Campus University of Oldenburg Germany
| | - Andre Ewers
- Institute of Nursing Science and Practice Paracelsus Medical University Salzburg Austria
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Hopfner F, Künstner A, Müller SH, Künzel S, Zeuner KE, Margraf NG, Deuschl G, Baines JF, Kuhlenbäumer G. Gut microbiota in Parkinson disease in a northern German cohort. Brain Res 2017; 1667:41-45. [PMID: 28506555 DOI: 10.1016/j.brainres.2017.04.019] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/29/2017] [Accepted: 04/29/2017] [Indexed: 11/16/2022]
Abstract
Pathologic and epidemiologic studies suggest that Parkinson disease (PD) may in some cases start in the enteric nervous system and spread via the vagal nerve to the brainstem. Mounting evidence suggests that the gut microbiome plays an important role in the communication between gut and brain and that alteration of the gut microbiome is involved in the pathogenesis of numerous diseases, including Parkinson disease. The aim of this study was to determine whether Parkinson disease is associated with qualitative or quantitative changes in the gut microbiome. We analyzed the gut microbiome in 29 PD cases and 29 age-matched controls by next-generation-sequencing of the 16S rRNA gene and compared diversity indices and bacterial abundances between cases and controls. Alpha diversity measures and the abundance of major phyla did not differ between cases and controls. Beta diversity analyses and analysis on the bacterial family level revealed significant differences between cases and controls for four bacterial families. In keeping with recently published studies, Lactobacillaceae were more abundant in cases. Barnesiellaceae and Enterococcacea were also more abundant in cases in this study but not in other studies. Larger studies, accounting for drug effects and further functional investigations of the gut microbiome are necessary to delineate the role of the gut microbiome in the pathogenesis of PD.
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Affiliation(s)
| | - Axel Künstner
- Group of Medical Systems Biology, Lübeck Institute of Experimental Dermatology, University of Lübeck, 23538 Lübeck, Germany; Max Planck Institute for Evolutionary Biology, August-Thienemann-Str. 2, 24306 Plön, Germany
| | | | - Sven Künzel
- Max Planck Institute for Evolutionary Biology, August-Thienemann-Str. 2, 24306 Plön, Germany
| | | | | | | | - John F Baines
- Max Planck Institute for Evolutionary Biology, August-Thienemann-Str. 2, 24306 Plön, Germany; Institute for Experimental Medicine, Kiel University, 24105 Kiel, Germany
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Juhász J, Lindner T, Jansen O, Margraf NG, Rohr A. Changes in intracranial venous hemodynamics in a patient with idiopathic intracranial hypertension after lumbar puncture precedes therapeutic success. J Magn Reson Imaging 2017; 47:286-288. [DOI: 10.1002/jmri.25660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/24/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Julia Juhász
- Clinic for Radiology and Neuroradiology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Thomas Lindner
- Clinic for Radiology and Neuroradiology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Olav Jansen
- Clinic for Radiology and Neuroradiology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Nils G. Margraf
- Clinic for Neurology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Axel Rohr
- Clinic for Radiology and Neuroradiology; University Hospital Schleswig-Holstein; Kiel Germany
- Vancouver General Hospital; Vancouver BC Canada
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Zeuner KE, Knutzen A, Kühl C, Möller B, Hellriegel H, Margraf NG, Deuschl G, Stolze H. Functional impact of different muscle localization techniques for Botulinum neurotoxin A injections in clinical routine management of post-stroke spasticity. Brain Inj 2016; 31:75-82. [DOI: 10.1080/02699052.2016.1218545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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)
| | - Arne Knutzen
- Department of Neurology, Kiel University, Germany
| | - Carina Kühl
- Department of Neurology, Kiel University, Germany
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Margraf NG, Granert O, Hampel J, Wrede A, Schulz-Schaeffer WJ, Deuschl G. Clinical Definition of Camptocormia in Parkinson's Disease. Mov Disord Clin Pract 2016; 4:349-357. [PMID: 30363363 DOI: 10.1002/mdc3.12437] [Citation(s) in RCA: 26] [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: 04/24/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 12/29/2022] Open
Abstract
Background Clinical key aspects of camptocormia in patients with idiopathic Parkinson's disease (PD) await further definition. Methods Based on a self-assessment of PD patients, we performed an observational study, asking patients with subjectively felt involuntary forward bending to return a questionnaire and provide photographs showing their axial disorder. Forty-two matched PD patients without subjective signs of camptocormia were recruited as controls. Results The stooped posture of patients with advanced PD without camptocormia is characterized by a forward bending angle of always less than 30 degrees. Of the 145 camptocormia patients in our study, 70% had an angle ≥30 degrees. The patients with a more-severe forward bending angle were more severely affected in daily life than those with an angle of less than 30 degrees. Back pain was more frequent (81% vs. 43%) and more severe in PD patients with camptocormia than in controls. Back diseases in camptocormia PD patients were also significantly more frequent than in the PD control patients (55% vs. 26%). Camptocormia is a relevant burden in everyday life. Seventy-seven percent of patients needed walking aids and 85% reported specific disabilities attributed to camptocormia (e.g. increased risk of falling, dyspnea, problems in eating or swallowing). Conclusions Camptocormia cannot be clinically defined based on the forward bending angle alone, but an angle larger than 30 degrees is only found in camptocormia. Back pain is an essential aspect of camptocormia in PD. Back diseases can be seen as a risk factor in these patients.
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Affiliation(s)
- Nils G Margraf
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Oliver Granert
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Julia Hampel
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Arne Wrede
- Institute of Neuropathology University Medical Center Göttingen Germany
| | | | - Günther Deuschl
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
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Schulz-Schaeffer WJ, Margraf NG, Munser S, Wrede A, Buhmann C, Deuschl G, Oehlwein C. Effect of neurostimulation on camptocormia in Parkinson's disease depends on symptom duration. Mov Disord 2015; 30:368-72. [PMID: 25678310 PMCID: PMC5132064 DOI: 10.1002/mds.26081] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 10/06/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
Although some reports on neurostimulation are positive, no effective treatment method for camptocormia in Parkinson's disease (PD) is known to date. We aim to identify prognostic factors for a beneficial DBS effect on camptocormia. In an observational cohort study, we investigated 25 idiopathic PD patients, who suffered additionally from camptocormia, and underwent bilateral neurostimulation of the subthalamic nucleus (STN) to improve classical PD symptoms. Using an established questionnaire, we examined deep brain stimulation (DBS) effects on camptocormia in addition to general neurostimulation effects. A beneficial neurostimulation effect on camptocormia was defined as an improvement in the bending angle of a least 50%. In 13 patients, the bending angle of camptocormia improved, in 12 patients it did not. A multifactorial analysis revealed a short duration between onset of camptocormia and start of neurostimulation to be the relevant factor for outcome. All patients with duration of camptocormia up to 1.5 years showed a beneficial effect; patients between 1.5 and ∼3 years showed mixed results, but none with a duration of more than 40 months improved except for 1 patient whose camptocormia was levodopa responsive. The bending angle was not a prognostic factor. Our data indicate that the main prognostic factor for a beneficial DBS effect on camptocormia is its short duration. As an explanation, we suggest that neurostimulation may improve camptocormia only as long as muscle pathology is limited. Our findings may help to elucidate the mode of action of neurostimulation. A prospective study is necessary. © 2015 International Parkinson and Movement Disorder Society
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Affiliation(s)
- Walter J Schulz-Schaeffer
- Prion and Dementia Research Unit, Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
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Wrede A, Margraf NG, Goebel HH, Deuschl G, Schulz-Schaeffer WJ. Myofibrillar disorganization characterizes myopathy of camptocormia in Parkinson's disease. Acta Neuropathol 2012; 123:419-32. [PMID: 22160321 PMCID: PMC3282910 DOI: 10.1007/s00401-011-0927-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/26/2011] [Accepted: 12/02/2011] [Indexed: 10/29/2022]
Abstract
Camptocormia is a highly disabling syndrome that occurs in various diseases but is particularly associated with Parkinson's disease (PD). Although first described nearly 200 years ago, the morphological changes associated with camptocormia are still under debate and the pathophysiology is unknown. We analyzed paraspinal muscle biopsies of 14 PD patients with camptocormia and compared the findings to sex-matched postmortem controls of comparable age to exclude biopsy site-specific changes. Camptocormia in PD showed a consistent lesion pattern composed of myopathic changes with type-1 fiber hypertrophy, loss of type-2 fibers, loss of oxidative enzyme activity, and acid phosphatase reactivity of lesions. Ultrastructurally, myofibrillar disorganization and Z-band streaming up to electron-dense patches/plaques were seen in the lesions. No aberrant protein aggregation, signs of myositis or mitochondriopathy were found, but the mitochondrial content of paraspinal muscles in patients and controls was markedly higher than known from limb biopsies. Additionally, we were able to demonstrate a link between the severity of the clinical syndrome and the degree of the myopathic changes. Because of the consistent lesion pattern, we propose criteria for the diagnosis of camptocormia in PD from muscle biopsies. The morphological changes show obvious parallels to the muscle pathology of experimental tenotomy reported in the 1970s, which depend on an intact innervation and do not occur after interruption of the myotactic reflexes. A dysregulation of the proprioception could be part of the pathogenesis of camptocormia in Parkinson's disease, particularly in view of the clinical symptoms of rigidity and loss of muscle strength.
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Affiliation(s)
- Arne Wrede
- Prion and Dementia Research Unit, Institute of Neuropathology, Medical University Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Nils G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hans H. Goebel
- Institute of Neuropathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Walter J. Schulz-Schaeffer
- Prion and Dementia Research Unit, Institute of Neuropathology, Medical University Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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Margraf NG, Wrede A, Rohr A, Schulz-Schaeffer WJ, Raethjen J, Eymess A, Volkmann J, Mehdorn MH, Jansen O, Deuschl G. Camptocormia in idiopathic Parkinson's disease: a focal myopathy of the paravertebral muscles. Mov Disord 2010; 25:542-51. [PMID: 20108372 DOI: 10.1002/mds.22780] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The objective of our study was to describe the clinical features of camptocormia, an involuntary, marked flexion of the thoracolumbar spine in idiopathic Parkinson's disease (PD) and to understand its etiology. In a prospective, cross-sectional study, we examined 15 patients with PD and camptocormia using laboratory parameters, EMG, muscle magnetic resonance imaging, and biopsy of the paravertebral muscles. The clinical data were compared with a matched control group of PD patients without camptocormia, and the biopsies were compared with muscles from age-matched autopsies. Almost all the patients (median age, 68.0 years; 7 women) with camptocormia suffered from advanced PD. Camptocormia occurred at a median of 9.0 years after the PD diagnosis. Compared with our clinical control group, back pain was more frequent and less dopa-sensitive in the patients with camptocormia who suffered more often from additional diseases of the back. On EMG, we found mainly a myopathic pattern. The MRI of the paravertebral muscles showed localized changes ranging from edema with contrast enhancement, which are considered to be early signs, to atrophy and/or fatty degeneration, interpreted as late degenerative changes. Early signs were seen mainly during the first year and degenerative changes after 1.5 years. Biopsies revealed consistently myopathic changes and in some cases fatty degeneration. Clinical or electromyographic features favoring dystonia were absent. Camptocormia is a major disabling, non-fluctuating and levodopa-resistant complication of advanced PD. The cause of camptocormia in idiopathic PD is a focal myopathy. Our findings suggest that the myopathy has a progressive course, which finally leads to degeneration of the paravertebral muscles.
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Affiliation(s)
- Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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