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Vill K, Tacke M, König A, Baumann M, Baumgartner M, Steinbach M, Bernert G, Blaschek A, Deschauer M, Flotats-Bastardas M, Friese J, Goldbach S, Gross M, Günther R, Hahn A, Hagenacker T, Hauser E, Horber V, Illsinger S, Johannsen J, Kamm C, Koch JC, Koelbel H, Koehler C, Kolzter K, Lochmüller H, Ludolph A, Mensch A, Meyer Zu Hoerste G, Mueller M, Mueller-Felber W, Neuwirth C, Petri S, Probst-Schendzielorz K, Pühringer M, Steinbach R, Schara-Schmidt U, Schimmel M, Schrank B, Schwartz O, Schlachter K, Schwerin-Nagel A, Schreiber G, Smitka M, Topakian R, Trollmann R, Tuerk M, Theophil M, Rauscher C, Vorgerd M, Walter MC, Weiler M, Weiss C, Wilichowski E, Wurster CD, Wunderlich G, Zeller D, Ziegler A, Kirschner J, Pechmann A. 5qSMA: standardised retrospective natural history assessment in 268 patients with four copies of SMN2. J Neurol 2024; 271:2787-2797. [PMID: 38409538 PMCID: PMC11055798 DOI: 10.1007/s00415-024-12188-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024]
Abstract
Newborn screening for 5qSMA offers the potential for early, ideally pre-symptomatic, therapeutic intervention. However, limited data exist on the outcomes of individuals with 4 copies of SMN2, and there is no consensus within the SMA treatment community regarding early treatment initiation in this subgroup. To provide evidence-based insights into disease progression, we performed a retrospective analysis of 268 patients with 4 copies of SMN2 from the SMArtCARE registry in Germany, Austria and Switzerland. Inclusion criteria required comprehensive baseline data and diagnosis outside of newborn screening. Only data prior to initiation of disease-modifying treatment were included. The median age at disease onset was 3.0 years, with a mean of 6.4 years. Significantly, 55% of patients experienced symptoms before the age of 36 months. 3% never learned to sit unaided, a further 13% never gained the ability to walk independently and 33% of ambulatory patients lost this ability during the course of the disease. 43% developed scoliosis, 6.3% required non-invasive ventilation and 1.1% required tube feeding. In conclusion, our study, in line with previous observations, highlights the substantial phenotypic heterogeneity in SMA. Importantly, this study provides novel insights: the median age of disease onset in patients with 4 SMN2 copies typically occurs before school age, and in half of the patients even before the age of three years. These findings support a proactive approach, particularly early treatment initiation, in this subset of SMA patients diagnosed pre-symptomatically. However, it is important to recognize that the register will not include asymptomatic individuals.
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Affiliation(s)
- Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany.
- School of Medicine, Klinikum Rechts Der Isar, Department of Human Genetics, Technical University of Munich, Munich, Germany.
| | - Moritz Tacke
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Anna König
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Matthias Baumann
- Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuela Baumgartner
- Department of Children and Adolescents, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Meike Steinbach
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Marcus Deschauer
- School of Medicine, Klinikum Rechts Der Isar, Department of Neurology, Technical University of Munich, Munich, Germany
| | | | - Johannes Friese
- Department of Neuropediatrics, University Hospital Bonn, Center for Pediatrics, Bonn, Germany
| | | | - Martin Gross
- Department of Neurological Intensive Care and Rehabilitation, Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany
| | - René Günther
- University Hospital Carl Gustav Carus Dresden at Technische Universität Dresden, Dresden, Germany
| | - Andreas Hahn
- Department of Child Neurology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Tim Hagenacker
- Department of Neurology, and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, Essen, Germany
| | - Erwin Hauser
- Department for Neuropädiatrie, Landeskrankenhaus Mödling, Mödling, Austria
| | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Sabine Illsinger
- Hannover Medical School, Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases, Hannover, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Kamm
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jan C Koch
- Klinik Für Neurologie Universitätsmedizin Göttingen, Göttingen, Germany
| | - Heike Koelbel
- Department of Pediatric Neurology, Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Essen, Germany
| | - Cornelia Koehler
- Klinik Für Kinder-Und Jugendmedizin der Ruhr-Universität Bochum Im St. Josef-Hospital, Bochum, Germany
| | - Kirsten Kolzter
- Kliniken Köln, Sozialpädiatrisches Zentrum, Cologne, Germany
| | - Hanns Lochmüller
- Division of Neurology, Department of Medicine, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
- Department of Neuropediatrics and Muscle Disorders, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Albert Ludolph
- Department for Neurology, University of Ulm, Ulm, Germany
- Department of Neurology, Ulm University, Ulm, Germany
| | - Alexander Mensch
- Department of Neurology, University Medicine Halle, Halle, Saale, Germany
| | | | - Monika Mueller
- Department for Neuropediatrics, University of Wuerzburg, Würzburg, Germany
| | - Wolfgang Mueller-Felber
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. Von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Manuel Pühringer
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | - Robert Steinbach
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - Ulrike Schara-Schmidt
- Department of Pediatric Neurology, Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Essen, Germany
| | - Mareike Schimmel
- Pediatric Neurology, Pediatrics and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
| | - Bertold Schrank
- Department of Neurology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - Oliver Schwartz
- Universitätsklinikum Münster Klinik Für Kinder- Und Jugendpädiatrie- Neuropädiatrie, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Kurt Schlachter
- Department of Neuropediatrics, Landeskrankenhaus Bregenz, Bregenz, Austria
| | | | | | - Martin Smitka
- Department of Neuropediatrics, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Regina Trollmann
- Department of Pediatrics, Friedrich-Alexander Universität Erlangen-Nürnberg Pediatric Neurology, Erlangen, Germany
| | - Matthias Tuerk
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Centre for Rare Diseases Erlangen (ZSEER), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | | | - Christian Rauscher
- Department for Neuropediatrics, University of Salzburg, Salzburg, Austria
| | - Mathias Vorgerd
- Department of Neurology, BG-University Hospital Bergmannsheil gGmbH, Heimer Institute for Muscle Research, Ruhr-University Bochum, Bochum, Germany
| | - Maggie C Walter
- Friedrich Baur Institute at the Department of Neurology, LMU University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Claudia Weiss
- Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany
| | | | | | - Gilbert Wunderlich
- German Center for Neurodegenerative Diseases, DZNE, Site Ulm, Ulm, Germany
- Faculty of Medicine and University Hospital, Department of Neurology and Center for Rare Diseases, University of Cologne, Cologne, Germany
| | - Daniel Zeller
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Ziegler
- Center for Childhood and Adolescent Medicine, Department of Metabolic Medicine and Pediatric Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Janbernd Kirschner
- Klinik Für Kinder-Und Jugendmedizin der Ruhr-Universität Bochum Im St. Josef-Hospital, Bochum, Germany
| | - Astrid Pechmann
- Klinik Für Kinder-Und Jugendmedizin der Ruhr-Universität Bochum Im St. Josef-Hospital, Bochum, Germany
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2
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Kleinveld VEA, Keritam O, Horlings CGC, Cetin H, Wanschitz J, Hotter A, Zirch LS, Zimprich F, Topakian R, Müller P, Oel D, Quasthoff S, Erdler M, Rauschka H, Grinzinger S, Jecel J, Gaulhofer P, Castek B, Stadler K, Löscher WN. Multifocal motor neuropathy as a mimic of amyotrophic lateral sclerosis: Serum neurofilament light chain as a reliable diagnostic biomarker. Muscle Nerve 2024; 69:422-427. [PMID: 38334356 DOI: 10.1002/mus.28054] [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: 11/09/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION/AIMS The clinical presentation of multifocal motor neuropathy (MMN) may mimic early amyotrophic lateral sclerosis (ALS) with predominant lower motor neuron (LMN) involvement, posing a diagnostic challenge. Both diseases have specific treatments and prognoses, highlighting the importance of early diagnosis. The aim of this study was to assess the diagnostic value of serum neurofilament light chain (NfL) in differentiating MMN from LMN dominant ALS. METHODS NfL was measured in serum in n = 37 patients with MMN and n = 37 age- and sex-matched patients with LMN dominant ALS, to determine the diagnostic accuracy. Clinical and demographic data were obtained at the time of NfL sampling. RESULTS Serum NfL concentration was significantly lower in MMN patients compared to ALS patients (mean 20.7 pg/mL vs. 59.4 pg/mL, p < .01). NfL demonstrated good diagnostic value in discriminating the two groups (AUC 0.985 [95% CI 0.963-1.000], sensitivity 94.6%, specificity 100%, cut-off 44.00 pg/mL). DISCUSSION NfL could be a helpful tool in differentiating MMN from LMN dominant ALS in those patients in whom electrophysiological and clinical examinations remain inconclusive early in the diagnostic process.
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Affiliation(s)
- Vera E A Kleinveld
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Omar Keritam
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Hotter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura S Zirch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
- Klinisches Forschungsinstitut Neurowissenschaften, Johannes Kepler UniversitätLinz, Linz, Austria
| | - Petra Müller
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Dierk Oel
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Marcus Erdler
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
| | - Helmut Rauschka
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
| | - Susanne Grinzinger
- Department of Neurology, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg, Austria
| | - Julia Jecel
- Department of Neurology, KH Hietzing, Vienna, Austria
| | | | | | | | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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3
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Paraskevas KI, Mikhailidis DP, Ringleb PA, Brown MM, Dardik A, Poredos P, Gray WA, Nicolaides AN, Lal BK, Mansilha A, Antignani PL, de Borst GJ, Cambria RP, Loftus IM, Lavie CJ, Blinc A, Lyden SP, Matsumura JS, Jezovnik MK, Bacharach JM, Meschia JF, Clair DG, Zeebregts CJ, Lanza G, Capoccia L, Spinelli F, Liapis CD, Jawien A, Parikh SA, Svetlikov A, Menyhei G, Davies AH, Musialek P, Roubin G, Stilo F, Sultan S, Proczka RM, Faggioli G, Geroulakos G, Fernandes E Fernandes J, Ricco JB, Saba L, Secemsky EA, Pini R, Myrcha P, Rundek T, Martinelli O, Kakkos SK, Sachar R, Goudot G, Schlachetzki F, Lavenson GS, Ricci S, Topakian R, Millon A, Di Lazzaro V, Silvestrini M, Chaturvedi S, Eckstein HH, Gloviczki P, White CJ. An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis. J Vasc Surg 2024; 79:420-435.e1. [PMID: 37944771 DOI: 10.1016/j.jvs.2023.09.031] [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: 08/22/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Despite the publication of various national/international guidelines, several questions concerning the management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis remain unanswered. The aim of this international, multi-specialty, expert-based Delphi Consensus document was to address these issues to help clinicians make decisions when guidelines are unclear. METHODS Fourteen controversial topics were identified. A three-round Delphi Consensus process was performed including 61 experts. The aim of Round 1 was to investigate the differing views and opinions regarding these unresolved topics. In Round 2, clarifications were asked from each participant. In Round 3, the questionnaire was resent to all participants for their final vote. Consensus was reached when ≥75% of experts agreed on a specific response. RESULTS Most experts agreed that: (1) the current periprocedural/in-hospital stroke/death thresholds for performing a carotid intervention should be lowered from 6% to 4% in patients with SxCS and from 3% to 2% in patients with AsxCS; (2) the time threshold for a patient being considered "recently symptomatic" should be reduced from the current definition of "6 months" to 3 months or less; (3) 80% to 99% AsxCS carries a higher risk of stroke compared with 60% to 79% AsxCS; (4) factors beyond the grade of stenosis and symptoms should be added to the indications for revascularization in AsxCS patients (eg, plaque features of vulnerability and silent infarctions on brain computed tomography scans); and (5) shunting should be used selectively, rather than always or never. Consensus could not be reached on the remaining topics due to conflicting, inadequate, or controversial evidence. CONCLUSIONS The present international, multi-specialty expert-based Delphi Consensus document attempted to provide responses to several unanswered/unresolved issues. However, consensus could not be achieved on some topics, highlighting areas requiring future research.
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Affiliation(s)
| | - Dimitri P Mikhailidis
- Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London Medical School, University College London (UCL) and Department of Clinical Biochemistry, Royal Free Hospital Campus, UCL, London, United Kingdom
| | | | - Martin M Brown
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Pavel Poredos
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Andrew N Nicolaides
- Vascular Screening and Diagnostic Center, Nicosia, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus; Department of Vascular Surgery, Imperial College, London, United Kingdom
| | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Department of Vascular Surgery, Baltimore VA Medical Center, Baltimore, MD; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard P Cambria
- Division of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Boston, MA
| | - Ian M Loftus
- St George's Vascular Institute, St George's University London, London, United Kingdom
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Ales Blinc
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sean P Lyden
- Department of Vascular Surgery, The Cleveland Clinic, Cleveland, OH
| | - Jon S Matsumura
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX
| | - J Michael Bacharach
- Department of Vascular Medicine and Endovascular Intervention, North Central Heart Institute and the Avera Heart Hospital, Sioux Falls, SD
| | | | - Daniel G Clair
- Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gaetano Lanza
- Vascular Surgery Department, IRCSS Multimedica Hospital, Castellanza, Italy
| | - Laura Capoccia
- Vascular Surgery Division, Department of Surgery, SS. Filippo e Nicola Hospital, Avezzano, Italy
| | - Francesco Spinelli
- Vascular Surgery Division, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/ Columbia University Irving Medical Center, New York, NY; Center for Interventional Cardiovascular Care and Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Alexei Svetlikov
- Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St Petersburg, Russia
| | - Gabor Menyhei
- Department of Vascular Surgery, University of Pecs, Pecs, Hungary
| | - Alun H Davies
- Department of Surgery and Cancer, Section of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Piotr Musialek
- Jagiellonian University Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Gary Roubin
- Department of Cardiology, Cardiovascular Associates of the Southeast/ Brookwood, Baptist Medical Center, Birmingham, AL
| | - Francesco Stilo
- Vascular Surgery Division, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, University of Galway, Galway, Ireland
| | - Robert M Proczka
- First Department of Vascular Surgery, Medicover Hospital, Warsaw, Poland, Lazarski University Faculty of Medicine, Warsaw, Poland
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - George Geroulakos
- Department of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jose Fernandes E Fernandes
- Faculty of Medicine, Lisbon Academic Medical Center, University of Lisbon, Portugal, Hospital da Luz Torres de Lisboa, Lisbon, Portugal
| | - Jean-Baptiste Ricco
- Department of Vascular Surgery, University Hospital of Toulouse, Toulouse, France
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy
| | - Eric A Secemsky
- Division of Cardiology, Department of Medicine, Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Rodolfo Pini
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Ombretta Martinelli
- Faculty of Medicine, Sapienza University of Rome, Rome, Italy; Vascular Surgery Unit, "Umberto I." Hospital, Rome, Italy
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Ravish Sachar
- North Carolina Heart and Vascular Hospital, UNC-REX Healthcare, University of North Carolina, Raleigh, NC
| | - Guillaume Goudot
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France
| | - Felix Schlachetzki
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | | | - Stefano Ricci
- Neurology Department-Stroke Unit, Gubbio-Gualdo Tadino and Citta di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Louis Pradel Hospital, Hospices Civil de Lyon, Bron, France
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Universita Campus Bio-Medico di Roma, Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Christopher J White
- Department of Medicine and Cardiology, Ochsner Clinical School, University of Queensland, Brisbane, Australia; Department of Cardiology, The John Ochsner Heart and Vascular Institute, New Orleans, LA
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Etgen T, Cappellari M, Černík D, Topakian R, Sposato LA, Sardag P, Wiestler H. Ultraearly repeated systemic thrombolysis in recurrent ischemic stroke - A multicentre case study. J Neurol Sci 2023; 451:120714. [PMID: 37385029 DOI: 10.1016/j.jns.2023.120714] [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: 03/08/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE We analysed outcomes of patients who received off-label repeated thrombolysis with recombinant tissue plasminogen activator for ischemic stroke recurrence within 10 days (ultraearly repeated thrombolysis, UERT). METHOD We identified patients receiving UERT from the prospective telestroke network of South-East Bavaria (TEMPiS) registry and by database search (Pubmed, Google scholar). Corresponding authors were contacted for further details. Baseline demographic data and clinical, laboratory, and imaging findings were analysed in a multicentric case study. RESULTS Sixteen patients receiving UERT were identified. The median time between first and second thrombolysis was 3.5 days. In patients with available data, second thrombolysis achieved an early clinical improvement (NIHSS reduction ≥4 points) in 12 of 14 (85.7%) and a favourable outcome (mRS 0-2 after 3 months) in 11 of 16 (68.8%) patients. Intracerebral haemorrhage (ICH) occurred in 4 patients (25.0%) with one fatal large parenchymatous haemorrhage (6.3%). Neither allergic reactions nor other immunoreactive events were observed. CONCLUSIONS In our analysis UERT led to early clinical improvement and a favourable clinical outcome in a high percentage of patients with ICH rates comparable to prior publications. UERT might be considered in patients with early recurrent stroke under careful risk-benefit assessment.
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Affiliation(s)
- Thorleif Etgen
- Klinik für Neurologie, Klinikum Traunstein, Germany; Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany.
| | - Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - David Černík
- Comprehensive Stroke Center, Department of Neurology, Masaryk Hospital, Krajská zdravotní a.s., Ústí nad Labem, Czech Republic
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Luciano A Sposato
- Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, Anatomy and Cell Biology, Robarts Research Institute, Lawson Health Research Institute, Heart & Brain Lab, Western University, London, ON, Canada
| | - Philippe Sardag
- Helios Klinikum München West, Klinik für Neurologie und Neurogeriatrie, München, Germany
| | - Hanni Wiestler
- TEMPiS - Telemedizinisches Schlaganfallzentrum, Klinik für Neurologie und Neurologische Intensivmedizin, München Klinik Harlaching, München, Germany
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Pechmann A, Behrens M, Dörnbrack K, Tassoni A, Wenzel F, Stein S, Vogt S, Zöller D, Bernert G, Hagenacker T, Schara-Schmidt U, Walter MC, Bertsche A, Vill K, Baumann M, Baumgartner M, Cordts I, Eisenkölbl A, Flotats-Bastardas M, Friese J, Günther R, Hahn A, Horber V, Husain RA, Illsinger S, Jahnel J, Johannsen J, Köhler C, Kölbel H, Müller M, von Moers A, Schwerin-Nagel A, Reihle C, Schlachter K, Schreiber G, Schwartz O, Smitka M, Steiner E, Trollmann R, Weiler M, Weiß C, Wiegand G, Wilichowski E, Ziegler A, Lochmüller H, Kirschner J, Ameshofer L, Andres B, Angelova-Toshkina D, Banholzer D, Bant C, Baum P, Baumann S, Baur U, Becker B, Behring B, Bellut J, Bevot A, Bischofberger J, Bitzan L, Bjelica B, Blankenburg M, Böger S, Bonetti F, Bongartz A, Brakemeier S, Bratka L, Braun N, Braun S, Brauner B, Bretschneider C, Burgenmeister N, Burke B, Cirak S, Dall A, de Vries H, Marina AD, Denecke J, Deschauer M, Dibrani Z, Diebold U, Dondit L, Drebes J, Driemeyer J, Dukic V, Eckenweiler M, Eminger M, Fischer M, Fischer C, Freigang M, Gaiser P, Gangfuß A, Geitmann S, George A, Gosk-Tomek M, Grinzinger S, Gröning K, Groß M, Güttsches AK, Hagenmeyer A, Hartmann H, Haverkamp J, Hiebeler M, Hoevel A, Hoffmann GF, Holtkamp B, Holzwarth D, Homma A, Horneff V, Hörnig C, Hotter A, Hubert A, Huppke P, Jansen E, Jung L, Kaiser N, Kappel S, Katharina B, Koch J, Kölke S, Korschinsky B, Kostede F, Krause K, Küpper H, Lang A, Lange I, Langer T, Lechner Y, Lehmann H, Leypold C, Lingor P, Lipka J, Löscher W, Luiking A, Machetanz G, Malm E, Martakis K, Menzen B, Metelmann M, zu Hörste GM, Montagnese F, Mörtlbauer K, Müller P, Müller A, Müller A, Müschen L, Neuwirth C, Niesert M, Pauschek J, Pernegger E, Petri S, Pilshofer V, Plecko B, Pollok J, Preisel M, Pühringer M, Quinten AL, Raffler S, Ramadan B, Rappold M, Rauscher C, Reckmann K, Reinhardt T, Röder M, Roland-Schäfer D, Roth E, Ruß L, Saffari A, Schimmel M, Schlag M, Schlotter-Weigel B, Schneider J, Schöne-Bake JC, Schorling D, Schreiner I, Schüssler S, Schwarzbach M, Schwippert M, Semmler L, Smuda K, Sprenger-Svacina A, Stadler T, Steffens P, Steuernagel D, Stolte B, Stoltenburg C, Tasch G, Thimm A, Tiefenthaler E, Topakian R, Türk M, van der Stam L, Vettori K, Vollmann P, Vorgerd M, Weiss D, Wenninger S, Werring S, Wessel M, Weyen U, Wider S, Wiebe NO, Wiesenhofer A, Wiethoff S, Wirner C, Wohnrade C, Wunderlich G, Zeller D, Zemlin M, Zobel J. Improved upper limb function in non-ambulant children with SMA type 2 and 3 during nusinersen treatment: a prospective 3-years SMArtCARE registry study. Orphanet J Rare Dis 2022; 17:384. [PMID: 36274155 PMCID: PMC9589836 DOI: 10.1186/s13023-022-02547-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The development and approval of disease modifying treatments have dramatically changed disease progression in patients with spinal muscular atrophy (SMA). Nusinersen was approved in Europe in 2017 for the treatment of SMA patients irrespective of age and disease severity. Most data on therapeutic efficacy are available for the infantile-onset SMA. For patients with SMA type 2 and type 3, there is still a lack of sufficient evidence and long-term experience for nusinersen treatment. Here, we report data from the SMArtCARE registry of non-ambulant children with SMA type 2 and typen 3 under nusinersen treatment with a follow-up period of up to 38 months. Methods SMArtCARE is a disease-specific registry with data on patients with SMA irrespective of age, treatment regime or disease severity. Data are collected during routine patient visits as real-world outcome data. This analysis included all non-ambulant patients with SMA type 2 or 3 below 18 years of age before initiation of treatment. Primary outcomes were changes in motor function evaluated with the Hammersmith Functional Motor Scale Expanded (HFMSE) and the Revised Upper Limb Module (RULM). Results Data from 256 non-ambulant, pediatric patients with SMA were included in the data analysis. Improvements in motor function were more prominent in upper limb: 32.4% of patients experienced clinically meaningful improvements in RULM and 24.6% in HFMSE. 8.6% of patients gained a new motor milestone, whereas no motor milestones were lost. Only 4.3% of patients showed a clinically meaningful worsening in HFMSE and 1.2% in RULM score. Conclusion Our results demonstrate clinically meaningful improvements or stabilization of disease progression in non-ambulant, pediatric patients with SMA under nusinersen treatment. Changes were most evident in upper limb function and were observed continuously over the follow-up period. Our data confirm clinical trial data, while providing longer follow-up, an increased number of treated patients, and a wider range of age and disease severity.
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Kamtchum-Tatuene J, Saba L, Heldner M, Poorthuis MHF, Borst GD, Rundek T, Kakkos S, Chaturvedi S, Topakian R. Parallel Session 3: Acute/Vascular/Trauma| Wed 18 May, 1445 – 1600|4 Circulating Interleukin-6 predicts carotid study. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and AimsInterleukin-6 (IL-6) has important roles in atherosclerosis pathophysiology. To determine if anti-IL-6 therapy could be an adjuvant stroke prevention strategy in patients with carotid atherosclerosis, we tested whether circulating IL-6 levels predict carotid plaque severity, vulnerability, and progression in the Cardiovascular Health Study.MethodsCarotid ultrasound was performed at baseline and 5 years. Plaque severity was scored 0 to 5 based on NASCET grade of stenosis. Plaque vulnerability at baseline was the presence of irregular, ulcerated or echolucent plaques. Plaque progression at 5 years was a ≥1 point increase in stenosis severity. Relationship of plasma IL-6 levels with plaque characteristics was modeled using multivariable linear (severity) or logistic (vulnerability and progression) regression. Risk factors of atherosclerosis were included as independent variables.ResultsIn 4334 participants with complete data (58.9% women, 72.7 ± 5.1 years). There were 1267 (29.2%) participants with vulnerable plaque and 1474 (34.0%) with plaque progression. Log IL-6 predicted plaque severity (β = 0.09, p=0.04), vulnerability (OR = 1.22, 95% CI: 1.06-1.40, p=0.006) and progression (OR = 1.44, 95% CI: 1.23-1.69, p<0.001). In participants with >50% probability of progression, mean log IL-6 was 0.54 corresponding to 2.0 pg/mL. Dichotomizing IL-6 levels did not affect performance of regression models.ConclusionsPlasma IL-6 predicts carotid plaque severity, vulnerability, and progression. The 2.0 pg/mL cut-off could help select individuals that would benefit from anti-IL-6 drugs for stroke prevention.
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Tatuene JK, Saba L, Heldner M, Poorthuis M, De Borst G, Rundek T, Kakkos S, Dichgans M, Chaturvedi S, Topakian R, Polak J, Jickling G. Plasma interleukin-6 predicts carotid plaque severity, vulnerability, and progression in the cardiovascular health study. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kamtchum-Tatuene J, Saba L, Heldner MR, Poorthuis MHF, Borst GJD, Rundek T, Kakkos SK, Chaturvedi S, Topakian R, Polak JF, Jickling GC. Interleukin-6 Predicts Carotid Plaque Severity, Vulnerability, and Progression. Circ Res 2022; 131:e22-e33. [PMID: 35713008 DOI: 10.1161/circresaha.122.320877] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND IL-6 (interleukin-6) has important roles in atherosclerosis pathophysiology. To determine if anti-IL-6 therapy warrants evaluation as an adjuvant stroke prevention strategy in patients with carotid atherosclerosis, we tested whether circulating IL-6 levels predict carotid plaque severity, vulnerability, and progression in the prospective population-based CHS (Cardiovascular Health Study). METHODS Duplex carotid ultrasound was performed at baseline and 5 years. Baseline plaque severity was scored 0 to 5 based on North American Symptomatic Carotid Endarterectomy Trial grade of stenosis. Plaque vulnerability at baseline was the presence of markedly irregular, ulcerated, or echolucent plaques. Plaque progression at 5 years was a ≥1 point increase in stenosis severity. The relationship of baseline plasma IL-6 levels with plaque characteristics was modeled using multivariable linear (severity) or logistic (vulnerability and progression) regression. Risk factors of atherosclerosis were included as independent variables. Stepwise backward elimination was used with P>0.05 for variable removal. To assess model stability, we computed the E-value or minimum strength of association (odds ratio scale) that unmeasured confounders must have with log IL-6 and the outcome to suppress the association. We performed internal validation with 100 bootstrap samples. RESULTS There were 4334 participants with complete data (58.9% women, mean age: 72.7±5.1 years), including 1267 (29.2%) with vulnerable plaque and 1474 (34.0%) with plaque progression. Log IL-6 predicted plaque severity (β=0.09, P=1.3×10-3), vulnerability (OR, 1.21 [95% CI, 1.05-1.40]; P=7.4×10-3, E-value=1.71), and progression (OR, 1.44 [95% CI, 1.23-1.69], P=9.1×10-6, E-value 2.24). In participants with >50% predicted probability of progression, mean log IL-6 was 0.54 corresponding to 2.0 pg/mL. Dichotomizing IL-6 levels did not affect the performance of prediction models. CONCLUSIONS Circulating IL-6 predicts carotid plaque severity, vulnerability, and progression. The 2.0 pg/mL cutoff could facilitate the selection of individuals that would benefit from anti-IL-6 drugs for stroke prevention.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. (J.K.-T.)
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy (L.S.)
| | - Mirjam R Heldner
- Department of Neurology, University Hospital Bern, Switzerland (M.R.H.)
| | - Michiel H F Poorthuis
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands. (M.H.F.P.)
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands. (G.J.d.B.)
| | | | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Greece (S.K.K.)
| | | | - Raffi Topakian
- Department of Neurology, University of Miami Miller School of Medicine (T.R.).,Academic Teaching Hospital Wels-Grieskirchen, Austria (R.T.)
| | - Joseph F Polak
- Department of Radiology, Tufts University School of Medicine and Boston University School of Medicine (J.F.P.)
| | - Glen C Jickling
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. (G.C.J.)
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Krenn M, Tomschik M, Wagner M, Zulehner G, Weng R, Rath J, Klotz S, Gelpi E, Bsteh G, Keritam O, Colonna I, Paternostro C, Jäger F, Lindeck-Pozza E, Iglseder S, Grinzinger S, Schönfelder M, Hohenwarter C, Freimüller M, Embacher N, Wanschitz J, Topakian R, Töpf A, Straub V, Quasthoff S, Zimprich F, Löscher WN, Cetin H. Clinico-genetic spectrum of limb-girdle muscular weakness in Austria: a multi-centre cohort study. Eur J Neurol 2022; 29:1815-1824. [PMID: 35239206 PMCID: PMC9314602 DOI: 10.1111/ene.15306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
Abstract
Background and purpose Hereditary myopathies with limb‐girdle muscular weakness (LGW) are a genetically heterogeneous group of disorders, in which molecular diagnosis remains challenging. Our aim was to present a detailed clinical and genetic characterization of a large cohort of patients with LGW. Methods This nationwide cohort study included patients with LGW suspected to be associated with hereditary myopathies. Parameters associated with specific genetic aetiologies were evaluated, and we further assessed how they predicted the detection of causative variants by conducting genetic analyses. Results Molecular diagnoses were identified in 62.0% (75/121) of the cohort, with a higher proportion of patients diagnosed by next‐generation sequencing (NGS) than by single‐gene testing (77.3% vs. 22.7% of solved cases). The median (interquartile range) time from onset to genetic diagnosis was 8.9 (3.7–19.9) and 17.8 (7.9–27.8) years for single‐gene testing and NGS, respectively. The most common diagnoses were myopathies associated with variants in CAPN3 (n = 9), FKRP (n = 9), ANO5 (n = 8), DYSF (n = 8) and SGCA (n = 5), which together accounted for 32.2% of the cohort. Younger age at disease onset (p = 0.043), >10× elevated creatine kinase activity levels (p = 0.024) and myopathic electromyography findings (p = 0.007) were significantly associated with the detection of causative variants. Conclusions Our findings suggest that an earlier use of NGS in patients with LGW is needed to avoid long diagnostic delays. We further present parameters predictive of a molecular diagnosis that may help to select patients for genetic analyses, especially in centres with limited access to sequencing.
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Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matias Wagner
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute for Neurogenomics, Helmholtz Center Munich, Neuherberg, Germany.,LMU University Hospital, Department of Pediatrics, Dr. von Hauner Children's Hospital, Division of Pediatric Neurology, LMU Center for Development and Children with Medical Complexity, Ludwig-Maximilians-University, Munich, Germany
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Rosa Weng
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sigrid Klotz
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Omar Keritam
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Isabella Colonna
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Fiona Jäger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Stephan Iglseder
- Department of Neurology, KH der Barmherzigen Brüder, Linz, Austria
| | - Susanne Grinzinger
- Department of Neurology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Martina Schönfelder
- Department of Neurology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | | | | | - Norbert Embacher
- Department of Neurology, University Hospital St, Pölten, St. Pölten, Austria
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raffi Topakian
- Department of Neurology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Wolfsegger T, Pichler R, Assar H, Topakian R. Quantitative trunk sway analysis under challenging gait conditions in early and untreated Parkinson's disease. Neurol Sci 2021; 43:1411-1413. [PMID: 34727255 DOI: 10.1007/s10072-021-05699-w] [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: 06/14/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Even experienced clinicians may encounter difficulties in making a definitive diagnosis in the early motor stages of Parkinson's disease (PD). We investigated whether quantitative biomechanical trunk sway analysis could support the diagnosis of PD early on. METHODS We quantified trunk sway performance using body-worn sensors during a test battery of six challenging gait conditions in a cohort of 17 early and untreated PD patients (with evidence of reduced tracer uptake in the basal ganglia on dopamine transporter scans) and 17 age- and sex-matched healthy controls (HCs). RESULTS Compared to HC, the PD group (Hoehn & Yahr ≤ 2, Unified Parkinson's Disease Rating Scale motor score: mean 13.7 ± 3.5 points) showed significant trunk rigidity in five challenging gait tasks (decreased medio-lateral direction and sway angle area). Post hoc receiver operating characteristic analysis of the significant parameters revealed excellent discrimination with high sensitivity and specificity. CONCLUSION In the early and untreated motor stages of PD, patients exhibit significant trunk rigidity during challenging gait tasks. Trunk sway motion recorded with body-worn sensors might be a useful tool to disclose a sometimes hard-to-trace cardinal motor sign of PD and support an early clinical diagnosis.
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Affiliation(s)
- Thomas Wolfsegger
- Department of Neurology 1, Kepler University Hospital-Neuromed Campus, Wagner-Jauregg-Weg 15, 4020, Linz, Austria.
| | - Robert Pichler
- Institute of Nuclear Medicine, Kepler University Hospital-Neuromed Campus, Linz, Austria
| | - Hamid Assar
- Department of Neurology 1, Kepler University Hospital-Neuromed Campus, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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Oel D, Rigler-Hohenwarter K, Trenkler J, Topakian R. Cytomegalovirus Encephalitis Under Fingolimod Mimicking Progressive Multifocal Leukoencephalopathy? Neurol Neuroimmunol Neuroinflamm 2021; 8:8/4/e996. [PMID: 33837125 PMCID: PMC8042783 DOI: 10.1212/nxi.0000000000000996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 03/16/2021] [Indexed: 11/21/2022]
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Seifert-Held T, Eberhard K, Lechner C, Macher S, Hegen H, Moser T, Jacob GB, Puttinger G, Topakian R, Guger M, Kacar E, Zoche L, De Simoni D, Seiser A, Oberndorfer S, Baumgartner C, Struhal W, Zimprich F, Sellner J, Deisenhammer F, Enzinger C, Reindl M, Rauschka H, Berger T, Höftberger R. Functional Recovery in Autoimmune Encephalitis: A Prospective Observational Study. Front Immunol 2021; 12:641106. [PMID: 34093529 PMCID: PMC8175889 DOI: 10.3389/fimmu.2021.641106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background Prospective observations of functional recovery are lacking in patients with autoimmune encephalitis defined by antibodies against synaptic proteins and neuronal cell surface receptors. Methods Adult patients with a diagnosis of autoimmune encephalitis were included into a prospective registry. At 3, 6 and 12 months of follow-up, the patients’ modified Rankin Scale (mRS) was obtained. Results Patients were stratified into three groups according to their antibody (Ab) status: anti-NMDAR-Ab (n=12; group I), anti-LGI1/CASPR2-Ab (n=35; group II), and other antibodies (n=24; group III). A comparably higher proportion of patients in group I received plasma exchange/immunoadsorption and second line immunosuppressive treatments at baseline. A higher proportion of patients in group II presented with seizures. Group III mainly included patients with anti-GABABR-, anti-GAD65- and anti-GlyR-Ab. At baseline, one third of them had cancer. Patients in groups I and III had much higher median mRS scores at 3 months compared to patients in group II. A median mRS of 1 was found at all follow-up time points in group II. Conclusions The different dynamics in the recovery of patients with certain autoimmune encephalitides have important implications for clinical trials. The high proportion of patients with significant disability at 3 months after diagnosis in groups I and III points to the need for improving treatment options. More distinct scores rather than the mRS are necessary to differentiate potential neurological improvements in patients with anti-LGI1-/CASPR2-encephalitis.
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Affiliation(s)
| | - Katharina Eberhard
- Core Facility Computational Bioanalytics, Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Christian Lechner
- Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tobias Moser
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Brecl Jacob
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gertraud Puttinger
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Michael Guger
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Emrah Kacar
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Lea Zoche
- Department of Neurology, Hospital Hietzing, Vienna, Austria
| | - Desiree De Simoni
- Department of Neurology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Andreas Seiser
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Christoph Baumgartner
- Department of Neurology, Hospital Hietzing, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Walter Struhal
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | | | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | | | | | - Markus Reindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Rauschka
- Department of Neurology, Hospital Donaustadt, Vienna, Austria.,Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Diseases, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
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Einsiedler S, Hödl G, Topakian R. Thrombose des sinus veineux cérébraux compliquée par une thromboangéite oblitérante. CMAJ 2021; 193:E748-E749. [PMID: 34001556 PMCID: PMC8177940 DOI: 10.1503/cmaj.201166-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Stefan Einsiedler
- Service de neurologie (Einsiedler, Topakian) et Institut de radiologie (Hödl), Centre hospitalier universitaire Wels-Grieskirchen, Wels, Aut
| | - Georg Hödl
- Service de neurologie (Einsiedler, Topakian) et Institut de radiologie (Hödl), Centre hospitalier universitaire Wels-Grieskirchen, Wels, Aut
| | - Raffi Topakian
- Service de neurologie (Einsiedler, Topakian) et Institut de radiologie (Hödl), Centre hospitalier universitaire Wels-Grieskirchen, Wels, Aut.
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Einsiedler S, Hödl G, Topakian R. Cerebral venous and sinus thrombosis with complicating thromboangiitis obliterans. CMAJ 2021; 193:E311. [PMID: 33649171 PMCID: PMC8034302 DOI: 10.1503/cmaj.201166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Stefan Einsiedler
- Department of Neurology (Einsiedler, Topakian), and Institute of Radiology (Hödl), Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Georg Hödl
- Department of Neurology (Einsiedler, Topakian), and Institute of Radiology (Hödl), Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Raffi Topakian
- Department of Neurology (Einsiedler, Topakian), and Institute of Radiology (Hödl), Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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Wolfsegger T, Hauser A, Wimmer S, Neuwirth K, Assar H, Topakian R. A comprehensive clinico-radiological, neuropsychological and biomechanical analysis approach to patients with idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2020; 201:106402. [PMID: 33348122 DOI: 10.1016/j.clineuro.2020.106402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND A systematic approach to patients with suspected idiopathic normal pressure hydrocephalus (iNPH) is essential to recognize the subset of patients who may benefit from ventriculoperitoneal shunt surgery (VPS). Quantitative biomechanical analysis of gait and balance (QBAGB) may help objectify the response to the cerebrospinal fluid tap test (CSF-TT) and VPS outcome after 3 months and support identification of candidates for VPS. METHODS We retrospectively reviewed data from all patients with probable iNPH who 1) underwent clinico-radiological and neuropsychological assessments using validated scales (iNPH Scale and iNPH Radscale) at our centre in the period from January to December 2018; and 2) had completed QBAGB before CSF-TT ('baseline'), shortly after CSF-TT, and at three months after either VPS or conservative treatment. RESULTS At the time-points 'after CSF-TT' and '3 months', patients with iNPH and VPS (n = 11) significantly improved on the Kiefer Scale score, iNPH Scale total score and gait domain score, as well as in gait velocity and step length measured by QBAGB. In contrast, patients without surgery (n = 10) had unchanged iNPH Scale scores and motor performance throughout. Using data from all patients, we calculated cut-off levels for substantial improvements in gait velocity, step length, and the iNPH Scale domain gait score at the time-point 'after CSF-TT'. CONCLUSION QBAGB helps to objectify the response to CSF-TT to select candidates for VPS and corroborates clinico-radiological and neuropsychological data derived from validated scales. The QBAGB cut-off values for substantial improvement after CSF-TT need further elucidation in larger, preferably prospective studies.
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Affiliation(s)
- Thomas Wolfsegger
- Department of Neurology 1, Kepler University Hospital, Neuromed Campus, Linz, Austria.
| | - Anna Hauser
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Sibylle Wimmer
- Institute of Neuroradiology, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Katharina Neuwirth
- Clinical Psychology, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Hamid Assar
- Department of Neurology 1, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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Topakian R, Müller P, Ciovica-Oel IC, Trenkler J. In the borderland of multifocal motor neuropathy and chronic inflammatory demyelinating polyradiculopathy. Neurol Sci 2020; 42:1131-1134. [PMID: 33074453 DOI: 10.1007/s10072-020-04804-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
Chronic inflammatory demyelinating polyradiculopathy (CIDP) and multifocal motor neuropathy (MMN) are seen as distinct entities with marked differences in pathophysiology and clinical, laboratory, and imaging features. We report a patient with an immune-mediated neuropathy in the borderland of CIDP and MMN, whose magnetic resonance imaging and cerebrospinal fluid (CSF) features strongly resembled CIDP, while the clinical course and treatment response suggested the diagnosis of MMN without conduction blocks. There is strong evidence that MMN is not a variant of CIDP and that these conditions can be separated pathologically. Our case report widens the spectrum of MMN presentations, indicating the existence of a clinical overlap syndrome of MMN and CIDP, and emphasizing the need for more precise criteria regarding CSF and nerve root imaging abnormalities in the differentiation of chronic immune-mediated neuropathies.
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Affiliation(s)
- Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria.
| | - Petra Müller
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria
| | | | - Johannes Trenkler
- Institute of Neuroradiology, Kepler University Hospital, Linz, Austria
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17
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Abbott AL, Brunser AM, Giannoukas A, Harbaugh RE, Kleinig T, Lattanzi S, Poppert H, Rundek T, Shahidi S, Silvestrini M, Topakian R. Rectifying the misconceptions about current best management of asymptomatic carotid stenosis is not about revising history. J Vasc Surg 2020; 72:765-767. [PMID: 32259621 DOI: 10.1016/j.jvs.2020.03.020] [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: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Anne L Abbott
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Alejandro M Brunser
- Department of Neurology, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Athanasios Giannoukas
- University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Timothy Kleinig
- Neurology Department, Royal Adelaide Hospital, Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Holger Poppert
- Neurology Department, Helios Dr Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla
| | - Saeid Shahidi
- Department of Vascular and Endovascular Surgery, Acute Regional Hospital Slagelse, Copenhagen & South Denmark University, Copenhagen, Denmark
| | | | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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18
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Topakian R. Surgery for asymptomatic carotid stenosis: Laying one's hands on a marker of high overall cardiovascular risk. J Vasc Surg 2020; 72:767-768. [PMID: 32711912 DOI: 10.1016/j.jvs.2020.03.063] [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: 02/25/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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19
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Lintner H, Hochgatterer-Rechberger P, Pischinger B, Seier J, Vollmann P, Haushofer A, Rittner H, Sommer C, Topakian R. Sensitivity and specificity of cerebrospinal fluid CXCL13 for diagnosing Lyme neuroborreliosis - a study on 1410 patients and review of the literature. J Neurol Sci 2020; 414:116843. [PMID: 32344220 DOI: 10.1016/j.jns.2020.116843] [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: 08/29/2019] [Revised: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The B-cell chemoattractant CXCL13 has been suggested as a cerebrospinal fluid (CSF) biomarker for Lyme neuroborreliosis (LNB). Our aim was to substantiate the value of CXCL13 in a large unselected cohort and determine a practical cut-off value to diagnose LNB. METHODS We retrospectively studied clinical and CSF data of consecutive patients who underwent CSF CXCL13 testing over a period of three years (February 2015 to January 2018) at our academic teaching hospital. Patients were classified into 12 groups according to their final diagnosis. To diagnose LNB (definite or probable/possible), definitions of the respective guideline of the German Neurological Society were applied. RESULTS Of 1410 patients, 29 were diagnosed with definite LNB and 9 with probable/possible LNB. Median CXCL13 levels were highly elevated in both LNB groups (554 pg/mL and 649 pg/mL, respectively) and the group with bacterial/fungal CNS infections (410 pg/mL; n = 6), while all other groups had markedly lower median CXCL13 levels (p < .001). For definite LNB, the best CXCL13 test cut-off was 55.5 pg/mL with a sensitivity of 96.6% (95% confidence interval, CI, 80.4%-99.8%) and a specificity of 94.9% (95% CI 93.5%-95.9%). All patients with LNB showed clinical improvement after antibiotic treatment. CONCLUSION In this large monocentric cohort, CSF CXCL13 was found to be a highly sensitive and useful marker for LNB. In conditions with low index of suspicion for LNB, CXCL13 testing may be unwarranted. A review of the literature on the sensitivity and specificity of CSF CXCL13 in the differential of LNB is provided.
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Affiliation(s)
- Hannes Lintner
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | | | - Barbara Pischinger
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Josef Seier
- Central Laboratory, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Peter Vollmann
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Alexander Haushofer
- Central Laboratory, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Heike Rittner
- Department of Anaesthesiology, University Hospital of Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
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Abbott AL, Brunser AM, Giannoukas A, Harbaugh RE, Kleinig T, Lattanzi S, Poppert H, Rundek T, Shahidi S, Silvestrini M, Topakian R. Reply. J Vasc Surg 2020; 72:384-385. [PMID: 32259618 DOI: 10.1016/j.jvs.2020.03.019] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/14/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Anne L Abbott
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Alejandro M Brunser
- Department of Neurology, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Athanasios Giannoukas
- University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Timothy Kleinig
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Holger Poppert
- Neurology Department, Helios Dr Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla
| | - Saeid Shahidi
- Department of Vascular and Endovascular Surgery, Acute Regional Hospital Slagelse, Copenhagen & South Denmark University, Copenhagen, Denmark
| | | | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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21
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Hörmanseder B, Heitzeneder T, Hödl G, Topakian R. [Dystextia as a sign of acute stroke]. Nervenarzt 2020; 91:541-542. [PMID: 32430551 DOI: 10.1007/s00115-020-00925-w] [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] [Indexed: 06/11/2023]
Affiliation(s)
- Birgit Hörmanseder
- Abteilung für Neurologie, Klinikum Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Österreich
| | - Teresa Heitzeneder
- Abteilung für Neurologie, Klinikum Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Österreich
| | - Georg Hödl
- Institut für Radiologie, Klinikum Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Österreich
| | - Raffi Topakian
- Abteilung für Neurologie, Klinikum Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Österreich.
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22
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Abbott AL, Brunser AM, Giannoukas A, Harbaugh RE, Kleinig T, Lattanzi S, Poppert H, Rundek T, Shahidi S, Silvestrini M, Topakian R. Misconceptions regarding the adequacy of best medical intervention alone for asymptomatic carotid stenosis. J Vasc Surg 2020; 71:257-269. [PMID: 31564585 DOI: 10.1016/j.jvs.2019.04.490] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Medical intervention (risk factor identification, lifestyle coaching, and medication) for stroke prevention has improved significantly. It is likely that no more than 5.5% of persons with advanced asymptomatic carotid stenosis (ACS) will now benefit from a carotid procedure during their lifetime. However, some question the adequacy of medical intervention alone for such persons and propose using markers of high stroke risk to intervene with carotid endarterectomy (CEA) and/or carotid angioplasty/stenting (CAS). Our aim was to examine the scientific validity and implications of this proposal. METHODS We reviewed the evidence for using medical intervention alone or with additional CEA or CAS in persons with ACS. We also reviewed the evidence regarding the validity of using commonly cited makers of high stroke risk to select such persons for CEA or CAS, including markers proposed by the European Society for Vascular Surgery in 2017. RESULTS Randomized trials of medical intervention alone versus additional CEA showed a definite statistically significant CEA stroke prevention benefit for ACS only for selected average surgical risk men aged less than 75 to 80 years with 60% or greater stenosis using the North American Symptomatic Carotid Endarterectomy Trial criteria. However, the most recent measurements of stroke rate with ACS using medical intervention alone are overall lower than for those who had CEA or CAS in randomized trials. Randomized trials of CEA versus CAS in persons with ACS were underpowered. However, the trend was for higher stroke and death rates with CAS. There are no randomized trial results related to comparing current optimal medical intervention with CEA or CAS. Commonly cited markers of high stroke risk in relation to ACS lack specificity, have not been assessed in conjunction with current optimal medical intervention, and have not been shown in randomized trials to identify those who benefit from a carotid procedure in addition to current optimal medical intervention. CONCLUSIONS Medical intervention has an established role in the current routine management of persons with ACS. Stroke risk stratification studies using current optimal medical intervention alone are the highest research priority for identifying persons likely to benefit from adding a carotid procedure.
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Affiliation(s)
- Anne L Abbott
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Alejandro M Brunser
- Department of Neurology, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Athanasios Giannoukas
- University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Robert E Harbaugh
- Department of Neurosurgery, Penn State University, State College, Pa
| | - Timothy Kleinig
- Neurology Department, Royal Adelaide Hospital, Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Holger Poppert
- Neurology Department, Helios Dr Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla
| | - Saeid Shahidi
- Department of Vascular and Endovascular Surgery, Acute Regional Hospital Slagelse, Copenhagen & South Denmark University, Copenhagen, Denmark
| | | | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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23
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Finsterer J, Iglseder S, Wanschitz J, Topakian R, Löscher WN, Grisold W. Hereditary transthyretin-related amyloidosis. Acta Neurol Scand 2019; 139:92-105. [PMID: 30295933 DOI: 10.1111/ane.13035] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/09/2018] [Accepted: 09/04/2018] [Indexed: 12/15/2022]
Abstract
Hereditary transthyretin(TTR)-related amyloidosis (ATTRm amyloidosis) is an endemic/non-endemic, autosomal-dominant, early- and late-onset, rare, progressive disorder, predominantly manifesting as length-dependent, small fiber dominant, axonal polyneuropathy and frequently associated with cardiac disorders and other multisystem diseases. ATTRm amyloidosis is due to variants in the TTR gene, with the substitution Val30Met as the most frequent mutation. TTR mutations lead to destabilization and dissociation of TTR tetramers into variant TTR monomers, and formation of amyloid fibrils, which are consecutively deposited extracellularly in various tissues, such as nerves, heart, brain, eyes, intestines, kidneys, or the skin. Neuropathy may not only include large nerve fibers but also small fibers, and not only sensory and motor fibers but also autonomic fibers. Types of TTR variants, age at onset, penetrance, and clinical presentation vary between geographical areas. Suggestive of a ATTRm amyloidosis are a sensorimotor polyneuropathy, positive family history, autonomic dysfunction, cardiomyopathy, carpal tunnel syndrome, unexplained weight loss, and resistance to immunotherapy. If only sensory A-delta or C fibers are affected, small fiber neuropathy ensues. Diagnostic tests for small fiber neuropathy include determination of intraepidermal nerve fiber density, laser-evoked potentials, heat- and cold-detection thresholds, and measurement of the electrochemical skin conductance. Therapy currently relies on liver transplantation and TTR-stabilizers (tafamidis, diflunisal).
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Affiliation(s)
| | | | - Julia Wanschitz
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - Raffi Topakian
- Department of Neurology; Klinikum Wels-Grieskirchen; Wels Austria
| | | | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology; Vienna Austria
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24
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Löscher WN, Oberreiter EM, Erdler M, Quasthoff S, Culea V, Berek K, Embacher N, Grinzinger S, Hess I, Höger FS, Horlings CGC, Huemer M, Jecel J, Kleindienst W, Laich E, Müller P, Oel D, Örtl W, Lenzenweger E, Rath J, Stadler K, Stieglbauer K, Thaler-Wolf C, Wanschitz J, Zimprich F, Cetin H, Topakian R. Multifocal motor neuropathy in Austria: a nationwide survey of clinical features and response to treatment. J Neurol 2018; 265:2834-2840. [PMID: 30259176 PMCID: PMC6244652 DOI: 10.1007/s00415-018-9071-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Multifocal motor neuropathy (MMN) is a rare neuropathy and detailed descriptions of larger patient cohorts are scarce. The objective of this study was to evaluate epidemiological, clinical, and laboratory features of MMN patients and their response to treatment in Austria and to compare these data with those from the literature. METHODS Anonymized demographic and clinical data about MMN patients until 31.12.2017 were collected from registered Austrian neurologists. Exploratory statistics on clinical and laboratory features as well as treatment regimens and responses were performed. RESULTS 57 Patients with MMN were identified, resulting in a prevalence of 0.65/100.000. Mean age of onset was 44.1 ± 13.1 years, the diagnostic delay 5.5 ± 8.4 years. In 77% of patients, symptom onset was in the upper limbs, and in 92%, it occurred in distal muscles. Proximal onset was never observed in the lower limbs. At the final follow-up, the majority of patients had atrophy (88%) in affected regions. Definite motor conduction blocks (CB) were found in 54 patients. Anti-GM1-IgM antibodies were present in 43%. Treatment with intravenous immunoglobulins improved muscle strength and INCAT score initially, but at last follow-up, both scores deteriorated to values before treatment. DISCUSSION The findings of the present study corroborate the previous findings in MMN. Onset typically occurs in the upper limbs and mostly distal, CBs are found in the majority of cases, while anti-GM1-IgM antibodies are detected in only approximately 40%. Our study underlines that the initial good response to treatment fades over time.
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Affiliation(s)
- Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Eva-Maria Oberreiter
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | | | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Valeriu Culea
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Klaus Berek
- Department of Neurology, BKH Kufstein, Kufstein, Austria
| | - Norbert Embacher
- Department of Neurology, St. Pölten University, Sankt Pölten, Austria
| | - Susanne Grinzinger
- Department of Neurology, Paracelsus University of Salzburg, Salzburg, Austria
| | | | | | - Corinne G C Horlings
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Michael Huemer
- Department of Neurology, Kardinal Schwarzenberg Hospital, Schwarzach im Pongau, Austria
| | - Julia Jecel
- 2. Department of Neurology, KH Hietzing, Vienna, Austria
| | | | - Eva Laich
- Department of Neurology, LKH Steyr, Steyr, Austria
| | - Petra Müller
- Department of Neurology, KH Wels-Grieskirchen, Wels, Austria
| | - Dierk Oel
- Department of Neurology, KH Wels-Grieskirchen, Wels, Austria
| | - Wolfgang Örtl
- Department of Neurology, Johannes Kepler-University Linz, Linz, Austria
| | - Eva Lenzenweger
- Department of Neurology 2, Johannes Kepler-University Linz, Linz, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Klaus Stadler
- Department of Neurology, KH Wels-Grieskirchen, Wels, Austria
| | | | | | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Raffi Topakian
- Department of Neurology, KH Wels-Grieskirchen, Wels, Austria
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Abbott AL, Silvestrini M, Topakian R, Golledge J, Brunser AM, de Borst GJ, Harbaugh RE, Doubal FN, Rundek T, Thapar A, Davies AH, Kam A, Wardlaw JM. Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice. Front Neurol 2017; 8:537. [PMID: 29104559 PMCID: PMC5654955 DOI: 10.3389/fneur.2017.00537] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/25/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Until now, stroke and transient ischemic attack (TIA) have been clinically based terms which describe the presence and duration of characteristic neurological deficits attributable to intrinsic disorders of particular arteries supplying the brain, retina, or (sometimes) the spinal cord. Further, infarction has been pathologically defined as death of neural tissue due to reduced blood supply. Recently, it has been proposed we shift to definitions of stroke and TIA determined by neuroimaging results alone and that neuroimaging findings be equated with infarction. METHODS We examined the scientific validity and clinical implications of these proposals using the existing published literature and our own experience in research and clinical practice. RESULTS We found that the proposals to change to imaging-dominant definitions, as published, are ambiguous and inconsistent. Therefore, they cannot provide the standardization required in research or its application in clinical practice. Further, we found that the proposals are scientifically incorrect because neuroimaging findings do not always correlate with the clinical status or the presence of infarction. In addition, we found that attempts to use the proposals are disrupting research, are otherwise clinically unhelpful and do not solve the problems they were proposed to solve. CONCLUSION We advise that the proposals must not be accepted. In particular, we explain why the clinical focus of the definitions of stroke and TIA should be retained with continued sub-classification of these syndromes depending neuroimaging results (with or without other information) and that infarction should remain a pathological term. We outline ways the established clinically based definitions of stroke and TIA, and use of them, may be improved to encourage better patient outcomes in the modern era.
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Affiliation(s)
- Anne L. Abbott
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- The Neurology Department, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia
| | - Alejandro M. Brunser
- Cerebrovascular Program, Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Centre of Utrecht, Utrecht, Netherlands
| | - Robert E. Harbaugh
- Department of Neurosurgery, Penn State University, State College, PA, United States
| | - Fergus N. Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Department of Medicine, Elderly Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, Miami, FL, United States
| | - Ankur Thapar
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College, London, United Kingdom
| | - Alun H. Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom
| | - Anthony Kam
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | - Joanna M. Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom
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Wolfsegger T, Topakian R. Cognitive impairment predicts worse short-term response to spinal tap test in normal pressure hydrocephalus. J Neurol Sci 2017; 379:222-225. [DOI: 10.1016/j.jns.2017.06.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/22/2017] [Accepted: 06/16/2017] [Indexed: 01/28/2023]
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Bustamante A, Vilar-Bergua A, Guettier S, Sánchez-Poblet J, García-Berrocoso T, Giralt D, Fluri F, Topakian R, Worthmann H, Hug A, Molnar T, Waje-Andreassen U, Katan M, Smith CJ, Montaner J. C-reactive protein in the detection of post-stroke infections: systematic review and individual participant data analysis. J Neurochem 2017; 141:305-314. [PMID: 28171699 DOI: 10.1111/jnc.13973] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/29/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
We conducted a systematic review and individual participant data meta-analysis to explore the role of C-reactive protein (CRP) in early detection or prediction of post-stroke infections. CRP, an acute-phase reactant binds to the phosphocholine expressed on the surface of dead or dying cells and some bacteria, thereby activating complement and promoting phagocytosis by macrophages. We searched PubMed up to May-2015 for studies measuring CRP in stroke and evaluating post-stroke infections. Individual participants' data were merged into a single database. CRP levels were standardized and divided into quartiles. Factors independently associated with post-stroke infections were determined by logistic regression analysis and the additional predictive value of CRP was assessed by comparing areas under receiver operating characteristic curves and integrated discrimination improvement index. Data from seven studies including 699 patients were obtained. Standardized CRP levels were higher in patients with post-stroke infections beyond 24 h. Standardized CRP levels in the fourth quartile were independently associated with infection in two different logistic regression models, model 1 [stroke severity and dysphagia, odds ratio = 9.70 (3.10-30.41)] and model 2 [age, sex, and stroke severity, odds ratio = 3.21 (1.93-5.32)]. Addition of CRP improved discrimination in both models [integrated discrimination improvement = 9.83% (0.89-18.77) and 5.31% (2.83-7.79), respectively], but accuracy was only improved for model 1 (area under the curve 0.806-0.874, p = 0.036). In this study, CRP was independently associated with development of post-stroke infections, with the optimal time-window for measurement at 24-48 h. However, its additional predictive value is moderate over clinical information. Combination with other biomarkers in a panel seems a promising strategy for future studies.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Vilar-Bergua
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sophie Guettier
- Department of Neurology, Centre Hospitalo-Universitaire Côte de Nacre, Université Caen-Normandie, Caen, France
| | - Josep Sánchez-Poblet
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felix Fluri
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andreas Hug
- Spinal Cord Injury Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Tihamer Molnar
- Department of Anesthesiology and Intensive Care, University of Pecs, Pecs, Hungary
| | | | - Mira Katan
- Department of Neurology, University Hospital of Zurich, Switzerland
| | - Craig J Smith
- Greater Manchester Comprehensive Stroke Centre and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Schneider A, Pischinger B, Wimmer S, Topakian R. Anterocollis and startle myoclonus due to Lyme meningomyeloradiculitis. Acta Neurol Belg 2017; 117:317-318. [PMID: 27037820 DOI: 10.1007/s13760-016-0636-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/20/2016] [Accepted: 03/23/2016] [Indexed: 11/25/2022]
Affiliation(s)
| | - Barbara Pischinger
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria
| | - Sibylle Wimmer
- Institute of Radiology, Neuromed Campus, Medical School, Johannes Kepler University, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria.
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Stieglbauer K, Pichler R, Topakian R. 10-year-outcomes after rituximab for myasthenia gravis: Efficacy, safety, costs of inhospital care, and impact on childbearing potential. J Neurol Sci 2017; 375:241-244. [PMID: 28320139 DOI: 10.1016/j.jns.2017.02.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/15/2017] [Accepted: 02/03/2017] [Indexed: 12/12/2022]
Abstract
Rituximab (RTX) has emerged as an attractive off-label treatment option for patients with myasthenia gravis (MG) refractory to other immune therapies. However, data on long-term outcome after RTX for MG are still scarce. Here we present the 10-year outcomes [median (range) 10.1 (6.7-11.2) years] with respect to efficacy, safety, costs of inhospital care, and impact on childbearing potential in all four MG patients treated by one of the authors with RTX. In all patients, RTX led to sustained clinical improvement and eventual tapering of other immune therapies. RTX was well tolerated, and complications were not observed. After the start of RTX, annual costs for hospital admissions were markedly reduced compared to costs in the year preceding RTX. Under close clinical observation, two patients had uncomplicated pregnancies giving birth to a healthy child. With regard to its efficacy, excellent tolerance, lack of complications, low frequency of repeat infusions and pending patent expiry in many countries, RTX appears to compare favourably with other immune therapies used for MG. Multicentre trials and registries are urgently needed to further address long-term safety issues and clarify the efficacy and role of RTX in managing MG.
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Affiliation(s)
| | - Robert Pichler
- Institute of Nuclear Medicine, Neuromed Campus, Johannes Kepler University, Linz, Austria.
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
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Topakian R, Stieglbauer K, Wolfsegger T, Pichler R. A Bodybuilder With Weak Hands and Feet: Corticosteroid-Responsive Pure Motor Chronic Inflammatory Demyelinating Polyradiculoneuropathy Following Anabolic Steroid Use. Muscle Nerve 2016; 55:E3-E5. [PMID: 27438336 DOI: 10.1002/mus.25261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | | | - Thomas Wolfsegger
- Department of Neurology, Neuromed Campus, Johannes Kepler University, Linz, Austria
| | - Robert Pichler
- Institute of Nuclear Medicine, Neuromed Campus, Johannes Kepler University, Linz, Austria
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Hodolic M, Topakian R, Pichler R. (18)F-fluorodeoxyglucose and (18)F-flumazenil positron emission tomography in patients with refractory epilepsy. Radiol Oncol 2016; 50:247-53. [PMID: 27679539 PMCID: PMC5024661 DOI: 10.1515/raon-2016-0032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/29/2016] [Indexed: 11/19/2022] Open
Abstract
Background Epilepsy is a neurological disorder characterized by epileptic seizures as a result of excessive neuronal activity in the brain. Approximately 65 million people worldwide suffer from epilepsy; 20–40% of them are refractory to medication therapy. Early detection of disease is crucial in the management of patients with epilepsy. Correct localization of the ictal onset zone is associated with a better surgical outcome. The modern non-invasive techniques used for structural-functional localization of the seizure focus includes electroencephalography (EEG) monitoring, magnetic resonance imaging (MRI), single photon emission tomography/computed tomography (SPECT/CT) and positron emission tomography/computed tomography (PET/CT). PET/CT can predict surgical outcome in patients with refractory epilepsy. The aim of the article is to review the current role of routinely used tracer 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) as well as non routinely used 18F-Flumazenil (18F-FMZ) tracers PET/CT in patients with refractory epilepsy. Conclusions Functional information delivered by PET and the morphologic information delivered by CT or MRI are essential in presurgical evaluation of epilepsy. Nowadays 18F-FDG PET/CT is a routinely performed imaging modality in localization of the ictal onset zone in patients with refractory epilepsy who are unresponsive to medication therapy. Unfortunately, 18F-FDG is not an ideal PET tracer regarding the management of patients with epilepsy: areas of glucose hypometabolism do not correlate precisely with the proven degree of change within hippocampal sclerosis, as observed by histopathology or MRI. Benzodiazepine-receptor imaging is a promising alternative in nuclear medicine imaging of epileptogenic focus. The use of 11C-FMZ in clinical practice has been limited by its short half-life and necessitating an on-site cyclotron for production. Therefore, 18F-FMZ might be established as one of the tracers of choice for patients with refractory epilepsy because of better sensitivity and anatomical resolution.
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Affiliation(s)
- Marina Hodolic
- Nuclear Medicine Research Department, Iason, Graz, Austria; Department of Nuclear Medicine, Palacký University Olomouc, Czech Republic
| | - Raffi Topakian
- Department of Neurology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Robert Pichler
- Institute of Nuclear Medicine, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
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Taucher V, Hoermanseder B, Oel D, Einsiedler S, Lugmayr H, Topakian R. Hematomyelia after cervical facet infiltration mimicking brainstem stroke. Spine J 2016; 16:e441. [PMID: 26778822 DOI: 10.1016/j.spinee.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/05/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Valentin Taucher
- Medical University Graz, Universitätsstraße 15, 8010 Graz, Austria
| | - Birgit Hoermanseder
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600 Wels, Austria
| | - Dierk Oel
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600 Wels, Austria
| | - Stefan Einsiedler
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600 Wels, Austria
| | - Herbert Lugmayr
- Institute of Radiology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600 Wels, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600 Wels, Austria
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Topakian R, Artemian H, Metschitzer B, Lugmayr H, Kühr T, Pischinger B. Dramatic response to a 3-week course of ceftriaxone in late neuroborreliosis mimicking atypical dementia and normal pressure hydrocephalus. J Neurol Sci 2016; 366:146-148. [PMID: 27288794 DOI: 10.1016/j.jns.2016.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/01/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Herta Artemian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Bettina Metschitzer
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Herbert Lugmayr
- Institute of Radiology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Thomas Kühr
- Department of Internal Medicine IV, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Barbara Pischinger
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
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Wolfsegger T, Topakian R, Schwameder H. Biomechanische Ganganalyse von neurodegenerativen Parkinson-Syndromen. KLIN NEUROPHYSIOL 2015. [DOI: 10.1055/s-0035-1559717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- T. Wolfsegger
- Abteilung für Neurologie, Landesnervenklinik Wagner-Jauregg, Universitätslehrkrankenhaus, Linz, Österreich
| | - R. Topakian
- Abteilung für Neurologie, Landesnervenklinik Wagner-Jauregg, Universitätslehrkrankenhaus, Linz, Österreich
| | - H. Schwameder
- Institut für Sport- und Bewegungswissenschaften, Universität Salzburg, Salzburg, Österreich
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Assar H, Topakian R, Weis S, Rahimi J, Trenkler J, Höftberger R, Aboulenein-Djamshidian F, Ströbel T, Budka H, Yull H, Head MW, Ironside JW, Kovacs GG. A case of variably protease-sensitive prionopathy treated with doxycyclin. J Neurol Neurosurg Psychiatry 2015; 86:816-8. [PMID: 25575846 DOI: 10.1136/jnnp-2014-309871] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/19/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Hamid Assar
- Neuromedizinisches Ambulanzzentrum, State Neuropsychiatric Hospital Wagner-Jauregg, Medical School, Johannes Kepler University of Linz, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Serge Weis
- Laboratory of Neuropathology, Department of Pathology and Neuropathology, State Neuropsychiatric Hospital Wagner-Jauregg, Medical School, Johannes Kepler University of Linz, Linz, Austria
| | - Jasmin Rahimi
- Institute of Neurology, Medical University of Vienna and Austrian Reference Centre for Human Prion Diseases, Vienna, Austria
| | - Johannes Trenkler
- Institute of Radiology, State Neuropsychiatric Hospital Wagner-Jauregg, Medical School, Johannes Kepler University of Linz, Linz, Austria
| | - Romana Höftberger
- Institute of Neurology, Medical University of Vienna and Austrian Reference Centre for Human Prion Diseases, Vienna, Austria
| | - Fahmy Aboulenein-Djamshidian
- Department of Neurology, SMZ-Ost Donauspital, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
| | - Thomas Ströbel
- Institute of Neurology, Medical University of Vienna and Austrian Reference Centre for Human Prion Diseases, Vienna, Austria
| | - Herbert Budka
- Institute of Neuropathology, University Hospital Zürich, Zürich, Switzerland
| | - Helen Yull
- National CJD Research & Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - Mark W Head
- National CJD Research & Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - James W Ironside
- National CJD Research & Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna and Austrian Reference Centre for Human Prion Diseases, Vienna, Austria
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Wolfsegger T, Assar H, Topakian R. 3-week whole body vibration does not improve gait function in mildly affected multiple sclerosis patients—a randomized controlled trial. J Neurol Sci 2014; 347:119-23. [DOI: 10.1016/j.jns.2014.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/11/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022]
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Topakian R, Wimmer S, Pischinger B, Pichler R. Hereditary neuropathy with liability to pressure palsies presenting with sciatic neuropathy. BMJ Case Rep 2014; 2014:bcr-2014-206883. [PMID: 25326571 DOI: 10.1136/bcr-2014-206883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant disorder associated with recurrent mononeuropathies following compression or trivial trauma. Reports on sciatic neuropathy as the presenting manifestation of HNPP are very scarce. We report on a 21-year-old previously healthy man who was admitted with sensorimotor deficits in his left leg. He had no history of preceding transient episodes of weakness or sensory loss. Clinical and electrophysiological examinations were consistent with sciatic neuropathy. Cerebrospinal fluid investigation and MRI of the nerve roots, plexus, and sciatic nerve did not indicate the underlying aetiology. When extended electrophysiological tests revealed multiple subclinical compression neuropathies in the upper limbs, HNPP was contemplated and eventually confirmed by genetic testing.
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Affiliation(s)
- Raffi Topakian
- Department of Neurology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Sibylle Wimmer
- Institute of Radiology, Wagner-Jauregg Hospital, Linz, Austria
| | | | - Robert Pichler
- Institute of Nuclear Medicine, Academic Teaching Hospital Wagner-Jauregg, Linz, Austria
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Affiliation(s)
- R Topakian
- Abteilung für Neurologie, Klinikum Wels-Grieskirchen, Wels, Austria.
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Böck K, Pschaid C, Topakian R, Stieglbauer K, Doppler S, von Oertzen JT, Pichler R. Mononeuritis multiplex: association with infectious condition and familial background in a tropical environment: a case report. Wien Klin Wochenschr 2014; 126 Suppl 1:S42-5. [PMID: 24664309 DOI: 10.1007/s00508-014-0504-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 01/14/2014] [Indexed: 01/19/2023]
Abstract
Mononeuritis multiplex is characterized by an asymmetric pattern with affection of the peripheral nervous system; this form of polyneuropathy is often seen in non-systemic vasculitis. We present a case of multiplex neuropathy in a patient with histologicaly verified Hailey-Hailey disease. With the exception of this comorbidity--in its characteristic form presenting additionally with a superinfected subdermal node--we did not find any other possible etiologic factor possibly causative of multiplex neuritis. The diagnosis was confirmed by electrophysiological testing. To our knowledge, this is the first case report indicating a possible relationship between Hailey-Hailey disease and multiplex neuritis. There exists only one related study in the literature, which was conducted in Columbia--our patient's home country. This study delineates a clinically similar dermal disease (pemphigus foliaceus) in patients from rural Colombia (El Bagre). The authors detected anti-neuronal antibodies which were interpreted to be responsible for the pathognomonic burning sensations.
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Affiliation(s)
- Klaus Böck
- Department of Neurology, Wagner Jauregg Hospital, Wagner Jauregg Weg 15, 4021, Linz, Austria,
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Topakian R, Pischinger B, Stieglbauer K, Pichler R. Rare clinical findings in a patient with sporadic hemiplegic migraine: FDG-PET provides diminished brain metabolism at 10-year follow-up. Cephalalgia 2013; 34:392-6. [PMID: 24270521 DOI: 10.1177/0333102413513182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sporadic hemiplegic migraine (SHM) is defined as migraine attacks associated with some degree of motor weakness during the aura phase and where no first-degree relative has identical attacks. SHM has a wide inter- and intraindividual clinical spectrum and, in case of prolonged aura symptoms and disturbed consciousness, can mimic several other acute neurological diseases. CASE In 1996, during his wedding night, a 28-year-old man developed left face, arm and leg weakness, nausea and a throbbing headache. Neurological examination on presentation revealed stupor, fever, meningism and left hemiplegia. There were no abnormalities on emergency magnetic resonance. Lumbar puncture showed mild lymphocytic pleocytosis and slightly elevated protein. He received symptomatic treatment. Subsequent genetic analysis revealed the T666M mutation in the CACNA1A gene of chromosome 19. He was diagnosed with SHM. In 2005, at the end of another episode of hemiplegic migraine (HM), he for the first time developed an episode of paranoid psychosis with anxiety and visual hallucinations. The psychiatric symptoms resolved within a week. DISCUSSION All perfusion SPECT and transcranial Doppler studies performed in the first days of HM attacks were consistent with hyperemia of the hemisphere contralateral to the neurological signs. FDG-PET/CT in January 2013 revealed a diffusely reduced glucose metabolism of the supratentorial cortex and marked asymmetric hypometabolism of the left cerebellum. The finding of progressive cortical metabolic dysfunction over years appears as a new finding. Glucose hypometabolism may indicate primary neuronal dysfunction as the cause of the prolonged deficits.
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Affiliation(s)
- R Topakian
- Department of Neurology, Wagner-Jauregg Hospital, Austria
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41
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Müller P, Topakian R, Sonnberger M, Nußbaumer K, Windpessl M, Eder V, Nesser HJ, Trenkler J, Haring HP. Endovascular thrombectomy for acute ischemic stroke patients anticoagulated with dabigatran. Clin Neurol Neurosurg 2013; 115:2257-9. [PMID: 23921437 DOI: 10.1016/j.clineuro.2013.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 06/26/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Petra Müller
- Department of Neurology, Landes-Nervenklinik Wagner-Jauregg, Linz, Austria.
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42
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Horner S, Niederkorn K, Gattringer T, Furtner M, Topakian R, Lang W, Maier R, Gamillscheg A, Fazekas F. Management of right-to-left shunt in cryptogenic cerebrovascular disease: results from the observational Austrian paradoxical cerebral embolism trial (TACET) registry. J Neurol 2012; 260:260-7. [PMID: 22865239 DOI: 10.1007/s00415-012-6629-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 01/25/2023]
Abstract
Paradoxical embolism due to a patent foramen ovale (PFO) is a possible cause of ischemic stroke, particularly in young cryptogenic stroke patients. In most cases, however, it is difficult to establish a firm etiological association and the debate about management is ongoing. The Austrian Paradoxical Cerebral Embolism Trial was designed as a prospective, national, multi-center, non-randomized registry to add further data on this topic before the completion of randomized controlled trials. Over 27 months 188 cryptogenic stroke/TIA patients ≤55 years were entered by 15 Austrian stroke units. Contrast transesophageal echocardiography demonstrated a cardiac right-to-left shunt (RLS) in 176 patients; a pulmonary RLS was assumed in 10, and 2 showed both. Ninety-seven (55 %) patients with cardiac RLS underwent interventional treatment, and this was more likely for patients with stroke as index event, a symptomatic infarction on MRI and a large size of PFO. Over 2 years, recurrences occurred at a rate of approximately 1.3 % for stroke and 4.3 % for TIA, and were especially frequent in patients with pulmonary RLS. When comparing outcomes in patients with cardiac RLS there was a trend for fewer recurrences with interventional management (closure: four TIA in four patients vs. medical: three strokes and seven TIA in nine patients; p = 0.066 for events, p = 0.085 for patients). The complication rate was 13.4, and 5.7 % had residual shunting. The possible causes for paradoxical embolism in young patients with cryptogenic stroke appear more variable than usually considered, and other causes than PFO should not be neglected. Interventional treatment of a cardiac RLS may offer a small benefit, but has to be weighed against possible complications and the problem of establishing causality.
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Affiliation(s)
- Susanna Horner
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
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Topakian R, King A, Kwon S. Ultrasonic Plaque Echolucency and Embolic Signals Predict Stroke in Asymptomatic Carotid Stenosis. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wolfsegger T, Rotaru I, Topakian R, Pichler R, Sonnberger M, Aichner FT, Schwameder H. [A biomechanical analysis of cyclical hand motor function: a pilot study in different Parkinsonian syndromes]. Nervenarzt 2012; 83:766-771. [PMID: 22349627 DOI: 10.1007/s00115-011-3464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Clinical assessment of hand bradykinesia in Parkinson's disease (PD) focuses mainly on the frequency, amplitude and rhythm of movements, thereby subjectively evaluating the correct performance of hand movements. The aim of the study was to quantify hand bradykinesia with kinematic data in different Parkinsonian syndromes. PATIENTS AND METHODS This retrospective study compared patients with idiopathic PD (IPD, n = 18), atypical Parkinson's syndrome (APS, n = 17), secondary Parkinson's syndrome (SPS, n = 18) and healthy controls (C, n = 18). All patients were receiving the best medical treatment. Hand movements were recorded using an ultrasound-system (Zebris®, Isny, Germany). Subjects were asked to perform pronation/supination of the forearm (diadochokinesis), flexion/extension of the hand (hand tapping) and tapping of the index finger. Mean amplitude, mean frequency and mean variability of movements were determined. RESULTS APS patients had significant complex hand movement disability with reduced amplitude and frequency in combination with increased motion variability in all movement tasks. The key disturbance in the IPD group concerned the rhythm in hand tapping and index finger tapping in combination with moderately reduced velocity and range of motion in all conditions. The cyclical hand movement characteristics in SPS patients showed movement slowness with normal amplitude and variability in all motor conditions. CONCLUSION Our results suggest that computerized quantitative analysis of cyclical hand movements can characterize and identify different representations of hand bradykinesia in different Parkinsonian disorders and hence may help clinicians to accurately assess therapeutic targets and outcome of interventions.
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Affiliation(s)
- T Wolfsegger
- Abteilung für Neurologie - Labor für Bewegungsanalyse, Landes-Nervenklinik Wagner-Jauregg, Universitätslehrkrankenhaus, Wagner-Jauregg-Weg 15, 4020 Linz, Österreich.
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Silye R, Rieger R, Topakian R, Dunzinger A, Aigner RM, Pichler R. Cushing syndrome due to ectopic adrenocorticotropin secretion by oncocytic thyroid nodule. J Clin Endocrinol Metab 2012; 97:39A-40A. [PMID: 22223766 DOI: 10.1210/jcem.97.12.zeg39a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rene Silye
- Institute of Pathology, Wagner-Jauregg Hospital, Wagner-Jauregg Weg 15, A-4021 Linz, Austria
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Topakian R, King A, Kwon SU, Schaafsma A, Shipley M, Markus HS. Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis. Neurology 2011; 77:751-8. [PMID: 21849657 DOI: 10.1212/wnl.0b013e31822b00a6] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Better methods are required to identify patients with asymptomatic carotid stenosis (ACS) at risk of future stroke. Two potential markers of high risk are echolucent plaque morphology on carotid ultrasound and embolic signals (ES) in the ipsilateral middle cerebral artery on transcranial Doppler ultrasound (TCD). We explored the predictive value of a score based on these 2 measures in the prospective, observational, international multicenter Asymptomatic Carotid Emboli Study. METHODS A total of 435 recruited subjects with ACS ≥70% had baseline ultrasound images and TCD data available. Subjects were prospectively followed up for 2 years. RESULTS A total of 164 (37.7%) plaques were graded as echolucent. Plaque echolucency at baseline was associated with an increased risk of ipsilateral stroke alone (hazard ratio [HR] 6.43, 95% confidence interval [CI] 1.36-30.44, p = 0.019). A combined variable of plaque echolucency and ES positivity at baseline was associated with a markedly increased risk of ipsilateral stroke alone (HR 10.61, 95% CI 2.98-37.82, p = 0.0003). This association remained significant after controlling for risk factors, degree of carotid stenosis, and antiplatelet medication. CONCLUSIONS Plaque morphology assessed using a simple, and clinically applicable, visual rating scale predicts ipsilateral stroke risk in ACS. The combination of ES detection and plaque morphology allows a greater prediction than either measure alone and identifies a high-risk group with an annual stroke risk of 8%, and a low-risk group with a risk of <1% per annum. This risk stratification may prove useful in the selection of patients with ACS for endarterectomy.
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Affiliation(s)
- R Topakian
- Clinical Neuroscience, St. Georges University of London, London, UK.
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Wolfsegger T, Rotaru I, Topakian R, Aichner F, Schwameder H. Eine vergleichende biomechanische Ganganalyse zwischen dem Idiopathischen Parkinson-Syndrom und dem Normaldruckhydrozephalus. Akt Neurol 2011. [DOI: 10.1055/s-0031-1287787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Topakian R, Brainin M, Eckhardt R, Kiechl S, Ahmed N, Ferrari J, Iglseder B, Wahlgren NG, Lang W, Fazekas F, Willeit J, Aichner FT. Thrombolytic therapy for acute stroke in Austria: data from the Safe Implementation of Thrombolysis in Stroke (SITS) register. Eur J Neurol 2011; 18:306-311. [DOI: 10.1111/j.1468-1331.2010.03141.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R. Topakian
- Department of Neurology, Academic Teaching Hospital Wagner‐Jauregg, Linz
| | - M. Brainin
- Department of Neurology, Landesklinikum Donauregion Tulln, Tulln
- Centre for Clinical Neurosciences, Danube University Krems, Krems
| | - R. Eckhardt
- Department of Neurology, Landesklinikum Donauregion Tulln, Tulln
- Centre for Clinical Neurosciences, Danube University Krems, Krems
| | - S. Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - N. Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - J. Ferrari
- Department of Neurology, Hospital Barmherzige Brueder Vienna, Vienna
| | - B. Iglseder
- Department of Neurology, Paracelsus Medical University, Salzburg
| | - N. G. Wahlgren
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - W. Lang
- Department of Neurology, Hospital Barmherzige Brueder Vienna, Vienna
| | - F. Fazekas
- Department of Neurology, University Hospital Graz, Graz, Austria
| | - J. Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - F. T. Aichner
- Department of Neurology, Academic Teaching Hospital Wagner‐Jauregg, Linz
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Bangalore S, Bhatt DL, Röther J, Alberts MJ, Thornton J, Wolski K, Goto S, Hirsch AT, Smith SC, Aichner FT, Topakian R, Cannon CP, Steg PG. Late Outcomes After Carotid Artery Stenting Versus Carotid Endarterectomy. Circulation 2010; 122:1091-100. [PMID: 20805431 DOI: 10.1161/circulationaha.109.933341] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In patients with carotid artery disease, carotid endarterectomy (CEA) and carotid stenting (CAS) are treatment options. Controversy exists as to the relative efficacy of the 2 techniques in preventing late events.
Methods and Results—
The Reduction of Atherothrombosis for Continued Health (REACH) Registry recruited >68 000 outpatients ≥45 years of age with established atherothrombotic disease or ≥3 risk factors for atherothrombosis. Patients with CAS or CEA were chosen and followed up prospectively for the occurrence of cardiovascular events. Propensity score matching was performed to assemble a cohort of patients in whom all baseline covariates would be well balanced. Primary outcome was defined as death or stroke at the 2-year follow-up. Secondary outcome was stroke or transient ischemic attack. Tertiary outcome was a composite of death, myocardial infarction, or stroke and the individual outcomes. Of the 68 236 patients with atherothrombosis, 3412 patients (5%) had a history of carotid artery revascularization (70% asymptomatic carotid stenosis), 1025 (30%) with CAS and 2387 (70%) with CEA. Propensity score analyses matched 836 CAS patients with 836 CEA patients. At the end of 2 years of follow-up, in the propensity score–matched cohort, CAS was associated with a risk similar to CEA for the primary (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.57 to 1.26), secondary (HR, 1.20; 95% CI, 0.73 to 1.96), and tertiary (HR, 0.72; 95% CI, 0.51 to 1.01) composite outcome, death (HR, 0.63; 95% CI, 0.40 to 1.00), and stroke (HR, 1.48; 95% CI, 0.79 to 2.80).
Conclusion—
In a real-world cohort of patients with a history of carotid artery revascularization, CAS was comparable to CEA for late outcomes.
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Affiliation(s)
- Sripal Bangalore
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Deepak L. Bhatt
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Joachim Röther
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Mark J. Alberts
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Julie Thornton
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Kathy Wolski
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Shinya Goto
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Alan T. Hirsch
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Sidney C. Smith
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Franz T. Aichner
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Raffi Topakian
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - Christopher P. Cannon
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
| | - P. Gabriel Steg
- From the The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY (S.B.); Brigham and Women’s Hospital, Boston, Mass (D.L.B.); Harvard Clinical Research Institute, Boston, Mass (S.B.); VA Boston Healthcare System, Boston, Mass (D.L.B.); Department of Neurology, Academic Teaching Hospital Hamburg Medical School, Asklepios Klinik Altona, Hamburg, Germany (J.R.); Northwestern University Feinberg School of Medicine, Chicago, Ill (M.J.A.); Cleveland Clinic,
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