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Arba F, Rinaldi C, Jensen M, Endres M, Fiebach JB, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen C, Thijs V, Gerloff C, Wardlaw J, Thomalla G. Validation of a Simple Clinical Tool for Screening of Acute Lacunar Stroke - a substudy of the WAKE-UP trial. Int J Stroke 2024:17474930241253987. [PMID: 38676549 DOI: 10.1177/17474930241253987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Lacunar stroke represents around a quarter of all ischemic strokes, however, their identification with Computed Tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging. METHODS We analysed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by NIHSS<7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score. RESULTS We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6), 325 (65%) males, median (IQR) NIHSS=6 (4-9); 108 (22%) lacunar infarcts were identified on MR, patients fulfilling lacunar score criteria were 120 (24%), of which 47 (44%) had a lacunar infarct. Lacunar score correctly identified 322 (82%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7,p<0.001), higher systolic (157 mmHg vs 151 mmHg,p=0.001) and diastolic (86 mmHg vs 83 mmHg,p=0.013) blood pressure and smaller infarct volume (2.4 ml vs 9.5 ml,p<0.001). Performance of lacunar score was: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; accuracy 0.73. Assuming a prevalence of lacunar stroke of 13%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts. CONCLUSIONS Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials.
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Affiliation(s)
- Francesco Arba
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | | | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany
| | - Jochen Benedikt Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robin Lemmens
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology; VIB Center for Brain & Disease Research; University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon; Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnòstic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Claus Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences and UK Dementia Research Institute Centre, University of Edinburgh, Edinburgh, UK
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Sadeghi F, Pötter-Nerger M, Grimm K, Gerloff C, Schulz R, Zittel S. Smaller Cerebellar Lobule VIIb is Associated with Tremor Severity in Parkinson's Disease. Cerebellum 2024; 23:355-362. [PMID: 36802020 PMCID: PMC10950956 DOI: 10.1007/s12311-023-01532-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/23/2023]
Abstract
Alterations in the cerebellum's morphology in Parkinson's disease (PD) point to its pathophysiological involvement in this movement disorder. Such abnormalities have previously been attributed to different PD motor subtypes. The aim of the study was to relate volumes of specific cerebellar lobules to motor symptom severity, in particular tremor (TR), bradykinesia/rigidity (BR), and postural instability and gait disorders (PIGD) in PD. We performed a volumetric analysis based on T1-weighted MRI images of 55 participants with PD (22 females, median age 65 years, Hoehn and Yahr stage 2). Multiple regression models were fitted to investigate associations between volumes of cerebellar lobules with clinical symptom severity based on MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score and sub-scores for TR, BR, and PIGD; adjusted for age, sex, disease duration, and intercranial volume as cofactors. Smaller volume of lobule VIIb was associated with higher tremor severity (P = 0.004). No structure-function relationships were detected for other lobules or other motor symptoms. This distinct structural association denotes the involvement of the cerebellum in PD tremor. Characterizing morphological features of the cerebellum leads to a better understanding of its role in the spectrum of motor symptoms in PD and contributes further to identifying potential biological markers.
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Affiliation(s)
- Fatemeh Sadeghi
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Monika Pötter-Nerger
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kai Grimm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Robert Schulz
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Zittel
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany.
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Kamogawa N, Miwa K, Toyoda K, Jensen M, Inoue M, Yoshimura S, Fukuda-Doi M, Kitazono T, Boutitie F, Ma H, Ringleb P, Wu O, Schwamm LH, Warach S, Hacke W, Davis SM, Donnan GA, Gerloff C, Thomalla G, Koga M. Thrombolysis for Wake-Up Stroke Versus Non-Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis. Stroke 2024; 55:895-904. [PMID: 38456303 PMCID: PMC10978262 DOI: 10.1161/strokeaha.123.043358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Stroke with unknown time of onset can be categorized into 2 groups; wake-up stroke (WUS) and unwitnessed stroke with an onset time unavailable for reasons other than wake-up (non-wake-up unwitnessed stroke, non-WUS). We aimed to assess potential differences in the efficacy and safety of intravenous thrombolysis (IVT) between these subgroups. METHODS Patients with an unknown-onset stroke were evaluated using individual patient-level data of 2 randomized controlled trials (WAKE-UP [Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke], THAWS [Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes With Alteplase at 0.6 mg/kg]) comparing IVT with placebo or standard treatment from the EOS (Evaluation of Unknown-Onset Stroke Thrombolysis trial) data set. A favorable outcome was prespecified as a modified Rankin Scale score of 0 to 1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage at 22 to 36 hours and 90-day mortality. The IVT effect was compared between the treatment groups in the WUS and non-WUS with multivariable logistic regression analysis. RESULTS Six hundred thirty-four patients from 2 trials were analyzed; 542 had WUS (191 women, 272 receiving alteplase), and 92 had non-WUS (42 women, 43 receiving alteplase). Overall, no significant interaction was noted between the mode of onset and treatment effect (P value for interaction=0.796). In patients with WUS, the frequencies of favorable outcomes were 54.8% and 45.5% in the IVT and control groups, respectively (adjusted odds ratio, 1.47 [95% CI, 1.01-2.16]). Death occurred in 4.0% and 1.9%, respectively (P=0.162), and symptomatic intracranial hemorrhage in 1.8% and 0.3%, respectively (P=0.194). In patients with non-WUS, no significant difference was observed in favorable outcomes relative to the control (37.2% versus 29.2%; adjusted odds ratio, 1.76 [0.58-5.37]). One death and one symptomatic intracranial hemorrhage were reported in the IVT group, but none in the control. CONCLUSIONS There was no difference in the effect of IVT between patients with WUS and non-WUS. IVT showed a significant benefit in patients with WUS, while there was insufficient statistical power to detect a substantial benefit in the non-WUS subgroup. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: CRD42020166903.
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Affiliation(s)
- Naruhiko Kamogawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mayumi Fukuda-Doi
- Center for Advancing Clinical and Translational Sciences, National Cerebral, and Cardiovascular Center, Suita, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France; Université Lyon 1, Villeurbanne, France; Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Henry Ma
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Peter Ringleb
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Ona Wu
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven Warach
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Stephen M Davis
- Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, the University of Melbourne, Melbourne, VIC, Australia
| | - Geoffrey A Donnan
- Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, the University of Melbourne, Melbourne, VIC, Australia
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Schweingruber N, Bremer J, Wiehe A, Mader MMD, Mayer C, Woo MS, Kluge S, Grensemann J, Quandt F, Gempt J, Fischer M, Thomalla G, Gerloff C, Sauvigny J, Czorlich P. Early prediction of ventricular peritoneal shunt dependency in aneurysmal subarachnoid haemorrhage patients by recurrent neural network-based machine learning using routine intensive care unit data. J Clin Monit Comput 2024:10.1007/s10877-024-01151-4. [PMID: 38512361 DOI: 10.1007/s10877-024-01151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
Aneurysmal subarachnoid haemorrhage (aSAH) can lead to complications such as acute hydrocephalic congestion. Treatment of this acute condition often includes establishing an external ventricular drainage (EVD). However, chronic hydrocephalus develops in some patients, who then require placement of a permanent ventriculoperitoneal (VP) shunt. The aim of this study was to employ recurrent neural network (RNN)-based machine learning techniques to identify patients who require VP shunt placement at an early stage. This retrospective single-centre study included all patients who were diagnosed with aSAH and treated in the intensive care unit (ICU) between November 2010 and May 2020 (n = 602). More than 120 parameters were analysed, including routine neurocritical care data, vital signs and blood gas analyses. Various machine learning techniques, including RNNs and gradient boosting machines, were evaluated for their ability to predict VP shunt dependency. VP-shunt dependency could be predicted using an RNN after just one day of ICU stay, with an AUC-ROC of 0.77 (CI: 0.75-0.79). The accuracy of the prediction improved after four days of observation (Day 4: AUC-ROC 0.81, CI: 0.79-0.84). At that point, the accuracy of the prediction was 76% (CI: 75.98-83.09%), with a sensitivity of 85% (CI: 83-88%) and a specificity of 74% (CI: 71-78%). RNN-based machine learning has the potential to predict VP shunt dependency on Day 4 after ictus in aSAH patients using routine data collected in the ICU. The use of machine learning may allow early identification of patients with specific therapeutic needs and accelerate the execution of required procedures.
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Affiliation(s)
- Nils Schweingruber
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jan Bremer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Anton Wiehe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
- Department of Informatics, University of Hamburg, 22527, Hamburg, Germany
| | - Marius Marc-Daniel Mader
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Christina Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Marcel Seungsu Woo
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Fanny Quandt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Marlene Fischer
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jennifer Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Konrad K, Gerloff C, Kohl SH, Mehler DMA, Mehlem L, Volbert EL, Komorek M, Henn AT, Boecker M, Weiss E, Reindl V. Interpersonal neural synchrony and mental disorders: unlocking potential pathways for clinical interventions. Front Neurosci 2024; 18:1286130. [PMID: 38529267 PMCID: PMC10962391 DOI: 10.3389/fnins.2024.1286130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Interpersonal synchronization involves the alignment of behavioral, affective, physiological, and brain states during social interactions. It facilitates empathy, emotion regulation, and prosocial commitment. Mental disorders characterized by social interaction dysfunction, such as Autism Spectrum Disorder (ASD), Reactive Attachment Disorder (RAD), and Social Anxiety Disorder (SAD), often exhibit atypical synchronization with others across multiple levels. With the introduction of the "second-person" neuroscience perspective, our understanding of interpersonal neural synchronization (INS) has improved, however, so far, it has hardly impacted the development of novel therapeutic interventions. Methods To evaluate the potential of INS-based treatments for mental disorders, we performed two systematic literature searches identifying studies that directly target INS through neurofeedback (12 publications; 9 independent studies) or brain stimulation techniques (7 studies), following PRISMA guidelines. In addition, we narratively review indirect INS manipulations through behavioral, biofeedback, or hormonal interventions. We discuss the potential of such treatments for ASD, RAD, and SAD and using a systematic database search assess the acceptability of neurofeedback (4 studies) and neurostimulation (4 studies) in patients with social dysfunction. Results Although behavioral approaches, such as engaging in eye contact or cooperative actions, have been shown to be associated with increased INS, little is known about potential long-term consequences of such interventions. Few proof-of-concept studies have utilized brain stimulation techniques, like transcranial direct current stimulation or INS-based neurofeedback, showing feasibility and preliminary evidence that such interventions can boost behavioral synchrony and social connectedness. Yet, optimal brain stimulation protocols and neurofeedback parameters are still undefined. For ASD, RAD, or SAD, so far no randomized controlled trial has proven the efficacy of direct INS-based intervention techniques, although in general brain stimulation and neurofeedback methods seem to be well accepted in these patient groups. Discussion Significant work remains to translate INS-based manipulations into effective treatments for social interaction disorders. Future research should focus on mechanistic insights into INS, technological advancements, and rigorous design standards. Furthermore, it will be key to compare interventions directly targeting INS to those targeting other modalities of synchrony as well as to define optimal target dyads and target synchrony states in clinical interventions.
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Affiliation(s)
- Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | - Christian Gerloff
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
- Department of Applied Mathematics and Theoretical Physics, Cambridge Centre for Data-Driven Discovery, University of Cambridge, Cambridge, United Kingdom
| | - Simon H. Kohl
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | - David M. A. Mehler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- School of Psychology, Cardiff University Brain Research Imaging Center (CUBRIC), Cardiff University, Cardiff, United Kingdom
| | - Lena Mehlem
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Emily L. Volbert
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Maike Komorek
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Alina T. Henn
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Maren Boecker
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH, Aachen, Germany
| | - Eileen Weiss
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH, Aachen, Germany
| | - Vanessa Reindl
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Department of Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
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Cordes D, Gerloff C, Heise KF, Hummel FC, Schulz R, Wolf S, Haevernick K, Krüger H, Krause L, Suling A, Wegscheider K, Zapf A, Dressnandt J, Schäpers B, Schrödl C, Hauptmann B, Kirchner A, Brault A, Gutschalk A, Richter C, Nowak DA, Veldema J, Koch G, Maiella M, Dohle C, Jettkowski K, Pilz M, Hamzei F, Olischer L, Renner C, Groß M, Jöbges M, Voller B. Efficacy and safety of transcranial direct current stimulation to the ipsilesional motor cortex in subacute stroke (NETS): a multicenter, randomized, double-blind, placebo-controlled trial. Lancet Reg Health Eur 2024; 38:100825. [PMID: 38476746 PMCID: PMC10928272 DOI: 10.1016/j.lanepe.2023.100825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 03/14/2024]
Abstract
Background Each year, five million people are left disabled after stroke. Upper-extremity (UE) dysfunction is a leading problem. Neuroplasticity can be enhanced by non-invasive brain stimulation (NIBS) but evidence from large, randomized multicenter trials is lacking. We aimed at demonstrating efficacy of NIBS to enhance motor recovery after ischemic stroke. Methods We randomly assigned patients to receive anodal transcranial direct current (tDCS, 1 mA, 20 min) or placebo stimulation ('control') over the primary motor cortex of the lesioned hemisphere in addition to standardized rehabilitative training over ten days in the subacute phase after stroke. The original study was planned to enrol 250 but, following a blinded interim analysis, ended with 123 participants. The primary outcome parameter was UE impairment, measured by UE-Fugl-Meyer-Assessment (UEFMA), one to seven days after the end of the treatment intervention (ClinicalTrials.gov, NCT00909714). Findings From 2009 to 2019, 123 patients were included, with 119 entering intention-to-treat analysis (ITT). The control group (N = 61) improved 8.9 (SD 7.7) UEFMA points, the tDCS group (N = 58) improved 9.0 (8.8) points. ITT was neutral with respect to the primary efficacy endpoint (p = 0.820). We found no difference in UEFMA change between active tDCS and control. The safety profile of tDCS was favorable. In particular, there were no seizures. Interpretation In patients with ischemic stroke, anodal tDCS applied to the motor cortex of the lesioned hemisphere over 10 days in the subacute phase was safe but did not improve the recovery of upper extremity function compared with placebo stimulation. Funding Deutsche Forschungsgemeinschaft (GE 844/4-1).
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Braaß H, Feldheim J, Chu Y, Tinnermann A, Finsterbusch J, Büchel C, Schulz R, Gerloff C. Association between activity in the ventral premotor cortex and spinal cord activation during force generation-A combined cortico-spinal fMRI study. Hum Brain Mapp 2023; 44:6471-6483. [PMID: 37873743 PMCID: PMC10681651 DOI: 10.1002/hbm.26523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
Force generation is a crucial element of dexterity and a highly relevant skill of the human motor system. How cerebral and spinal components interact and how spinal activation is associated with the activity in the cerebral primary motor and premotor areas is poorly understood. Here, we conducted combined cortico-spinal functional magnetic resonance imaging during a simple visually guided isometric force generation task in 20 healthy young subjects. Activation was localized in the right cervical spinal cord and left primary motor and premotor areas. The main finding is that spinal activation was negatively correlated with ventral premotor cortex activation. Spinal activation was furthermore significantly correlated with primary motor cortex activation, while increasing target forces led to an increase in the amount of activation. These data indicate that human premotor areas such as the ventral premotor cortex might be functionally connected to the lower cervical spinal cord contributing to distal upper limb functions, a finding that extends our understanding of human motor function beyond the animal literature.
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Affiliation(s)
- Hanna Braaß
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jan Feldheim
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Ying Chu
- Institute of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Alexandra Tinnermann
- Institute of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jürgen Finsterbusch
- Institute of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian Büchel
- Institute of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Robert Schulz
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian Gerloff
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Hidding U, Lezius S, Schaper M, Buhmann C, Gerloff C, Pötter-Nerger M, Hamel W, Moll CKE, Choe CU. Combined Short-Pulse and Directional Deep Brain Stimulation of the Thalamic Ventral Intermediate Area for Essential Tremor. Neuromodulation 2023; 26:1680-1688. [PMID: 36369082 DOI: 10.1016/j.neurom.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Novel deep brain stimulation (DBS) systems allow directional and short-pulse stimulation to potentially improve symptoms and reduce side effects. The aim of this study was to investigate the effect of short-pulse and directional stimulation, in addition to a combination of both, in the ventral intermediate thalamus (VIM)/posterior subthalamic area (PSA) on tremor and stimulation-induced side effects in patients with essential tremor. MATERIALS AND METHODS We recruited 11 patients with essential tremor and VIM/PSA-DBS. Tremor severity (Fahn-Tolosa-Marin), ataxia (International Cooperative Ataxia Rating Scale), and paresthesia (visual analog scale) were assessed with conventional omnidirectional and directional stimulation with pulse width of 60 μs and 30 μs. RESULTS All stimulation conditions reduced tremor. The best directional stimulation with 60 μs reduced more tremor than did most other stimulation settings. The best directional stimulation, regardless of pulse width, effectively reduced stimulation-induced ataxia compared with the conventional stimulation (ring 60 μs) or worst directional stimulation with 60 μs. All new stimulation modes reduced occurrence of paresthesia, but only the best directional stimulation with 30 μs attenuated paresthesia compared with the conventional stimulation (ring 60 μs) or worst directional stimulation with 60 μs. The best directional stimulation with 30 μs reduced tremor, ataxia, and paresthesia compared with conventional stimulation in most patients. Correlation analyses indicated that more anterior stimulation sites are associated with stronger ataxia reduction with directional 30 μs than with conventional 60 μs stimulation. CONCLUSION Directional and short-pulse stimulation, and a combination of both, revealed beneficial effects on stimulation-induced adverse effects.
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Affiliation(s)
- Ute Hidding
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Guder S, Sadeghi F, Zittel S, Quandt F, Choe C, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. Disability and persistent motor deficits are linked to structural crossed cerebellar diaschisis in chronic stroke. Hum Brain Mapp 2023; 44:5336-5345. [PMID: 37471691 PMCID: PMC10543354 DOI: 10.1002/hbm.26434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/15/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
Brain imaging has significantly contributed to our understanding of the cerebellum being involved in recovery after non-cerebellar stroke. Due to its connections with supratentorial brain networks, acute stroke can alter the function and structure of the contralesional cerebellum, known as crossed cerebellar diaschisis (CCD). Data on the spatially precise distribution of structural CCD and their implications for persistent deficits after stroke are notably limited. In this cross-sectional study, structural MRI and clinical data were analyzed from 32 chronic stroke patients, at least 6 months after the event. We quantified lobule-specific contralesional atrophy, as a surrogate of structural CCD, in patients and healthy controls. Volumetric data were integrated with clinical scores of disability and motor deficits. Diaschisis-outcome models were adjusted for the covariables age, lesion volume, and damage to the corticospinal tract. We found that structural CCD was evident for the whole cerebellum, and particularly for lobules V and VI. Lobule VI diaschisis was significantly correlated with clinical scores, that is, volume reductions in contralesional lobule VI were associated with higher levels of disability and motor deficits. Lobule V and the whole cerebellum did not show similar diaschisis-outcome relationships across the spectrum of the clinical scores. These results provide novel insights into stroke-related cerebellar plasticity and might thereby promote lobule VI as a key area prone to structural CCD and potentially involved in recovery and residual motor functioning.
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Affiliation(s)
- Stephanie Guder
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Fatemeh Sadeghi
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Simone Zittel
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Fanny Quandt
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Chi‐un Choe
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Marlene Bönstrup
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of NeurologyUniversity Medical Center LeipzigLeipzigGermany
| | - Bastian Cheng
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Götz Thomalla
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian Gerloff
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Robert Schulz
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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10
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Grimm K, Prilop L, Schön G, Gelderblom M, Misselhorn J, Gerloff C, Zittel S. Cerebellar Modulation of Sensorimotor Associative Plasticity Is Impaired in Cervical Dystonia. Mov Disord 2023; 38:2084-2093. [PMID: 37641392 DOI: 10.1002/mds.29586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In recent years, cervical dystonia (CD) has been recognized as a network disorder that involves not only the basal ganglia but other brain regions, such as the primary motor and somatosensory cortex, brainstem, and cerebellum. So far, the role of the cerebellum in the pathophysiology of dystonia is only poorly understood. OBJECTIVE The objective of this study was to investigate the role of the cerebellum on sensorimotor associative plasticity in patients with CD. METHODS Sixteen patients with CD and 13 healthy subjects received cerebellar transcranial direct current stimulation (ctDCS) followed by a paired associative stimulation (PAS) protocol based on transcranial magnetic stimulation that induces sensorimotor associative plasticity. Across three sessions the participants received excitatory anodal, inhibitory cathodal, and sham ctDCS in a double-blind crossover design. Before and after the intervention, motor cortical excitability and motor symptom severity were assessed. RESULTS PAS induced an increase in motor cortical excitability in both healthy control subjects and patients with CD. In healthy subjects this effect was attenuated by both anodal and cathodal ctDCS with a stronger effect of cathodal stimulation. In patients with CD, anodal stimulation suppressed the PAS effect, whereas cathodal stimulation had no influence on PAS. Motor symptom severity was unchanged after the intervention. CONCLUSIONS Cerebellar modulation with cathodal ctDCS had no effect on sensorimotor associative plasticity in patients with CD, in contrast with the net inhibitory effect in healthy subjects. This is further evidence that the cerebello-thalamo-cortical network plays a role in the pathophysiology of dystonia. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kai Grimm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Prilop
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Misselhorn
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Schlemm E, Piepke M, Kessner SS, Meyer L, Cheng B, Gerloff C, Thomalla G. Clinical Judgment vs Triage Scales for Detecting Large Vessel Occlusions in Suspected Acute Stroke. JAMA Netw Open 2023; 6:e2332894. [PMID: 37698866 PMCID: PMC10498329 DOI: 10.1001/jamanetworkopen.2023.32894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/25/2023] [Indexed: 09/13/2023] Open
Abstract
This cohort study examines clinical judgment of large vessel occlusions compared with triage scales in a sample of patients admitted to the emergency department with suspicion of acute stroke.
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Affiliation(s)
- Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marius Piepke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon S. Kessner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosomatic Medicine und Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Steinacker JM, van Mechelen W, Bloch W, Börjesson M, Casasco M, Wolfarth B, Knoke C, Papadopoulou T, Wendt J, Al Tunaiji H, Andresen D, Andrieieva O, Bachl N, Badtieva V, Beucher FJ, Blauwet CA, Casajus Mallen JA, Chang JH, Clénin G, Constantini N, Constantinou D, Di Luigi L, Declercq L, Doutreleau S, Drozdovska S, Duclos M, Ermolao A, Fischbach T, Fischer AN, Fossati C, Franchella J, Fulcher M, Galle JC, Gerloff C, Georgiades E, Gojanovic B, González Gross M, Grote A, Halle M, Hauner H, Herring MP, Hiura M, Holze K, Huber G, Hughes D, Hutchinson MR, Ionescu A, Janse van Rensburg DC, Jegier A, Jones N, Kappert-Gonther K, Kellerer M, Kimura Y, Kiopa A, Kladny B, Koch G, Kolle E, Kolt G, Koutedakis Y, Kress S, Kriemler S, Kröger J, Kuhn C, Laszlo R, Lehnert R, Lhuissier FJ, Lüdtke K, Makita S, Manonelles Marqueta P, März W, Micallef-Stafrace K, Miller M, Moore M, Müller E, Neunhäuserer D, Onur IR, Ööpik V, Perl M, Philippou A, Predel HG, Racinais S, Raslanas A, Reer R, Reinhardt K, Reinsberger C, Rozenstoka S, Sallis R, Sardinha LB, Scherer M, Schipperijn J, Seil R, Tan B, Schmidt-Trucksäss A, Schumacher N, Schwaab B, Schwirtz A, Suzuki M, Swart J, Tiesler R, Tippelt U, Tillet E, Thornton J, Ulkar B, Unt E, Verhagen E, Weikert T, Vettor R, Zeng S, Budgett R, Engebretsen L, Erdener U, Pigozzi F, Pitsiladis YP. Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration. BMJ Open Sport Exerc Med 2023; 9:e001626. [PMID: 37533594 PMCID: PMC10391804 DOI: 10.1136/bmjsem-2023-001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.
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Affiliation(s)
- Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Institute for Rehabilitation Medicine Research at Ulm University, Institut für rehabilitationsmedizinische Forschung an der Universität Ulm, Bad Buchau, Germany
| | - Willem van Mechelen
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- Department of Public and Occupational Health, location Vrije Universiteit, Amsterdam University Medical Centers, Amsterdam, Netherlands
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Wilhelm Bloch
- Institute for Cardiology and Sports Medicine, German Sport University, Cologne, Germany
- Exercise is Medicine Germany, Frankfurt, Germany
| | - Mats Börjesson
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Institute of Medicine, Sahlgrenska University Hospital, Goteborg, Region Västra Götaland, Sweden
| | | | - Bernd Wolfarth
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Department of Sport Medicine, Humboldt University and Charité University School of Medicine, Berlin, Deutschland, Germany
- German Society for Sports Medicine and Prevention, Deutsche Gesellschaft für Sportmedizin und Prävention (DGSP), Frankfurt, Germany
| | - Carolin Knoke
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
| | - Theodora Papadopoulou
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- British Association of Sport and Exercise Medicine, Doncaster, South Yorkshire, UK
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Hashel Al Tunaiji
- Sports Medicine, United Arab Emirates National Olympic Committee, Dubai, UAE
- Sports Medicine & Sciences Unit, Zayed Military University, Abu Dhabi, UAE
| | | | - Olena Andrieieva
- Department of Health, Fitness and Recreation, National University of Physical Education and Sport of Ukraine, Kiew, Ukraine
| | - Norbert Bachl
- Institute of Sports Science, University of Vienna, Vienna, Austria
- International Federation of Sports Medicine, Lausanne, Switzerland
| | - Victoriya Badtieva
- Sport Medicine, I M Sechenov First Moscow State Medical University, Moscow, Russia
- Sport Medicine, Moscow Scientific and Practical Center of Medical Rehabilitation and Sports Medicine, Moscow, Russian
| | - Friedhelm J Beucher
- National Paralympic Committee Germany (Deutscher Behindertensportverband (DBS), Bonn, Germany
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose-Antonio Casajus Mallen
- University of Zaragoza, GENUD “Growth, Exercise, NUtrition and Development” Research Group, Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
- Exercise is Medicine Spain, University of Zaragoza, Zaragoza, Spain
| | - Ju-Ho Chang
- The Association for International Sport for All (TAFISA), Frankfurt, Germany
| | - German Clénin
- Sportsmedical Centre Bern-Ittigen, Ittigen, Switzerland
- Sport and Exercise Medicine Switzerland (SEMS), Bern, Switzerland
| | - Naama Constantini
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
- Exercise is Medicine Israel, Hebrew University, Jerusalem, Israel
| | - Demitri Constantinou
- Centre for Exercise Science and Sports Medicine, University of Witwatersrand, Johannesburg, South Africa
- South African Sports Medicine Association (SASMA), Pretoria, South Africa
| | - Luigi Di Luigi
- Unit of Endocrinology - Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
| | | | - Stephane Doutreleau
- Department of Sports Medicine, University Grenoble Alpes, Grenoble, Auvergne-Rhône-Alpes, France
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
| | - Svitlana Drozdovska
- National University of Physical Education and Sport of Ukraine, Kyiv, Ukraine
| | - Martine Duclos
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
- Department of Sport Medicine and Functional Explorations, University-Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France
- UMR 1019, INRAE, French National Research Institute for Agriculture, Food and Environment, Clermont-Ferrand, France
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, Università degli Studi di Padova, Padova, Italy
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
| | - Thomas Fischbach
- German Association of Paediatric and Adolescent Care Specialists, BVKJ - Berufsverband der Kinder- und Jugendärzte, Cologne, Germany
| | - Anastasia N Fischer
- Sports Medicine and Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
- American College of Sports Medicine, Indianapolis, Indiana, USA
| | - Chiara Fossati
- Faculty of Sport and Exercise Sciences, University of Rome 'Foro Italico', Roma, Lazio, Italy
| | - Jeorge Franchella
- Hospital de Clínicas José San Martin, University of Buenos Aires, Buenos Aires, Argentina
| | - Mark Fulcher
- Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
- AUT Sports Performance Research Institute New Zealand, Auckland, New Zealand
| | - Jan C Galle
- German Society of Nephrology (Deutsche Gesellschaft für Nephrologie (DGfN)), Berlin, Germany
| | - Christian Gerloff
- German Society for Neurology (Deutsche Gesellschaft für Neurologie (DGN)), Berlin, Germany
| | | | - Boris Gojanovic
- Sports Medicine, Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland
- SportAdo Consultation - Multidisciplinary Unit of Adolescent Health, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marcela González Gross
- Exercise is Medicine Spain, University of Zaragoza, Zaragoza, Spain
- Department of Health and Human Performance - Facultad de CC de la Actividad Física y del Deporte, INEF Universidad Politécnica de Madrid, Madrid, Spain
| | - Andy Grote
- Senat, Freie und Hansestadt Hamburg, Hamburg, Germany
| | - Martin Halle
- European Association of Preventive Cardiology (EAPC), European Society of Cardiology (ECS), Biot, France
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans Hauner
- German Diabetes Foundation, Deutsche Diabetes Stiftung, Düsseldorf, Germany
| | | | - Mikio Hiura
- Center for Brain and Health Sciences, Aomori University, Aomori, Japan
| | - Kerstin Holze
- German Olympic Sports Confederation, Deutscher Olympischer Sportbund, Frankfurt am Main, Germany
| | - Gerhard Huber
- Institute of Sports and Sport Science, University Heidelberg, Heidelberg, Germany
- Deutscher Verband für Gesundheitssport und Sporttherapie e.V. (DVGS), Hamburg, Germany
| | - David Hughes
- Sports Medicine, Australian Institute of Sport, Canberra, Canberra, Australia
- Australian Institute of Sport, Australian Sports Commission, Canberra, Canberra, Australia
| | - Mark R. Hutchinson
- American College of Sports Medicine, Indianapolis, Indiana, USA
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA
- American College of Sports Medicine Foundation, Indianapolis, Indiana, USA
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Carol Davila University of Medicine and Pharmacy, Bucharest, Bucharest, Romania
| | - Dina Christina Janse van Rensburg
- South African Sports Medicine Association (SASMA), Pretoria, South Africa
- Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
| | - Anna Jegier
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Department of Sports Medicine, Medical University of Lodz, Lodz, Poland
| | - Natasha Jones
- Moving Medicine, Faculty of Sport and Exercise Medicine UK, Edinburgh, UK
| | | | - Monika Kellerer
- German Diabetes Foundation, Deutsche Diabetes Stiftung, Düsseldorf, Germany
| | - Yutaka Kimura
- Health Science Center, Kansai Medical University, Osaka, Japan
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
| | | | - Bernd Kladny
- German Society of Orthopaedics and Trauma (Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)) with the German Society for Trauma Surgery (DGU) and German Society of Orthopaedics and Orthopaedic Surgery (DGOOC), Berlin, Germany
| | - Gerhard Koch
- Platform on Nutrition and Physical Activity, Plattform Ernährung und Bewegung e.V. (peb), Berlin, Germany
| | - Elin Kolle
- Exercise is Medicine Norway, Oslo, Norway
| | - Greg Kolt
- School of Science and Health, University of Western Sydney, Sydney, New South Wales, Australia
| | - Yiannis Koutedakis
- Exercise is Medicine Greece, National and Kapodistrian University of Athens, Athens, Greece
- School of Exercise Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Stephan Kress
- German Diabetes Association (Deutsche Diabetes Gesellschaft (DDG)), Berlin, Germany
| | - Susi Kriemler
- Sport and Exercise Medicine Switzerland (SEMS), Bern, Switzerland
- Institute of Epidemiology, Biostatistics and Prevention, Zuerich University, Zuerich, Switzerland
| | - Jens Kröger
- German Diabetes Support (diabetesDE - Deutsche Diabetes-Hilfe), Charlottenburg, Germany
| | - Christian Kuhn
- German Alliance for Baths, Bäderallianz Deutschland, Köln, Germany
- International Assocation for Sport and Leisure Facilities, Köln, Germany
| | - Roman Laszlo
- German Cardiac Society (Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK)), Düsseldorf, Nordrhein-Westfalen, Germany
| | - Ralph Lehnert
- Hamburg Sport Association (Hamburger Sportbund e.V.), Hamburg, Germany
| | - François J Lhuissier
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
- UMR INSERM 1272 Hypoxie et poumon, Université Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
- Hôpital Jean-Verdier, Médecine de l’exercice et du sport, Assistance Publique - Hôpitaux de Paris, Bondy, France
| | - Kerstin Lüdtke
- German Society for Physiotherapy Science (Deutsche Gesellschaft für Physiotherapiewissenschaft (DGPTW)), Hamburg, Germany
| | - Shigeru Makita
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
- Dept. of Rehabilitation, Saitama Medical University, Saitama, Japan
| | - Pedro Manonelles Marqueta
- International Federation of Sports Medicine, Lausanne, Switzerland
- Dept. of Rehabilitation, Saitama Medical University, Saitama, Japan
| | - Winfried März
- D.A.CH Society Prevention of Cardiovascular Diseases, D.A.CH-Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen, Hamburg, Germany
| | - Kirill Micallef-Stafrace
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- University Sports Complex, Institute for Physical Education and Sport, Msida, Malta
| | - Mike Miller
- World Olympians Association (WOA), Lausanne, Switzerland
| | | | - Erich Müller
- European College of Sport Science, Köln, Germany
| | - Daniel Neunhäuserer
- Sports and Exercise Medicine Division, Department of Medicine, Università degli Studi di Padova, Padova, Italy
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
| | - I. Renay Onur
- Istanbul Spor Etkinlikleri ve Isletmeciligi A S, City of Istanbul, Istanbul, Turkey
| | - Vahur Ööpik
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | | | - Anastassios Philippou
- Exercise is Medicine Greece, National and Kapodistrian University of Athens, Athens, Greece
| | - Hans-Georg Predel
- German Hypertension League (Deutsche Hochdruckliga e.V. (DHL)), Heidelberg, Baden-Württemberg, Germany
- German Society for Hypertension and Prevention (Deutsche Gesellschaft für Hypertonie und Prävention), Heidelberg, Germany
| | - Sebastien Racinais
- Research Education Centre, ASPETAR - Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Algirdas Raslanas
- Department of Educational Assistance, Physical and Health Education, Vytautas Magnus University, Vilnius, Lithuania
| | - Ruediger Reer
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Department of Movement Science, University of Hamburg, Hamburg, Germany
| | - Klaus Reinhardt
- German Medical Association (Bundesaerztekammer), Berlin, Germany
| | - Claus Reinsberger
- German Society for Sports Medicine and Prevention, Deutsche Gesellschaft für Sportmedizin und Prävention (DGSP), Frankfurt, Germany
| | - Sandra Rozenstoka
- International Federation of Sports Medicine, Lausanne, Switzerland
- Rīga Stradiņš University, Riga, Latvia
- Sports Laboratory, Sports Medicine and Physical Health Centre, Riga, Latvia, Riga, Latvia
- Latvian Sports Medicine Association, Riga, Latvia
| | - Robert Sallis
- Family Medicine, Kaiser Permanente, Fontana, California, USA
| | - Luis B Sardinha
- Exercise is Medicine Portugal, Universidade de Lisboa, Lisboa, Portugal
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Martin Scherer
- German Society of General Practice and Family Medicine (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)), Berlin, Germany
- Department of General Practice and Primary Care, University Medical Center, Hamburg, Germany
| | - Jasper Schipperijn
- International Society for Physical Activity and Health (ISPAH), Vancouver, British Columbia, Canada
| | - Romain Seil
- Society for Orthopaedic and Traumatologic Sports Medicine (GOTS), Jena, Germany
| | - Benedict Tan
- Exercise is Medicine Singapore, Singapore
- Department of Sport & Exercise Medicine, Changi General Hospital, Singapore
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, Basel, Switzerland
| | - Nils Schumacher
- Department of Movement Science, University of Hamburg, Hamburg, Germany
| | - Bernhard Schwaab
- German Society for the Prevention and Rehabilitation of Cardiovascular Diseases (Deutsche Gesellschaft für Prävention und Rehabilitation von Herz-Kreislauferkrankungen (DGPR)), Koblenz, Germany
| | - Ansgar Schwirtz
- German Society of Sports Science, Deutsche Vereinigung für Sportwissenschaft (DVS), Frankfurt, Germany
| | - Masato Suzuki
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
| | - Jeroen Swart
- International Federation of Sports Medicine, Lausanne, Switzerland
- Health through Physical Activity, Lifestyle and Sport (HPALS) Research Centre, University of Cape Town, Cape Town, South Africa
| | - Ralph Tiesler
- Federal Institute for Sports Science (Bundesinstitut für Sportwissenschaft (BISp)), Bonn, Nordrhein-Westfalen, Germany
| | - Ulf Tippelt
- Institute for Applied Training Science Leipzig, Leipzig, Sachsen, Germany
| | - Eleanor Tillet
- British Association of Sport and Exercise Medicine, Doncaster, South Yorkshire, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Jane Thornton
- Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Bulent Ulkar
- International Federation of Sports Medicine, Lausanne, Switzerland
- Sports Medicine Department, Faculty of Medicine, Ankara University, Ankara, Ankara, Turkey
| | - Eve Unt
- Department of Sports Medicine and Rehabilitation, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Evert Verhagen
- Department of Public and Occupational Health, location Vrije Universiteit, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Thomas Weikert
- German Olympic Sports Confederation, Deutscher Olympischer Sportbund, Frankfurt am Main, Germany
| | - Roberto Vettor
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
- Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Sheng Zeng
- International Federation of Sports Medicine, Lausanne, Switzerland
- Laboratory of Regenerative Medicine, Haikou, Hainan, China
| | | | - Lars Engebretsen
- International Olympic Committee, Lausanne, Switzerland
- Division of Orthopedic Surgery, University of Oslo, Oslo, Norway
| | - Ugur Erdener
- International Olympic Committee, Lausanne, Switzerland
| | - Fabio Pigozzi
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Yannis P Pitsiladis
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
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13
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Schwieren L, Jensen M, Schulz R, Lezius S, Laxy E, Milatz M, Thomalla G, Böger R, Gerloff C, Magnus T, Schwedhelm E, Choe CU. Homoarginine Associates with Carotid Intima-Media Thickness and Atrial Fibrillation and Predicts Adverse Events after Stroke. Life (Basel) 2023; 13:1590. [PMID: 37511965 PMCID: PMC10381763 DOI: 10.3390/life13071590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Homoarginine is associated with cardio- and cerebrovascular morbidity and mortality. However, the underlying pathomechanisms remain elusive. Here, we evaluated the association of homoarginine with adverse events (i.e., death, stroke, and myocardial infarction) and carotid intima-media thickness (cIMT) in stroke patients. In the prospective bioMARKers in STROKE (MARK-STROKE) cohort, patients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled. Plasma homoarginine concentrations were analyzed and associated with clinical phenotypes in cross-sectional (374 patients) and prospective (273 patients) analyses. Adjustments for possible confounders were evaluated. A two-fold increase in homoarginine was inversely associated with the National Institutes of Health Stroke Scale (NIHSS) score at admission, cIMT, and prevalent atrial fibrillation (mean factor -0.68 [95% confidence interval (CI): -1.30, -0.07], -0.14 [95% CI: -0.22, -0.05]; and odds ratio 0.57 [95% CI: 0.33, 0.96], respectively). During the follow-up (median 284 [25th, 75th percentile: 198, 431] days), individuals with homoarginine levels in the highest tertile had fewer incident events compared with patients in the lowest homoarginine tertile independent of traditional risk factors (hazard ratio 0.22 [95% CI: 0.08, 0.63]). A lower prevalence of atrial fibrillation and a reduced cIMT pinpointed potential underlying pathomechanisms.
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Affiliation(s)
- Laura Schwieren
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
- Institute of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Märit Jensen
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Elena Laxy
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Magalie Milatz
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Rainer Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Tim Magnus
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK e.V.) Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
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14
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Braaß H, Gutgesell L, Backhaus W, Higgen FL, Quandt F, Choe CU, Gerloff C, Schulz R. Early functional connectivity alterations in contralesional motor networks influence outcome after severe stroke: a preliminary analysis. Sci Rep 2023; 13:11010. [PMID: 37419966 PMCID: PMC10328915 DOI: 10.1038/s41598-023-38066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023] Open
Abstract
Connectivity studies have significantly extended the knowledge on motor network alterations after stroke. Compared to interhemispheric or ipsilesional networks, changes in the contralesional hemisphere are poorly understood. Data obtained in the acute stage after stroke and in severely impaired patients are remarkably limited. This exploratory, preliminary study aimed to investigate early functional connectivity changes of the contralesional parieto-frontal motor network and their relevance for the functional outcome after severe motor stroke. Resting-state functional imaging data were acquired in 19 patients within the first 2 weeks after severe stroke. Nineteen healthy participants served as a control group. Functional connectivity was calculated from five key motor areas of the parieto-frontal network on the contralesional hemisphere as seed regions and compared between the groups. Connections exhibiting stroke-related alterations were correlated with clinical follow-up data obtained after 3-6 months. The main finding was an increase in coupling strength between the contralesional supplementary motor area and the sensorimotor cortex. This increase was linked to persistent clinical deficits at follow-up. Thus, an upregulation in contralesional motor network connectivity might be an early pattern in severely impaired stroke patients. It might carry relevant information regarding the outcome which adds to the current concepts of brain network alterations and recovery processes after severe stroke.
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Affiliation(s)
- Hanna Braaß
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Lily Gutgesell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Focko L Higgen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Fanny Quandt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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15
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Fründt O, Mainka T, Vettorazzi E, Baspinar E, Schwarz C, Südmeyer M, Gerloff C, Zangemeister WH, Poetter-Nerger M, Hidding U, Hamel W, Moll CKE, Buhmann C. Prospective controlled study on the effects of deep brain stimulation on driving in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:105. [PMID: 37394536 DOI: 10.1038/s41531-023-00545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/07/2023] [Indexed: 07/04/2023] Open
Abstract
To explore the influence of bilateral subthalamic deep brain stimulation (STN-DBS) on car driving ability in patients with Parkinson's disease (PD), we prospectively examined two age-matched, actively driving PD patient groups: one group undergone DBS-surgery (PD-DBS, n = 23) and one group that was eligible for DBS but did not undergo surgery (PD-nDBS, n = 29). In PD-DBS patients, investigation at Baseline was done just prior and at Follow-up 6-12 month after DBS-surgery. In PD-nDBS patients, time interval between Baseline and Follow-up was aimed to be comparable. To assess the general PD driving level, driving was assessed once in 33 age-matched healthy controls at Baseline. As results, clinical and driving characteristics of PD-DBS, PD-nDBS and controls did not differ at Baseline. At Follow-up, PD-DBS patients drove unsafer than PD-nDBS patients. This effect was strongly driven by two single PD-DBS participants (9%) with poor Baseline and disastrous Follow-up driving performance. Retrospectively, we could not identify any of the assessed motor and non-motor clinical Baseline characteristics as predictive for this driving-deterioration at Follow-up. Excluding these two outliers, comparable driving performance between PD-DBS and PD-nDBS patients not only at Baseline but also at Follow-up was demonstrated. Age, disease duration and severity as well as Baseline driving insecurity were associated with poorer driving performance at Follow-up. This first prospective study on driving safety in PD after DBS surgery indicates that DBS usually does not alter driving safety but might increase the risk for driving deterioration, especially in single subjects with already unsafe driving prior to DBS surgery.
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Affiliation(s)
- Odette Fründt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
- Department of Neurology, Ernst von Bergmann Clinic, 14467, Potsdam, Germany
| | - Tina Mainka
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
- Department of Neurology with Experimental Neurology, Charité Campus Mitte, 10117, Berlin, Germany
- BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Ela Baspinar
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Cindy Schwarz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Martin Südmeyer
- Department of Neurology, Ernst von Bergmann Clinic, 14467, Potsdam, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Wolfgang H Zangemeister
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Monika Poetter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Ute Hidding
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University-Hospital Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian K E Moll
- Institute of Neurophysiology and Pathophysiology, University-Hospital Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
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16
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Mayer C, Walther C, Borof K, Nägele FL, Petersen M, Schell M, Gerloff C, Kühn S, Heydecke G, Beikler T, Cheng B, Thomalla G, Aarabi G. Association between periodontal disease and microstructural brain alterations in the Hamburg City Health Study. J Clin Periodontol 2023. [PMID: 37263624 DOI: 10.1111/jcpe.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/24/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
AIM The aim of the PAROBRAIN study was to examine the association of periodontal health with microstructural white matter integrity and cerebral small vessel disease (CSVD) in the Hamburg City Health Study, a large population-based cohort with dental examination and brain magnetic resonance imaging (MRI). MATERIALS AND METHODS Periodontal health was determined by measuring clinical attachment loss (CAL) and plaque index. Additionally, the decayed/missing/filled teeth (DMFT) index was quantified. 3D-FLAIR and 3D-T1-weighted images were used for white matter hyperintensity (WMH) segmentation. Diffusion-weighted MRI was used to quantify peak width of skeletonized mean diffusivity (PSMD). RESULTS Data from 2030 participants were included in the analysis. Median age was 65 years, with 43% female participants. After adjusting for age and sex, an increase in WMH load was significantly associated with more CAL, higher plaque index and higher DMFT index. PSMD was significantly associated with the plaque index and DMFT. Additional adjustment for education and cardiovascular risk factors revealed a significant association of PSMD with plaque index (p < .001) and DMFT (p < .01), whereas effects of WMH load were attenuated (p > .05). CONCLUSIONS These findings suggest an adverse effect of periodontal health on CSVD and white matter integrity. Further research is necessary to examine whether early treatment of periodontal disease can prevent microstructural brain damage.
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Affiliation(s)
- Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Borof
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix L Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Petersen M, Nägele FL, Mayer C, Schell M, Petersen E, Kühn S, Gallinat J, Fiehler J, Pasternak O, Matschke J, Glatzel M, Twerenbold R, Gerloff C, Thomalla G, Cheng B. Brain imaging and neuropsychological assessment of individuals recovered from a mild to moderate SARS-CoV-2 infection. Proc Natl Acad Sci U S A 2023; 120:e2217232120. [PMID: 37220275 DOI: 10.1073/pnas.2217232120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/23/2023] [Indexed: 05/25/2023] Open
Abstract
As severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections have been shown to affect the central nervous system, the investigation of associated alterations of brain structure and neuropsychological sequelae is crucial to help address future health care needs. Therefore, we performed a comprehensive neuroimaging and neuropsychological assessment of 223 nonvaccinated individuals recovered from a mild to moderate SARS-CoV-2 infection (100 female/123 male, age [years], mean ± SD, 55.54 ± 7.07; median 9.7 mo after infection) in comparison with 223 matched controls (93 female/130 male, 55.74 ± 6.60) within the framework of the Hamburg City Health Study. Primary study outcomes were advanced diffusion MRI measures of white matter microstructure, cortical thickness, white matter hyperintensity load, and neuropsychological test scores. Among all 11 MRI markers tested, significant differences were found in global measures of mean diffusivity (MD) and extracellular free water which were elevated in the white matter of post-SARS-CoV-2 individuals compared to matched controls (free water: 0.148 ± 0.018 vs. 0.142 ± 0.017, P < 0.001; MD [10-3 mm2/s]: 0.747 ± 0.021 vs. 0.740 ± 0.020, P < 0.001). Group classification accuracy based on diffusion imaging markers was up to 80%. Neuropsychological test scores did not significantly differ between groups. Collectively, our findings suggest that subtle changes in white matter extracellular water content last beyond the acute infection with SARS-CoV-2. However, in our sample, a mild to moderate SARS-CoV-2 infection was not associated with neuropsychological deficits, significant changes in cortical structure, or vascular lesions several months after recovery. External validation of our findings and longitudinal follow-up investigations are needed.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Felix Leonard Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Elina Petersen
- Department of Cardiology, University Heart and Vascular Center, 20251 Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, 20251 Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 202115 Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 202 Boston, MA
| | - Jakob Matschke
- Institute of Neuropathology, University Center Hamburg-Eppendorf, Hamburg, 20251 Gemany
| | - Markus Glatzel
- Institute of Neuropathology, University Center Hamburg-Eppendorf, Hamburg, 20251 Gemany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center, 20251 Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, 20251 Hamburg, Germany
- German Center for Cardiovascular Research, Partner site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
- University Center of Cardiovascular Science, University Heart and Vascular Center, 202115 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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18
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Frey BM, Shenas F, Boutitie F, Cheng B, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Barow E, Königsberg A, Schlemm E, Pedraza S, Lemmens R, Thijs V, Muir KW, Nighoghossian N, Simonsen CZ, Gerloff C, Thomalla G. Intravenous Thrombolysis in Patients With White Matter Hyperintensities in the WAKE-UP Trial. Stroke 2023. [PMID: 37226772 DOI: 10.1161/strokeaha.122.040247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND White matter hyperintensities of presumed vascular origin (WMH) are the most prominent imaging feature of cerebral small vessel disease (cSVD). Previous studies suggest a link between cSVD burden and intracerebral hemorrhage and worse functional outcome after thrombolysis in acute ischemic stroke. We aimed to determine the impact of WMH burden on efficacy and safety of thrombolysis in the MRI-based randomized controlled WAKE-UP trial of intravenous alteplase in unknown onset stroke. METHODS The design of this post hoc study was an observational cohort design of a secondary analysis of a randomized trial. WMH volume was quantified on baseline fluid-attenuated inversion recovery images of patients randomized to either alteplase or placebo in the WAKE-UP trial. Excellent outcome was defined as score of 0-1 on the modified Rankin Scale after 90 days. Hemorrhagic transformation was assessed on follow-up imaging 24-36 hours after randomization. Treatment effect and safety were analyzed by fitting multivariable logistic regression models. RESULTS Quality of scans was sufficient in 441 of 503 randomized patients to delineate WMH. Median age was 68 years, 151 patients were female, and 222 patients were assigned to receive alteplase. Median WMH volume was 11.4 mL. Independent from treatment, WMH burden was statistically significantly associated with worse functional outcome (odds ratio, 0.72 [95% CI, 0.57-0.92]), but not with higher chances of any hemorrhagic transformation (odds ratio, 0.78 [95% CI, 0.60-1.01]). There was no interaction of WMH burden and treatment group for the likelihood of excellent outcome (P=0.443) or any hemorrhagic transformation (P=0.151). In a subgroup of 166 patients with severe WMH, intravenous thrombolysis was associated with higher odds of excellent outcome (odds ratio, 2.40 [95% CI, 1.19-4.84]) with no significant increase in the rate of hemorrhagic transformation (odds ratio, 1.96 [95% CI, 0.80-4.81]). CONCLUSIONS Although WMH burden is associated with worse functional outcome, there is no association with treatment effect or safety of intravenous thrombolysis in patients with ischemic stroke of unknown onset. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01525290.
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Affiliation(s)
- Benedikt M Frey
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Farhad Shenas
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France; Université Lyon 1, FranceCNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France (F.B.)
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, France (T.-H.C., N.N.)
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
- Neurologie der Rehaklinik Medical Park Humboldtmühle, Berlin, Germany (M. Ebinger)
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (M. Endres)
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.)
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
| | - Ewgenia Barow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt, Girona, Spain (S.P.)
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (R.L.)
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Belgium (R.L.)
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Belgium (R.L.)
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia (V.T.)
- Austin Health, Department of Neurology, Heidelberg, VIC, Australia (V.T.)
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, Glasgow, United Kingdom (K.W.M.)
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, France (T.-H.C., N.N.)
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.)
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.M.F., F.S., B.C., E.B., A.K., E.S., C.G., G.T.)
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Wróbel PP, Guder S, Feldheim JF, Graterol Pérez JA, Frey BM, Choe CU, Bönstrup M, Cheng B, Rathi Y, Pasternak O, Thomalla G, Gerloff C, Shenton ME, Schulz R. Altered microstructure of the contralesional ventral premotor cortex and motor output after stroke. Brain Commun 2023; 5:fcad160. [PMID: 37265601 PMCID: PMC10231803 DOI: 10.1093/braincomms/fcad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/17/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
Cortical thickness analyses have provided valuable insights into changes in cortical brain structure after stroke and their association with recovery. Across studies though, relationships between cortical structure and function show inconsistent results. Recent developments in diffusion-weighted imaging of the cortex have paved the way to uncover hidden aspects of stroke-related alterations in cortical microstructure, going beyond cortical thickness as a surrogate for cortical macrostructure. We re-analysed clinical and imaging data of 42 well-recovered chronic stroke patients from 2 independent cohorts (mean age 64 years, 4 left-handed, 71% male, 16 right-sided strokes) and 33 healthy controls of similar age and gender. Cortical fractional anisotropy and cortical thickness values were obtained for six key sensorimotor areas of the contralesional hemisphere. The regions included the primary motor cortex, dorsal and ventral premotor cortex, supplementary and pre-supplementary motor areas, and primary somatosensory cortex. Linear models were estimated for group comparisons between patients and controls and for correlations between cortical fractional anisotropy and cortical thickness and clinical scores. Compared with controls, stroke patients exhibited a reduction in fractional anisotropy in the contralesional ventral premotor cortex (P = 0.005). Fractional anisotropy of the other regions and cortical thickness did not show a comparable group difference. Higher fractional anisotropy of the ventral premotor cortex, but not cortical thickness, was positively associated with residual grip force in the stroke patients. These data provide novel evidence that the contralesional ventral premotor cortex might constitute a key sensorimotor area particularly susceptible to stroke-related alterations in cortical microstructure as measured by diffusion MRI and they suggest a link between these changes and residual motor output after stroke.
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Affiliation(s)
- Paweł P Wróbel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Stephanie Guder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Jan F Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - José A Graterol Pérez
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Chi-un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
- Department of Neurology, University Medical Center, Leipzig 04103, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
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20
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Scheldeman L, Wouters A, Bertels J, Dupont P, Cheng B, Ebinger M, Endres M, Fiebach JB, Gerloff C, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Thijs V, Thomalla G, Lemmens R. Reversibility of Diffusion-Weighted Imaging Lesions in Patients With Ischemic Stroke in the WAKE-UP Trial. Stroke 2023; 54:1560-1568. [PMID: 37158080 DOI: 10.1161/strokeaha.122.041505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Reversibility of the diffusion-weighted imaging (DWI) lesion means that not all of the DWI lesion represents permanently injured tissue. We investigated DWI reversibility and the association with thrombolysis, reperfusion and functional outcome in patients from the WAKE-UP trial (Efficacy and Safety of Magnetic Resonance Imaging-Based Thrombolysis in Wake-Up Stroke). METHODS In this retrospective analysis of WAKE-UP, a randomized controlled trial (RCT) between September 2012 and June 2017 in Belgium, Denmark, France, Germany, Spain and United Kingdom, a convolutional neural network segmented the DWI lesions (b=1000 s/mm2) at baseline and follow-up (24 hours). We calculated absolute and relative DWI reversibility in 2 ways: first, a volumetric (baseline volume-24-hour volume >0) and second, a voxel-based (part of baseline lesion not overlapping with 24-hour lesion) approach. We additionally defined relative voxel-based DWI-reversibility >50% to account for coregistration inaccuracies. We calculated the odds ratio for reversibility according to treatment arm. We analyzed the association of reversibility with excellent functional outcome (modified Rankin Scale score of 0-1), in a multivariable model. RESULTS In 363 patients, the median DWI volume was 3 (1-10) mL at baseline and 6 (2-20) mL at follow-up. Volumetric DWI reversibility was present in 19% (69/363) with a median absolute reversible volume of 1 mL (0-2) or 28% (14-50) relatively. Voxel-based DWI reversibility was present in 358/363 (99%) with a median absolute volume of 1 mL (0-2), or 22% (9-38) relatively. In 18% of the patients (67/363), relative voxel-based DWI reversibility >50% was present. Volumetric DWI reversibility and relative voxel-based DWI reversibility >50% was more frequent in patients treated with alteplase versus placebo (OR, 1.86 [95% CI, 1.09-3.17] and OR, 2.03 [95% CI, 1.18-3.50], respectively). Relative voxel-based DWI reversibility >50% was associated with excellent functional outcome (OR, 2.30 [95% CI, 1.17-4.51]). CONCLUSIONS Small absolute volumes of DWI reversibility were present in a large proportion of randomized patients in the WAKE-UP trial. Reversibility was more often present after thrombolysis.
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Affiliation(s)
- Lauranne Scheldeman
- Department of Neurology, University Hospitals Leuven, Belgium (L.S., A.W., R.L.)
- Department of Neurosciences, Experimental Neurology KU Leuven, University of Leuven, Belgium. (L.S., A.W., R.L.)
- Center for Brain and Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium (L.S., A.W., R.L., J.B.)
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Belgium (L.S., A.W., R.L.)
- Department of Neurosciences, Experimental Neurology KU Leuven, University of Leuven, Belgium. (L.S., A.W., R.L.)
- Center for Brain and Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium (L.S., A.W., R.L., J.B.)
- Department of Neurology, Amsterdam University Medical Centers, the Netherlands (A.W.)
| | - Jeroen Bertels
- Processing Speech and Images, Department of Electrial Engineering, University of Leuven, Belgium. (J.B.)
| | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology KU Leuven, University of Leuven, Belgium. (P.D.)
- Leuven Brain Institute, Belgium (P.D.)
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.C., C.G., G.T.)
| | - Martin Ebinger
- Center for Stroke Research Berlin (CSB) Charit. - Universit.tsmedizin Berlin, Germany (M. Ebinger, M. Endres, J.B.F.)
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Germany (M. Ebinger)
| | - Matthias Endres
- Center for Stroke Research Berlin (CSB) Charit. - Universit.tsmedizin Berlin, Germany (M. Ebinger, M. Endres, J.B.F.)
- Klinik und Hochschulambulanz für Neurologie, Charit. - Universit.tsmedizin Berlin, Germany (M. Endres)
- German Center for Cardiovascular Research (DZHK), partner site Berlin (M. Endres)
- German Center for Neurodegenerative Diseases (DZNE), partner site Berlin (M. Endres)
| | - Jochen B Fiebach
- Center for Stroke Research Berlin (CSB) Charit. - Universit.tsmedizin Berlin, Germany (M. Ebinger, M. Endres, J.B.F.)
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.C., C.G., G.T.)
| | - Keith W Muir
- ExcellenceCluster NeuroCure (M. Endres). School of Psychology & Neuroscience, University of Glasgow, United Kingdom (K.W.M.)
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Universit. Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA- Lyon, Hospices Civils de Lyon, France (N.N.)
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigaci. Biomedica de Girona (IDIBGI), Parc Hospitalari Marti i Julia de Salt - Edifici M2, Girona, Spain (S.P.)
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.)
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.)
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.)
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.C., C.G., G.T.)
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (L.S., A.W., R.L.)
- Department of Neurosciences, Experimental Neurology KU Leuven, University of Leuven, Belgium. (L.S., A.W., R.L.)
- Center for Brain and Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium (L.S., A.W., R.L., J.B.)
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21
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Woo MS, Mayer C, Fischer M, Kluge S, Roedl K, Gerloff C, Czorlich P, Thomalla G, Schulze Zur Wiesch J, Schweingruber N. Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit. Neurol Res Pract 2023; 5:17. [PMID: 37143130 PMCID: PMC10157117 DOI: 10.1186/s42466-023-00243-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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Unpredictable vegetative deteriorations made the treatment of patients with acute COVID-19 on intensive care unit particularly challenging during the first waves of the pandemic. Clinical correlates of dysautonomia and their impact on the disease course in critically ill COVID-19 patients are unknown. METHODS We retrospectively analyzed data collected during a single-center observational study (March 2020-November 2021) which was performed at the University Medical Center Hamburg-Eppendorf, a large tertiary medical center in Germany. All patients admitted to ICU due to acute COVID-19 disease during the study period were included (n = 361). Heart rate variability (HRV) and blood pressure variability (BPV) per day were used as clinical surrogates of dysautonomia and compared between survivors and non-survivors at different time points after admission. Intraindividual correlation of vital signs with laboratory parameters were calculated and corrected for age, sex and disease severity. RESULTS Patients who deceased in ICU had a longer stay (median days ± IQR, survivors 11.0 ± 27.3, non-survivors 14.1 ± 18.7, P = 0.85), in contrast time spent under invasive ventilation was not significantly different (median hours ± IQR, survivors 322 ± 782, non-survivors 286 ± 434, P = 0.29). Reduced HRV and BPV predicted lethal outcome in patients staying on ICU longer than 10 days after adjustment for age, sex, and disease severity. Accordingly, HRV was significantly less correlated with inflammatory markers (e.g. CRP and Procalcitonin) and blood carbon dioxide in non-survivors in comparison to survivors indicating uncoupling between autonomic function and inflammation in non-survivors. CONCLUSIONS Our study suggests autonomic dysfunction as a contributor to mortality in critically ill COVID-19 patients during the first waves of the pandemic. Serving as a surrogate for disease progression, these findings could contribute to the clinical management of COVID-19 patients admitted to the ICU. Furthermore, the suggested measure of dysautonomia and correlation with other laboratory parameters is non-invasive, simple, and cost-effective and should be evaluated as an additional outcome parameter in septic patients treated in the ICU in the future.
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Affiliation(s)
- Marcel Seungsu Woo
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christina Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Marlene Fischer
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, 20246, Hamburg, Germany
| | - Nils Schweingruber
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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22
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Wróbel P, Higgen F, Frey B, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. P-19 Lateralization of cortical microstructure in the human motor network. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.036] [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: 03/08/2023]
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23
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Popova M, Messé A, Gulberti A, Gerloff C, Pötter-Nerger M, Hilgetag C. P-117 A topology-based computational framework to assess the effect of deep brain stimulation in the context of freezing of gait in Parkinson’s disease. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.134] [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: 03/08/2023]
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Sadeghi Hassanabadi F, Pötter-Nerger M, Grimm K, Gerloff C, Schulz R, Zittel S. P-22 Smaller cerebellar lobules are associated with tremor severity in Parkinson’s disease. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.039] [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: 03/08/2023]
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25
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Zeitzschel M, Maheu M, Donner T, Gerloff C, Moll C, Gulberti A, Pötter-Nerger M. P-135 Effects of venlafaxine on clinical and pupillometry measures in patients with progressive supranuclear palsy. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.152] [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: 03/08/2023]
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26
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Biskamp J, Isla Cainzos S, Higgen F, Gerloff C, Magnus T. P-121 Studying ischemic stroke in mice: The normalization of spectral exponents in electrocorticographic signals indicates functional recovery. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.138] [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: 03/08/2023]
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27
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Heinze M, Cheng B, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Puig J, Lemmens R, Thijs V, Muir KW, Nighoghossian N, Königsberg A, Jensen M, Barow E, Lettow I, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G. Predictors of Early Neurological Improvement and Its Relationship to Thrombolysis Treatment and Long-Term Outcome in the WAKE-UP Study. Cerebrovasc Dis 2023; 52:560-566. [PMID: 36863328 DOI: 10.1159/000528805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/07/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION The aims of this study were to evaluate the relationship of clinical and imaging baseline factors and treatment on the occurrence of early neurological improvement (ENI) in the WAKE-UP trial of MRI-guided intravenous thrombolysis in unknown onset stroke and to examine the association of ENI with long-term favorable outcome in patients treated with intravenous thrombolysis. METHODS We analyzed data from all patients with at least moderate stroke severity, reflected by an initial National Institutes of Health Stroke Scale (NIHSS) score ≥4 randomized in the WAKE-UP trial. ENI was defined as a decrease in NIHSS of ≥8 or a decline to zero or 1 at 24 h after initial presentation to the hospital. Favorable outcome was defined as a modified Rankin Scale score of 0-1 at 90 days. We performed group comparison and multivariable analysis of baseline factors associated with ENI and performed mediation analysis to evaluate the effect of ENI on the relationship between intravenous thrombolysis and favorable outcome. RESULTS ENI occurred in 93 out of 384 patients (24.2%) and was more likely to occur in patients who received treatment with alteplase (62.4% vs. 46.0%, p = 0.009), had smaller acute diffusion-weighted imaging lesion volume (5.51 mL vs. 10.9 mL, p ≤ 0.001), and less often large-vessel occlusion on initial MRI (7/93 [12.1%] versus 40/291 [29.9%], p = 0.014). In multivariable analysis, treatment with alteplase (OR 1.97, 95% confidence interval [CI] 0.954-1.100), lower baseline stroke volume (OR 0.965, 95% CI: 0.932-0.994), and shorter time from symptom recognition to treatment (OR 0.994, 95% CI: 0.989-0.999) were independently associated with ENI. Patients with ENI had higher rates of favorable outcome at 90-day follow-up (80.6% vs. 31.3%, p ≤ 0.001). The occurrence of ENI significantly mediated the association of treatment with a good outcome, with ENI at 24 h explaining 39.4% (12.9-96%) of the treatment effect. CONCLUSION Intravenous alteplase increases the odds of ENI in patients with at least moderate stroke severity, especially when given early. In patients with large-vessel occlusion, ENI is rarely observed without thrombectomy. ENI represents a good surrogate early marker of treatment effect as more than a third of good outcome at 90 days is explained by ENI at 24 h.
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Affiliation(s)
- Marlene Heinze
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Medical Park Berlin Humboldtmühle, Klinik für Neurologie, Berlin, Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt-Edifici M2, Girona, Spain
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven - University of Leuven, Experimental Neurology, Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, Glasgow, UK
| | | | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ewgenia Barow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Iris Lettow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt-Edifici M2, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wouters A, Scheldeman L, Liessens H, Dupont P, Boutitie F, Cheng B, Ebinger M, Endres M, Fiebach JB, Gerloff C, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Thijs V, Thomalla G, Lemmens R. Sex differences in imaging and clinical characteristics of patients from the WAKE-UP trial. Eur J Neurol 2023; 30:641-647. [PMID: 36349887 PMCID: PMC10099623 DOI: 10.1111/ene.15629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Sex-based differences in acute ischemic stroke are a well-known phenomenon. We aimed to explore these differences between women and men in the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial. METHODS We compared baseline demographic and imaging characteristics (visual fluid-attenuated inversion recovery [FLAIR] positivity, relative FLAIR signal intensity, collateral status) between women and men in all screened patients. In randomized patients (i.e., those with diffusion-weighted imaging (DWI)-FLAIR mismatch), we evaluated a modifying role of sex on the treatment effect of alteplase in multivariable logistic regression, with treatment adjusted for National Institute of Health Stroke Scale (NIHSS) score and age. Dependent variables were modified Rankin Scale (mRS) score of 0-1 at 90 days and distribution of mRS scores at 90 days. RESULTS Of 1362 screened patients, 529 (38.8%) were women. Women were older than men, had higher baseline NIHSS scores and smoked less frequently. FLAIR positivity of the DWI lesion was equally present in women (174/529, 33.1%) and men (273/833, 33.3%; p = 1.00) and other imaging variables also did not differ between the sexes. In a total of 503 randomized patients, of whom 178 were women (35.4%), sex did not modify the treatment effect of alteplase on mRS score 0-1 or on the total distribution of mRS scores. CONCLUSION As in many other stroke trials, more men than women were included in the WAKE-UP trial, but the presence of a visual DWI-FLAIR mismatch and the relative FLAIR signal intensity did not differ between the sexes. The treatment effect of alteplase was not modified by sex.
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Affiliation(s)
- Anke Wouters
- Neurology, Amsterdam University Medical Centers location AMC, Amsterdam, the Netherlands
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
| | - Lauranne Scheldeman
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Leuven Brain Institute, Leuven, Belgium
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Université Lyon, Lyon, France
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité- Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1; Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomedica de Girona (IDIBGI), Parc Hospitalari Marti i Julia de Salt - Edifici M2, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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29
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Barow E, Probst AC, Pinnschmidt H, Heinze M, Jensen M, Rimmele DL, Flottmann F, Broocks G, Fiehler J, Gerloff C, Thomalla G. Effect of Comorbidity Burden and Polypharmacy on Poor Functional Outcome in Acute Ischemic Stroke. Clin Neuroradiol 2023; 33:147-154. [PMID: 35831611 PMCID: PMC10014774 DOI: 10.1007/s00062-022-01193-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Comorbidities and polypharmacy are risk factors for worse outcome in stroke. However, comorbidities and polypharmacy are mostly studied separately with various approaches to assess them. We aimed to analyze the impact of comorbidity burden and polypharmacy on functional outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). METHODS Acute ischemic stroke patients with large vessel occlusion (LVO) treated with MT from a prospective observational study were analyzed. Relevant comorbidity burden was defined as a Charlson Comorbidity Index (CCI) score ≥ 2, polypharmacy as the intake of ≥ 5 medications at time of stroke onset. Favorable outcome was a score of 0-2 on the modified Rankin scale at 90 days after stroke. The effect of comorbidity burden and polypharmacy on favorable outcome was studied via multivariable regression analysis. RESULTS Of 903 patients enrolled, 703 AIS patients (mean age 73.4 years, 54.9% female) with anterior circulation LVO were included. A CCI ≥ 2 was present in 226 (32.1%) patients, polypharmacy in 315 (44.8%) patients. Favorable outcome was less frequently achieved in patients with a CCI ≥ 2 (47, 20.8% vs. 172, 36.1%, p < 0.001), and in patients with polypharmacy (69, 21.9% vs. 150, 38.7%, p < 0.001). In multivariable regression analysis including clinical covariates, a CCI ≥ 2 was associated with lower odds of favorable outcome (odds ratio, OR 0.52, 95% confidence interval, 95% CI 0.33-0.82, p = 0.005), while polypharmacy was not (OR 0.81, 95% CI 0.52-1.27, p = 0.362). CONCLUSION Relevant comorbidity burden and polypharmacy are common in AIS patients with LVO, with comorbidity burden being a risk factor for poor outcome.
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Affiliation(s)
- Ewgenia Barow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Ann-Cathrin Probst
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans Pinnschmidt
- Institut für Medizinische Biometrie und Epidemiologie, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Heinze
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - David Leander Rimmele
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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30
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Lotter LD, Kohl SH, Gerloff C, Bell L, Niephaus A, Kruppa JA, Dukart J, Schulte-Rüther M, Reindl V, Konrad K. Revealing the neurobiology underlying interpersonal neural synchronization with multimodal data fusion. Neurosci Biobehav Rev 2023; 146:105042. [PMID: 36641012 DOI: 10.1016/j.neubiorev.2023.105042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Humans synchronize with one another to foster successful interactions. Here, we use a multimodal data fusion approach with the aim of elucidating the neurobiological mechanisms by which interpersonal neural synchronization (INS) occurs. Our meta-analysis of 22 functional magnetic resonance imaging and 69 near-infrared spectroscopy hyperscanning experiments (740 and 3721 subjects) revealed robust brain regional correlates of INS in the right temporoparietal junction and left ventral prefrontal cortex. Integrating this meta-analytic information with public databases, biobehavioral and brain-functional association analyses suggested that INS involves sensory-integrative hubs with functional connections to mentalizing and attention networks. On the molecular and genetic levels, we found INS to be associated with GABAergic neurotransmission and layer IV/V neuronal circuits, protracted developmental gene expression patterns, and disorders of neurodevelopment. Although limited by the indirect nature of phenotypic-molecular association analyses, our findings generate new testable hypotheses on the neurobiological basis of INS.
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Affiliation(s)
- Leon D Lotter
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine - Brain & Behaviour (INM-7), Jülich Research Centre, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Max Planck School of Cognition, Stephanstrasse 1A, 04103 Leipzig, Germany.
| | - Simon H Kohl
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | - Christian Gerloff
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany; Chair II of Mathematics, Faculty of Mathematics, Computer Science and Natural Sciences, RWTH Aachen University, Aachen, Germany
| | - Laura Bell
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; Audiovisual Media Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Alexandra Niephaus
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Jana A Kruppa
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Juergen Dukart
- Institute of Neuroscience and Medicine - Brain & Behaviour (INM-7), Jülich Research Centre, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martin Schulte-Rüther
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Vanessa Reindl
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany; Psychology, School of Social Sciences, Nanyang Technological University, S639818, Singapore
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
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31
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Gulberti A, Wagner JR, Horn MA, Reuss JH, Schaper M, Koeppen JA, Pinnschmidt HO, Westphal M, Engel AK, Gerloff C, Sharott A, Hamel W, Moll CKE, Pötter-Nerger M. Subthalamic and nigral neurons are differentially modulated during parkinsonian gait. Brain 2023:7024802. [PMID: 36730026 DOI: 10.1093/brain/awad006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 02/03/2023] Open
Abstract
The parkinsonian gait disorder and freezing of gait are therapeutically demanding symptoms with considerable impact on quality of life. The aim of this study was to assess the role of subthalamic and nigral neurons in the parkinsonian gait control using intraoperative microelectrode recordings of basal ganglia neurons during a supine stepping task. 12 male patients (56±7 years) suffering from moderate idiopathic Parkinson's disease (disease duration 10±3 years, Hoehn & Yahr stage 2) participated in the study. After 10 seconds resting period, stepping at self-paced speed for 35 seconds was followed by short intervals of stepping in response to random "start" and "stop" cues. Single- and multi-unit activity was analysed offline in relation to different aspects of the stepping task (attentional "start" and "stop" cues, heel strikes, stepping irregularities) in terms of firing frequency, firing pattern, and oscillatory activity. Subthalamic nucleus and the substantia nigra neurons responded to different aspects of the stepping task. 24% of the subthalamic nucleus neurons exhibited movement-related activity modulation as an increase of the firing rate, suggesting a predominant role of the subthalamic nucleus in motor aspects of the task, while 8% of subthalamic nucleus neurons showed a modulation in response to the attentional cues. In contrast, responsive substantia nigra neurons showed activity changes exclusively associated with attentional aspects of the stepping task (15%). The firing pattern of subthalamic nucleus neurons revealed gait-related firing regulation and a drop of beta oscillations during regular stepping performance. During freezing episodes instead, there was a rise of beta oscillatory activity. This study shows for the first time specific, task-related, subthalamic nucleus and substantia nigra single unit activity during gait-like movements in humans with differential roles in motor and attentional control of gait. The emergence of perturbed firing patterns in the subthalamic nucleus indicates a disturbed information transfer within the gait network, resulting in freezing of gait.
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Affiliation(s)
- Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.,Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jonas R Wagner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Martin A Horn
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Joacob H Reuss
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Johannes A Koeppen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andreas K Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andrew Sharott
- MRC Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Oxford OX1 3TH, UK
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - M Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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32
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Feil K, Berndt MT, Wunderlich S, Maegerlein C, Bernkopf K, Zimmermann H, Herzberg M, Tiedt S, Küpper C, Wischmann J, Schönecker S, Dimitriadis K, Liebig T, Dieterich M, Zimmer C, Kellert L, Boeckh-Behrens T, Boeckh-Behrens T, Wunderlich S, Ludolph A, Henn KH, Reich A, Nikoubashman O, Wiesmann M, Ernemann U, Poli S, Nolte CH, Siebert E, Zweynert S, Bohner G, Solymosi L, Petzold G, Pfeilschifter W, Keil F, Röther J, Eckert B, Berrouschot J, Bormann A, Alegiani A, Fiehler J, Gerloff C, Thomalla G, Thonke S, Bangard C, Kraemer C, Dichgans M, Psychogios M, Liman J, Petersen M, Stögbauer F, Kraft P, Pham M, Braun M, Hamann GF, Roth C, Gröschel K, Uphaus T, Limmroth V. Endovascular thrombectomy for basilar artery occlusion stroke: Analysis of the German Stroke Registry-Endovascular Treatment. Eur J Neurol 2023; 30:1293-1302. [PMID: 36692229 DOI: 10.1111/ene.15694] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke due to basilar artery occlusion (BAO) causes the most severe strokes and has a poor prognosis. Data regarding efficacy of endovascular thrombectomy in BAO are sparse. Therefore, in this study, we performed an analysis of the therapy of patients with BAO in routine clinical practice. METHODS Patients enrolled between June 2015 and December 2019 in the German Stroke Registry-Endovascular Treatment (GSR-ET) were analyzed. Primary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b-3), substantial neurological improvement (≥8-point National Institute of Health Stroke Scale [NIHSS] score reduction from admission to discharge or NIHSS score at discharge ≤1), and good functional outcome at 3 months (modified Rankin Scale [mRS] score of 0-2). RESULTS Out of 6635 GSR-ET patients, 640 (9.6%) patients (age 72.2 ± 13.3, 43.3% female) experienced BAO (median [interquartile range] NIHSS score 17 [8, 27]). Successful reperfusion was achieved in 88.4%. Substantial neurological improvement at discharge was reached by 45.5%. At 3-month follow-up, good clinical outcome was observed in 31.1% of patients and the mortality rate was 39.2%. Analysis of mTICI3 versus mTICI2b groups showed considerable better outcome in those with mTICI3 (38.9% vs. 24.4%; p = 0.005). The strongest predictors of good functional outcome were intravenous thrombolysis (IVT) treatment (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.76-5.23) and successful reperfusion (OR 4.92, 95% CI 1.15-21.11), while the effect of time between symptom onset and reperfusion seemed to be small. CONCLUSIONS Acute reperfusion strategies in BAO are common in daily practice and can achieve good rates of successful reperfusion, neurological improvement and good functional outcome. Our data suggest that, in addition to IVT treatment, successful and, in particular, complete reperfusion (mTICI3) strongly predicts good outcome, while time from symptom onset seemed to have a lower impact.
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Affiliation(s)
- Katharina Feil
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany.,Department of Neurology and Stroke, Eberhard-Karls University Tübingen/Universitätsklinikum Tübingen (UKT), Tübingen, Germany
| | - Maria Teresa Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen Bernkopf
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Moriz Herzberg
- Institute of Neuroradiology, LMU, Munich, Germany.,Department of Radiology, University Hospital, Würzburg, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Clemens Küpper
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany
| | - Johannes Wischmann
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany
| | - Sonja Schönecker
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany
| | - Konstantin Dimitriadis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | | | - Marianne Dieterich
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,German Center for Vertigo and Balance Disorders, LMU, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Königsberg A, Belau MH, Ascone L, Gallinat J, Kühn S, Jensen M, Gerloff C, Cheng B, Thomalla G. Subjective Cognitive Decline Is Associated with Health-Related Quality of Life in the Middle-Aged to Elderly Population. J Alzheimers Dis 2023; 91:427-436. [PMID: 36442192 DOI: 10.3233/jad-220659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is considered to be a preliminary stage of dementia, and its prevalence is increasing with age. OBJECTIVE We aimed to study the association of SCD with health-related quality of life (HRQoL) in a large population-based sample. METHODS We analyzed data of the first 10,000 participants from the Hamburg City Health Study in Germany, a single center prospective cohort study, aged between 45 and 74 years that scored higher than 25 points in the Mini-Mental State Examination and had no known pre-existing dementia. HRQoL was assessed by the EQ-5D-5 L index, as well as the mental (MCS) and physical component summary (PCS) score of the Short Form-8. We computed linear regression analyses with 99% bias-corrected and accelerated (BCa) confidence intervals (CI) from 10,000 bootstrap samples to investigate the association between SCD and different indicators of HRQoL, while controlling for depression (PHQ-9), age, sex, and education as potential confounders. RESULTS Of 7,799 eligible participants (mean (SD) age 62.01 (8.41) years, 51.1% female), 3,708 (47.5%) reported SCD. Participants with SCD were older (62.7 versus 61.4 years) and more frequently female (54.2% versus 48.2%). SCD was independently associated with a lower EQ-5D-5 L index (β=-0.01, 99% BCa CI = [-0.020, -0.003], p < 0.001) and PCS (β=-1.00, 99% BCa CI = [-1.48, -0.51], p < 0.001) but not with MCS score. CONCLUSION In a population of middle-aged to elderly participants, there is a significant negative association between SCD and HRQoL across different instruments of HRQoL measurement independent of depression, demographics, and education.
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Affiliation(s)
- Alina Königsberg
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias H Belau
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Leonie Ascone
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Hamburg, Germany
| | - Jürgen Gallinat
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Hamburg, Germany
| | - Simone Kühn
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Hamburg, Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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34
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Jensen M, Sehner S, Cheng B, Schlemm E, Quandt F, Barow E, Wegscheider K, Boutitie F, Ebinger M, Endres M, Fiebach JB, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Thomalla G, Gerloff C. Patient-Reported Quality of Life After Intravenous Alteplase for Stroke in the WAKE-UP Trial. Neurology 2023; 100:e154-e162. [PMID: 36302662 DOI: 10.1212/wnl.0000000000201375] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intravenous alteplase improves functional outcome after acute ischemic stroke. However, little is known about the effects on self-reported health-related quality of life (HRQoL). METHODS WAKE-UP was a multicenter, randomized, placebo-controlled trial of MRI-guided intravenous alteplase in stroke with unknown onset time. HRQoL was assessed using the EuroQol five-dimensional questionnaire (EQ-5D) at 90 days, comprising the EQ-5D index and the EQ visual analogue scale (VAS). Functional outcome was assessed by the modified Rankin Scale (mRS). We calculated the effect of treatment on EQ-5D index and EQ VAS using multiple linear regression models. Mediation analysis was performed on stroke survivors to explore the extent to which the effect of alteplase on HRQoL was mediated by functional outcome. RESULTS Among 490 stroke survivors, the EQ-5D index was available for 452 (92.2%), of whom 226 (50%) were assigned to treatment with alteplase and 226 (50%) to placebo. At 90 days, mean EQ-5D index was higher, reflecting a better health state, in patients randomized to treatment with alteplase than with placebo (0.75 vs 0.67) with an adjusted mean difference of 0.07 (95% CI 0.02-0.12, p = 0.005). In addition, mean EQ VAS was higher with alteplase than with placebo (72.6 vs 64.9), with an adjusted mean difference of 7.6 (95% CI 3.9-11.8, p < 0.001). Eighty-five percent of the total treatment effect of alteplase on the EQ-5D index was mediated using the mRS score while there was no significant direct effect. By contrast, the treatment effect on the EQ VAS was mainly through the direct pathway (60%), whereas 40% was mediated by the mRS. DISCUSSION Assessment of patient-reported outcome measures reveals a potential benefit of intravenous alteplase for HRQoL beyond improvement of functional outcome. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov number, NCT01525290; EudraCT number, 2011-005906-32.
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Affiliation(s)
- Märit Jensen
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark.
| | - Susanne Sehner
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Bastian Cheng
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Eckhard Schlemm
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Fanny Quandt
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Ewgenia Barow
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Karl Wegscheider
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Florent Boutitie
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Martin Ebinger
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Matthias Endres
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Jochen B Fiebach
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Vincent Thijs
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Robin Lemmens
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Keith W Muir
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Norbert Nighoghossian
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Salvador Pedraza
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Claus Z Simonsen
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Götz Thomalla
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Christian Gerloff
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
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Gelderblom M, Koch S, Strecker JK, Jørgensen C, Garcia-Bonilla L, Ludewig P, Schädlich IS, Piepke M, Degenhardt K, Bernreuther C, Pinnschmidt H, Arumugam TV, Thomalla G, Faber C, Sedlacik J, Gerloff C, Minnerup J, Clausen BH, Anrather J, Magnus T. A preclinical randomized controlled multi-centre trial of anti-interleukin-17A treatment for acute ischaemic stroke. Brain Commun 2023; 5:fcad090. [PMID: 37056478 PMCID: PMC10088471 DOI: 10.1093/braincomms/fcad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/19/2023] [Accepted: 03/22/2023] [Indexed: 04/15/2023] Open
Abstract
Multiple consensus statements have called for preclinical randomized controlled trials to improve translation in stroke research. We investigated the efficacy of an interleukin-17A neutralizing antibody in a multi-centre preclinical randomized controlled trial using a murine ischaemia reperfusion stroke model. Twelve-week-old male C57BL/6 mice were subjected to 45 min of transient middle cerebral artery occlusion in four centres. Mice were randomly assigned (1:1) to receive either an anti-interleukin-17A (500 µg) or isotype antibody (500 µg) intravenously 1 h after reperfusion. The primary endpoint was infarct volume measured by magnetic resonance imaging three days after transient middle cerebral artery occlusion. Secondary analysis included mortality, neurological score, neutrophil infiltration and the impact of the gut microbiome on treatment effects. Out of 136 mice, 109 mice were included in the analysis of the primary endpoint. Mixed model analysis revealed that interleukin-17A neutralization significantly reduced infarct sizes (anti-interleukin-17A: 61.77 ± 31.04 mm3; IgG control: 75.66 ± 34.79 mm3; P = 0.01). Secondary outcome measures showed a decrease in mortality (hazard ratio = 3.43, 95% confidence interval = 1.157-10.18; P = 0.04) and neutrophil invasion into ischaemic cortices (anti-interleukin-17A: 7222 ± 6108 cells; IgG control: 28 153 ± 23 206 cells; P < 0.01). There was no difference in Bederson score. The analysis of the gut microbiome showed significant heterogeneity between centres (R = 0.78, P < 0.001, n = 40). Taken together, neutralization of interleukin-17A in a therapeutic time window resulted in a significant reduction of infarct sizes and mortality compared with isotype control. It suggests interleukin-17A neutralization as a potential therapeutic target in stroke.
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Affiliation(s)
- Mathias Gelderblom
- Correspondence to: Mathias Gelderblom Department of Neurology University Medical Center Hamburg-Eppendorf Martinistrasse 52, 20246 Hamburg, Germany E-mail:
| | | | - Jan-Kolja Strecker
- Department of Neurology with Institute of Translational Neurology, University of Münster, 48149 Münster, Germany
| | - Carina Jørgensen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Lidia Garcia-Bonilla
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, USA
| | - Peter Ludewig
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ines Sophie Schädlich
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Marius Piepke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Karoline Degenhardt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Bernreuther
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Hans Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thiruma V Arumugam
- Department of Physiology, Anatomy & Microbiology School of Life Sciences, La Trobe University, Melbourne 3086, Australia
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Cornelius Faber
- Translational Research Imaging Center, Clinic of Radiology, University of Münster, 48149 Münster, Germany
| | - Jan Sedlacik
- Department of Biomedical Engineering, Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jens Minnerup
- Department of Neurology with Institute of Translational Neurology, University of Münster, 48149 Münster, Germany
| | - Bettina H Clausen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, USA
| | - Tim Magnus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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36
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Woo MS, Mayer C, Brehm TT, Andersen G, Weigel A, Löwe B, Lohse AW, Addo MM, Gerloff C, Knobloch JKM, Schulze zur Wiesch J, Friese MA. Absence of self-reported neuropsychiatric and somatic symptoms after Omicron variant SARS-CoV-2 breakthrough infections. Brain Commun 2023; 5:fcad092. [PMID: 37038497 PMCID: PMC10082557 DOI: 10.1093/braincomms/fcad092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/16/2022] [Accepted: 03/23/2023] [Indexed: 04/12/2023] Open
Abstract
Persistent somatic and neuropsychiatric symptoms have been frequently described in patients after infection with severe acute respiratory syndrome coronavirus 2 even after a benign clinical course of the acute infection during the early phases of the coronavirus severe acute respiratory syndrome coronavirus 2 pandemic and are part of Long COVID. The Omicron variant emerged in November 2021 and has rapidly become predominant due to its high infectivity and suboptimal vaccine cross-protection. The frequency of neuropsychiatric post-acute sequelae after infection with the severe acute respiratory syndrome coronavirus 2 Omicron and adequate vaccination status is not known. Here, we aimed to characterize post-acute symptoms in individuals with asymptomatic or mildly symptomatic breakthrough infection with severe acute respiratory syndrome coronavirus 2. These individuals had either proven infection with the Omicron variant (n = 157) or their infection occurred in 2022 where Omicron was the predominant variant of severe acute respiratory syndrome coronavirus 2 in Germany (n = 107). This monocentric cross-sectional study was conducted at the University Medical Center Hamburg-Eppendorf between 11 February 2022 and 11 April 2022. We employed questionnaires addressing self-reported somatic symptom burden (Somatic Symptom Scale 8) and neuropsychiatric symptoms including mood (Patient Health Questionnaire 2), anxiety (Generalized Anxiety Disorder 7), attention (Mindful Attention Awareness Scale) and fatigue (Fatigue Assessment Scale) in a cohort of hospital workers. Scores were compared between 175 individuals less than 4 weeks after positive testing for severe acute respiratory syndrome coronavirus 2, 88 individuals more than 4 weeks after positive testing and 87 severe acute respiratory syndrome coronavirus 2 uninfected controls. The majority (n = 313; 89.5%) of included individuals were vaccinated at least three times. After recovery from infection, no significant differences in scores assessing neuropsychiatric and somatic symptoms were detected between the three groups (severe acute respiratory syndrome coronavirus 2 uninfected controls, individuals less and more than 4 weeks after positive testing) independent of age, sex, preconditions and vaccination status. In addition, self-reported symptom burden did not significantly correlate with the number of vaccinations against severe acute respiratory syndrome coronavirus 2, time from recovery or the number of infections. Notably, in all three groups, the mean scores for each item of our questionnaire lay below the pathological threshold. Our data show that persistent neuropsychiatric and somatic symptoms after recovery from severe acute respiratory syndrome coronavirus 2 infection in fully vaccinated hospital workers do not occur more frequently than that in uninfected individuals. This will guide healthcare professionals in the clinical management of patients after recovery from breakthrough infections with severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
| | | | - Thomas Theo Brehm
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg 20246, Germany
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Gabriele Andersen
- Department of Occupational Safety and Health, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Ansgar W Lohse
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg 20246, Germany
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Marylyn M Addo
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg 20246, Germany
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
- Institute for Infection Research and Vaccine Development, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Johannes K M Knobloch
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg 20246, Germany
- Institute of Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Julian Schulze zur Wiesch
- Correspondence to: Julian Schulze zur Wiesch I. Department of Medicine University Medical Center Hamburg-Eppendorf Martinistraße 52, Hamburg 20246, Germany E-mail:
| | - Manuel A Friese
- Correspondence may also be addressed to: Manuel A. Friese Institute of Neuroimmunology and Multiple Sclerosis University Medical Center Hamburg-Eppendorf Falkenried 94, Hamburg 20251, Germany
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Cheng B, Chen J, Königsberg A, Mayer C, Rimmele L, Patil KR, Gerloff C, Thomalla G, Eickhoff SB. Mapping the deficit dimension structure of the National Institutes of Health Stroke Scale. EBioMedicine 2022; 87:104425. [PMID: 36563488 PMCID: PMC9800288 DOI: 10.1016/j.ebiom.2022.104425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The National Institutes of Health Stroke Scale (NIHSS) is the most frequently applied clinical rating scale for standardized assessment of neurological deficits in acute stroke in both clinical and research settings. Notwithstanding this prominent role, important questions regarding its validity remain insufficiently addressed: Investigations of the underlying dimensional structure of the NIHSS yielded inconsistent results that are largely not generalizable across studies. Neurobiological validations by linking measured deficit dimensions to brain anatomy and function are missing. METHODS We, therefore, employ advanced machine learning to identify an optimal representation of the dimensional structure of the NIHSS across two independent and heterogeneous stroke datasets (N = 503 and N = 690). Associated lesion locations are identified by multivariate lesion-deficit mapping (LDM) and their functional relevance is profiled based on a-priori task activation meta-data analysis, to provide an independent link to the behavioural level. FINDINGS A five-factor structure of the NIHSS was identified as the most robust and generalizable representation of stroke deficit dimensions across study populations, settings, and clinical phenotypes. Specifically, the identified dimensions comprised NIHSS items for (F1) left motor deficits, (F2) right motor deficits, (F3) dysarthria and facial palsy, (F4) language, and (F5) deficits in spatial attention and gaze. LDM linked four of these factors to differentially localized, eloquent neuroanatomical areas. Functional characterization of LDM results aligned with detected deficit dimensions, revealing associations with motor functions, language processing, and various functions in the perception domain. INTERPRETATION By cross-validating machine learning in heterogeneous multi-site stroke cohorts, we report evidence on the validity of the NIHSS: We identified an overarching structure of the NISHS containing a five-dimensional representation of stroke deficits. We provide an anatomical map of the NIHSS that is of value for future applications of individualized stroke treatment and rehabilitation. FUNDING This research was supported by the National Key R&D Program of China (Grant No. 2021YFC2502200), the National Human Brain Project of China (Grant No. 2022ZD0214000)", the German Research Foundation (Deutsche Forschungsgemeinschaft), Project 178316478 (A1, C1, C2), and Project 454012190 of the SPP 2041, the Helmholtz Portfolio Theme "Supercomputing and Modelling for the Human Brain" and Helmholtz Imaging Platform grant NimRLS (ZT-I-PF-4-010).
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Affiliation(s)
- Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Corresponding author.
| | - Ji Chen
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany,Corresponding author.
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leander Rimmele
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kaustubh R. Patil
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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38
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Quandt F, Meißner N, Wölfer TA, Flottmann F, Deb-Chatterji M, Kellert L, Fiehler J, Goyal M, Saver JL, Gerloff C, Thomalla G, Tiedt S. RCT versus real-world cohorts: Differences in patient characteristics drive associations with outcome after EVT. Eur Stroke J 2022; 8:231-240. [PMID: 37021166 PMCID: PMC10069173 DOI: 10.1177/23969873221142642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The selection of patients with large-vessel occlusion (LVO) stroke for endovascular treatment (EVT) depends on patient characteristics and procedural metrics. The relation of these variables to functional outcome after EVT has been assessed in numerous datasets from both randomized controlled trials (RCT) and real-world registries, but whether differences in their case mix modulate outcome prediction is unknown. Methods: We leveraged data from individual patients with anterior LVO stroke treated with EVT from completed RCTs from the Virtual International Stroke Trials Archive ( N = 479) and from the German Stroke Registry ( N = 4079). Cohorts were compared regarding (i) patient characteristics and procedural pre-EVT metrics, (ii) these variables’ relation to functional outcome, and (iii) the performance of derived outcome prediction models. Relation to outcome (functional dependence defined by a modified Rankin Scale score of 3–6 at 90 days) was analyzed by logistic regression models and a machine learning algorithm. Results: Ten out of 11 analyzed baseline variables differed between the RCT and real-world cohort: RCT patients were younger, had higher admission NIHSS scores, and received thrombolysis more often (all p < 0.0001). Largest differences at the level of individual outcome predictors were observed for age (RCT: adjusted odds ratio (aOR), 1.29 (95% CI, 1.10–1.53) vs real-world aOR, 1.65 (95% CI, 1.54–1.78) per 10-year increments, p < 0.001). Treatment with intravenous thrombolysis was not significantly associated with functional outcome in the RCT cohort (aOR, 1.64 (95 % CI, 0.91–3.00)), but in the real-world cohort (aOR, 0.81 (95% CI, 0.69–0.96); p for cohort heterogeneity = 0.056). Outcome prediction was more accurate when constructing and testing the model using real-world data compared to construction with RCT data and testing on real-world data (area under the curve, 0.82 (95% CI, 0.79–0.85) vs 0.79 (95% CI, 0.77–0.80), p = 0.004). Conclusions: RCT and real-world cohorts considerably differ in patient characteristics, individual outcome predictor strength, and overall outcome prediction model performance.
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Affiliation(s)
- Fanny Quandt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Meißner
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Teresa A Wölfer
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Milani Deb-Chatterji
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Kellert
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
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Rimmele DL, Petersen EL, Schlemm E, Kessner SS, Petersen M, Mayer C, Cheng B, Zeller T, Waldeyer C, Behrendt CA, Gerloff C, Thomalla G. Association of Carotid Plaque and Flow Velocity With White Matter Integrity in a Middle-aged to Elderly Population. Neurology 2022; 99:e2699-e2707. [PMID: 36123124 DOI: 10.1212/wnl.0000000000201297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES It is uncertain whether there is an association of carotid plaques (CPs) and flow velocities with peak width mean diffusivity (PSMD) and white matter hyperintensities (WMH) independent of shared risk factors. We aimed to study this association controlling for biomarkers of inflammation and cardiac dysfunction and typical cardiovascular risk factors and spatial distribution. METHODS We included participants from the population-based Hamburg City Health Study, recruiting citizens between 45 and 74 years of age. Medical history was obtained from structured interviews and extended laboratory tests, physical examinations, MRI of the head, echocardiography, and abdominal and carotid ultrasound were performed. We performed multivariable regression analysis with PSMD and periventricular, deep, and total volume of WMH (pWMH, dWMH, tWMH) as dependent variables. PSMD was calculated as the difference between the 95th and 5th percentiles of MD values on the white skeleton in standard space. Volumes of WMH were determined by the application of a manually trained k-nearest neighbor segmentation algorithm. WMH measured within a distance of 1 cm from the surface of the lateral ventricles were defined as pWMH and above 1 cm as dWMH. RESULTS Two thousand six hundred twenty-three participants were included. The median age was 65 years, and 56% were women. Their median tWMH was 946 mm3(IQR:419, 2,164), PSMD 2.24 mm2/s × 10-4 (IQR: 2.04, 2.47), peak systolic velocity (PSV) of internal carotid arteries 0.70m/second (IQR:0.60, 0.81), and 35% had CPs. Adjusted for age, sex, high-sensitive CRP, NT-proBNP, and commonly measured cardiovascular risk and systemic hemodynamic factors, both CPs (B = 0.15; CI: 0.04, 0.26; p = 0.006) and low PSV (B = -0.49; CI: -0.87, -0.11; p = 0.012) were significantly associated with a higher tWMH and PSMD. Low PSV (B = -0.48; CI: -0.87, -0.1; p = 0.013) was associated with pWMH and the presence of CP with pWMH (B = 0.15; CI: 0.04, 0.26; p = 0.008) and dWMH (B = 0.42; CI: 0.11, 0.74; p < 0.009). DISCUSSION Low PSV and CP are associated with WMH and PSMD independent of cardiovascular risk factors and biomarkers of inflammation and cardiac dysfunction. This points toward pathophysiologic pathways underlying both large and small vessel disease beyond the common cardiovascular risk profile. TRIAL REGISTRATION INFORMATION The trial was submitted at clinicaltrials.gov, under NCT03934957 on January 4, 2019. The first participant was enrolled in February 2016.
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Affiliation(s)
- David Leander Rimmele
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany.
| | - Elina Larissa Petersen
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Eckhard Schlemm
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Simon S Kessner
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Marvin Petersen
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Carola Mayer
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Bastian Cheng
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Tanja Zeller
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Christoph Waldeyer
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Christian-Alexander Behrendt
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Christian Gerloff
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Götz Thomalla
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
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Rojas Albert A, Backhaus W, Graterol Pérez JA, Braaβ H, Schön G, Choe CU, Feldheim J, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. Cortical thickness of contralesional cortices positively relates to future outcome after severe stroke. Cereb Cortex 2022; 32:5622-5627. [PMID: 35169830 DOI: 10.1093/cercor/bhac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/25/2023] Open
Abstract
Imaging studies have evidenced that contralesional cortices are involved in recovery after motor stroke. Cortical thickness (CT) analysis has proven its potential to capture the changes of cortical anatomy, which have been related to recovery and treatment gains under therapy. An open question is whether CT obtained in the acute phase after stroke might inform correlational models to explain outcome variability. Data of 38 severely impaired (median NIH Stroke Scale 9, interquartile range: 6-13) acute stroke patients of 2 independent cohorts were reanalyzed. Structural imaging data were processed via the FreeSurfer pipeline to quantify regional CT of the contralesional hemisphere. Ordinal logistic regression models were fit to relate CT to modified Rankin Scale as an established measure of global disability after 3-6 months, adjusted for the initial deficit, lesion volume, and age. The data show that CT of contralesional cortices, such as the precentral gyrus, the superior frontal sulcus, and temporal and cingulate cortices, positively relates to the outcome after stroke. This work shows that the baseline cortical anatomy of selected contralesional cortices can explain the outcome variability after severe stroke, which further contributes to the concept of structural brain reserve with respect to contralesional cortices to promote recovery.
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Affiliation(s)
- Alina Rojas Albert
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - José A Graterol Pérez
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Hanna Braaβ
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Jan Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.,Department of Neurology, University Medical Center, Leipzig 04103, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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Abstract
The accurate assessment of cerebrospinal fluid opening pressure during spinal puncture provides important medical information in diagnosis, prognosis and therapy of several neurological conditions. However, purpose-specific spinal needle choice is debated. While atraumatic needles are associated with lower incidence of post-puncture headache and re-hospitalisation, some clinicians believe that they lack in accuracy of CSF opening pressure assessment. Our primary objective was to investigate different needle types on correctly assessing CSF opening pressure. We compared typical clinically utilised traumatic (0.9 mm outer diameter) and atraumatic (0.7 mm; 0.45 mm) spinal needles with regards to the assessment of the opening pressure in an experimental spinal puncture model testing experimental and cerebrospinal fluids in predefined pressures. Our goal was to measure the time until indicated pressure levels were correctly shown. Atraumatic needles of at least 0.7 mm diameter had a similar accuracy as traumatic needles without significant differences in time-to-equilibrium. These results were independent of protein and glucose concentration and the presence of haemoglobin. This study demonstrates that atraumatic needles can be used to accurately measure CSF opening pressure. This knowledge might guide clinicians in their choice of needle and help to reduce post-puncture headaches and re-hospitalisation.
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Affiliation(s)
- Marcel S Woo
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Simon S Kessner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
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Wolf S, Holm SE, Ingwersen T, Bartling C, Bender G, Birke G, Meyer A, Nolte A, Ottes K, Pade O, Peller M, Steinmetz J, Gerloff C, Thomalla G. Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation. Ann Med 2022; 54:1265-1276. [PMID: 35510813 PMCID: PMC9090381 DOI: 10.1080/07853890.2022.2059557] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke. PATIENTS AND METHODS In a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment. RESULTS One hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R2: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02). CONCLUSIONS Higher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.KEY MESSAGEHigher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.Higher SES is associated with significantly higher utilization of outpatient therapies.Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery. Article registration: clinicaltrials.gov NCT04119479.
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Affiliation(s)
- S Wolf
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S E Holm
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - T Ingwersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bartling
- Clinic for Neurological Rehabilitation, MEDICLIN Klinikum Soltau, Soltau, Germany
| | - G Bender
- Department Neurology, RehaCentrum Hamburg, Hamburg, Germany
| | - G Birke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Meyer
- Clinic for Neurological Rehabilitation, MEDICLIN Klinikum Soltau, Soltau, Germany
| | - A Nolte
- Department Neurology, VAMED Klinik Geesthacht, Geesthacht, Germany
| | - K Ottes
- Department Neurology, RehaCentrum Hamburg, Hamburg, Germany
| | - O Pade
- Clinic for Neurological Rehabilitation, Klinikum Bad Bramstedt, Bad Bramstedt, Germany
| | - M Peller
- Department Neurology, VAMED Rehaklinik Damp, Damp, Germany
| | - J Steinmetz
- Clinic for Neurological Rehabilitation, Klinikum Bad Bramstedt, Bad Bramstedt, Germany
| | - C Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Engel AK, Gerloff C. Dynamic functional connectivity: causative or epiphenomenal? Trends Cogn Sci 2022; 26:1020-1022. [PMID: 36335013 DOI: 10.1016/j.tics.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
Abstract
Dynamic coupling of neural signals is a hallmark of brain networks, but its potential relevance is still debated. Does coupling play a causal role for network functions, or is it just a by-product of structural connectivity or other physiological processes? With intervention techniques that have become available, experiments seem within reach that may provide answers to this long-standing question.
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Affiliation(s)
- Andreas K Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Deb-Chatterji M, Flottmann F, Meyer L, Brekenfeld C, Fiehler J, Gerloff C, Thomalla G, Fiehler J, Thomalla G, Alegiani A, Boeckh-Behrens, Wunderlich S, Ernemann U, Poli S, Siebert E, Nolte CH, Zweynert S, Bohner G, Ludolph A, Henn KH, Schäfer JH, Keil F, Röther J, Eckert B, Berrouschot J, Bormann A, Dorn F, Petzold G, Kraemer C, Leischner H, Trumm C, Tiedt S, Kellert L, Petersen M, Stögbauer F, Braun M, Hamann GF, Gröschel K, Uphaus T, Reich A, Nikoubashman O, Schellinger P, Borggrefe J, Hattingen J, Liman J, Ernst M. Side matters: differences in functional outcome and quality of life after thrombectomy in left and right hemispheric stroke. Neurol Res Pract 2022; 4:58. [PMID: 36411484 PMCID: PMC9677692 DOI: 10.1186/s42466-022-00223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with a left (LHS) or right hemispheric stroke (RHS) differ in terms of clinical symptoms due to lateralization of specific cortical functions. Studies on functional outcome after stroke and endovascular thrombectomy (EVT) comparing both hemispheres showed conflicting results so far. The impact of stroke laterality on patient-reported health-related quality of life (HRQoL) after EVT has not yet been adequately addressed and still remains unclear. METHODS Consecutive stroke thrombectomy patients, derived from a multi-center, prospective registry (German Stroke Registry) between June 2015 and December 2019, were included in this study. At 90 days, outcome after EVT was assessed by the modified Rankin scale (mRS) and HRQoL using the European QoL-five dimensions questionnaire utility-index (EQ-5D-I; higher values indicate better HRQoL) in patients with LHS and RHS. Adjusted regression analysis was applied to evaluate the influence of stroke laterality on outcome after EVT. RESULTS In total, 5683 patients were analyzed. Of these, 2953 patients (52.8%) had LHS and 2637 (47.2%) RHS. LHS patients had a higher baseline NIHSS (16 vs. 13, p < 0.001) and a higher ASPECTS (9 vs. 8, p < 0.001) compared to RHS patients. Among survivors, patients with LHS less frequently had a self-reported affected mobility (p = 0.037), suffered less often from pain (p = 0.04) and anxiety/depression (p = 0.032) three months after EVT. After adjusting for confounders (age, sex, baseline NIHSS), LHS was associated with a better HRQoL (ß coefficient 0.04, CI 95% 0.017-0.063; p = 0.001), and better functional outcome assessed by lower values on the mRS (ß coefficient - 0.109, CI 95% - 0.217-0.000; p = 0.049). CONCLUSIONS Ninety days after EVT, LHS patients have a better functional outcome and HRQoL. Patients with RHS should be actively assessed and treated for pain, anxiety and depression to improve their HRQoL after EVT.
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Affiliation(s)
- Milani Deb-Chatterji
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Fabian Flottmann
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Götz Thomalla
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Heinze M, Lebherz L, Rimmele DL, Frese M, Jensen M, Barow E, Lettow I, Kriston L, Gerloff C, Härter M, Thomalla G. Higher comorbidity burden is associated with lower self-reported quality of life after stroke. Front Neurol 2022; 13:1023271. [DOI: 10.3389/fneur.2022.1023271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
IntroductionThis study assesses the association of comorbidity burden and polypharmacy with self-reported quality of life after stroke.Patients and methodsWe performed a post-hoc analysis of a prospective, single-center, observational study of outcome evaluation by patient-reported outcome measures in stroke clinical practice. Consecutive patients with acute ischemic stroke (AIS) were enrolled and self-reported health–related quality of life (HrQoL) was assessed 90 days after acute stroke using the Patient-reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10). Comorbidities at baseline were assessed by the Charlson Comorbidity Index (CCI). Polypharmacy was defined as medication intake of ≥5 at baseline. We used linear regression analysis to study the association of CCI, polypharmacy and other clinical covariates with HrQoL after stroke.ResultsOf 781 patients (median age 76 years, 48.4% female) enrolled, 30.2% had a CCI Score ≥2, and 31.5% presented with polypharmacy. At follow up, 71 (9.1%) had died. In 409 (52.4%) reached for outcome evaluation, Global Physical Health T-Score was 43.8 ± 10 and Global Mental Health T-Score was 43.5 ± 8.76, indicating lower HrQoL than the average population. A CCI Score ≥2, higher NIHSS Score, female sex, dependency on others for dressing, toileting and mobility before index stroke, atrial fibrillation and hypertension were independent predictors of worse physical and mental health outcomes, while polypharmacy was not.ConclusionIn patients with AIS, high comorbidity burden and polypharmacy are frequent. Comorbidity burden at admission is independently associated with worse self-reported physical and mental health three months after stroke.
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Gülke E, Juárez Paz L, Scholtes H, Gerloff C, Kühn AA, Pötter-Nerger M. Multiple input algorithm-guided Deep Brain stimulation-programming for Parkinson's disease patients. NPJ Parkinsons Dis 2022; 8:144. [PMID: 36309508 PMCID: PMC9617933 DOI: 10.1038/s41531-022-00396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/14/2022] [Indexed: 12/04/2022] Open
Abstract
Technological advances of Deep Brain Stimulation (DBS) within the subthalamic nucleus (STN) for Parkinson's disease (PD) provide increased programming options with higher programming burden. Reducing the effort of DBS optimization requires novel programming strategies. The objective of this study was to evaluate the feasibility of a semi-automatic algorithm-guided-programming (AgP) approach to obtain beneficial stimulation settings for PD patients with directional DBS systems. The AgP evaluates iteratively the weighted combination of sensor and clinician assessed responses of multiple PD symptoms to suggested DBS settings until it converges to a final solution. Acute clinical effectiveness of AgP DBS settings and DBS settings that were found following a standard of care (SoC) procedure were compared in a randomized, crossover and double-blind fashion in 10 PD subjects from a single center. Compared to therapy absence, AgP and SoC DBS settings significantly improved (p = 0.002) total Unified Parkinson's Disease Rating Scale III scores (median 69.8 interquartile range (IQR) 64.6|71.9% and 66.2 IQR 58.1|68.2%, respectively). Despite their similar clinical results, AgP and SoC DBS settings differed substantially. Per subject, AgP tested 37.0 IQR 34.0|37 settings before convergence, resulting in 1.7 IQR 1.6|2.0 h, which is comparable to previous reports. Although AgP long-term clinical results still need to be investigated, this approach constitutes an alternative for DBS programming and represents an important step for future closed-loop DBS optimization systems.
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Affiliation(s)
- Eileen Gülke
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - León Juárez Paz
- grid.418905.10000 0004 0437 5539Boston Scientific, Valencia, CA Spain
| | - Heleen Scholtes
- grid.418905.10000 0004 0437 5539Boston Scientific, Valencia, CA Spain
| | - Christian Gerloff
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea A. Kühn
- grid.6363.00000 0001 2218 4662Department of Neurology, Movement disorders & Neuromodulation section, Charité – University Medicine Berlin, Berlin, Germany
| | - Monika Pötter-Nerger
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schlemm E, Frey BM, Mayer C, Petersen M, Fiehler J, Hanning U, Kühn S, Twerenbold R, Gallinat J, Gerloff C, Thomalla G, Cheng B. Equalization of Brain State Occupancy Accompanies Cognitive Impairment in Cerebral Small Vessel Disease. Biol Psychiatry 2022; 92:592-602. [PMID: 35691727 DOI: 10.1016/j.biopsych.2022.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cognitive impairment is a hallmark of cerebral small vessel disease (cSVD). Functional magnetic resonance imaging has highlighted connections between patterns of brain activity and variability in behavior. We aimed to characterize the associations between imaging markers of cSVD, dynamic connectivity, and cognitive impairment. METHODS We obtained magnetic resonance imaging and clinical data from the population-based Hamburg City Health Study. cSVD was quantified by white matter hyperintensities and peak-width of skeletonized mean diffusivity (PSMD). Resting-state blood oxygen level-dependent signals were clustered into discrete brain states, for which fractional occupancies (%) and dwell times (seconds) were computed. Cognition in multiple domains was assessed using validated tests. Regression analysis was used to quantify associations between white matter damage, spatial coactivation patterns, and cognitive function. RESULTS Data were available for 979 participants (ages 45-74 years, median white matter hyperintensity volume 0.96 mL). Clustering identified five brain states with the most time spent in states characterized by activation (+) or suppression (-) of the default mode network (DMN) (fractional occupancy: DMN+ = 25.1 ± 7.2%, DMN- = 25.5 ± 7.2%). Every 4.7-fold increase in white matter hyperintensity volume was associated with a 0.95-times reduction of the odds of occupying DMN+ or DMN-. Time spent in DMN-related brain states was associated with executive function. CONCLUSIONS Associations between white matter damage, whole-brain spatial coactivation patterns, and cognition suggest equalization of time spent in different brain states as a marker for cSVD-associated cognitive decline. Reduced gradients between brain states in association with brain damage and cognitive impairment reflect the dedifferentiation hypothesis of neurocognitive aging in a network-theoretical context.
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Affiliation(s)
- Eckhard Schlemm
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Benedikt M Frey
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Schlemm E, Jensen M, Kuceyeski A, Jamison K, Ingwersen T, Mayer C, Königsberg A, Boutitie F, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Puig J, Simonsen CZ, Thijs V, Wouters A, Gerloff C, Thomalla G, Cheng B. Early effect of thrombolysis on structural brain network organisation after anterior‐circulation stroke in the randomized
WAKE‐UP
trial. Hum Brain Mapp 2022; 43:5053-5065. [PMID: 36102287 PMCID: PMC9582379 DOI: 10.1002/hbm.26073] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
The symptoms of acute ischemic stroke can be attributed to disruption of the brain network architecture. Systemic thrombolysis is an effective treatment that preserves structural connectivity in the first days after the event. Its effect on the evolution of global network organisation is, however, not well understood. We present a secondary analysis of 269 patients from the randomized WAKE‐UP trial, comparing 127 imaging‐selected patients treated with alteplase with 142 controls who received placebo. We used indirect network mapping to quantify the impact of ischemic lesions on structural brain network organisation in terms of both global parameters of segregation and integration, and local disruption of individual connections. Network damage was estimated before randomization and again 22 to 36 h after administration of either alteplase or placebo. Evolution of structural network organisation was characterised by a loss in integration and gain in segregation, and this trajectory was attenuated by the administration of alteplase. Preserved brain network organization was associated with excellent functional outcome. Furthermore, the protective effect of alteplase was spatio‐topologically nonuniform, concentrating on a subnetwork of high centrality supported in the salvageable white matter surrounding the ischemic cores. This interplay between the location of the lesion, the pathophysiology of the ischemic penumbra, and the spatial embedding of the brain network explains the observed potential of thrombolysis to attenuate topological network damage early after stroke. Our findings might, in the future, lead to new brain network‐informed imaging biomarkers and improved prognostication in ischemic stroke.
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Affiliation(s)
- Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Amy Kuceyeski
- Department of Radiology Weill Cornell Medicine New York New York USA
| | - Keith Jamison
- Department of Radiology Weill Cornell Medicine New York New York USA
| | - Thies Ingwersen
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Carola Mayer
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Florent Boutitie
- Department of Radiology Weill Cornell Medicine New York New York USA
- Hospices Civils de Lyon, Service de Biostatistique Lyon France
- Université Lyon 1 Villeurbanne France
- CNRS, UMR 5558 Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique‐Santé Villeurbanne France
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Klinik für Neurologie Medical Park Berlin Humboldtmühle Berlin Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Klinik und Hochschulambulanz für Neurologie Charité‐Universitätsmedizin Berlin Berlin Germany
- German Centre for Neurodegenerative Diseases (DZNE) Berlin Germany
- German Centre for Cardiovascular Research (DZHK) Berlin Germany
- ExcellenceCluster NeuroCure Berlin Germany
| | - Jochen B. Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Robin Lemmens
- Department of Neurology University Hospitals Leuven Leuven Belgium
- Department of Neurosciences Division of Experimental Neurology KU Leuven—University of Leuven Leuven Belgium
- VIB, Centre for Brain & Disease Research Laboratory of Neurobiology Leuven Belgium
| | - Keith W. Muir
- Institute of Neuroscience & Psychology University of Glasgow Glasgow UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1 CREATIS CNRS UMR 5220‐INSERM U1206, INSA‐Lyon Lyon France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI) Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona Spain
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI) Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona Spain
| | | | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health University of Melbourne Heidelberg Victoria Australia
- Department of Neurology Austin Health Heidelberg Victoria Australia
| | - Anke Wouters
- Department of Neurology University Hospitals Leuven Leuven Belgium
- Department of Neurosciences Division of Experimental Neurology KU Leuven—University of Leuven Leuven Belgium
- VIB, Centre for Brain & Disease Research Laboratory of Neurobiology Leuven Belgium
- Department of Neurology Amsterdam UMC University of Amsterdam Amsterdam Netherlands
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
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Weller JM, Dorn F, Meissner JN, Stösser S, Beckonert NM, Nordsiek J, Kindler C, Riegler C, Keil F, Petzold GC, Bode FJ, Reich A, Nikoubashman O, Röther J, Eckert B, Braun M, Hamann GF, Siebert E, Nolte CH, Bohner G, Eckert RM, Borggrefe J, Schellinger P, Berrouschot J, Bormann A, Kraemer C, Leischner H, Petersen M, Stögbauer F, Boeck-Behrens T, Wunderlich S, Ludolph A, Henn KH, Gerloff C, Fiehler J, Thomalla G, Alegiani A, Schäfer JH, Tiedt S, Kellert L, Trumm C, Ernemann U, Poli S, Liman J, Ernst M, Gröschel K, Uphaus T. Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation. Neurol Res Pract 2022; 4:42. [PMID: 36089621 PMCID: PMC9465921 DOI: 10.1186/s42466-022-00207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.
Methods This is a subgroup analysis of the German Stroke Registry—Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days. Results Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high. Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3–10.5] vs 7 [4–11], p = 0.73, mRS 4 [IQR 3–4] vs. 4 [IQR 3–5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02). Conclusions In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC. Registration: https://www.clinicaltrials.gov; Unique identifier: NCT03356392. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-022-00207-7.
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Mayer C, Nägele FL, Petersen M, Frey BM, Hanning U, Pasternak O, Petersen E, Gerloff C, Thomalla G, Cheng B. Free-water diffusion MRI detects structural alterations surrounding white matter hyperintensities in the early stage of cerebral small vessel disease. J Cereb Blood Flow Metab 2022; 42:1707-1718. [PMID: 35410517 PMCID: PMC9441727 DOI: 10.1177/0271678x221093579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In cerebral small vessel disease (CSVD), both white matter hyperintensities (WMH) of presumed vascular origin and the normal-appearing white matter (NAWM) contain microstructural brain alterations on diffusion-weighted MRI (DWI). Contamination of DWI-derived metrics by extracellular free-water can be corrected with free-water (FW) imaging. We investigated the alterations in FW and FW-corrected fractional anisotropy (FA-t) in WMH and surrounding tissue and their association with cerebrovascular risk factors. We analysed 1,000 MRI datasets from the Hamburg City Health Study. DWI was used to generate FW and FA-t maps. WMH masks were segmented on FLAIR and T1-weighted MRI and dilated repeatedly to create 8 NAWM masks representing increasing distance from WMH. Linear models were applied to compare FW and FA-t across WMH and NAWM masks and in association with cerebrovascular risk. Median age was 64 ± 14 years. FW and FA-t were altered 8 mm and 12 mm beyond WMH, respectively. Smoking was significantly associated with FW in NAWM (p = 0.008) and FA-t in WMH (p = 0.008) and in NAWM (p = 0.003) while diabetes and hypertension were not. Further research is necessary to examine whether FW and FA-t alterations in NAWM are predictors for developing WMH.
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Affiliation(s)
- Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix L Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Elina Petersen
- Clinical for Cardiology, University Heart and Vascular Center, Germany.,Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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