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Gerstl L, Olivieri M, Heinen F, Bidlingmaier C, Schroeder AS, Reiter K, Hoffmann F, Kurnik K, Liebig T, Trumm CG, Haas NA, Jakob A, Borggraefe I. Notfall-Neuropädiatrie – Der arteriell ischämische Schlaganfall als einer der zeitkritischsten Notfälle bei Kindern und Jugendlichen. Nervenarzt 2022; 93:158-166. [PMID: 35072763 PMCID: PMC8785019 DOI: 10.1007/s00115-021-01252-4] [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] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/21/2022]
Abstract
Der arteriell ischämische Schlaganfall im Kindes- und Jugendalter gehört zu den zeitkritischsten Notfällen in der Pädiatrie. Dennoch wird er häufig mit einer oft prognostisch relevanten Zeitverzögerung diagnostiziert. Gründe dafür liegen neben der geringen Awareness auch in der zuweilen unspezifischen klinischen Präsentation mit einer herausfordernden Breite kritischer Differenzialdiagnosen sowie in der Fläche noch wenig verzahnter Akutversorgungsstrukturen. Gleichwohl zeigen grundsätzlich die beim Erwachsenen etablierten Revaskularisationsstrategien auch beim Kind ihre möglichen, zum Teil spektakulären Erfolge. Es gilt also, diese nach Möglichkeit auch den betroffenen Kindern zur Verfügung zu stellen, auch wenn hier derzeit ein nicht annähernd vergleichbarer Grad an Evidenz erreicht ist. Postakut ist die ätiologische Aufarbeitung durch die größere Bandbreite zu bedenkender Risikofaktoren besonders komplex, muss aber in der Lage sein, das individuelle Risikoprofil mit Sekundärprophylaxe, Rezidivrisiko und Outcome präzise zu identifizieren. Die Langzeitbetreuung im multiprofessionellen, interdisziplinären Team muss die biopsychosozialen Aspekte des Kindes in seiner jeweiligen Entwicklungsphase berücksichtigen und damit eine bestmögliche Integration des Kindes in sein soziales und schulisches, später berufliches Umfeld realisieren.
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Koy A, Bockhorn N, Kühn A, Schneider GH, Krause P, Lauritsch K, Witt K, Paschen S, Deuschl G, Krauss J, Saryyeva A, Runge J, Borggraefe I, Mehrkens J, Horn A, Vesper J, Schnitzler A, Siegert S, Freilinger M, Eckenweiler M, Coenen V, Tadic V, Voges J, Pauls K, Wirths J, Timmermann L, Hellmich M, Abdallat M, Ascencao LC, Grünwald S, Wloch A, Schrader C, Groiss SJ, Wojtecki L. Adverse events associated with deep brain stimulation in patients with childhood-onset dystonia. Brain Stimul 2019; 12:1111-1120. [DOI: 10.1016/j.brs.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022] Open
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Vill K, Blaschek A, Gläser D, Kuhn M, Haack T, Alhaddad B, Wagner M, Kovacs-Nagy R, Tacke M, Gerstl L, Schroeder AS, Borggraefe I, Mueller C, Schlotter-Weigel B, Schoser B, Walter MC, Müller-Felber W. Early-Onset Myopathies: Clinical Findings, Prevalence of Subgroups and Diagnostic Approach in a Single Neuromuscular Referral Center in Germany. J Neuromuscul Dis 2019; 4:315-325. [PMID: 29172004 DOI: 10.3233/jnd-170231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/19/2023]
Abstract
BACKGROUND Early-onset myopathies are a heterogeneous group of neuromuscular diseases with broad clinical, genetic and histopathological overlap. The diagnostic approach has considerably changed since high throughput genetic methods (next generation sequencing, NGS) became available. OBJECTIVE We present diagnostic subgroups in a single neuromuscular referral center and describe an algorithm for the diagnostic work-up. METHODS The diagnostic approach of 98 index patients was retrospectively analysed. In 56 cases targeted sequencing of a known gene was performed, in 44 patients NGS was performed using large muscle specific panels, and in 12 individuals whole exome sequencing (WES) was undertaken. One patient was diagnosed via array CGH. Clinical features of all patients are provided. RESULTS The final diagnosis could be found in 63 out of 98 patients (64%) with molecular genetic analysis. In 55% targeted gene sequencing could establish the genetic diagnosis. However, this rate largely depended on the presence of distinct histological or clinical features. NGS (large myopathy-related panels and WES) revealed genetic diagnosis in 58.5% (52% and 67%, respectively). The genes detected by WES in our cohort of patients were all covered by the panels. Based on our findings we propose an algorithm for a practical diagnostic approach.Prevalences:MTM1- and LAMA2-patients are the two biggest subgroups, followed by SEPN1-, RYR1- and Collagen VI-related diseases. 31% of genetically confirmed cases represents a group with overlap between "congenital myopathies (CM)" and "congenital muscular dystrophies (CMD)". In 36% of the patients a specific genetic diagnosis could not be assigned. CONCLUSIONS A final diagnosis can be confirmed by high throughput genetic analysis in 58.5% of the cases, which is a higher rate than reported in the literature for muscle biopsy and should in many cases be considered as a first diagnostic tool. NGS cannot replace neuromuscular expertise and a close discussion with the geneticists on NGS is mandatory. Targeted candidate gene sequencing still plays a role in selected cases with highly suspicious clinical or histological features. There is a relevant clinical and genetic overlap between the entities CM and CMD.
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Affiliation(s)
- K Vill
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - A Blaschek
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - D Gläser
- genetikum® Center for Human Genetics, Neu-Ulm, Germany
| | - M Kuhn
- genetikum® Center for Human Genetics, Neu-Ulm, Germany
| | - T Haack
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Human Genetics, University of Tübingen, Germany
| | - B Alhaddad
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Wagner
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute für Neurogenomik, Helmholtz Zentrum München, Neuherberg, Germany
| | - R Kovacs-Nagy
- Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - M Tacke
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - L Gerstl
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - A S Schroeder
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - I Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - C Mueller
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - B Schlotter-Weigel
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - B Schoser
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - M C Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - W Müller-Felber
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
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Weinberger R, Warken B, König H, Vill K, Gerstl L, Borggraefe I, Heinen F, von Kries R, Schroeder AS. Three by three weeks of robot-enhanced repetitive gait therapy within a global rehabilitation plan improves gross motor development in children with cerebral palsy - a retrospective cohort study. Eur J Paediatr Neurol 2019; 23:581-588. [PMID: 31155454 DOI: 10.1016/j.ejpn.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/14/2018] [Revised: 04/08/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
AIM To assess the improvement in gross motor function following three blocks of a three-week, intensive robot-enhanced treadmill therapy (ROBERT-Program). METHOD retrospective chart review in a before-after interventional trial in children with cerebral palsy attending a university hospital outpatient rehabilitation centre. Patients received three blocks of a three-week, 12 sessions ROBERT-Program over a mean period of 24 months. Outcome measures were block specific and cumulative improvement in GMFM 66, D and E. Longterm GMFM 66 improvements were compared to the individuals' expected increment as derived from previously published GMFM-66 percentiles. 95% confidence intervals (CI) and paired t-test were calculated. RESULTS 20 children (8 GMFCS Level II; 12 GMFCS Level III, mean age 5.9 years (CI: [5.0; 6.7])) were treated. For each block a significant increase in motor performance in similar size could be observed without deterioration between blocks. The cumulative improvement during 21 months observation period was: 6.5 (CI: [4.8; 8.2]) in GMFM 66, which represents a clinically meaningful effect size of 3.6 (CI: [1.4; 5.8]) above the expected improvement. INTERPRETATION Progressive clinically meaningful improvement in motor performance for three blocks of ROBERT-Program was observed. Cumulative GMFM 66 improvements exceeded the individuals' age-specific expected course.
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Affiliation(s)
- R Weinberger
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany; Ludwig Maximilian University of Munich (LMU), Department of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Haydnstraße 5/IV. Stock, D-80336 Munich, Germany
| | - B Warken
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - H König
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - K Vill
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - L Gerstl
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - I Borggraefe
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - F Heinen
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - R von Kries
- Ludwig Maximilian University of Munich (LMU), Department of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Haydnstraße 5/IV. Stock, D-80336 Munich, Germany
| | - A S Schroeder
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany.
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Tacke M, Neubauer BA, Gerstl L, Roser T, Rémi J, Borggraefe I. [Epilepsy-new diagnostic tools, old drugs? : Therapeutic consequences of epilepsy genetics]. Nervenarzt 2017; 88:1385-1394. [PMID: 28932874 DOI: 10.1007/s00115-017-0427-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent advances in the field of epilepsy genetics have led to an increased fraction of patients with epilepsies where the etiology of the disease could be identified. Nevertheless, there is some criticism regarding the use of epilepsy genetics because in many cases the identification of a pathogenetic mutation does not lead to an adaptation of therapy or to an improved prognosis. In addition, the interpretation of genetic results might be complicated due to the considerable numbers of variants of unclear significance. OBJECTIVE This publication presents the arguments in favour of a broad use of genetic investigations for children with epilepsies. Several diseases where a genetic diagnosis does in fact have direct therapeutic consequences are mentioned. In addition, the indirect impact of an established etiology, encompassing the avoidance of unnecessary diagnostic measures, possibility of genetic counselling, and the easing of the psychologic burden for the caregivers, should not be underestimated. CONCLUSION The arguments in favour of broad genetic diagnostics prevail notwithstanding the lack of relevant new developments regarding the therapy.
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Affiliation(s)
- M Tacke
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Sektion für Pädiatrische Epileptologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - B A Neubauer
- Abteilung für Neuropädiatrie, Sozialpädiatrie und Epileptologie, Universitätskinderklinik, Universität Gießen-Marburg, Gießen, Deutschland
| | - L Gerstl
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Sektion für Pädiatrische Epileptologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - T Roser
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Sektion für Pädiatrische Epileptologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - J Rémi
- Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Campus Großhadern, Klinikum der Universität München, München, Deutschland.,Interdisziplinäres Epilepsiezentrum am Campus Großhadern und im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, München, Deutschland
| | - I Borggraefe
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Sektion für Pädiatrische Epileptologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland. .,Interdisziplinäres Epilepsiezentrum am Campus Großhadern und im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, München, Deutschland.
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Gerstl L, Heinen F, Borggraefe I, Olivieri M, Kurnik K, Nicolai T, Reiter K, Berweck S, Schröder AS. Pädiatrischer Schlaganfall – ein kinderneurologischer Notfall. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-016-0119-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Haberlandt E, Ensslen M, Gruber-Sedlmayr U, Plecko B, Brunner-Krainz M, Schimmel M, Schubert-Bast S, Neirich U, Philippi H, Kurleman G, Tardieu M, Wohlrab G, Borggraefe I, Rostásy K. Epileptic phenotypes, electroclinical features and clinical characteristics in 17 children with anti-NMDAR encephalitis. Eur J Paediatr Neurol 2017; 21:457-464. [PMID: 28017557 DOI: 10.1016/j.ejpn.2016.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 10/27/2015] [Revised: 09/03/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anti-N-methyl d-aspartate receptor (NMDAR) encephalitis is a rare disorder characterized by seizures, neuropsychiatric symptoms, dyskinesia and autonomic instability. OBJECTIVE Aim of the present study was to evaluate the seizure phenotypes and electroencephalogram (EEG) features in children with anti-NMDAR encephalitis. METHODS Seizure types, electroclinical features and clinical characteristics of 17 children with anti-NMDAR encephalitis were analysed in a retrospective case series from nine centres in Europe. RESULTS Nearly half (8/17) of the children presented with psychiatric symptoms, whereas in 4/17 patients seizures were the first symptom and in 5/17 both symptoms occurred at the same time. During the following course seizures were reported in 16/17 children. The first EEG detected generalized slowing in 11/17 patients, focal slowing in 3/17 and normal background activity in only 3/17 children. The extreme delta brush (EDB) pattern was detected in 9/17 (53%) patients. CONCLUSION In addition to psychiatric symptoms, children with anti-NMDAR encephalitis often show generalized slowing in EEG with or without seizures at initial presentation. EDB is present in half of all children and is potentially a helpful tool for early detection of this immune-mediated disease.
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Affiliation(s)
- E Haberlandt
- Clinical Department of Pediatrics I, Neuropediatrics, Medical University of Innsbruck, Innsbruck, Austria.
| | - M Ensslen
- Department of Pediatric Neurology and Developmental Medicine and Social Pediatrics, Dr. von Haunersches Children's Hospital, University of Munich, Munich, Germany
| | | | - B Plecko
- Department of Neuropaediatrics and Neurophysiology, University Children's Hospital, Zuerich, Switzerland
| | - M Brunner-Krainz
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - M Schimmel
- Department of Pediatrics, Klinikum Augsburg, Augsburg, Germany
| | - S Schubert-Bast
- Department of Pediatric Neurology, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - U Neirich
- Department of Pediatrics, Neurology, Stiftungskrankenhäuser Frankfurt am Main, Clementine Kinderhospital, Frankfurt am Main, Germany
| | - H Philippi
- Sozialpädiatrisches Zentrum Frankfurt Mitte, Frankfurt am Main, Germany
| | - G Kurleman
- Department of General Pediatrics, Neuropediatrics, University Children's Hospital Münster, Münster, Germany
| | - M Tardieu
- Assistance publique hôpitaux de Paris, Hôpitaux universitaires Paris-Sud, Université Paris-Sud, Paris, France
| | - G Wohlrab
- Department of Neuropaediatrics and Neurophysiology, University Children's Hospital, Zuerich, Switzerland
| | - I Borggraefe
- Department of Pediatric Neurology and Developmental Medicine and Social Pediatrics, Dr. von Haunersches Children's Hospital, University of Munich, Munich, Germany
| | - K Rostásy
- Department of Pediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Witten, Germany
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Reunert J, Lotz-Havla AS, Polo G, Kannenberg F, Fobker M, Griese M, Mengel E, Muntau AC, Schnabel P, Sommerburg O, Borggraefe I, Dardis A, Burlina AP, Mall MA, Ciana G, Bembi B, Burlina AB, Marquardt T. Niemann-Pick Type C-2 Disease: Identification by Analysis of Plasma Cholestane-3β,5α,6β-Triol and Further Insight into the Clinical Phenotype. JIMD Rep 2015; 23:17-26. [PMID: 25772320 DOI: 10.1007/8904_2015_423] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/26/2015] [Accepted: 02/13/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Niemann-Pick type C disease is a rare disorder caused by impaired intracellular lipid transport due to mutations in either the NPC1 or the NPC2 gene. Ninety-five % of NPC patients show mutations in the NPC1 gene. A much smaller number of patients suffer from NPC2 disease and present respiratory failure as one of the most frequent symptoms. Several plasma oxysterols are highly elevated in NPC1 and can be used as a biomarker in the diagnosis of NPC1. METHODS Plasma cholestane-3β,5α,6β-triol was evaluated as biomarker for NPC2 by GC/MS and LC-MS/MS analysis. The diagnosis was confirmed by Sanger sequencing and filipin staining. RESULTS We report three NPC2 patients with typical respiratory problems and a detailed description of the nature of the lung disease in one of them. All patients had elevated levels of plasma cholestane-3β,5α,6β-triol. In two of these patients, the positive oxysterol result led to a rapid diagnosis of NPC2 by genetic analysis. The phenotype of the third patient has been described previously. In this patient a cholestane-3β,5α,6β-triol concentration markedly above the reference range was found. CONCLUSIONS Measurement of plasma cholestane-3β,5α,6β-triol enables to discriminate between controls and NPC1 and NPC2 patients, making it a valuable biomarker for the rapid diagnosis not only for NPC1 but also for NPC2 disease.The measurement of oxysterols should be well kept in mind in the differential diagnosis of lysosomal diseases, as the elevation of oxysterols in plasma may speed up the diagnosis of NPC1 and NPC2.
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Affiliation(s)
- J Reunert
- Department of Pediatrics, University Hospital of Muenster, Muenster, Germany
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Schroeder AS, Homburg M, Warken B, Auffermann H, Koerte I, Berweck S, Jahn K, Heinen F, Borggraefe I. Prospective controlled cohort study to evaluate changes of function, activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy. Eur J Paediatr Neurol 2014; 18:502-10. [PMID: 24821475 DOI: 10.1016/j.ejpn.2014.04.012] [Citation(s) in RCA: 40] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Robot-enhanced therapies are increasingly being used to improve gross motor performance in patients with cerebral palsy. AIM To evaluate gross motor function, activity and participation in patients with bilateral spastic cerebral palsy (BS-CP) after Robot-enhanced repetitive treadmill therapy (ROBERT) in a prospective, controlled cohort study. METHODS Participants trained for 30-60 min in each of 12 sessions within a three-week-period. Changes in Gross Motor Function Measure (GMFM 66) scores, standardized walking distance, self-selected and maximum walking speed (ICF domain "Activity"), and Canadian Occupational Performance Measure (COPM; "Participation") were measured. Outcome measures were assessed three weeks in advance (V1), the day before (V2) as well as the day after, and 8 weeks after ROBERT (V3 + V4). RESULTS 18 patients with BS-CP participated; age 11.5 (mean, range: 5.0-21.8) years, body weight 36.4 (15.0-72.0) kg. GMFCS levels I-IV were: n = 4; 5; 8; 1. There was no significant difference comparing V1 and V2. GMFM 66 (total +2.5 points, Dimension D +3.8 and E +3.2) and COPM (Performance +2.1 points, Satisfaction +1.8 points) showed statistically significant improvements for V3 or V4 compared to V1 or V2 representing clinically meaningful effect sizes. Age, GMFCS level, and repeated ROBERT blocks correlated negatively with GMFM improvement, but not with COPM improvement. INTERPRETATION Following ROBERT, this prospective controlled cohort study showed significant and clinically meaningful improvements of function in ICF domains of "activity" and "participation" in patients with BS-CP. Further assessment in a larger cohort is necessary to allow more specific definition of factors that influence responsiveness to ROBERT program.
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Affiliation(s)
- A S Schroeder
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany.
| | - M Homburg
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - B Warken
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - H Auffermann
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - I Koerte
- Institute of Clinical Radiology, University of Munich, Germany
| | - S Berweck
- Specialist Centre for Paediatric Neurology, Epilepsy Centre for Children and Adolescents, Vogtareuth, Germany
| | - K Jahn
- German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany
| | - F Heinen
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - I Borggraefe
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany
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Schröder A, Schäfer J, Warken B, Schlick C, Ilmberger J, Borggraefe I, Huss K, Homburg M, Jahn K, Heinen F. Integratives Behandlungskonzept bei Kindern mit bilateral spastischer Cerebralparese - Modulation der muskulären Dysbalance mithilfe eines intensivierten roboter-gestützten Laufbandtrainings und Injektion mit Botulinumtoxin. Akt Neurol 2011. [DOI: 10.1055/s-0031-1276548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Blaschek A, Lohse P, Huss K, Borggraefe I, Mueller-Felber W, Heinen F, Hohlfeld R, Kümpfel T. Concurrent TNFRSF1A R92Q and pyrin E230K mutations in a child with multiple sclerosis. Mult Scler 2010; 16:1517-20. [DOI: 10.1177/1352458510382933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a 16-year-old female patient with a severe course of multiple sclerosis and concomitant symptoms suggestive of a hereditary autoinflammatory disease. Genetic analyses revealed that she inherited a TNFRSF1A R92Q mutation from her mother and a pyrin E230K mutation from her father. To our knowledge, this is the first report of a patient with severe childhood multiple sclerosis and mutations in two genes which predispose to hereditary autoinflammatory disorders. We speculate that these mutations contribute to early multiple sclerosis manifestation and enhance the inflammatory damage inflicted by the autoimmune response.
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Affiliation(s)
- A Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr von Haunersches Children's Hospital, Ludwig-Maximilians University, Munich, Germany,
| | - P Lohse
- Department of Clinical Chemistry - Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - K Huss
- Department of Pediatric Neurology and Developmental Medicine, Dr von Haunersches Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - I Borggraefe
- Department of Pediatric Neurology and Developmental Medicine, Dr von Haunersches Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - W Mueller-Felber
- Department of Pediatric Neurology and Developmental Medicine, Dr von Haunersches Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - F Heinen
- Department of Pediatric Neurology and Developmental Medicine, Dr von Haunersches Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - R Hohlfeld
- Institute for Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - T Kümpfel
- Institute for Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
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12
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Borggraefe I, Kiwull L, Schaefer JS, Koerte I, Blaschek A, Meyer-Heim A, Heinen F. Sustainability of motor performance after robotic-assisted treadmill therapy in children: an open, non-randomized baseline-treatment study. Eur J Phys Rehabil Med 2010; 46:125-131. [PMID: 20485217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM The aim of the study was to investigate the sustainability of motor improvements achieved after a three week trial of robotic assisted treadmill therapy in children and adolescents with central gait disorders within a follow up period of about six months. METHODS Open, non-randomized, baseline-treatment study. Fourteen patients (mean age 8.2+/-5.4) underwent a trial of 12 sessions of robotic-assisted treadmill therapy using the Lokomat over a period of three weeks. Outcome measures were the dimensions D (standing) and E (walking) of the Gross Motor Function Measure, the ten meter walking test and the six minute walking test. Outcome variables were evaluated immediately before and after the trial and at a follow up of about six months. RESULTS Improvements after the trial in the dimension D from 49.5% to 54.4% (P=0.008) and from 38.9% to 42.3% (P=0.012) in the dimension E of the GMFM were seen and are within the same range of previously published results. The mean score at the follow up after six months was 56.8% and 43.3% for dimension D and E, respectively. Gait speed improved from 0.80 m/s to 1.01 m/s (P=0.006) after the trial and was 1.11 m/s at the follow-up visit at six months. Similar results were obtained for endurance. CONCLUSION The improvements of motor function after a three-week trial of robotic-assisted treadmill therapy appear to be sustained after a mean period of six months.
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Affiliation(s)
- I Borggraefe
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Haunersches Children's HospitalUniversity of Munich, Munich, Germany.
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13
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Borggraefe I, Peraud A, Noachtar S. [Not Available]. MMW Fortschr Med 2010; 152:35-37. [PMID: 27369925 DOI: 10.1007/bf03366010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Soheyl Noachtar
- Epilepsie-Zentrum, Neurologische Klinik Klinikum der Universität München - Großhadern, Marchioninistr. 15, D-81377 c[]München, Deutschland.
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Meyer-Heim A, Ammann-Reiffer C, Schmartz A, Schäfer J, Sennhauser FH, Heinen F, Knecht B, Dabrowski E, Borggraefe I. Improvement of walking abilities after robotic-assisted locomotion training in children with cerebral palsy. Arch Dis Child 2009; 94:615-20. [PMID: 19208675 DOI: 10.1136/adc.2008.145458] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To measure functional gait improvements of robotic-assisted locomotion training in children with cerebral palsy (CP). DESIGN Single-case experimental A-B design. SETTINGS Rehabilitation Centre Affoltern am Albis, Children's University Hospital Zurich, Switzerland (inpatient group) and Neurology Department of the Dr von Haunersches Children's Hospital Munich, Germany (outpatient group). PARTICIPANTS 22 children (mean age 8.6 years, range 4.6-11.7) with CP and a Gross Motor Function Classification System level II to IV. INTERVENTIONS 3 to 5 sessions of 45-60 minutes/week during a 3-5-week period of driven gait orthosis training. MAIN OUTCOME MEASURES 10-metre walk test (10MWT), 6-minute walk test (6MinWT), Gross Motor Function Measure (GMFM-66) dimension D (standing) and dimension E (walking), and Functional Ambulation Categories (FAC). RESULTS The mean (SD) maximum gait speed (0.78 (0.57) to 0.91 (0.61) m/s; p<0.01) as well as the mean (SD) dimension D of the GMFM-66 (40.3% (31.3%) to 46.6% (28.7%); p<0.05) improved significantly after the intervention period. The mean (SD) 6MinWT (176.3 (141.8) to 199.5 (157.7) m), the mean FAC (2.6 (1.7) to 3.0 (1.6)) and the mean (SD) dimension E of the GMFM-66 (29.5% (30.3%) to 31.6% (29.2%)) also showed an increase, but did not reach a statistically significant level. CONCLUSION These results suggest that children with CP benefit from robotic-assisted gait training in improving functional gait parameters.
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Affiliation(s)
- A Meyer-Heim
- Rehabilitation Centre, 8910 Affoltern am Albis, University Children's Hospital Zurich, Switzerland.
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15
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Borggraefe I, Remi J, Vollmar C, Winkler P, Noachtar S. 206. Localization of executive motor functions by cortical electrical stimulation. Clin Neurophysiol 2009. [DOI: 10.1016/j.clinph.2008.07.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Borggraefe I, Boetzel K, Boehmer J, Berweck S, Mueller-Felber W, Mueller K, Mehrkens JH, Heinen F. Return to participation - significant improvement after bilateral pallidal stimulation in rapidly progressive DYT-1 dystonia. Neuropediatrics 2008; 39:239-42. [PMID: 19165713 DOI: 10.1055/s-0028-1112117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report the case of an 8-year-old girl who developed progressive generalized dystonia, rendering her unable to walk and sit within months despite medical therapy with dopamine and anti-cholinergic agents. She was found to have a 9q34.1 GAG-deletion, which is known to cause DYT1-dystonia. DYT-1 dystonia is an autosomal dominant condition with incomplete penetrance that usually starts in childhood. It is known to be refractory to pharmacotherapy. Reports on deep brain stimulation in this condition reveal marked benefits of the treatment in the pediatric and adult populations. The patient underwent bilateral stimulation of the internal globus pallidus 18 months after symptom onset. Postoperatively, her clinical status improved significantly as measured by the Burke-Fahn-Marsden dystonia rating scale and the resolution of a unilateral hip dislocation. Normal participation was regained.
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Affiliation(s)
- I Borggraefe
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner's Children's Hospital, University of Munich, Munich, Germany.
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Borggraefe I, Remi J, Vollmar C, Winkler PA, Noachtar S. Localization of executive motor functions by cortical electrical stimulation. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1073000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Meyer-Heim A, Borggraefe I, Ammann-Reiffer C, Berweck S, Sennhauser FH, Colombo G, Knecht B, Heinen F. Feasibility of robotic-assisted locomotor training in children with central gait impairment. Dev Med Child Neurol 2007; 49:900-6. [PMID: 18039236 DOI: 10.1111/j.1469-8749.2007.00900.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intensive, task-specific training enabled by a driven gait orthosis (DGO) may be a cost-effective means of improving walking performance in children. A paediatric DGO has recently been developed. This study was the first paediatric trial aimed to determine the feasibility of robotic-assisted treadmill training in children with central gait impairment (n=26; 11 females, 15 males; mean age 10 y 1 mo [SD 4 y]; range 5 y 2 mo-19 y 5 mo). Diagnoses of the study group included cerebral palsy (n=19; Gross Motor Function Classification System Levels I-IV), traumatic brain injury (n=1), Guillain-Barré syndrome (n=2), incomplete paraplegia (n=2), and haemorrhagic shock (n=1), and encephalopathy (n=1). Sixteen children were in-patients and 10 were outpatients. Twenty-four of the 26 patients completed the training which consisted of a mean of 19 sessions (SD 2.2; range 13-21) in the in-patient group and 12 sessions (SD 1.0; range 10-13) in the outpatient group. Gait speed and 6-Minute Walking Test increased significantly (p<0.01). Functional Ambulation Categories and Standing dimension (in-patient group p<0.01; outpatient group p<0.05) of the Gross Motor Function Measure improved significantly. DGO training was successfully integrated into the rehabilitation programme and findings suggest an improvement of locomotor performance.
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Affiliation(s)
- A Meyer-Heim
- Rehabilitation Centre, Affoltern am Albis, University Children's Hospital Zurich, Switzerland.
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Hoffmann F, Reiter K, Kluger G, Holthausen H, Schwarz HP, Borggraefe I, Bonfig W. Seizures, psychosis and coma: severe course of hashimoto encephalopathy in a six-year-old girl. Neuropediatrics 2007; 38:197-9. [PMID: 18058628 DOI: 10.1055/s-2007-991145] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hashimoto encephalopathy (HE) is a rare steroid-responsive encephalopathy associated with elevated antithyroid antibodies and is a well recognised complication of autoimmune thyroid disease. The clinical picture is pleomorphic, presenting with variable symptoms like coma, seizures, neuropsychiatric changes (impairment of cognitive functions, behavioural and mood disturbances, hallucinations) or focal neurological deficits. HE is mainly diagnosed in adults, but also a rare differential diagnosis of encephalopathy or epilepsy in children. The diagnosis is often overlooked at presentation but is crucial as it is a treatable disease. We report on the youngest patient described up to now presenting with progressive epilepsy resistant to anticonvulsive treatment and unclear encephalopathy related to Hashimoto thyroiditis.
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Affiliation(s)
- F Hoffmann
- University Children's Hospital, Ludwig Maximilians University, Munich, Germany
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Ludwiczek O, Vannier E, Borggraefe I, Kaser A, Siegmund B, Dinarello CA, Tilg H. Imbalance between interleukin-1 agonists and antagonists: relationship to severity of inflammatory bowel disease. Clin Exp Immunol 2004; 138:323-9. [PMID: 15498044 PMCID: PMC1809217 DOI: 10.1111/j.1365-2249.2004.02599.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [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] [Accepted: 07/19/2004] [Indexed: 12/25/2022] Open
Abstract
Interleukin (IL)-1 is a key mediator in the pathogenesis of inflammatory bowel disease (IBD). Naturally occurring IL-1 modulators include IL-1 receptor antagonist (IL-1Ra), IL-1 soluble receptor Type I (IL-1sRI), IL-1sRII and IL-1 receptor accessory protein (AcP). Systemic and mucosal levels of IL-1 soluble receptors remain unknown in IBD. Plasma or colonic tissues were obtained from 185 consecutive unselected patients with Crohn's disease (CD) or ulcerative colitis (UC) and from 52 control subjects. Plasma and colonic explant culture supernatants were assessed for IL-1alpha, IL-1beta, IL-1Ra, IL-1sRI and IL-1sRII. Plasma IL-1Ra levels were higher in UC (+93%) than in healthy subjects. IL-1alpha and IL-1beta were not detected. IL-1sRII levels were marginally lower in CD (-10%) and UC (-9%), whereas IL-1sRI levels were elevated in CD (+28%) only. Plasma IL-1sRI levels correlated positively (P < 0.01) with Crohn's disease activity index (r = 0.53), C-reactive protein (r = 0.46) and alpha1-acid glycoprotein (r = 0.42). In colonic explant cultures, IL-1alpha and IL-1Ra levels were elevated in non-lesional (+233% and +185% respectively) and lesional CD (+353% and +1069%), lesional UC (+604% and +1138%), but not in non-lesional UC. IL-1beta was elevated in lesional UC (+152%) and CD (+128%). In contrast, IL-1sRII levels were elevated in non-lesional CD (+65%), but remained unchanged in lesional CD, non-lesional and lesional UC. IL-1sRI levels did not differ between patient and control groups. These results indicate that (i) the proinflammatory moiety IL-1sRI is a systemic marker of inflammation and activity in CD and (ii) local shedding of the functional antagonist IL-1sRII may dampen colonic inflammation in CD, but not in UC.
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Affiliation(s)
- O Ludwiczek
- Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria
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