1
|
Stricker S, Prüss H, Horvath R, Baruffini E, Lodi T, Siebert E, Endres M, Zschenderlein R, Meisel A. A variable neurodegenerative phenotype with polymerase gamma mutation. J Neurol Neurosurg Psychiatry 2009; 80:1181-2. [PMID: 19762913 DOI: 10.1136/jnnp.2008.166066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
2
|
|
3
|
Tackenberg B, Lünemann JD, Steinbrecher A, Rothenfusser-Korber E, Sailer M, Brück W, Schock S, Zschenderlein R, Zipp F, Sommer N. Classifications and treatment responses in chronic immune-mediated demyelinating polyneuropathy. Neurology 2007; 68:1622-9. [PMID: 17485651 DOI: 10.1212/01.wnl.0000260972.07422.ea] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic immune-mediated demyelinating polyneuropathy (CIP) represents a heterogeneous pool of motor, sensory, sensorimotor, symmetric, or asymmetric syndromes. OBJECTIVE To evaluate published diagnostic classifications and characterize predictors of treatment response. METHODS One hundred two of 158 patients with a working diagnosis of CIP were included and clinically characterized because they had electrophysiologic and/or histologic evidence of demyelination. The biostatistical profile of patients with symmetric clinical manifestation was analyzed using three proposed classifications (American Academy of Neurology [AAN] criteria, modified AAN criteria, European Federation of Neurological Societies/Peripheral Nerve Society [EFNS/PNS] criteria). Treatment responses to IV immunoglobulins (IVIg) and their positive predictors were investigated. RESULTS Sensitivities (0.52 [AAN] vs 0.83 [modified AAN] vs 0.95 [EFNS/PNS]) and negative predictive values (0.68 vs 0.85 vs 0.92) differed markedly, whereas specificities (0.94 vs 0.90 vs 0.96) and positive predictive values (0.89 vs 0.89 vs 0.97) were similar. In CIP patients treated with IVIg, a positive response was found in 62 of 76 (82%). Patients with a monophasic or relapsing-remitting course or a more than twofold CSF protein increase had the highest probability to respond to IVIg, most evident when using the modified AAN criteria. CONCLUSIONS The European Federation of Neurological Societies/Peripheral Nerve Society criteria for chronic inflammatory demyelinating polyneuropathy improve treatment of patients with chronic immune-mediated demyelinating polyneuropathy, particularly with respect to diagnostic issues. To predict IV immunoglobulin treatment response, the modified American Academy of Neurology criteria are the most valuable classification provided an increased CSF protein level.
Collapse
Affiliation(s)
- B Tackenberg
- Philipps-University, Department of Neurology, Clinical Neuroimmunology Group, Marburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Tackenberg B, Lünemann JD, Steinbrecher A, Rindock H, Sailer M, Zschenderlein R, Zipp F, Sommer N. Initial CSF protein predicts treatment response in chronic inmmune mediated demyelinating polyneuropathy (CIP). KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
5
|
Beyer AM, Klehmet J, Zschenderlein R, Wandinger KP. Das klinische Spektrum der Neuromyelitis optica – Fallbericht und kritische Stellungnahme. Akt Neurol 2007. [DOI: 10.1055/s-2007-987770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
6
|
Trendelenburg G, Vanier MT, Maza S, Millat G, Bohner G, Munz DL, Zschenderlein R. Niemann-Pick type C disease in a 68-year-old patient. J Neurol Neurosurg Psychiatry 2006; 77:997-8. [PMID: 16844962 PMCID: PMC2077625 DOI: 10.1136/jnnp.2005.086785] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
7
|
Petzold GC, Bohner G, Klingebiel R, Amberger N, van der Knaap MS, Zschenderlein R. Adult onset leucoencephalopathy with brain stem and spinal cord involvement and normal lactate. J Neurol Neurosurg Psychiatry 2006; 77:889-91. [PMID: 16788019 PMCID: PMC2117479 DOI: 10.1136/jnnp.2005.078568] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
8
|
Affiliation(s)
- H Prüss
- Department of Neurology, Charité University Medicine Berlin, Schumannstr. 20/21, 10117 Berlin, Germany.
| | | | | |
Collapse
|
9
|
Bellmann-Strobl J, Aktas O, Würfel J, Schmierer K, Paul F, Zschenderlein R, Villringer A, Zipp F. Primary progressive multiple sclerosis: evidence for uncoupling disease progression and inflammation. Akt Neurol 2006. [DOI: 10.1055/s-2006-953204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
Katchanov J, Bohner G, Könneker M, Kopp U, Izadpanah K, Larmann E, Klingebiel R, van Landeghem F, Masuhr F, Zschenderlein R. Sporadische zerebrale Amyloidangiopathie mit ischämischer Leukenzephalopathie und Mikroblutungen. Nervenarzt 2005; 76:1250-4. [PMID: 15776260 DOI: 10.1007/s00115-005-1884-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe a 72-year-old patient with rapidly progressive dementia and a complex focal seizure. Magnetic resonance (MR) imaging revealed leukoencephalopathy with the involvement of the U-fibers as well as cortical and subcortical microbleeds. Brain biopsy confirmed the diagnosis of cerebral Abeta amyloid angiopathy (CAA). The presented case illustrates the significance of CAA as a cause of rapidly progressive dementia and leukoencephalopathy and points out the importance of T2-weighted MR imaging in the evaluation of dementia.
Collapse
Affiliation(s)
- J Katchanov
- Klinik für Neurologie, Universitätsmedizin Charité, Berlin.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Petzold GC, Stiepani H, Klingebiel R, Zschenderlein R. Diffusion-weighted magnetic resonance imaging of acute disseminated encephalomyelitis. Eur J Neurol 2005; 12:735-6. [PMID: 16128879 DOI: 10.1111/j.1468-1331.2005.01069.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Röhl JE, Lünemann JD, Zimmer C, Zschenderlein R, Valdueza JM. Multiple sclerosis coinciding with Machado-Joseph disease. Neurol Sci 2005; 26:135-6. [PMID: 15995831 DOI: 10.1007/s10072-005-0447-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 04/04/2005] [Indexed: 10/25/2022]
Abstract
Although inflammatory demyelination is considered to be the key feature in multiple sclerosis (MS) pathogenesis, histopathological investigations and MRI studies recently highlighted the extent of neuronal damage that occurs even in the early stages of the disease. We report the unusual case of a patient with Machado-Joseph disease (MJD; spinocerebellar ataxia (SCA) III) and discuss this coincidence in light current pathogenetic paradigms of CNS autoimmunity.
Collapse
Affiliation(s)
- J E Röhl
- Department of Neurology, University Hospital Charité, Humboldt University, Schumannstrasse 20/21, 10098 Berlin, Germany.
| | | | | | | | | |
Collapse
|
13
|
Katchanov J, Doepp F, Borges AC, Bohner G, Klingebiel R, Ziemer S, Masuhr F, Zschenderlein R. [Adenocarcinoma-associated nonbacterial thrombotic endocarditis as the cause of recurrent strokes]. Nervenarzt 2005; 76:471-4. [PMID: 15197453 DOI: 10.1007/s00115-004-1743-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We describe a 60-year-old female patient without vascular risk factors diagnosed with cardioembolic ischemic stroke due to an atrial septal aneurysm with a right-to-left shunt. However, further investigation after recurrent strokes revealed a nonbacterial thrombotic endocarditis (NBTE) caused by a metastatic adenocarcinoma. The presented case illustrates the difficulties in establishing the diagnosis of NBTE premortally and points out the importance of repeated echocardiographic evaluations of cardiac valves and serological examination of tumor markers in patients with recurrent strokes of unknown origin.
Collapse
Affiliation(s)
- J Katchanov
- Klinik für Neurologie, Universitätsmedizin Charité, Berlin.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Rieckmann P, Toyka KV, Bassetti C, Beer K, Beer S, Buettner U, Chofflon M, Götschi-Fuchs M, Hess K, Kappos L, Kesselring J, Goebels N, Ludin HP, Mattle H, Schluep M, Vaney C, Baumhackl U, Berger T, Deisenhammer F, Fazekas F, Freimüller M, Kollegger H, Kristoferitsch W, Lassmann H, Markut H, Strasser-Fuchs S, Vass K, Altenkirch H, Bamborschke S, Baum K, Benecke R, Brück W, Dommasch D, Elias WG, Gass A, Gehlen W, Haas J, Haferkamp G, Hanefeld F, Hartung HP, Heesen C, Heidenreich F, Heitmann R, Hemmer B, Hense T, Hohlfeld R, Janzen RWC, Japp G, Jung S, Jügelt E, Koehler J, Kölmel W, König N, Lowitzsch K, Manegold U, Melms A, Mertin J, Oschmann P, Petereit HF, Pette M, Pöhlau D, Pohl D, Poser S, Sailer M, Schmidt S, Schock G, Schulz M, Schwarz S, Seidel D, Sommer N, Stangel M, Stark E, Steinbrecher A, Tumani H, Voltz R, Weber F, Weinrich W, Weissert R, Wiendl H, Wiethölter H, Wildemann U, Zettl UK, Zipp F, Zschenderlein R, Izquierdo G, Kirjazovas A, Packauskas L, Miller D, Koncan Vracko B, Millers A, Orologas A, Panellus M, Sindic CJM, Bratic M, Svraka A, Vella NR, Stelmasiak Z, Selmaj K, Bartosik-Psujik H, Mitosek-Szewczyk K, Belniak E, Mochecka A, Bayas A, Chan A, Flachenecker P, Gold R, Kallmann B, Leussink V, Mäurer M, Ruprecht K, Stoll G, Weilbach FX. Escalating immunotherapy of multiple sclerosis--new aspects and practical application. J Neurol 2005; 251:1329-39. [PMID: 15592728 DOI: 10.1007/s00415-004-0537-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 05/07/2004] [Accepted: 05/17/2004] [Indexed: 11/24/2022]
Abstract
Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies. Initiation of treatment after the first relapse may be indicated if there is clear evidence on MRI for subclinical dissemination of disease. Recent trials show that the efficacy of interferon beta treatment is more likely if patients in the secondary progressive phase of the disease still have superimposed bouts or other indicators of inflammatory disease activity than without having them. There are now data available, which suggest a possible dose-effect relation for recombinant beta-interferons. These studies have to be interpreted with caution, as some potentially important issues in the design of these studies (e. g. maintenance of blinding in the clinical part of the study) were not adequately addressed. A meta-analysis of selected interferon trials has been published challenging the value of recombinant IFN beta in MS. The pitfalls of that report are discussed in the present review as are other issues relevant to treatment including the new definition of MS, the problem of treatment failure and the impact of cost-effectiveness analyses. The MSTCG panel recommends that the new diagnostic criteria proposed by McDonald et al. should be applied if immunoprophylactic treatment is being considered. The use of standardized clinical documentation is now generally proposed to facilitate the systematic evaluation of individual patients over time and to allow retrospective evaluations in different patient cohorts. This in turn may help in formulating recommendations for the application of innovative products to patients and to health care providers. Moreover, in long-term treated patients, secondary treatment failure should be identified by pre-planned follow-up examinations, and other treatment options should then be considered.
Collapse
Affiliation(s)
- P Rieckmann
- Dept. of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Affiliation(s)
- N G Müller
- Department of Neurology,Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | | | | |
Collapse
|
16
|
Katchanov J, Lünemann JD, Masuhr F, Becker D, Ahmadi M, Bösel J, Zschenderlein R, Bamborschke S, Klingebiel R. Acute combined central and peripheral inflammatory demyelination. J Neurol Neurosurg Psychiatry 2004; 75:1784-6. [PMID: 15548509 PMCID: PMC1738842 DOI: 10.1136/jnnp.2004.037572] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
17
|
Lünemann JD, Prass K, Zschenderlein R. Immuntherapie der chronisch inflammatorischen demyelinisierenden Polyneuropathie. Fortschr Neurol Psychiatr 2004; 72:672-8. [PMID: 15580532 DOI: 10.1055/s-2004-830039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired immune-mediated disease of the peripheral nervous system with an estimated prevalence of 1-2/100,000. The clinical presentation is heterogeneous, but the most common form causes symmetrical progressive or relapsing weakness affecting proximal and distal muscles. CIDP is among the most treatable peripheral nerve disorders and corticosteroids, plasmapheresis and intravenous immunoglobulin have been shown to be effective in short-term prospective, randomized controlled trials. Data however indicate that approximately one-third of patients do not respond to these treatment modalities, nor do they provide equivalent evidence for a durable clinical response. There is a lack of good quality controlled trials of any other immunosuppressive agent, but cyclophosphamide and cyclosporin may be of value in patients with poor response to first-line modalities. Alternatively, the use of combination therapy may increase the efficacy in unresponsive patients. This review highlights the current status of CIDP treatment trials and discusses the significance of any therapeutic option in terms of efficacy, tolerability and cost-effects.
Collapse
Affiliation(s)
- J D Lünemann
- Klinik und Poliklinik für Neurologie, Campus Mitte, Charité-Universitätsmedizin Berlin.
| | | | | |
Collapse
|
18
|
|
19
|
Schmierer K, Grosse P, De Camilli P, Solimena M, Floyd S, Zschenderlein R. Paraneoplastic stiff-person syndrome: no tumor progression over 5 years. Neurology 2002; 58:148. [PMID: 11781426 DOI: 10.1212/wnl.58.1.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K Schmierer
- Department of Neurology, Charité, Humboldt University, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
20
|
Prass K, Brück W, Schröder NW, Bender A, Prass M, Wolf T, Van der Knaap MS, Zschenderlein R. Adult-onset Leukoencephalopathy with vanishing white matter presenting with dementia. Ann Neurol 2001; 50:665-8. [PMID: 11706974 DOI: 10.1002/ana.1259] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report on a case of dementia and extensive cerebral white matter abnormalities seen on magnetic resonance-images which meet the criteria for leukoencephalopathy with vanishing white matter. This is an inherited condition that was first thought to occur only in children. Our patient shows that vanishing white matter should be considered in adult patients with early-onset dementia and extensive white matter changes seen on magnetic resonance images.
Collapse
Affiliation(s)
- K Prass
- Neurologische Klinik, Charité, Humboldt-Universität, Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Lünemann JD, Aktas O, Gniadek P, Zschenderlein R, Zipp F. Downregulation of transforming growth factor-beta1 in interferon-beta1a-treated MS patients. Neurology 2001; 57:1132-4. [PMID: 11571354 DOI: 10.1212/wnl.57.6.1132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors report an intense downregulation of transforming growth factor-beta1 (TGF-beta1) serum levels 4 weeks from start of interferon-beta1a (IFN-beta1a) treatment at 44 microg/week in 271 patients with relapsing-remitting MS, which was still present after 1 year (p < 0.001). In line with previous data, interleukin-10 serum levels did not vary significantly. These results indicate that the immunomodulatory effects of IFN-beta might not be restricted to the postulated anti-inflammatory mechanisms and address the role of TGF-beta in the pathogenesis of MS.
Collapse
Affiliation(s)
- J D Lünemann
- Division of Neuroimmunology, Department of Neurology, Charité University Hospital, Berlin, Germany
| | | | | | | | | |
Collapse
|
22
|
Holtkamp M, Zschenderlein R, Brück W, Weber JR. Chronic inflammatory demyelinating polyradiculoneuropathy with histologically proven optic neuritis. Acta Neuropathol 2001; 101:529-31. [PMID: 11484826 DOI: 10.1007/s004010000309] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although patient series of clinical, electrophysiological, or magnetic resonance imaging evidence for involvement of the central nervous system in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have been published, the histological proof has never been reported. We present the case of a 46-year-old male patient who developed CIDP in his early 20s and who died of relapsing severe pneumonia. In late stages of the disease the patient presented visual loss and bilateral atrophy of the optic nerve. Neuropathological examination revealed severe peripheral neuropathy consistent with CIDP and central involvement with bilateral optic neuritis. This is the first case reporting CIDP and histologically proven optic neuritis.
Collapse
Affiliation(s)
- M Holtkamp
- Department of Neurology, Charité, Humboldt-Universität Berlin, Germany.
| | | | | | | |
Collapse
|
23
|
Aktas O, Waiczies S, Grieger U, Wendling U, Zschenderlein R, Zipp F. Polyspecific immunoglobulins (IVIg) suppress proliferation of human (auto)antigen-specific T cells without inducing apoptosis. J Neuroimmunol 2001; 114:160-7. [PMID: 11240027 DOI: 10.1016/s0165-5728(01)00243-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Polyspecific immunoglobulins (IVIg) have been shown to reduce disease activity in multiple sclerosis (MS). To investigate the mechanisms of action of IVIg, we studied the impact of IVIg on growth and death (apoptosis) of human (auto)antigen-specific T cells. We observed a substantial suppression of proliferation of specifically activated T cells, in absence of caspase activation or DNA fragmentation. Further, neither susceptibility of T cells to undergo CD95-mediated apoptosis nor expression of apoptosis-blocking bcl-2 was modulated by IVIg. We conclude that IVIg may inhibit the reactivity of antigen-specific T cells in MS through suppression of proliferation rather than modulation of apoptosis.
Collapse
Affiliation(s)
- O Aktas
- Department of Neurology, Division of Neuroimmunology, University Hospital Charité, NWFZ 2680, Schumannstrasse 20/21, 10117 Berlin, Germany
| | | | | | | | | | | |
Collapse
|
24
|
Lünemann JD, Zarmas S, Priem S, Franz J, Zschenderlein R, Aberer E, Klein R, Schouls L, Burmester GR, Krause A. Rapid typing of Borrelia burgdorferi sensu lato species in specimens from patients with different manifestations of Lyme borreliosis. J Clin Microbiol 2001; 39:1130-3. [PMID: 11230440 PMCID: PMC87886 DOI: 10.1128/jcm.39.3.1130-1133.2001] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To further investigate the pathogenic potential of different Borrelia burgdorferi genospecies, specimens from 27 patients with different manifestations of Lyme borreliosis were analyzed by PCR and reverse line blotting (RLB). In samples from Lyme arthritis patients, B. burgdorferi sensu stricto was predominantly identified, while in patients with neuroborreliosis or acrodermatitis, Borrelia garinii and Borrelia afzelii, respectively, were exclusively detected. The results demonstrate that PCR-RLB is a valuable tool for epidemiological and pathogenetic studies of Lyme borreliosis.
Collapse
Affiliation(s)
- J D Lünemann
- Department of Medicine, Rheumatology and Clinical Immunology, Charité University Hospital, 10098 Berlin, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Aktas O, Wendling U, Zschenderlein R, Zipp F. [Apoptosis in multiple sclerosis. Etiopathogenetic relevance and prospects for new therapeutic strategies]. Nervenarzt 2000; 71:767-73. [PMID: 11082807 DOI: 10.1007/s001150050664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Apoptosis, or programmed cell death, is a physiological cell suicide program mainly leading to selective elimination of useless cells. This mechanism is important for the homeostasis of the immune system and presumably plays a two-sided role in the pathogenesis of multiple sclerosis (MS). On the one hand, evidence has been provided that impaired apoptosis might result in increased numbers or persistence of activated myelin-specific T cells, thus inducing the pathophysiologic processes in MS. On the other hand, local tissue damage might involve apoptosis of glial and neuronal cells and lead to the clinical symptoms. Here, an overview is presented on the current knowledge of the role of apoptosis in the pathogenesis of MS, and implications for related therapeutic strategies are discussed.
Collapse
Affiliation(s)
- O Aktas
- Neurologische Klinik und Poliklinik, Medizinische Fakultät der Humboldt-Universität Berlin
| | | | | | | |
Collapse
|
26
|
Knirsch UI, Bachus R, Gosztonyi G, Zschenderlein R, Ludolph AC. Clinicopathological study of atypical motor neuron disease with vertical gaze palsy and ballism. Acta Neuropathol 2000; 100:342-6. [PMID: 10965806 DOI: 10.1007/s004010000185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The case of a 38-year-old patient with rapidly progressing motor neuron disease, complicated by major dysfunction of the extrapyramidal system and of vertical gaze is described. Neuropathological examination revealed a degenerative process that severely affected the lower motor neurons, as well as the neurons of the pars compacta of the substantia nigra, the nucleus of Darkschewitsch, the nucleus interstitialis of Cajal, the colliculi superiores, and the pallidum. The long tracts were unaffected at all levels of the brain stem and spinal cord. There was no convincing evidence for the presence of a multiple system atrophy or progressive supranuclear palsy; the results rather revealed a pattern of vulnerability characteristic of a variant of motor neuron disease.
Collapse
Affiliation(s)
- U I Knirsch
- Department of Neurology, University of Ulm, Germany.
| | | | | | | | | |
Collapse
|
27
|
Wendling U, Aktas O, Schmierer K, Zschenderlein R, Zipp F. Partial synergy of bisindolylmaleimide with apoptotic stimulus in antigen-specific T cells--implications for multiple sclerosis. J Neuroimmunol 2000; 103:69-75. [PMID: 10674991 DOI: 10.1016/s0165-5728(99)00214-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In multiple sclerosis (MS), induction of T cell apoptosis constitutes a promising therapeutic strategy. Recently, bisindolylmaleimide has been shown to be an effective treatment of experimental autoimmune encephalomyelitis, presumably due to enhancement of CD95-mediated T cell apoptosis. Therefore, we studied the effects of bisindolylmaleimide on human (auto)antigen-specific T cells. We observed a synergistic effect of bisindolylmaleimide with apoptotic stimulus assessed via caspase activity and annexin V-binding, but no potentiation of DNA fragmentation or cell death. Thus, bisindolylmaleimide might be useful for modulating T cell apoptosis, yet more potent substances have to be generated re-establishing immunological control over auto-reactive T cells.
Collapse
Affiliation(s)
- U Wendling
- Department of Neurology, University Hospital Charité, Schumannstr, Berlin, Germany
| | | | | | | | | |
Collapse
|
28
|
Abstract
Interferon (IFN)-beta, the most effective immunomodulatory treatment for MS, inhibits the proliferation of myelin-specific T cells. We report that IFN-beta moderately enhances the expression of the death receptor, CD95, at the surface of human antigen-specific T cells. However, T-cell apoptosis was not induced by IFNbeta-1a or IFNbeta-1b as assessed by caspase activity or DNA fragmentation. Immunomodulation mediated by IFN-beta does not directly involve apoptotic pathways in human T cells.
Collapse
Affiliation(s)
- F Zipp
- Department of Neurology, University Hospital Charité, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
29
|
Schmierer K, Valdueza JM, Bender A, DeCamilli P, David C, Solimena M, Zschenderlein R. Atypical stiff-person syndrome with spinal MRI findings, amphiphysin autoantibodies, and immunosuppression. Neurology 1998; 51:250-2. [PMID: 9674811 DOI: 10.1212/wnl.51.1.250] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In an atypical case of stiff-person syndrome (SPS), spinal T2-weighted MRI revealed a hyperintense lesion extending from C2 to C7 that corresponded with the clinical symptoms and signs. CSF showed lymphocytic pleocytosis and oligoclonal bands. Amphiphysin autoantibodies were detected in serum and CSF; however, unlike other reported cases, no malignancy occurred during a 3-year observation period. Methylprednisolone and cyclophosphamide pulse therapy led to a marked reduction of symptoms.
Collapse
Affiliation(s)
- K Schmierer
- Department of Neurology, Charité University Hospital, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
30
|
Kluge A, Kettner B, Zschenderlein R, Sandrock D, Munz DL, Hesse S, Meierkord H. Changes in perfusion pattern using ECD-SPECT indicate frontal lobe and cerebellar involvement in exercise-induced paroxysmal dystonia. Mov Disord 1998; 13:125-34. [PMID: 9452337 DOI: 10.1002/mds.870130124] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The clinical features of exercise-induced paroxysmal dystonia (EPD) are delineated in a pedigree including two affected members (both male) showing an autosomal-dominant inheritance trait. Gait analysis using kinematic electromyography during the motor attacks revealed coactivation of antagonistic calf muscles characteristic of dystonia. In the interval, impaired muscular alternation was observed. To characterize further the pathophysiological basis of the condition, ictal and interictal cerebral perfusion SPECT studies using technetium 99m-ethyl cysteinate dimer (ECD) were performed to establish whether cortical hyperactivity indicative of epilepsy is present during the motor attacks and to identify regional changes in the ictal perfusion pattern that could indicate an anatomic structure relevant to the disease. During the motor attacks, decreased ictal perfusion of the frontal cortex was found in both patients. In contrast, increased cerebellar perfusion was observed. The perfusion of the basal ganglia also decreased. No cortical hyperperfusion indicative of an epileptic nature was seen. Cerebellar hyperactivity in connection with prominent frontal hypoactivity has also been described in both the idiopathic and the symptomatic forms of dystonia. Our findings therefore suggest that EPD represents a paroxysmal movement disorder rather than epilepsy. It is concluded that changes in frontal and in cerebellar function are relevant to the pathophysiology of EPD.
Collapse
Affiliation(s)
- A Kluge
- Neurological Clinic, Faculty of Medicine, Humboldt University of Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
31
|
Back T, Stoltenburg-Didinger G, Ploner CJ, Meisel H, Zschenderlein R. A new variant of progressive encephalomyelitis with rigidity associated with cerebellar ataxia and dementia: correlation of MRI and histopathological changes. A case report. Neurol Res 1997; 19:187-91. [PMID: 9175149 DOI: 10.1080/01616412.1997.11740794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 27 year-old patient developed a progressive neurological multisystem disorder. Initial signs were cerebellar ataxia and dementia, followed by rigidity and oculomotor dysfunction. Myoclonus was not present. MRI showed a marked atrophy of the spinal cord, the cerebellum, and mild (sub)cortical atrophy. CSF contained oligoclonal bands, but no anti-glutamic acid dehydrogenase antibodies. He died 33 months after onset of symptoms. Autopsy revealed widespread neuropathological alterations including perivascular lymphocytic cutting, neuronal cell loss, and micro/astrogliosis the distribution of which corresponded to the changes seen in MRI. The diagnosis of progressive encephalomyelitis with rigidity was pathohistologically confirmed. Brain samples were negative for neurotrophic viruses tested by polymerase chain reaction. A new variant of this rare disorder is described initially presenting with ataxia and dementia, but without myoclonus.
Collapse
Affiliation(s)
- T Back
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
| | | | | | | | | |
Collapse
|
32
|
Gericke CA, Zschenderlein R, Ludolph AC. Amyotrophic lateral sclerosis associated with multiple myeloma, endocrinopathy and skin changes suggestive of a POEMS syndrome variant. J Neurol Sci 1995; 129 Suppl:58-60. [PMID: 7595623 DOI: 10.1016/0022-510x(95)00065-a] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- C A Gericke
- Department of Neurology, University Clinic Charité, Humboldt University, Berlin, Germany
| | | | | |
Collapse
|
33
|
Fuhrmann E, Pfeiffer L, Zschenderlein R, Leonhardt T, Melster U, Kölmel HW. [Clinico-genetic diagnosis of ataxia telangiectatica (Louis-Bar syndrome)]. Nervenarzt 1993; 64:140-2. [PMID: 8450897] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We describe the possible difficulties in getting the diagnosis "ataxia telangiectasia" using the example of a 16 years old girl. If cases of cerebellar ataxia in childhood present without classical symptoms, the diagnosis of ataxia telangiectasia should not be excluded before chromosome analysis. In our case, first signs of cerebellar ataxia were observed from the age of 11 years and we found only mild, atypical located and late onset telangiectasis. Other signs of the syndrome, such as elevated alpha-fetoproteine and deficiency of IgA or IgE could not be detected. Chromosome analysis, however, demonstrated a breakage syndrome with chromosome 14 to 7 translocation and established a firm diagnosis of ataxia telangiectasia. Patients with chromosome breakage syndromes including the Louis-Bar-syndrome have an increased risk for malignomas. Therefore chromosome analysis should be undertaken in cases of children with cerebellar ataxia, and frequent radiological examination avoided.
Collapse
Affiliation(s)
- E Fuhrmann
- Neurologische Klinik, Medizinische Fakultät (Charité), Humboldt-Universität, Berlin
| | | | | | | | | | | |
Collapse
|
34
|
Hendrich A, Hertel G, Schmehl I, Zschenderlein R. Frequency of HLA-antigens in a group of North-East German patients with myasthenia gravis. J Autoimmun 1991. [DOI: 10.1016/0896-8411(91)90100-q] [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: 11/28/2022]
|
35
|
Schöffel M, Zschenderlein R, Michalik M. [Cyclophosphamide therapy in multiple sclerosis]. Psychiatr Neurol Med Psychol (Leipz) 1990; 42:298-304. [PMID: 2201987] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- M Schöffel
- Abteilung Neurologie, Bereiches Medizin (Charité), Humboldt-Universität zu Berlin
| | | | | |
Collapse
|
36
|
Zettler H, Michalik M, Zschenderlein R. [Standardized monitoring of brain function]. Psychiatr Neurol Med Psychol (Leipz) 1984; 36:604-11. [PMID: 6514860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A form is described for recording the results obtained when monitoring the brain function in cases of severe acute brain damage. The form follows the principles introduced in other countries for recording the results of similar standard examinations, but the symptoms and scalings have been modified to suit the author's requirements. The state consciousness as shown by the opening of the eyes, verbal response and motor reactions to various stimuli is considered essential for the continuous monitoring of the brain function, as are also the dilation of the pupile and their response to light and the vestibuloocular reaction. The form also contains entries for respiration, blood pressure, heart rate and body temperature. The neurological symptoms have been selected on the basis of their diagnostic value, consistency and simplicity of examination and interpretation. The advantages of a standard examination scheme are explained. Advice is given regarding the examination of the different symptoms.
Collapse
|
37
|
Schulze HA, Zettler H, Zschenderlein R, Schmidt D. [Correlations between clinical and pathologic findings in comatose states]. Cesk Neurol Neurochir 1980; 43:89-92. [PMID: 7363355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
38
|
Schulze HA, Nickel B, Zschenderlein R. [A paraneoplastic syndrome with symptoms of Harada's disease]. Psychiatr Neurol Med Psychol (Leipz) 1978; 30:397-401. [PMID: 704703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As a contribution to the question of participation of the central nervous system in paraneoplastic syndromes an unusual case of hypernephrotic carcinoma with heavy immunopathological disturbances and clinical symptoms like Harada's syndrome is reported. The development of the 63 years old patient's disease, the clinical, haematological, CSF-, biochemical and other laboratory as well as neuroradiological and electrophysiological findings are discussed in detail. Immunosuppressive treatment after nephrectomy repeatedly led to a distinct improvement.
Collapse
|
39
|
Nickel B, Haas W, Zschenderlein R, Planitzer J. [Aqueduct syndrome]. Psychiatr Neurol Med Psychol (Leipz) 1976; 28:623-9. [PMID: 1019264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|