1
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Trenkwalder C, Tinelli M, Sakkas GK, Dauvilliers Y, Ferri R, Rijsman R, Oertel W, Jaarsma J. Socioeconomic impact of restless legs syndrome and inadequate restless legs syndrome management across European settings. Eur J Neurol 2020; 28:691-706. [PMID: 33043569 DOI: 10.1111/ene.14582] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
Restless legs syndrome (RLS) is one of the most common neurological disorders. It describes an irresistible urge to move the legs, mostly manifested in the evening and at night, which can lead to severe sleep disturbance. As part of the European Brain Council (EBC)-led Value-of-Treatment project, this study aimed at capturing the socioeconomic impact of RLS related to the inadequate diagnosis and treatment across different European healthcare settings. The economic burden of RLS was estimated using the published EBC framework of analysis in three separate European Union healthcare systems (France, Germany, and Italy). The RLS care pathway was mapped to identify the unmet needs of patients. Based on specific patient stories, the economic impact of correctly diagnosing RLS and changing between inadequate and target treatment was calculated using appropriate scenario analysis. RLS proved to be a significant personal and social burden, when epidemiological data, high prevalence of RLS, and its need for treatment are combined. By looking at the savings emerging from the provision of optimal care management (timely and correct diagnosis, evidence-based therapy, avoidance of therapy-related complications such as augmentation), the authors foresee substantial economic savings with the achievement of adequate diagnosis and treatment of RLS. Education about RLS is urgently needed for all subspecialties involved in RLS patient care as well as the general public. Equally important, the search for new causal treatment strategies should be intensified to reduce suffering and substantial societal cost.
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Affiliation(s)
- C Trenkwalder
- Paracelsus-Elena Klinik Kassel, Kassl, Germany.,Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - M Tinelli
- Personal Social Services Research Unit, London School of Economics, London, United Kingdom
| | - G K Sakkas
- School of Sports and Nutritional Sciences, University of Thessaly, Greece, United Kingdom.,School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Y Dauvilliers
- Reference National Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, INSERM U1061, University of Montpellier, Montpellier, France
| | - R Ferri
- Oasi Research Institute-IRCCS, Troina, Italy
| | - R Rijsman
- Centre for Sleep and Wake Disorders, Department of Clinical Neurophysiology, Medical Center Haaglanden, The Hague, the Netherlands
| | - W Oertel
- Department of Neurology, University Clinic, Philipps University Marburg, Marburg, Germany.,European Brain Council, Brussels, Belgium.,European Academy of Neurology, Wien, Austria
| | - J Jaarsma
- European Brain Council, Brussels, Belgium.,European Alliance for Restless Legs Syndrome, Amsterdam, the Netherlands.,European Federation of Neurological Associations, Brussels, Belgium
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2
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Dodel R, Tinelli M, Deuschl G, Petersen G, Oertel W, Ahmerkamp-Böhme J. The economic benefit of timely, adequate, and adherence to Parkinson's disease treatment: the Value of Treatment Project 2. Eur J Neurol 2020; 28:707-716. [PMID: 33048415 DOI: 10.1111/ene.14584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a chronic progressive neurological disorder with a high psychosocial and economic burden. As part of the European Brain Council (EBC)-led Value of Treatment project, this study aimed to capture the economic benefit of timely, adequate, and adherence to PD treatment. METHODS The EBC Value of Treatment Initiative combined different stakeholders to identify unmet needs in the patients' journey according to Rotterdam methodology. The economic evaluation focused on three major topics identified as major gaps: start of treatment; best treatment for advanced disease; and adherence to treatment. Two separate healthcare systems (Germany and the UK) were chosen. Cost-effectiveness was determined by using decision-analytical modelling approaches. Effectiveness was expressed as quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio (ICER). RESULTS Treatment intervention in PD was found to be cost-effective regardless of the initial health state of the patient receiving the treatment. Cost savings were between -€1000 and -€5400 with 0.10 QALY gain and -€1800 and -€7600 with 0.10 QALY gain for Germany and the UK, respectively. Treatment remains cost-effective within the National Institute for Health and Care Excellence thresholds. Availability of adequate treatment to more patients was also found to be cost-effective, with an ICER of €15,000-€32,600 across country settings. Achieving the target adherence to treatment would generate cost-savings of €239,000-€576,000 (Germany) and €917,000-€2,980.000 (UK) for every 1,000 patients treated adequately. CONCLUSIONS The analyses confirmed that timely, adequate, and adherence to PD treatment will not only improve care of the patients but is also cost-effective across healthcare systems. Further studies with a distinct identification of gaps in care are necessary to develop better and affordable care.
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Affiliation(s)
- R Dodel
- Department of Geriatric Medicine, University Duisburg-Essen, Essen, Germany
| | - M Tinelli
- Care Policy Evaluation Centre (CPEC), London School of Economics and Political Science (LSE), London, UK
| | - G Deuschl
- Department of Neurology, UKSH, Christian-Albrechts University, Kiel, Germany
| | | | - W Oertel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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3
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Krohn L, Ruskey J, Rudakou U, Leveille E, Asayesh F, Hu M, Arnulf I, Dauvilliers Y, Högl B, Stefani A, Monaca C, Abril B, Plazzi G, Antelmi E, Ferini-Strambi L, Heidbreder A, Boeve B, Espay A, Cochen de Cock V, Mollenhauer B, Sixel-Döring F, Trenkwalder C, Sonka K, Kemlink D, Figorilli M, Puligheddu M, Dijkstra F, Viaene M, Oertel W, Janzen A, Toffoli M, Gigli G, Valente M, Gagnon JF, Desautels A, Montplaisir J, Postuma R, Rouleau G, Gan-Or Z. GBA variants in REM sleep behavior disorder risk and conversion: a multicenter study. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.118] [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: 10/22/2022]
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4
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Mufti K, Rudakou U, Yu E, Ruskey J, Asavesh F, Laurent S, Arnulf I, Hu M, Dauvilliers Y, Högl B, Stefani A, Holzknecht E, Monaca C, Abril B, Plazzi G, Antelmi E, Ferini-Strambi L, Heidbreder A, Young P, De Cock VC, Mollenhauer B, Sixel-Döring F, Trenkwalder C, Sonka K, Kemlink D, Figorilli M, Puligheddu M, Dijkstra F, Viaene M, Oertel W, Boeve B, Gigli G, Valente M, Gagnon JF, Desautels A, Montplaisir J, Postuma R, Rouleau G, Gan-Or Z. Analysis of dominant and recessive parkinsonism genes in REM sleep behavior disorder. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.121] [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: 10/22/2022]
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5
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Chahine LM, Iranzo A, Fernández-Arcos A, Simuni T, Seedorff N, Caspell-Garcia C, Amara AW, Comella C, Högl B, Hamilton J, Marek K, Mayer G, Mollenhauer B, Postuma R, Tolosa E, Trenkwalder C, Videnovic A, Oertel W. Basic clinical features do not predict dopamine transporter binding in idiopathic REM behavior disorder. NPJ Parkinsons Dis 2019; 5:2. [PMID: 30701189 PMCID: PMC6351563 DOI: 10.1038/s41531-018-0073-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/03/2018] [Indexed: 12/02/2022]
Abstract
REM sleep behavior disorder (RBD) is strongly associated with development of Parkinson’s Disease and other α-synuclein-related disorders. Dopamine transporter (DAT) binding deficit predicts conversion to α-synuclein-related disorders in individuals with RBD. In turn, identifying which individuals with RBD have the highest likelihood of having abnormal DAT binding would be useful. The objective of this analysis was to examine if there are basic clinical predictors of DAT deficit in RBD. Participants referred for inclusion in the RBD cohort of the Parkinson Progression Markers Initiative were included. Assessments at the screening visit including DAT SPECT imaging, physical examination, cognitive function screen, and questionnaire-based non-motor assessment. The group with DAT binding deficit (n = 49) was compared to those without (n = 26). There were no significant differences in demographic or clinical features between the two groups. When recruiting RBD cohorts enriched for high risk of neurodegenerative disorders, our data support the need for objective biomarker assessments. The clinical characteristics of patients with rapid eye movement sleep behavior disorder (RBD) are not associated with reduced dopamine transporter binding, an established imaging biomarker of Parkinson’s Disease (PD). Because around 80 percent of patients with RBD develop PD, there is great hope that research on these patients will help uncover early signs of the disease and guide the development of neuroprotective therapies. Lana Chahine at The University of Pittsburgh, USA, and colleagues in the Parkinson Progression Markers Initiative (PPMI) Sleep Working Group analyzed the clinical features of 75 individuals with RBD. They found no significant differences in demographic features or in motor and non-motor symptoms between RBD patients with dopamine transporter binding deficit and those without. These findings highlight the need to assess dopamine transporter binding to determine the future risk of PD.
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Affiliation(s)
- L M Chahine
- 1Department of Neurology, The University of Pittsburgh, Pittsburgh, PA USA
| | - A Iranzo
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - A Fernández-Arcos
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - T Simuni
- 3Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - N Seedorff
- 4Department of Biostatistics, The University of Iowa, Iowa City, IA USA
| | - C Caspell-Garcia
- 4Department of Biostatistics, The University of Iowa, Iowa City, IA USA
| | - A W Amara
- 5Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL USA
| | - C Comella
- 6Department of Neurology, Rush University, Chicago, IL USA
| | - B Högl
- 7Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - J Hamilton
- 8The Michael J. Fox Foundation for Parkinson's Research, New York, NY USA
| | - K Marek
- 9Institute for Neurodegenerative Disorders, New Haven, CT USA
| | - G Mayer
- Department of Neurology, Hephata-Klinik, Hephata Hessisches Diakoniezentrum, e.V, Weibersbrunn, Germany
| | - B Mollenhauer
- 11Department of Neurology, University Medical Center, Göttingen, Germany.,12Paracelsus-Elena-Klinik, Kassel, Germany
| | - R Postuma
- 13Division of Neurology, McGill University, Montreal, QC Canada
| | - E Tolosa
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - C Trenkwalder
- 11Department of Neurology, University Medical Center, Göttingen, Germany.,12Paracelsus-Elena-Klinik, Kassel, Germany
| | - A Videnovic
- 14Department of Neurology, Massachusetts General Hospital, Boston, MA USA
| | - W Oertel
- 15Department of Neurology, Philipps University, Marburg, Germany.,16Charitable Hertie Foundation, Frankfurt/Main, Germany
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Maetzler W, Krüger R, Müller T, Oertel W, Urban P, Warnecke T, Klucken J. [Wearable Technique for the Assessment of Parkinson Symptoms: What's the Future?]. Fortschr Neurol Psychiatr 2016; 84 Suppl 1:S48-51. [PMID: 27276073 DOI: 10.1055/s-0042-102786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Parkinson's disease (PD) is a multisystem disorder with a plethora of symptoms affecting the quality of life of patients in the home environment. Due to the rapid development of wearable technique in the health and fitness sector, an increasing number of such wearable devices are available to complement diagnostic strategies of PD symptoms not only in the clinical but also in the home environment. This development has clear advantages over clinical evaluation, as the latter is relatively subjective, time-consuming and costly, and provides only a snapshot of the condition. First results about the use of such technology for the assessment of PD symptoms (including bradykinesia, dyskinesia, tremor, daily activity and sleep behavior) in the home environment are promising. They suggest that these techniques can provide complementary information about the symptoms of PD patients, and have the potential to be included in future diagnostic workup concepts of routine care in PD. The use of such technique provides also the opportunity to more actively include patients into medical decision-making processes.
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Affiliation(s)
- W Maetzler
- Neurologie mit Schwerpunkt Neurodegeneration und Hertie Institut für klinische Hirnforschung, Universitätsklinikum Tübingen, Tübingen
| | - R Krüger
- Neurologie mit Schwerpunkt Neurodegeneration und Hertie Institut für klinische Hirnforschung, Universitätsklinikum Tübingen, Tübingen
| | - T Müller
- Klinik für Neurologie, St. Joseph Krankenhaus Berlin-Weißensee, Berlin
| | - W Oertel
- Klinik für Neurologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg
| | - P Urban
- Abteilung für Neurologie, Asklepios Klinik Barmbek, Hamburg
| | - T Warnecke
- Department für Neurologie, Universitätsklinikum Münster, Münster
| | - J Klucken
- Molekulare Neurologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
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7
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Morris RGM, Oertel W, Gaebel W, Goodwin GM, Little A, Montellano P, Westphal M, Nutt DJ, Di Luca M. Consensus Statement on European Brain Research: the need to expand brain research in Europe - 2015. Eur J Neurosci 2016; 44:1919-26. [PMID: 26990697 DOI: 10.1111/ejn.13236] [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: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R G M Morris
- Federation of European Neuroscience Societies (FENS), Bruxelles, Belgium
| | - W Oertel
- European Academy of Neurology (EAN), Vienna, Austria
| | - W Gaebel
- European Psychiatric Association (EPA), Strasburg, France
| | - G M Goodwin
- European College of Neuropsychopharmacology (ECNP), Utrecht, The Netherlands
| | - A Little
- European Federation of Neurological Associations (EFNA), Bruxelles, Belgium
| | - P Montellano
- Global Alliance of Mental Illness Advocacy Networks-Europe (Gamian-Europe), Bruxelles, Belgium
| | - M Westphal
- European Association of Neurosurgical Societies (EANS), Gent, Belgium
| | - D J Nutt
- European Brain Council, Bruxelles, Belgium
| | - M Di Luca
- Federation of European Neuroscience Societies (FENS), Bruxelles, Belgium.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9-20133, Milan, Italy
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8
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Menzler K, Hausdörfer M, Mayer C, Belke M, Gerstner A, Teepker M, Werner R, Hamer H, Oertel W, Rosenow F, Knake S. P99. Predictors of new cerebral microbleeds in patients with antiplatelet drug therapy. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Bujan B, Ginzburg E, Oertel W, Bürk K. Parkinson-Syndrome: Aspekte der sozialmedizinischen Versorgung. REHABILITATION 2015; 54:81-5. [DOI: 10.1055/s-0034-1394444] [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)
- B. Bujan
- Klinik für Neurologie, MediClin Reha-Zentrum Bad Orb
| | - E. Ginzburg
- Klinik für Neurologie, MediClin Reha-Zentrum Bad Orb
| | - W. Oertel
- Neurologische Klinik, Philipps Universität Marburg
| | - K. Bürk
- Neurologische Klinik, Philipps Universität Marburg
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10
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Oertel W, Hacke W. [Interdisciplinary neuromedicine]. Nervenarzt 2014; 85:927. [PMID: 25078386 DOI: 10.1007/s00115-014-4034-6] [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: 06/03/2023]
Affiliation(s)
- W Oertel
- Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
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11
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Grond M, Gold R, Oertel W. Handlungsrichtlinien der Deutschen Gesellschaft für Neurologie im Umgang mit wirtschaftlichen Interessen im Gesundheitswesen. Akt Neurol 2014. [DOI: 10.1055/s-0034-1370137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Menzler K, Belke M, Heverhagen J, Keil B, Oertel W, Rosenow F, Stiasny-Kolster K, Knake S. Diffusions Tensor Bildgebung zeigt Veränderungen der weißen Substanz bei Patienten mit Restless legs Syndrom. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Scheidt CE, Heinen F, Nickel T, Rayki O, Wissel J, Poewe W, Benecke R, Arnold G, Oertel W, Dengler R, Deuschl G. Spasmodic torticollis - a multicentre study on behavioural aspects IV: psychopathology. Behav Neurol 2014; 9:97-103. [PMID: 24487493 DOI: 10.3233/ben-1996-9206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The GSI (General Symptom Index) of the Symptom Checklist 90 R (SCL 90 R) (as a global indicator of the severity of psychiatric symptoms) of 27% of the spasmodic torticollis (ST) sample fell outside the 95% range of the normal control group (two standard deviations). Patients with a higher GSI were younger, more functionally disabled and subject to higher psychosocial stress due to the illness. The highest scores were reached on the subscales of somatization, interpersonal sensitivity and depression. On the depression scale, 23% of the patients' scores were abnormal. This scale correlated significantly with the neurological signs, particularly the TSUI-index and laterocollis. A statistically significant correlation also existed between psychiatric morbidity and a family history of mental disorder. More than 50% of the patients reported that stressful life events had triggered their illness. In order of frequency, a death came first, followed by marital strife, changes in employment and family arguments. The data suggest that psychopathology in ST should generally be considered as a result of a variety of interacting factors, biological, psychological and social.
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Affiliation(s)
- C E Scheidt
- Abteilung für Psychotherapie und Psychosomatik, Universität Freiburg, Germany
| | - F Heinen
- Neurologische Klinik und Poliklinik, Universität Freiburg, Germany
| | - T Nickel
- Abteilung für Psychotherapie und Psychosomatik, Universität Freiburg, Germany
| | - O Rayki
- Abteilung für Psychotherapie und Psychosomatik, Universität Freiburg, Germany
| | - J Wissel
- Neurologische Klinik, Rudolf-Virchow-Krankenhaus, Humboldt-Universität Berlin, Germany
| | - W Poewe
- Neurologische Klinik, Rudolf-Virchow-Krankenhaus, Humboldt-Universität Berlin, Germany
| | - R Benecke
- Neurologische Klinik, Universität Düsseldorf, Germany
| | - G Arnold
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Germany
| | - W Oertel
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Germany
| | - R Dengler
- Neurologische Klinik, Medizinische Hochschule Hannover, Germany
| | - G Deuschl
- Neurologische Klinik und Poliklinik, Universität Freiburg, Germany
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14
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Schenck C, Montplaisir J, Frauscher B, Hogl B, Gagnon JF, Postuma R, Sonka K, Jennum P, Partinen M, Arnulf I, de Cock VC, Dauvilliers Y, Luppi PH, Heidbreder A, Mayer G, Sixel-Döring F, Trenkwalder C, Unger M, Young P, Wing Y, Ferini-Strambi L, Ferri R, Plazzi G, Zucconi M, Inoue Y, Iranzo A, Santamaria J, Bassetti C, Möller J, Boeve B, Lai Y, Pavlova M, Saper C, Schmidt P, Siegel J, Singer C, St Louis E, Videnovic A, Oertel W. Corrigendum to “Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group” [Sleep Med 14(8) (2013) 795–806]. Sleep Med 2014. [DOI: 10.1016/j.sleep.2013.11.001] [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: 10/26/2022]
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15
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Oertel W, Riemann D, Pollmächer T. [Sleep]. Nervenarzt 2014; 85:7-8. [PMID: 24441881 DOI: 10.1007/s00115-013-3847-z] [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: 06/03/2023]
Affiliation(s)
- W Oertel
- Klinik für Neurologie, Philipps-Universität Marburg, Baldingerstr., 35043, Marburg, Deutschland,
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16
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Oertel W, Vadasz D, Ries V, Mayer G, Eggert K, Krenzer M, Unger M, Höglinger G, Mollenhauer B, Sixel-Döring F, Trenkwalder C, Depboylu C. Prodromale Marker der Parkinson-Krankheit. Akt Neurol 2013. [DOI: 10.1055/s-0033-1355379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- W. Oertel
- Klinik für Neurologie, Philipps-Universität, Marburg
| | - D. Vadasz
- Klinik für Neurologie, Philipps-Universität, Marburg
| | - V. Ries
- Klinik für Neurologie, Philipps-Universität, Marburg
| | - G. Mayer
- Hephata-Klinik, Klinik für Neurologie, Schwalmstadt-Treysa
| | - K. Eggert
- Klinik für Neurologie, Philipps-Universität, Marburg
| | - M. Krenzer
- Klinik für Neurologie, Philipps-Universität, Marburg
| | - M. Unger
- Klinik für Neurologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - G. Höglinger
- Klinik für Neurologie, Technische Universität, München
| | - B. Mollenhauer
- Zentrum für Parkinson-Syndrome und Bewegungsstörungen, Paracelsus-Elena Klinik, Kassel
| | - F. Sixel-Döring
- Zentrum für Parkinson-Syndrome und Bewegungsstörungen, Paracelsus-Elena Klinik, Kassel
| | - C. Trenkwalder
- Zentrum für Parkinson-Syndrome und Bewegungsstörungen, Paracelsus-Elena Klinik, Kassel
| | - C. Depboylu
- Klinik für Neurologie, Philipps-Universität, Marburg
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Krogias C, Tsivgoulis G, Grond M, Hartung H, Hemmer B, Oertel W, Wiendl H, Gold R. Übersicht und Analyse internationaler Fall-Kontroll-Studien zu „Chronischen zerebrospinalen venösen Insuffizienz“ (CCSVI) und Multipler Sklerose. Akt Neurol 2013. [DOI: 10.1055/s-0033-1351271] [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: 10/26/2022]
Affiliation(s)
- C. Krogias
- Neurologische Klinik, St. Josef-Hospital Bochum, Ruhr-Universität Bochum
| | - G. Tsivgoulis
- Klinik für Neurologie, „Attikon“ Hospital, Universität Athen, Griechenland
| | - M. Grond
- Klinik für Neurologie, Kreisklinikum Siegen
| | - H. Hartung
- Neurologische Klinik, Heinrich-Heine Universität Düsseldorf
| | - B. Hemmer
- Neurologische Klinik, Klinikum rechts der Isar, Technische Universität München
| | - W. Oertel
- Klinik für Neurologie, Philipps-Universität Marburg
| | - H. Wiendl
- Klinik für Neurologie, Universitätsklinikum Münster
| | - R. Gold
- Neurologische Klinik, St. Josef-Hospital Bochum, Ruhr-Universität Bochum
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Srulijes K, Hauser AK, Guella I, Asselta R, Brockmann K, Schulte C, Soldà G, Cilia R, Maetzler W, Schols L, Wenning GK, Poewe W, Barone P, Wüllner U, Oertel W, Berg D, Goldwurm S, Gasser T. No association of GBA mutations and multiple system atrophy. Eur J Neurol 2013; 20:e61-2. [PMID: 23490118 DOI: 10.1111/ene.12086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/30/2012] [Indexed: 11/28/2022]
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Schenck CH, Montplaisir JY, Frauscher B, Hogl B, Gagnon JF, Postuma R, Sonka K, Jennum P, Partinen M, Arnulf I, Cochen de Cock V, Dauvilliers Y, Luppi PH, Heidbreder A, Mayer G, Sixel-Döring F, Trenkwalder C, Unger M, Young P, Wing YK, Ferini-Strambi L, Ferri R, Plazzi G, Zucconi M, Inoue Y, Iranzo A, Santamaria J, Bassetti C, Möller JC, Boeve BF, Lai YY, Pavlova M, Saper C, Schmidt P, Siegel JM, Singer C, St Louis E, Videnovic A, Oertel W. Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy--a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group. Sleep Med 2013; 14:795-806. [PMID: 23886593 DOI: 10.1016/j.sleep.2013.02.016] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 01/25/2013] [Accepted: 02/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We aimed to provide a consensus statement by the International Rapid Eye Movement Sleep Behavior Disorder Study Group (IRBD-SG) on devising controlled active treatment studies in rapid eye movement sleep behavior disorder (RBD) and devising studies of neuroprotection against Parkinson disease (PD) and related neurodegeneration in RBD. METHODS The consensus statement was generated during the fourth IRBD-SG symposium in Marburg, Germany in 2011. The IRBD-SG identified essential methodologic components for a randomized trial in RBD, including potential screening and diagnostic criteria, inclusion and exclusion criteria, primary and secondary outcomes for symptomatic therapy trials (particularly for melatonin and clonazepam), and potential primary and secondary outcomes for eventual trials with disease-modifying and neuroprotective agents. The latter trials are considered urgent, given the high conversion rate from idiopathic RBD (iRBD) to Parkinsonian disorders (i.e., PD, dementia with Lewy bodies [DLB], multiple system atrophy [MSA]). RESULTS Six inclusion criteria were identified for symptomatic therapy and neuroprotective trials: (1) diagnosis of RBD needs to satisfy the International Classification of Sleep Disorders, second edition, (ICSD-2) criteria; (2) minimum frequency of RBD episodes should preferably be ⩾2 times weekly to allow for assessment of change; (3) if the PD-RBD target population is included, it should be in the early stages of PD defined as Hoehn and Yahr stages 1-3 in Off (untreated); (4) iRBD patients with soft neurologic dysfunction and with operational criteria established by the consensus of study investigators; (5) patients with mild cognitive impairment (MCI); and (6) optimally treated comorbid OSA. Twenty-four exclusion criteria were identified. The primary outcome measure for RBD treatment trials was determined to be the Clinical Global Impression (CGI) efficacy index, consisting of a four-point scale with a four-point side-effect scale. Assessment of video-polysomnographic (vPSG) changes holds promise but is costly and needs further elaboration. Secondary outcome measures include sleep diaries; sleepiness scales; PD sleep scale 2 (PDSS-2); serial motor examinations; cognitive indices; mood and anxiety indices; assessment of frequency of falls, gait impairment, and apathy; fatigue severity scale; and actigraphy and customized bed alarm systems. Consensus also was established for evaluating the clinical and vPSG aspects of RBD. End points for neuroprotective trials in RBD, taking lessons from research in PD, should be focused on the ultimate goal of determining the performance of disease-modifying agents. To date no compound with convincing evidence of disease-modifying or neuroprotective efficacy has been identified in PD. Nevertheless, iRBD patients are considered ideal candidates for neuroprotective studies. CONCLUSIONS The IRBD-SG provides an important platform for developing multinational collaborative studies on RBD such as on environmental risk factors for iRBD, as recently reported in a peer-reviewed journal article, and on controlled active treatment studies for symptomatic and neuroprotective therapy that emerged during the 2011 consensus conference in Marburg, Germany, as described in our report.
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Affiliation(s)
- C H Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA.
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Berardelli A, Wenning GK, Antonini A, Berg D, Bloem BR, Bonifati V, Brooks D, Burn DJ, Colosimo C, Fanciulli A, Ferreira J, Gasser T, Grandas F, Kanovsky P, Kostic V, Kulisevsky J, Oertel W, Poewe W, Reese JP, Relja M, Ruzicka E, Schrag A, Seppi K, Taba P, Vidailhet M. EFNS/MDS-ES/ENS [corrected] recommendations for the diagnosis of Parkinson's disease. Eur J Neurol 2013; 20:16-34. [PMID: 23279440 DOI: 10.1111/ene.12022] [Citation(s) in RCA: 323] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/18/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson's disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD. METHODS Following the EFNS instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations. RESULTS For the clinical diagnosis, we recommend the use of the Queen Square Brain Bank criteria (Level B). Genetic testing for specific mutations is recommended on an individual basis (Level B), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate PD from other parkinsonian disorders including recessive forms (Level A). Screening for pre-motor PD with olfactory testing requires additional tests due to limited specificity. Drug challenge tests are not recommended for the diagnosis in de novo parkinsonian patients. There is an insufficient evidence to support their role in the differential diagnosis between PD and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for REM sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected PD cases (Level A). Transcranial sonography is recommended for the differentiation of PD from atypical and secondary parkinsonian disorders (Level A), for the early diagnosis of PD and in the detection of subjects at risk for PD (Level A), although the technique is so far not universally used and requires some expertise. Because specificity of TCS for the development of PD is limited, TCS should be used in conjunction with other screening tests. Conventional magnetic resonance imaging and diffusion-weighted imaging at 1.5 T are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (MSA) or progressive supranuclear palsy versus PD on the basis of regional atrophy and signal change as well as diffusivity patterns (Level A). DaTscan SPECT is registered in Europe and the United States for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level A). More specifically, DaTscan is indicated in the presence of significant diagnostic uncertainty such as parkinsonism associated with neuroleptic exposure and atypical tremor manifestations such as isolated unilateral postural tremor. Studies of [(123) I]MIBG/SPECT cardiac uptake may be used to identify patients with PD versus controls and MSA patients (Level A). All other SPECT imaging studies do not fulfil registration standards and cannot be recommended for routine clinical use. At the moment, no conclusion can be drawn as to diagnostic efficacy of autonomic function tests, neurophysiological tests and positron emission tomography imaging in PD. CONCLUSIONS The diagnosis of PD is still largely based on the correct identification of its clinical features. Selected investigations (genetic, olfactory, and neuroimaging studies) have an ancillary role in confirming the diagnosis, and some of them could be possibly used in the near future to identify subjects in a pre-symptomatic phase of the disease.
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Affiliation(s)
- A Berardelli
- Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute, Sapienza, Università di Roma, Rome, Italy.
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Mayer G, Kesper K, Oertel W, Stiasny-Kolster K, Höffken H, Tsintaris A. REM Schlafverhaltensstörung (RBD) bei Narkolepsie als Prädiktor einer Neurodegeneration: Ergebnisse klinischer und bildgebender prospektiver Untersuchungen. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337147] [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: 10/27/2022]
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Diener H, Weimar C, Berlit P, Deuschl G, Elger C, Gerloff C, Gold R, Hacke W, Hufschmidt A, Mattle H, Meier U, Oertel W, Reichmann H, Schmutzhard E, Wallesch CW, Weller M, Kopp I, Olma M, Heuschmann P. Wie entstehen die Leitlinien der Deutschen Gesellschaft für Neurologie? Akt Neurol 2013. [DOI: 10.1055/s-0032-1331691] [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: 10/27/2022]
Affiliation(s)
- H. Diener
- Universitätsklinik für Neurologie, Essen
| | - C. Weimar
- Universitätsklinik für Neurologie, Essen
| | - P. Berlit
- Neurologische Klinik Alfried Krupp Krankenhaus Essen
| | - G. Deuschl
- Neurologische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel. Universität Kiel
| | - C. Elger
- Klinik für Epileptologie, Universität Bonn
| | - C. Gerloff
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße. 52, 20246 Hamburg, Deutschland
| | - R. Gold
- Neurologische Klinik, St. Josef Hospital, Kliniken der Ruhr Univ. Bochum
| | - W. Hacke
- Neurologische Universitätsklinik Heidelberg
| | - A. Hufschmidt
- Klinik für Neurologie, St. Elisabeth Krankenhaus Wittlich
| | - H. Mattle
- Universitätsklinik für Neurologie, Inselspital, Bern
| | - U. Meier
- Neurologische Gemeinschaftspraxis Grevenbroich, Vorsitzender des BDN
| | - W. Oertel
- Klinik für Neurologie, Philipps Universität Marburg, 1. Vorsitzender der DGN
| | - H. Reichmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | | | | | - M. Weller
- Klinik für Neurologie, Universitätsspital Zürich, Schweiz
| | - I. Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - M. Olma
- Centrum für Schlaganfallforschung, Charité – Universitätsmedizin Berlin
| | - P. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg; Deutsches Zentrum für Herzinsuffizienz, Universität Würzburg; Zentrale für Klinische Studien, Universitätsklinikum Würzburg
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Postuma RB, Montplaisir JY, Pelletier A, Dauvilliers Y, Oertel W, Iranzo A, Ferini-Strambi L, Arnulf I, Hogl B, Manni R, Miyamoto T, Mayer G, Stiasny-Kolster K, Puligheddu M, Ju Y, Jennum P, Sonka K, Santamaria J, Fantini ML, Zucconi M, Leu-Semenescu S, Frauscher B, Terzaghi M, Miyamoto M, Unger MM, Cochen De Cock V, Wolfson C. Environmental risk factors for REM sleep behavior disorder: a multicenter case-control study. Neurology 2012; 79:428-34. [PMID: 22744670 DOI: 10.1212/wnl.0b013e31825dd383] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [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
OBJECTIVE Idiopathic REM sleep behavior disorder is a parasomnia characterized by dream enactment and is commonly a prediagnostic sign of parkinsonism and dementia. Since risk factors have not been defined, we initiated a multicenter case-control study to assess environmental and lifestyle risk factors for REM sleep behavior disorder. METHODS Cases were patients with idiopathic REM sleep behavior disorder who were free of dementia and parkinsonism, recruited from 13 International REM Sleep Behavior Disorder Study Group centers. Controls were matched according to age and sex. Potential environmental and lifestyle risk factors were assessed via standardized questionnaire. Unconditional logistic regression adjusting for age, sex, and center was conducted to investigate the environmental factors. RESULTS A total of 694 participants (347 patients, 347 controls) were recruited. Among cases, mean age was 67.7 ± 9.6 years and 81.0% were male. Cases were more likely to smoke (ever smokers = 64.0% vs 55.5%, adjusted odds ratio [OR] = 1.43, p = 0.028). Caffeine and alcohol use were not different between cases and controls. Cases were more likely to report previous head injury (19.3% vs 12.7%, OR = 1.59, p = 0.037). Cases had fewer years of formal schooling (11.1 ± 4.4 years vs 12.7 ± 4.3, p < 0.001), and were more likely to report having worked as farmers (19.7% vs 12.5% OR = 1.67, p = 0.022) with borderline increase in welding (17.8% vs 12.1%, OR = 1.53, p = 0.063). Previous occupational pesticide exposure was more prevalent in cases than controls (11.8% vs 6.1%, OR = 2.16, p = 0.008). CONCLUSIONS Smoking, head injury, pesticide exposure, and farming are potential risk factors for idiopathic REM sleep behavior disorder.
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Affiliation(s)
- R B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.
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Fogel W, Ehret R, Buhmann C, Bilsing A, Skodda S, Oertel W. Welche Probleme bestehen bei der Umsetzung der Leitlinien zur Diagnostik der Parkinson-Erkrankung? Konsensus der Arbeitsgruppe anlässlich des 12. Experten Meeting Parkinson in Frankfurt. Akt Neurol 2011. [DOI: 10.1055/s-0031-1301324] [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: 10/14/2022]
Affiliation(s)
- W. Fogel
- Deutsche Klinik für Diagnostik, Neurologie, Wiesbaden
| | - R. Ehret
- Neurologiepraxis, Neurologiepraxis, Berlin
| | - C. Buhmann
- Ambulantes Rehazentrum Hunsrück, Ambulantes Rehazentrum Hunsrück, Kastellaun
| | - A. Bilsing
- Universitätsklinikum Eppendorf, Neurologie, Hamburg
| | - S. Skodda
- Philipps University, of Neurology, Marburg
| | - W. Oertel
- Knappschaftskrankenhaus, Klinik für Neurologie, Bochum
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Eggert K, Oertel W. Apomorphintest. Akt Neurol 2011. [DOI: 10.1055/s-0030-1265946] [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: 10/18/2022]
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Von Reichmann H, Deuschl G, Riedel O, Spottke A, Förstl H, Henn F, Heuser I, Oertel W, Riederer P, Trenkwalder C, Dodel R, Wittchen HU. [The German Study on the Epidemiology of Parkinson's Disease with Dementia (GEPAD): more than Parkinson]. MMW Fortschr Med 2010; 152 Suppl 1:1-6. [PMID: 20942300] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED It is unknown, how frequently Parkinson's disease (PD) is complicated by dementia, depression and other neuropsychiatric conditions. An epidemiologic characterisation of the situation in specialised neurologic settings is lacking. The Geman Study on the Epidemiology of Parkinson's Disease with Dementia (GEPAD) isa national representative epidemiological study of n=1449 PD patients in n=315 office-based neurological settings, designed to estimate the prevalence of dementia, depression and other neuropsychiatric conditions in patients with PD of all stages by using standardized clinical assessments. RESULTS 28.6% met DSM-IV criteria for dementia. 33.6% met criteria for depression and 61% additionally had other clinically significant psychopathological syndromes. Only 29.4% had no neuropsychiatric conditions. GEPAD reveals for the first time comprehensively that the neuropsychiatric burden of PD patients in all stages and even early stages is considerable, posing challenging questions for research and clinical management.
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Affiliation(s)
- H Von Reichmann
- Klinik für Neurologie, Medizinische Fakultät Carl Gustav Carus Dresden
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Woitalla D, Braak H, Del Tredici K, Fogel W, Hagenah J, Oertel W, Berg D. [Transcraniel ultrasound in the differential diagnosis of Parkinson's disease]. Fortschr Neurol Psychiatr 2010; 78 Suppl 1:S25-30. [PMID: 20195938 DOI: 10.1055/s-0029-1245167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Imaging of the brain structure with transcranial ultrasound has become an important tool for the diagnosis and differential diagnosis of Parkinson's Disease. In up to 90 % of parkinsonian patients abnormal echogenity of the substantia nigra could be demonstrated. Particularly in the early diagnosis in subjects with only very mild extrapyramidal features and in the differential diagnosis to other neurodegenerative disorders with parkinsonian features, such as the parkinsonian variant of multisystematrophy (MSA-P) and progressive supranuclear paralysis (PSP) ultrasound has a high diagnostic yield. Because of a prevalence of about 10 % in the normal population, the evidence of an abnormal echogenity of the substantia nigra has to be interpreted carefully in the context of a clinical examination. Although there are a number of studies indicating that in some of these subjects a vulnerability of the nigrostriatal system can be found, the meaning of an abnormal echogenicity of the substantia nigra in the healthy population needs to be further elucidated in already ongoing research projects.
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Affiliation(s)
- D Woitalla
- Neurologische Universitätsklinik der Ruhr-Universität Bochum im St. Josef Hospital, Bochum.
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Oertel W, LeWitt P, Watts R, Grieger F, Bauer L, Boroojerdi B. P2.147 Treatment of patients with early and advanced Parkinson's disease with transdermal rotigotine: safety and tolerability in elderly patients. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70498-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oertel W. O.088 Treatment of sleep disorders in PD. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70103-8] [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: 10/20/2022]
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Jauss M, Oertel W, Allendoerfer J, Misselwitz B, Hamer H. Bias in request for medical care and impact on outcome during office and non-office hours in stroke patients. Eur J Neurol 2009; 16:1165-7. [DOI: 10.1111/j.1468-1331.2009.02656.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ludolph AC, Kassubek J, Landwehrmeyer BG, Mandelkow E, Mandelkow EM, Burn DJ, Caparros-Lefebvre D, Frey KA, de Yebenes JG, Gasser T, Heutink P, Höglinger G, Jamrozik Z, Jellinger KA, Kazantsev A, Kretzschmar H, Lang AE, Litvan I, Lucas JJ, McGeer PL, Melquist S, Oertel W, Otto M, Paviour D, Reum T, Saint-Raymond A, Steele JC, Tolnay M, Tumani H, van Swieten JC, Vanier MT, Vonsattel JP, Wagner S, Wszolek ZK. Tauopathies with parkinsonism: clinical spectrum, neuropathologic basis, biological markers, and treatment options. Eur J Neurol 2009; 16:297-309. [PMID: 19364361 DOI: 10.1111/j.1468-1331.2008.02513.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tauopathies with parkinsonism represent a spectrum of disease entities unified by the pathologic accumulation of hyperphosphorylated tau protein fragments within the central nervous system. These pathologic characteristics suggest shared pathogenetic pathways and possible molecular targets for disease-modifying therapeutic interventions. Natural history studies, for instance, in progressive supranuclear palsy, frontotemporal dementia with parkinsonism linked to chromosome 17, corticobasal degeneration, and Niemann-Pick disease type C as well as in amyotrophic lateral sclerosis/Parkinson-dementia complex permit clinical characterization of the disease phenotypes and are crucial to the development and validation of biological markers for differential diagnostics and disease monitoring, for example, by use of neuroimaging or proteomic approaches. The wide pathologic and clinical spectrum of the tauopathies with parkinsonism is reviewed in this article, and perspectives on future advances in the understanding of the pathogenesis are given, together with potential therapeutic strategies.
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Affiliation(s)
- A C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany.
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Mylius V, Jung M, Teepker M, Hattemer K, Haag A, Oertel W, Rosenow F. Anodal transcranial direct current stimulation of the dorsolateral prefrontal cortex decreases the perception of experimentally-induced pain: contribution of working memory? KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ludolph AC, Kassubek J, Landwehrmeyer BG, Mandelkow E, Mandelkow EM, Burn DJ, Caparros-Lefebvre D, Frey KA, de Yebenes JG, Gasser T, Heutink P, Höglinger G, Jamrozik Z, Jellinger KA, Kazantsev A, Kretzschmar H, Lang AE, Litvan I, Lucas JJ, McGeer PL, Melquist S, Oertel W, Otto M, Paviour D, Reum T, Saint-Raymond A, Steele JC, Tolnay M, Tumani H, van Swieten JC, Vanier MT, Vonsattel JP, Wagner S, Wszolek ZK. Tauopathies with parkinsonism: clinical spectrum, neuropathologic basis, biological markers, and treatment options. Eur J Neurol 2009. [PMID: 19364361 DOI: 10.1111/j.l468-1331.2008.02513.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Tauopathies with parkinsonism represent a spectrum of disease entities unified by the pathologic accumulation of hyperphosphorylated tau protein fragments within the central nervous system. These pathologic characteristics suggest shared pathogenetic pathways and possible molecular targets for disease-modifying therapeutic interventions. Natural history studies, for instance, in progressive supranuclear palsy, frontotemporal dementia with parkinsonism linked to chromosome 17, corticobasal degeneration, and Niemann-Pick disease type C as well as in amyotrophic lateral sclerosis/Parkinson-dementia complex permit clinical characterization of the disease phenotypes and are crucial to the development and validation of biological markers for differential diagnostics and disease monitoring, for example, by use of neuroimaging or proteomic approaches. The wide pathologic and clinical spectrum of the tauopathies with parkinsonism is reviewed in this article, and perspectives on future advances in the understanding of the pathogenesis are given, together with potential therapeutic strategies.
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Affiliation(s)
- A C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany.
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Staude G, Wolf W, Wierzbicka M, Oertel W, Dengler R. Die Abhängigkeit schneller willkürlicher Kontraktionen von der Tremorphase beim Parkinsonismus. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hacke W, Oertel W, Wick W, Hartung HP, Ringleb P, Diener HC. Die großen klinischen Studien - Evidenzbasierte Medizin in der Deutschen Neurologie. Akt Neurol 2007. [DOI: 10.1055/s-2007-971032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hasselbalch SG, Baloyannis S, Denislic M, Dubois B, Oertel W, Rossor M, Tsiskaridze A, Waldemar G. Education and training of European neurologists in dementia. Eur J Neurol 2007; 14:505-9. [PMID: 17437608 DOI: 10.1111/j.1468-1331.2006.01679.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to describe the present involvement of neurologists in dementia management in European countries. Data were obtained from a questionnaire that members of The European Federation of Neurological Societies Scientific Panel on Dementia responded to. Information was obtained from 25 countries in Europe. A progressive decrease in the teaching activity from medical school to board-certified neurologists was reported. Teaching of medical students in dementia is obligatory in most countries, whereas there is no formal obligatory education in dementia after graduation from medical school. Further, in only half of the countries that responded to the questionnaire, obligatory courses in dementia are part of the training in neurology. Except for one country, the post-graduate training programs of board-certified neurologists do not include dementia as an obligatory topic. In only 10 of 25 countries, guidelines for neurologists on dementia evaluation have been published in local language. It is recommended to include obligatory teaching and training in dementia in the catalogue of minimum requirements for specialist training in neurology and this teaching should also be part of the ongoing update of certified neurologists.
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MESH Headings
- Academic Medical Centers/standards
- Academic Medical Centers/statistics & numerical data
- Academic Medical Centers/trends
- Dementia/diagnosis
- Dementia/therapy
- Education, Medical, Continuing/standards
- Education, Medical, Continuing/statistics & numerical data
- Education, Medical, Continuing/trends
- Education, Medical, Graduate/standards
- Education, Medical, Graduate/statistics & numerical data
- Education, Medical, Graduate/trends
- Europe
- Humans
- Interdisciplinary Communication
- Internship and Residency/standards
- Internship and Residency/statistics & numerical data
- Internship and Residency/trends
- Neurology/education
- Patient Care Team
- Surveys and Questionnaires
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Affiliation(s)
- S G Hasselbalch
- Memory Disorders Research Group 6702, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Trenkwalder C, Stiasny-Kolster K, Kupsch A, Oertel W, Koester J. P0019 Effect of pramipexole on quality of life in restless legs syndrome: results spanning 9 months. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70280-0] [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: 10/23/2022]
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Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedman A, Kanovsky P, Larsen JP, Lees A, Oertel W, Poewe W, Rascol O, Sampaio C. Review of the therapeutic management of Parkinson's disease. Report of a joint task force of the European Federation of Neurological Societies and the Movement Disorder Society-European Section. Part I: early (uncomplicated) Parkinson's disease. Eur J Neurol 2006; 13:1170-85. [PMID: 17038031 DOI: 10.1111/j.1468-1331.2006.01547.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [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: 11/28/2022]
Abstract
The aim of the study was to provide evidence-based recommendations for the management of early (uncomplicated) Parkinson's disease (PD), based on a review of the literature. Uncomplicated PD refers to patients suffering from the classical motor syndrome of PD only, without treatment-induced motor complications and without neuropsychiatric or autonomic problems. MEDLINE, Cochrane Library and International Network of Agencies for Health Technology Assessment (INAHTA) database literature searches were conducted. National guidelines were requested from all European Federation of Neurological Societies (EFNS) societies. Non-European guidelines were searched for using MEDLINE. Part I of the guidelines deals with prevention of disease progression, symptomatic treatment of motor features (parkinsonism), and prevention of motor and neuropsychiatric complications of therapy. For each topic, a list of therapeutic interventions is provided, including classification of evidence. Following this, recommendations for management are given, alongside ratings of efficacy. Classifications of evidence and ratings of efficacy are made according to EFNS guidance. In cases where there is insufficient scientific evidence, a consensus statement (good practice point) is made.
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Affiliation(s)
- M Horstink
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedman A, Kanovsky P, Larsen JP, Lees A, Oertel W, Poewe W, Rascol O, Sampaio C. Review of the therapeutic management of Parkinson's disease. Report of a joint task force of the European Federation of Neurological Societies (EFNS) and the Movement Disorder Society-European Section (MDS-ES). Part II: late (complicated) Parkinson's disease. Eur J Neurol 2006; 13:1186-202. [PMID: 17038032 DOI: 10.1111/j.1468-1331.2006.01548.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [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: 12/12/2022]
Abstract
To provide evidence-based recommendations for the management of late (complicated) Parkinson's disease (PD), based on a review of the literature. Complicated PD refers to patients suffering from the classical motor syndrome of PD along with other motor or non-motor complications, either disease-related (e.g. freezing) or treatment-related (e.g. dyskinesias or hallucinations). MEDLINE, Cochrane Library and INAHTA database literature searches were conducted. National guidelines were requested from all EFNS societies. Non-European guidelines were searched for using MEDLINE. Part II of the guidelines deals with treatment of motor and neuropsychiatric complications and autonomic disturbances. For each topic, a list of therapeutic interventions is provided, including classification of evidence. Following this, recommendations for management are given, alongside ratings of efficacy. Classifications of evidence and ratings of efficacy are made according to EFNS guidance. In cases where there is insufficient scientific evidence, a consensus statement ('good practice point') is made.
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Affiliation(s)
- M Horstink
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Riedel O, Dodel R, Spottke A, Deuschl G, Förstl H, Henn F, Heuser I, Oertel W, Reichmann H, Riederer P, Trenkwalder C, Wittchen HU. Wie beurteilen Ärzte die Häufigkeit demenzieller, depressiver und psychotischer Symptome bei Patienten mit der Parkinson-Krankheit? Akt Neurol 2006. [DOI: 10.1055/s-2005-915473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Geser F, Seppi K, Stampfer-Kountchev M, Köllensperger M, Diem A, Ndayisaba JP, Ostergaard K, Dupont E, Cardozo A, Tolosa E, Abele M, Dodel R, Klockgether T, Ghorayeb I, Yekhlef F, Tison F, Daniels C, Kopper F, Deuschl G, Coelho M, Ferreira J, Rosa MM, Sampaio C, Bozi M, Schrag A, Hooker J, Kim H, Scaravilli T, Mathias CJ, Fowler C, Wood N, Quinn N, Widner H, Nilsson CF, Lindvall O, Schimke N, Eggert KM, Oertel W, del Sorbo F, Carella F, Albanese A, Pellecchia MT, Barone P, Djaldetti R, Meco G, Colosimo C, Gonzalez-Mandly A, Berciano J, Gurevich T, Giladi N, Galitzky M, Ory F, Rascol O, Kamm C, Buerk K, Maass S, Gasser T, Poewe W, Wenning GK. The European Multiple System Atrophy-Study Group (EMSA-SG). J Neural Transm (Vienna) 2005; 112:1677-86. [PMID: 16049636 DOI: 10.1007/s00702-005-0328-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 04/30/2005] [Indexed: 11/26/2022]
Abstract
Introduction. The European Multiple System Atrophy-Study Group (EMSA-SG) is an academic network comprising 23 centers across Europe and Israel that has constituted itself already in January 1999. This international forum of established experts under the guidance of the University Hospital of Innsbruck as coordinating center is supported by the 5th framework program of the European Union since March 2001 (QLK6-CT-2000-00661). Objectives. Primary goals of the network include (1) a central Registry for European multiple system atrophy (MSA) patients, (2) a decentralized DNA Bank, (3) the development and validation of the novel Unified MSA Rating Scale (UMSARS), (4) the conduction of a Natural History Study (NHS), and (5) the planning or implementation of interventional therapeutic trials. Methods. The EMSA-SG Registry is a computerized data bank localized at the coordinating centre in Innsbruck collecting diagnostic and therapeutic data of MSA patients. Blood samples of patients and controls are recruited into the DNA Bank. The UMSARS is a novel specific rating instrument that has been developed and validated by the EMSA-SG. The NHS comprises assessments of basic anthropometric data as well as a range of scales including the UMSARS, Unified Parkinson's Disease Rating Scale (UPDRS), measures of global disability, Red Flag list, MMSE (Mini Mental State Examination), quality of live measures, i.e. EuroQoL 5D (EQ-5D) and Medical Outcome Study Short Form (SF-36) as well as the Beck Depression Inventory (BDI). In a subgroup of patients dysautonomic features are recorded in detail using the Queen Square Cardiovascular Autonomic Function Test Battery, the Composite Autonomic Symptom Scale (COMPASS) and measurements of residual urinary volume. Most of these measures are repeated at 6-monthly follow up visits for a total study period of 24 months. Surrogate markers of the disease progression are identified by the EMSA-SG using magnetic resonance and diffusion weighted imaging (MRI and DWI, respectively). Results. 412 patients have been recruited into the Registry so far. Probable MSA-P was the most common diagnosis (49% of cases). 507 patients donated DNA for research. 131 patients have been recruited into the NHS. There was a rapid deterioration of the motor disorder (in particular akinesia) by 26.1% of the UMSARS II, and - to a lesser degree - of activities of daily living by 16.8% of the UMSARS I in relation to the respective baseline scores. Motor progression was associated with low motor or global disability as well as low akinesia or cerebellar subscores at baseline. Mental function did not deteriorate during this short follow up period. Conclusion. For the first time, prospective data concerning disease progression are available. Such data about the natural history and prognosis of MSA as well as surrogate markers of disease process allow planning and implementation of multi-centre phase II/III neuroprotective intervention trials within the next years more effectively. Indeed, a trial on growth hormone in MSA has just been completed, and another on minocycline will be completed by the end of this year.
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Affiliation(s)
- F Geser
- Clinical Department of Neurology, Innsbruck Medical University, Austria
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Reichmann H, Storch A, Jost W, Vieregge P, Spiegel J, Greulich W, Durner J, Müller T, Kupsch A, Henningsen H, Oertel W, Fuchs G, Kuhn W. Coenzym Q10-Nanodispersion versus Plazebo zur symptomatischen Therapie von Patienten mit Morbus Parkinson. Eine multizentrische, plazebokontrollierte, randomisierte Doppelblindstudie. Akt Neurol 2005. [DOI: 10.1055/s-2005-866699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rascol O, Brooks DJ, Melamed E, Oertel W, Poewe W, Stocchi F, Tolosa E. Rasagiline as an adjunct to levodopa in patients with Parkinson's disease and motor fluctuations (LARGO, Lasting effect in Adjunct therapy with Rasagiline Given Once daily, study): a randomised, double-blind, parallel-group trial. Lancet 2005; 365:947-54. [PMID: 15766996 DOI: 10.1016/s0140-6736(05)71083-7] [Citation(s) in RCA: 399] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Rasagiline mesylate is a novel drug for Parkinson's disease with selective, irreversible monoamine oxidase B (MAO-B) inhibitor activity, and is effective as monotherapy in early disease. This study investigated rasagiline efficacy and safety in levodopa-treated patients with Parkinson's disease and motor fluctuations. METHODS In an 18-week, double-blind, multicentre (74 hospitals and academic centres in Israel, Argentina, and Europe) trial, 687 outpatients were randomly assigned to oral rasagiline (231 individuals; 1 mg once daily), entacapone (227; 200 mg with every levodopa dose), or placebo (229). Primary outcome was change in total daily off-time (intention-to-treat population). Other measures included the clinical global improvement (CGI) score and unified Parkinson's disease rating scale (UPDRS) scores. Analysis was by intention to treat. FINDINGS 88 (13%) patients who were assigned treatment did not complete the study (23 rasagiline, 30 entacapone, 35 placebo), mainly because of withdrawal of consent (n=34) and adverse events (n=34). Both rasagiline and entacapone reduced mean daily off-time (-1.18 h rasagiline and -1.2 h entacapone vs placebo -0.4 h; p=0.0001, p<0.0001, respectively) and increased daily on-time without troublesome dyskinesia (0.85 h vs placebo 0.03 h; p=0.0005 for both). We recorded significant mean improvements in CGI scores (-0.86 rasagiline and -0.72 entacapone vs -0.37 placebo; p<0.0001, p=0.0002, respectively). Changes in UPDRS scores also significantly improved for activities of daily living during off-time (-1.71 and -1.38 vs placebo; p<0.0001, p=0.0006, respectively) and motor function during on-time (-2.94 and -2.73 vs placebo; both p<0.0001). Frequency of adverse events was similar for all treatments. INTERPRETATION Once-daily rasagiline reduces mean daily off-time and improves symptoms of Parkinson's disease in levodopa-treated patients with motor fluctuations, an effect similar to that of entacapone.
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Affiliation(s)
- O Rascol
- Clinical Investigation Centre, Department of Clinical Pharmacology, University Hospital, Toulouse, France.
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Noelker C, Bortolussi G, Piontek G, Eggert K, Dodel R, Schlegel J, Oertel W. Nachweis differentieller Genexpression im 6-Hxdroxydopamin (6-OHDA)-Schädigungsmodell an humanen Neuroblastomzellen mittels RNA arbiträr geprimter Polymerasekettenreaktion. Akt Neurol 2004. [DOI: 10.1055/s-2004-833269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gerhard A, Dodel R, Schimke N, Wächter T, Oertel W, Brooks D. Aktivierte Mikroglia in kortikalen und subkortikalen Regionen bei Patienten mit Multisystematrophie. Eine [11C](R) PK11195-PET-Studie. Akt Neurol 2004. [DOI: 10.1055/s-2004-833017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bandmann O, Goertz M, Zschocke J, Deuschl G, Jost W, Hefter H, Müller U, Zöfel P, Hoffmann G, Oertel W. The phenylalanine loading test in the differential diagnosis of dystonia. Neurology 2003; 60:700-2. [PMID: 12601115 DOI: 10.1212/01.wnl.0000048205.18445.98] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [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
Early diagnosis of dopa-responsive dystonia (DRD) and its delineation from other dystonic syndromes is of great relevance because DRD is an eminently treatable condition. The possible relevance of the phenylalanine loading test (Phe-L) in differentiating DRD from primary focal and generalized dystonia was investigated. A marked difference in the phenylalanine/tyrosine ratio between patients with DRD and patients with other types of dystonia was observed. This indicates that Phe-L may be helpful in the differential diagnosis of dystonias.
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Affiliation(s)
- O Bandmann
- Department of Neurology, Philipps-University Marburg, Germany.
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Du Y, Dodel R, Hampel H, Buerger K, Lin S, Eastwood B, Bales K, Gao F, Moeller HJ, Oertel W, Farlow M, Paul S. Reduced levels of amyloid beta-peptide antibody in Alzheimer disease. Neurology 2001; 57:801-5. [PMID: 11552007 DOI: 10.1212/wnl.57.5.801] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [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: 11/15/2022] Open
Abstract
OBJECTIVE To investigate whether it was possible to detect the presence and different levels of naturally occurring anti-beta-amyloid (Abeta) antibodies in the CSF of patients with AD and age-matched controls by employing a sensitive ELISA. BACKGROUND Immunization with preaggregated amyloid beta-peptide (Abeta(1-42)) and administration of antibodies against Abeta into amyloid precursor protein APP(V717F)- transgenic mice (an animal model of AD) have recently been reported to dramatically reduce amyloid plaque deposition, neuritic dystrophy, and astrogliosis, most likely by enhancing Abeta clearance from brain. METHODS A sensitive ELISA was performed to detect levels of naturally occurring anti-Abeta antibodies in the CSF of patients with AD and age-matched controls. Additionally, an immunoprecipitation assay was performed to confirm that naturally occurring anti-Abeta antibodies also exist in the human blood. RESULT - Naturally occurring antibodies directed against Abeta were found in the CSF and plasma of patients with AD and healthy control subjects. Moreover, CSF anti-Abeta antibody titers are significantly lower in patients with AD compared with healthy control subjects. CONCLUSION Naturally occurring antibodies directed against Abeta exist in human CSF and plasma. The CSF anti-Abeta antibody titers may be helpful in better understanding the effects of future immunologic therapies for AD.
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Affiliation(s)
- Y Du
- Department of Pharmacology, Indiana University School of Medicine, Indianapolis 46285, USA.
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Hock C, Maddalena A, Heuser I, Naber D, Oertel W, von der Kammer H, Wienrich M, Raschig A, Deng M, Growdon JH, Nitsch RM. Treatment with the selective muscarinic agonist talsaclidine decreases cerebrospinal fluid levels of total amyloid beta-peptide in patients with Alzheimer's disease. Ann N Y Acad Sci 2001; 920:285-91. [PMID: 11193166 DOI: 10.1111/j.1749-6632.2000.tb06937.x] [Citation(s) in RCA: 27] [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: 11/28/2022]
Abstract
Brain amyloid load in Alzheimer's disease (AD) is, at least in genetic forms, associated with overproduction of amyloid beta-peptides (A beta). Thus, lowering A beta production is a central therapeutic target in AD and may be achieved by modulating such key enzymes of amyloid precursor protein (APP) processing as beta-, gamma-, and alpha-secretase activities. Talsaclidine is a selective muscarinic M1 agonist that stimulates the nonamyloidogenic alpha-secretase pathway in model systems. Talsaclidine was administered double-blind, placebo-controlled, and randomized to 24 AD patients and cerebrospinal fluid (CSF) levels of total A beta were quantitated before and after 4 weeks of drug treatment. We observed that talsaclidine decreases CSF levels of A beta significantly over time within the treatment group (n = 20) by a median of 16% as well as compared to placebo (n = 4) by a median of 27%. We conclude that treatment with selective M1 agonists may reduce A beta production and may thus be further evaluated as a potential amyloid-lowering therapy of AD.
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Affiliation(s)
- C Hock
- Department of Psychiatry Research, University of Zürich, Lenggstrasse 31, CH-8029 Zürich 8, Switzerland.
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