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  • Ovid Technologies (Wolters Kluwer Health)  (8)
  • 1
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    Mesiotemporal Volumetry, Cortical Thickness, and Neuropsychological Deficits in the Long-term Course of Limbic Encephalitis
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Neurology - Neuroimmunology Neuroinflammation Vol. 10, No. 4 ( 2023-07), p. e200125-
    Details
    In: Neurology - Neuroimmunology Neuroinflammation, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 4 ( 2023-07), p. e200125-
    Abstract: Limbic encephalitis (LE) is an autoimmune disease often associated with temporal lobe epilepsy and subacute memory deficits. It is categorized into serologic subgroups, which differ in clinical progress, therapy response, and prognosis. Using longitudinal MRI analysis, we hypothesized that mesiotemporal and cortical atrophy rates would reveal serotype-specific patterns and reflect disease severity. Methods In this longitudinal case-control study, all individuals with antibody-positive (glutamic acid decarboxylase 65 [GAD], leucine-rich glioma-inactivated protein 1 [LGI1] , contactin-associated protein 2 [CASPR2], and N -methyl- d -aspartate receptor [NMDAR]) nonparaneoplastic LE according to Graus' diagnostic criteria treated between 2005 and 2019 at the University Hospital Bonn were enrolled. A longitudinal healthy cohort was included as the control group. Subcortical segmentation and cortical reconstruction of T1-weighted MRI were performed using the longitudinal framework in FreeSurfer. We applied linear mixed models to examine mesiotemporal volumes and cortical thickness longitudinally. Results Two hundred fifty-seven MRI scans from 59 individuals with LE (34 female, age at disease onset [mean ± SD] 42.5 ± 20.4 years; GAD: n = 30, 135 scans; LGI1: n = 15, 55 scans; CASPR2: n = 9, 37 scans; and NMDAR: n = 5, 30 scans) were included. The healthy control group consisted of 128 scans from 41 individuals (22 female, age at first scan [mean ± SD] 37.7 ± 14.6 years). The amygdalar volume at disease onset was significantly higher in individuals with LE ( p ≤ 0.048 for all antibody subgroups) compared with that in healthy controls and decreased over time in all antibody subgroups, except in the GAD subgroup. We observed a significantly higher hippocampal atrophy rate in all antibody subgroups compared with that in healthy controls (all p ≤ 0.002), except in the GAD subgroup. Cortical atrophy rates exceeded normal aging in individuals with impaired verbal memory, while those who were not impaired did not differ significantly from healthy controls. Discussion Our data depict higher mesiotemporal volumes in the early disease stage, most likely due to edematous swelling, followed by volume regression and atrophy/hippocampal sclerosis in the late disease stage. Our study reveals a continuous and pathophysiologically meaningful trajectory of mesiotemporal volumetry across all serogroups and provides evidence that LE should be considered a network disorder in which extratemporal involvement is an important determinant of disease severity.
    Type of Medium: Online Resource
    ISSN: 2332-7812
    URL: Article
    DOI: 10.1212/NXI.0000000000200125
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 2
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    Direct Quantitative Assessment of the Peripheral Artery Collateral Circulation in Patients Undergoing Angiography
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation Vol. 128, No. 7 ( 2013-08-13), p. 737-744
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 128, No. 7 ( 2013-08-13), p. 737-744
    Abstract: Despite the fact that numerous studies have pursued the strategy of improving collateral function in patients with peripheral artery disease, there is currently no method available to quantify collateral arterial function of the lower limb. Methods and Results— Pressure-derived collateral flow index (CFIp, calculated as (occlusive pressure−central venous pressure)/(aortic pressure−central venous pressure); pressure values in mm Hg) of the left superficial femoral artery was obtained in patients undergoing elective coronary angiography using a combined pressure/Doppler wire (n=30). Distal occlusive pressure and toe oxygen saturation (Sa o 2 ) were measured for 5 minutes under resting conditions, followed by an exercise protocol (repetitive plantar-flexion movements in supine position; n=28). In all patients, balloon occlusion of the superficial femoral artery over 5 minutes was painless under resting conditions. CFIp increased during the first 3 minutes from 0.451±0.168 to 0.551±0.172 ( P =0.0003), whereas Sa o 2 decreased from 98±2% to 93±7% ( P =0.004). Maximal changes of Sa o 2 were inversely related to maximal CFIp ( r 2 =0.33, P =0.003). During exercise, CFIp declined within 1 minute from 0.560±0.178 to 0.393±0.168 ( P 〈 0.0001) and reached its minimum after 2 minutes of exercise (0.347±0.176), whereas Sa o 2 declined to a minimum of 86±6% ( P =0.002). Twenty-five patients (89%) experienced pain or cramps/tired muscles, whereas 3 (11%) remained symptom-free for an occlusion time of 10 minutes. CFIp values were positively related to the pain-free time span ( r 2 =0.50, P =0.002). Conclusions— Quantitatively assessed collateral arterial function at rest determined in the nonstenotic superficial femoral artery is sufficient to prevent ischemic symptoms during a total occlusion of 5 minutes. During exercise, there is a decline in CFIp that indicates a supply-demand mismatch via collaterals or, alternatively, a steal phenomenon. Clinical Trial Registration—URL: http://www.clinicaltrials.gov . Unique identifier: NCT01742455.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.112.000516
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1466401-X
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  • 3
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    Genome-wide Association Study Identifies 2 New Loci Associated With Anti-NMDAR Encephalitis
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Neurology - Neuroimmunology Neuroinflammation Vol. 8, No. 6 ( 2021-11), p. e1085-
    Details
    In: Neurology - Neuroimmunology Neuroinflammation, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 6 ( 2021-11), p. e1085-
    Abstract: To investigate the genetic determinants of the most common type of antibody-mediated autoimmune encephalitis, anti-NMDA receptor (anti-NMDAR) encephalitis. Methods We performed a genome-wide association study in 178 patients with anti-NMDAR encephalitis and 590 healthy controls, followed by a colocalization analysis to identify putatively causal genes. Results We identified 2 independent risk loci harboring genome-wide significant variants ( p 〈 5 × 10 −8 , OR ≥ 2.2), 1 on chromosome 15, harboring only the LRRK1 gene, and 1 on chromosome 11 centered on the ACP2 and NR1H3 genes in a larger region of high linkage disequilibrium. Colocalization signals with expression quantitative trait loci for different brain regions and immune cell types suggested ACP2 , NR1H3 , MADD , DDB2 , and C11orf49 as putatively causal genes. The best candidate genes in each region are LRRK1 , encoding leucine-rich repeat kinase 1, a protein involved in B-cell development, and NR1H3 liver X receptor alpha, a transcription factor whose activation inhibits inflammatory processes. Discussion This study provides evidence for relevant genetic determinants of antibody-mediated autoimmune encephalitides outside the human leukocyte antigen (HLA) region. The results suggest that future studies with larger sample sizes will successfully identify additional genetic determinants and contribute to the elucidation of the pathomechanism.
    Type of Medium: Online Resource
    ISSN: 2332-7812
    URL: Article
    DOI: 10.1212/NXI.0000000000001085
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2767740-0
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  • 4
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    Impaired Brain Growth in Myelin Oligodendrocyte Glycoprotein Antibody–Associated Acute Disseminated Encephalomyelitis
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Neurology - Neuroimmunology Neuroinflammation Vol. 10, No. 2 ( 2023-03), p. e200066-
    Details
    In: Neurology - Neuroimmunology Neuroinflammation, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 2 ( 2023-03), p. e200066-
    Abstract: Acute disseminated encephalomyelitis (ADEM) is the most common phenotype in pediatric myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease. A previous study demonstrated impaired brain growth in ADEM. However, the effect of MOG antibodies on brain growth remains unknown. Here, we performed brain volume analyses in MOG-positive and MOG-negative ADEM at onset and over time. Methods In this observational cohort study, we included a total of 62 MRI scans from 24 patients with ADEM (54.2% female; median age 5 years), of which 16 (66.7%) were MOG positive. Patients were compared with healthy controls from the NIH pediatric MRI data repository and a matched local cohort. Mixed-effect models were applied to assess group differences and other relevant factors, including relapses. Results At baseline and before any steroid treatment, patients with ADEM, irrespective of MOG antibody status, showed reduced brain volume compared with matched controls (median [interquartile range] 1,741.9 cm3 [1,645.1–1,805.2] vs 1,810.4 cm 3 [1,786.5–1,836.2]). Longitudinal analysis revealed reduced brain growth for both MOG-positive and MOG-negative patients with ADEM. However, MOG-negative patients showed a stronger reduction (−138.3 cm 3 [95% CI −193.6 to −82.9]) than MOG-positive patients (−50.0 cm 3 [−126.5 to −5.2]), independent of age, sex, and treatment. Relapsing patients (all MOG positive) showed additional brain volume loss (−15.8 cm 3 [−68.9 to 37.3]). Discussion Patients with ADEM exhibit brain volume loss and failure of age-expected brain growth. Importantly, MOG-negative status was associated with a more pronounced brain volume loss compared with MOG-positive patients.
    Type of Medium: Online Resource
    ISSN: 2332-7812
    URL: Article
    DOI: 10.1212/NXI.0000000000200066
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 5
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    Determinants and outcome of multiple and early recurrent cervical artery dissections
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Neurology Vol. 91, No. 8 ( 2018-08-21), p. e769-e780
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 91, No. 8 ( 2018-08-21), p. e769-e780
    Abstract: To assess putative risk factors and outcome of multiple and early recurrent cervical artery dissection (CeAD). Methods We combined data from 2 multicenter cohorts and compared patients with multiple CeAD at initial diagnosis, early recurrent CeAD within 3 to 6 months, and single nonrecurrent CeAD. Putative risk factors, clinical characteristics, functional outcome, and risk of recurrent ischemic events were assessed. Results Of 1,958 patients with CeAD (mean ± SD age 44.3 ± 10 years, 43.9% women), 1,588 (81.1%) had single nonrecurrent CeAD, 340 (17.4%) had multiple CeAD, and 30 (1.5%) presented with single CeAD at admission and had early recurrent CeAD. Patients with multiple or early recurrent CeAD did not significantly differ with respect to putative risk factors, clinical presentation, and outcome. In multivariable analyses, patients with multiple or early recurrent CeAD more often had recent infection (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.29–2.53), vertebral artery dissection (OR 1.82, 95% CI 1.34–2.46), family history of stroke (OR 1.55, 95% CI 1.06–2.25), cervical pain (OR 1.36, 95% CI 1.01–1.84), and subarachnoid hemorrhage (OR 2.85, 95% CI 1.01–8.04) at initial presentation compared to patients with single nonrecurrent CeAD. Patients with multiple or early recurrent CeAD also had a higher incidence of cerebral ischemia (hazard ratio 2.77, 95% CI 1.49–5.14) at 3 to 6 months but no difference in functional outcome compared to patients with single nonrecurrent CeAD. Conclusion Patients with multiple and early recurrent CeAD share similar risk factors, clinical characteristics, and functional outcome. Compared to patients with single nonrecurrent CeAD, they are more likely to have recurrent cerebral ischemia at 3 to 6 months, possibly reflecting an underlying transient vasculopathy.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000006037
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 6
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    Retrospective Analysis of Hearing-Impaired Adult Patients Treated With an Active Transcutaneous Bone Conduction Implant
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Otology & Neurotology Vol. 39, No. 7 ( 2018-08), p. 874-881
    Details
    In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 7 ( 2018-08), p. 874-881
    Abstract: To determine the therapeutic success and safety of an active transcutaneous bone conduction implant (tBCI) in adult patients with conductive or mixed hearing loss. Study Design: Retrospective case review. Setting: Five university hospitals in Frankfurt, Hannover, Dresden, Würzburg, and Vienna. Patients: Data were analyzed from 61 patients (31 women, 30 men) with a mean age of 50 years (min. 26, max. 80). Forty patients had mixed, and 21 conductive hearing loss. Typical etiologies were history of otitis media (n = 20) and cholesteatoma (n = 17). Interventions: Implantation of the active tBCI. Main Outcome Measures: Data were analyzed for the following time points: up to 6 months postoperatively (“short-term”), 6 to 37 months postoperatively (“long-term”), and the last available measurement per patient (“most recent”). Pure-tone audiometry (air and bone conduction, AC and BC) and sound field thresholds with warble tones (WT), word recognition scores with Freiburger monosyllables (WRS), as well as speech reception thresholds (SRT) using the Oldenburg sentence test (OLSA) in quiet (SRT) and in noise (signal-to-noise ratio, SNR) were collected. Results: No significant changes in air- and bone-conduction thresholds were observed after implantation. A mean WRS improvement of 54% using the active tBCI was shown at the short-term assessment, i.e., a mean score of 79% compared with 25% in the unaided condition. Results remained stable, with a mean score of 75% at the long-term assessment. SRT in noise improved by 3.6 dB SNR in the implanted ear at the short-term assessment. Overall six adverse events and four serious adverse events were reported, resulting in a rate of 9.84 and 6.56%, respectively. Conclusion: The tBCI clearly improves speech intelligibility in patients with conductive or mixed hearing loss, showing stable results up to 1 year post-implantation.
    Type of Medium: Online Resource
    ISSN: 1531-7129 , 1537-4505
    URL: Article
    DOI: 10.1097/MAO.0000000000001834
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2058738-7
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  • 7
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    Cervical artery dissection in patients ≥60 years : Often painless, few mechanical triggers
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Neurology Vol. 88, No. 14 ( 2017-04-04), p. 1313-1320
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 88, No. 14 ( 2017-04-04), p. 1313-1320
    Abstract: In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged 〈 60 vs ≥60 years. Methods: We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients–Plus consortium). We dichotomized cases into 2 groups, age ≥60 and 〈 60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated. Results: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (OR adjusted 0.47 [0.33–0.66]), headache (OR adjusted 0.58 [0.42–0.79]), mechanical trigger events (OR adjusted 0.53 [0.36–0.77]), and migraine (OR adjusted 0.58 [0.39–0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (OR adjusted 1.52 [1.1–2.10]) and hypertension (OR adjusted 3.08 [2.25–4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0–2) was less frequent in the older age group (OR adjusted 0.45 [0.25, 0.83]). Conclusion: In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000003788
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 8
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    Artery occlusion independently predicts unfavorable outcome in cervical artery dissection
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Neurology Vol. 94, No. 2 ( 2020-01-14), p. e170-e180
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 2 ( 2020-01-14), p. e170-e180
    Abstract: To assess the impact of dissected artery occlusion (DAO) on functional outcome and complications in patients with cervical artery dissection (CeAD). Methods We analyzed combined individual patient data from 3 multicenter cohorts of consecutive patients with CeAD (the Cervical Artery Dissection and Ischemic Stroke Patients [CADISP]–Plus consortium dataset). Patients with data on DAO and functional outcome were included. We compared patients with DAO to those without DAO. Primary outcome was favorable functional outcome (i.e., modified Rankin Scale [mRS] score 0–1) measured 3–6 months from baseline. Secondary outcomes included delayed cerebral ischemia, major hemorrhage, recurrent CeAD, and death. We performed univariate and multivariable binary logistic regression analyses and calculated odds ratios (OR) with 95% confidence intervals (CI), with adjustment for potential confounders. Results Of 2,148 patients (median age 45 years [interquartile range (IQR) 38–52], 43.6% women), 728 (33.9%) had DAO. Patients with DAO more frequently presented with cerebral ischemia (84.6% vs 58.5%, p 〈 0.001). Patients with DAO were less likely to have favorable outcome when compared to patients without DAO (mRS 0–1: 59.6% vs 80.1%, p unadjusted 〈 0.001). After adjustment for age, sex, and initial stroke severity, DAO was independently associated with less favorable outcome (mRS 0–1: OR 0.65, CI 0.50–0.84, p = 0.001). Delayed cerebral ischemia occurred more frequently in patients with DAO than in patients without DAO (4.5% vs 2.9%, p = 0.059). Conclusion DAO independently predicts less favorable functional outcome in patients with CeAD. Further research on vessel patency, collateral status and effects of revascularization therapies particularly in patients with DAO is warranted.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000008654
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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