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Katschnig H, Straßmayr C, Endel F, Posch M, Steiner I. Are early post-discharge physician contacts associated with 30-day psychiatric re-hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias. Int J Methods Psychiatr Res 2023; 33:e1983. [PMID: 37608583 PMCID: PMC10804335 DOI: 10.1002/mpr.1983] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/28/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES Cost containment and quality of care considerations have increased research interest in the potential preventability of early re-hospitalisations. Various registry-based retrospective cohort studies on psychiatric re-hospitalisation have focused on the role of early post-discharge service contacts, but either did not consider their time-dependent nature ('immortal time bias') or evaded the issue by analysing late re-hospitalisations. The present study takes care of the immortal time bias in studying early psychiatric re-hospitalisations. METHODS In a retrospective cohort study using nationwide electronic claims data in Austria, 10,689 adults discharged from acute psychiatric inpatient wards were followed up for 30 days. Cox regression analyses were performed with post-discharge psychiatric and general practitioner contacts as time-dependent covariates and time to first psychiatric re-hospitalisation as outcome. RESULTS Post-discharge ambulatory physician contacts were significantly associated with a decreased psychiatric re-hospitalisation rate (hazard ratio 0.77 [95% CI 0.69; 0.87], p < 0.0001), with similarly strong contributions to this association by general practitioners and psychiatrists. CONCLUSIONS Despite avoiding the immortal time bias and controlling for several confounders, we suggest to be cautious with a causal interpretation of the identified association, since potentially relevant confounders, such as disease severity, were unavailable in our claims data base.
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Affiliation(s)
- H. Katschnig
- Department of PsychiatryMedical University of ViennaViennaAustria
- IMEHPS.researchViennaAustria
| | | | | | - M. Posch
- Medical University of ViennaCenter for Medical Data ScienceInstitute of Medical StatisticsViennaAustria
| | - I. Steiner
- Medical University of ViennaCenter for Medical Data ScienceInstitute of Medical StatisticsViennaAustria
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2
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Oren N, Abecasis D, Inbar E, Glik A, Steiner I, Shapira-Lichter I. A new perspective on the role of the frontoparietal regions in Stroop-like conflicts. Hum Brain Mapp 2023. [PMID: 37226979 DOI: 10.1002/hbm.26347] [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] [Received: 05/29/2022] [Revised: 12/28/2022] [Accepted: 04/20/2023] [Indexed: 05/26/2023] Open
Abstract
Humans are goal-directed; however, goal-unrelated information still affects us, but how? The Stroop task is often used to answer this question, relying on conflict (incongruency) between attributes, one targeted by the task and another irrelevant to the task. The frontal regions of the brain are known to play a crucial role in processing such conflict, as they show increased activity when we encounter incongruent stimuli. Notably, the Stroop stimuli also consist of conceptual dimensions, such as semantic or emotional content, that are independent of the attributes that define the conflict. Since the non-targeted attribute usually refers to the same conceptual dimension as the targeted-attribute, it is relevant to the task at hand. For example, when naming the emotion of an emotional face superimposed by an emotional word, both the targeted-attribute and the non-targeted attribute refer to the conceptual dimension "emotion". We designed an fMRI paradigm to investigate how conflicts between different conceptual dimensions impact us. Even though the conflict was task-irrelevant, incongruent stimuli resulted in longer reaction times, indicating a behavioral congruency effect. When examining the neural mechanisms that underlie this effect, we found that the frontal regions exhibited repetition suppression, while the bilateral intraparietal sulcus (IPS) showed a congruency effect linked to the behavioral effect. Taken together, these findings suggest that individuals are unable to completely ignore task-irrelevant information, and that the IPS plays a crucial role in processing such information.
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Affiliation(s)
- Noga Oren
- Functional MRI Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Donna Abecasis
- Functional MRI Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Edna Inbar
- Imaging Department, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Glik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Cognitive Neurology Clinic, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
- Department of Neurology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Israel Steiner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Irit Shapira-Lichter
- Functional MRI Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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3
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Brandt JB, Golej J, Irschik S, Steiner A, Voitl P, Steiner I, Höflich A. Effects of pediatric intensive care due to congenital heart defects on maternal mental health. Acta Paediatr 2023. [PMID: 37166454 DOI: 10.1111/apa.16843] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/06/2023] [Accepted: 05/10/2023] [Indexed: 05/12/2023]
Abstract
AIM Successful mother-child-bonding is a fundamental step for a healthy development of the child. Different factors like postpartum depression can hinder the bonding process. This study aimed to investigate how intensive care treatment due to congenital heart diseases of the infant alters bonding and how mothers cope with the situation. METHODS Validated questionnaires were used to analyze postpartum depression, mother-child bonding, stress factors and coping strategies for mothers at a pediatric intensive care unit (PICU; n=38) and a group of mothers without known psychiatric disorders attending a babywell visit with their child (n=91). Descriptive statistics and interaction models were calculated. RESULTS The PICU group showed on average higher total scores on the postpartum bonding questionnaire indicating mother-child bonding impairment and a higher proportion of mothers with severe depression was observed (76% versus 11%). The model showed a significant interaction between effective coping strategies and mother infant bonding (p = 0.04). Ineffective coping had no effect on bonding or depression in the PICU group. CONCLUSION Mothers of children treated at an ICU due a congenital heart disease are at increased risk for the development of depression and difficulties in different aspects of postpartum bonding. Our results show that coping mechanisms might significantly influence postpartum bonding. Implementation of tailored support is needed to optimize maternal outcomes.
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Affiliation(s)
- J B Brandt
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - J Golej
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - S Irschik
- Out of hospital pediatrician, Vienna
| | - A Steiner
- Department of Internal Medicine, Hospital Lilienfeld, Austria
| | - P Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria
| | - I Steiner
- Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Austria
| | - A Höflich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
- Department of Psychiatry and Psychotherapeutic Medicine, Karl Landsteiner University for Health and Science, Tulln, Austria
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4
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Hersh N, Ben Zvi H, Goldstein L, Steiner I, Benninger F. Epilepsy following herpes simplex encephalitis - A case series. Epilepsy Res 2023; 192:107137. [PMID: 37060749 DOI: 10.1016/j.eplepsyres.2023.107137] [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: 01/25/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) is associated with severe mortality and morbidity. Its incidence is estimated at 1:250 000, and the typical symptomatology of acute disease including headaches, mental state disturbances, confusion, sleepiness, and seizures. The chronic phase of the disease is occasionally characterized by epilepsy and neurological deficits. STUDY RATIONALE The present retrospective single-center study aims to identify risk factors for predicting the development of epilepsy (epileptogenesis) following HSE. METHODS Medical records were screened for patients older than 18 years, hospitalized between January 2005 and September 2019 with a diagnosis of "encephalitis" and "herpes simplex virus, HSV" infection. HSE diagnosis was based on an analysis of the cerebrospinal fluid with positive HSV testing results. RESULTS Twenty-three patients fit our inclusion criteria: fever and behavioral changes, followed by seizures, were reported in 58.3 % of patients. On follow-up (59.7 ± 38.8 months), eight patients (34.8 %) developed epilepsy. Pathological imaging and EEG were correlated with acute symptomatic seizures (ASS). ASS was associated with an 8-fold risk increase to develop post-encephalitis epilepsy (PE). PE was associated with younger age but not with CSF results, imaging, or EEG. CONCLUSION Our retrospective single-center study on PE, following HSE, shows that younger age and ASS were associated with PE. Brain imaging, CSF analysis, and EEG were not associated with the development of epilepsy following HSE.
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Affiliation(s)
- Nir Hersh
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Neurology Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Haim Ben Zvi
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Lilach Goldstein
- Department of Neurology, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Tel Aviv, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel.
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5
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Romano F, Wendelspiess M, Mansour R, Abplanalp-Marti O, Starvaggi C, Holzner F, Steiner I, Keitel K. Safety of nurse-directed triage intranasal fentanyl protocol for acute pain management in a European pediatric emergency department: A retrospective observational analysis. Front Pediatr 2023; 11:1070685. [PMID: 36861074 PMCID: PMC9969078 DOI: 10.3389/fped.2023.1070685] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Nurse-directed pain protocols for intranasal fentanyl administration are not widely implemented in European (EU) pediatric emergency departments (PED). Barriers include perceived safety concerns for intranasal (IN) fentanyl. The aim of this study is to describe our experience with a nurse-directed triage IN fentanyl protocol with a focus on safety in a tertiary EU PED. METHODS We conducted a retrospective analysis of patient records of children aged 0-16 years who received nurse-directed IN fentanyl between January 2019 and December 2021 at the PED of the University Children's Hospital of Bern, Switzerland. Extracted data points included demographics, presenting complaint, pain score, IN fentanyl dosage, concomitant pain medication use, and adverse events. RESULTS A total of 314 patients were identified with ages ranging from 9 months to 15 years. The main indication for nurse-directed fentanyl administration was musculoskeletal pain due to trauma (n = 284, 90%). Mild adverse events (vertigo) were reported in two patients (0.6%), without a correlation to concomitant pain medication or protocol violation. The only reported severe adverse event of syncope and hypoxia in a 14-year-old adolescent occurred in a setting where the institutional nurse-directed protocol was violated. CONCLUSION In accordance with previous studies outside of Europe, our data support the case that when appropriately used, nurse-directed IN fentanyl is a safe potent opioid analgesic for pediatric acute pain management. We strongly encourage the introduction of nurse-directed triage fentanyl protocols Europe-wide in order to provide effective and adequate acute pain management in children.
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Affiliation(s)
- F Romano
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - M Wendelspiess
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - R Mansour
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - O Abplanalp-Marti
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - C Starvaggi
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - F Holzner
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - I Steiner
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - K Keitel
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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6
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Franke I, Streb J, Dudeck M, Mayer J, Steiner I, Wolf V. Alcohol use disorder as a risk factor for violent offending in a sample of female forensic-psychiatric inpatients. Eur Psychiatry 2022. [PMCID: PMC9564744 DOI: 10.1192/j.eurpsy.2022.883] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Female gender is associated with a lower risk for aggressive behaviour and violent offending. Well established risk factors for aggressive behaviour are alcohol and other substance use, but previous studies focused mainly on male offenders and the general population. However, for therapeutic and prognostic reasons it is important to understand pathways to female offending. Objectives To examine a sample of female forensic-psychiatric inpatients regarding the association of alcohol (AUD) and other substance use disorders (SUD) with violent offending (homicide, assault, robbery). Methods We conducted a retrospective cohort study of 334 female patients discharged before 01.01.2019 from a secure psychiatric hospital in Germany. Results In total, 72% of the patients with AUD committed a violent crime, leading to admission to secure psychiatric treatment. In comparison a statistically significant lower rate (19%) of the SUD group was convicted of violent offending. Over 70% of the participants with AUD had a family history of AUD, and over 83% experienced physical violence in adulthood. We found no group differences (AUD vs. SUD) regarding aggressive behaviour during inpatient treatment. Conclusions According to our results, AUD compared to other SUD, is a significant risk factor for violent offending in women. A family background with AUD and a history of physical abuse might function as a risk factor for both: developing an AUD and violent offending. The comparable rates of aggression in both groups during inpatient treatment suggest that abstinence is a protective factor. Disclosure No significant relationships.
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7
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Maor M, Naftali J, Wilf-Yarkoni A, Lotan I, Hellmann MA, Steiner I. Repeated lumbar puncture in search of oligoclonal bands – What is the yield? J Neurol Sci 2022; 439:120298. [DOI: 10.1016/j.jns.2022.120298] [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] [Received: 04/02/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
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8
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Benninger F, Steiner I. Non-infectious mechanisms of neurological damage due to infection. J Neurol Sci 2021; 431:120057. [PMID: 34800841 DOI: 10.1016/j.jns.2021.120057] [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: 01/29/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
Infections of the nervous system is a growing aspect of clinical neurology. Accumulating knowledge in early diagnosis, course, therapy and prognosis is enlarging the clinical tools required for effective therapy. Of special importance is the ability to differentiate between proper infections, where anti-microbial agents, when available, should be introduced and used and post infectious conditions where therapy is mainly directed against the host immune system. The two conditions sometimes overlap, a situation that requires the ability to combine clinical skills with the use of laboratory tools such as polymerase chain reaction (PCR), serology, and antigenic detection. In the era of the SARS-CoV-2 pandemic, the need to make this distinction is emphasized as correct diagnosis of post infectious conditions and expedited therapy is important and sometimes lifesaving. We here attempt to present several infectious agents and their possible indirect damage to the nervous system causing in some cases significant neurological deficits. We try to limit our focus on those mechanisms which do not involve the direct tissue damage by the infectious agents but rather are connected to para- and post-infectious mechanisms. We attempt to delineate the features that will enable to tailor the correct diagnosis and following the effective therapy.
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Affiliation(s)
- Felix Benninger
- Felsenstein Medical Research Center, Petach Tikva, Israel; Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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9
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Hersh N, Steiner I, Siegal T, Benninger F. Herpes simplex encephalitis in patients receiving chemotherapy and whole-brain radiation therapy. J Neurovirol 2021; 27:774-781. [PMID: 34546546 DOI: 10.1007/s13365-021-01018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/01/2021] [Revised: 05/15/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
Herpes simplex encephalitis (HSE) is a very severe infection of the central nervous system (CNS) caused mainly by herpes simplex virus type 1 (HSV-1) and occasionally by herpes simplex virus type 2 (HSV-2). After relapse or drug-resistant to chemotherapy, whole-brain radiation therapy (WBRT) is a mainstay of treatment in patients with both identifiable brain metastases and CNS lymphoma. Although HSV-1 encephalitis predominantly affects immunocompetent host, HSV encephalitis may be more common in immune-suppressed patients than is currently recognized. Disease presentation may be atypical including lack of pleocytosis in cerebrospinal fluid (CSF). We report four patients diagnosed with HSE following chemotherapy and WBRT. The occurrence of HSE in patients with cancer seems not to be increased compared to the general population, but as our case series shows, a high level of suspicion is needed by the treating physician to diagnose HSE early in patients presenting with new neurological symptoms following WBRT.
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Affiliation(s)
- Nir Hersh
- Neurology Unit, Sanz Medical Center - Laniado Hospital, Netanya, Israel.,Felsenstein Medical Research Institute, Tel Aviv University, Tel Aviv, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 4910, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Siegal
- Neuro-Oncology Center, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 4910, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Felsenstein Medical Research Institute, Tel Aviv University, Tel Aviv, Israel.
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10
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Lotan I, Wilf-Yarkoni A, Friedman Y, Stiebel-Kalish H, Steiner I, Hellmann MA. Safety of the BNT162b2 COVID-19 vaccine in multiple sclerosis (MS): Early experience from a tertiary MS center in Israel. Eur J Neurol 2021; 28:3742-3748. [PMID: 34288285 PMCID: PMC8444776 DOI: 10.1111/ene.15028] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022]
Abstract
Background and purpose Although the COVID‐19 vaccines are currently recommended for people with multiple sclerosis (MS), the fact that they were not specifically tested in people with MS raises uncertainty regarding their safety in this population. The purpose of this study was to report real‐life safety data of the BNT162b2 COVID‐19 vaccine in a cohort of MS patients. Methods An anonymous survey was distributed to 425 MS patients. Participants were asked general demographic and disease‐related questions and specific questions regarding the safety profile of the COVID‐19 vaccine. Results Of the 425 MS patients, 262 completed the questionnaire. The median (range) participant age was 42 (22–79) years, 199 participants were women (75.9%), and 66 participants (25.2%) had associated comorbidities. A total of 198 participants (75.6%) were treated with disease‐modifying therapies. In all, 239 participants (91.2% of the responders) had received the BNT162b2 COVID‐19 vaccine. Of these, 182 (76.1%) were aged <55 years, and 57 (23.9%) were aged >55 years. Adverse events were reported by 136 participants (56.9%; 52.5% of those aged <55 years and 40.3% of those aged >55 years; p = 0.1517) and 36 participants (15.1%) reported new or worsening neurological symptoms following the vaccination, the most frequent being sensory disturbances (21 participants, 58.3%). Most symptoms occurred within the first 24 h after vaccination and resolved within 3 days. A total of 28 participants (77.8%) did not require any medication to treat their symptoms. Conclusions This survey indicates an overall favorable safety profile of the BNT162b2 vaccine in people with MS. These data should be confirmed in further prospective, large‐scale studies. This study indicates an overall favorable safety profile of the BNT162b2 COVID‐19 vaccine in people with MS. The spectrum of adverse events reported in our study is comparable to that reported in the general population. Adverse events among MS patients were more frequent in the young‐age group (< 55 years old) compared to individuals older than 55 years old. The overall rate of adverse events may be lower in MS patients treated with DMTs. The rate of new or worsening neurological symptoms is relatively low (15.1%), with most events being of mild severity, not requiring specific treatment, and resolving within a few days.
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Affiliation(s)
- Itay Lotan
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.,Neuroimmunology Unit, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Adi Wilf-Yarkoni
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.,Neuroimmunology Unit, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yitzhak Friedman
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.,Neuroimmunology Unit, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Hadas Stiebel-Kalish
- Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Department of Ophthalmology and Neuro-Ophthalmology Unit, Rabin Medical Center, Petah Tikva, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Mark A Hellmann
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.,Neuroimmunology Unit, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Akhvlediani T, Jelcic I, Taba P, Pfausler B, Steiner I, Sellner J. What did we learn from the previous coronavirus epidemics and what can we do better: a neuroinfectiological point of view. Eur J Neurol 2020; 27:e69-e72. [PMID: 32526060 PMCID: PMC7307067 DOI: 10.1111/ene.14395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022]
Affiliation(s)
- T Akhvlediani
- American MD Program, Faculty of Medicine, Tbilisi State Medical University, Tblisi, Georgia
| | - I Jelcic
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - P Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - B Pfausler
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - I Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - J Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
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12
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Lotan I, Benninger F, Hellmann MA, Sicsic C, Brenner T, Kahana E, Steiner I. Incidence of AChR Ab-positive myasthenia gravis in Israel: A population-based study. Acta Neurol Scand 2020; 142:66-73. [PMID: 32145067 DOI: 10.1111/ane.13239] [Citation(s) in RCA: 8] [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: 01/20/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of myasthenia gravis (MG) has traditionally been low, ranging between 2-6/106 . Several recent epidemiological studies have reported a higher incidence. We, therefore, aimed to assess and characterize the incidence of MG in Israel. METHODS We retrospectively reviewed the records of all four laboratories that performed the acetylcholine receptor antibody (AChR Ab) test in Israel between 1994 and 2013 and documented the number of newly diagnosed seropositive MG patients each year. To assure that data indeed reflect only newly diagnosed patients, patient's names and ID numbers were screened at the Hadassah medical center database since 1978, the year when the test was first performed in Israel. In order to calculate the annual incidence of the disease, the population at risk was derived from the annual publication of the Israeli Central Bureau of Statistics. RESULTS The annual incidence of MG for this time period was 13.1/106 inhabitants. The mean incidence of MG between 1994 and 2003 was 7.695/106 /y, while the mean incidence between 2004 and 2013 was 18.49/106 (P < .0001). Mean age of diagnosis between 1994 and 2003 was 56.65 ± 0.9351, while between 2004 and 2013, it was 59.89 ± 0.5336 (P = .0012). Male to female (M:F) incidence ratio in the years 1994-2003 and 2004-2013 was 2:3.2 and 3:1.8, respectively, reflecting increased incidence among males (P < .0001). CONCLUSIONS The incidence of MG in Israel has increased significantly during the last decade, especially among males of older age. These findings may reflect an etiological role of an environmental factor, increased awareness, and increased longevity in general.
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Affiliation(s)
- Itay Lotan
- Department of Neurology Rabin Medical Center Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Felix Benninger
- Department of Neurology Rabin Medical Center Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Mark A. Hellmann
- Department of Neurology Rabin Medical Center Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Camille Sicsic
- Laboratory of Neuroimmunology Department of Neurology The Agnes –Ginges Center for Neurogenetics Hebrew University Hadassah Medical Center Jerusalem Israel
| | - Talma Brenner
- Laboratory of Neuroimmunology Department of Neurology The Agnes –Ginges Center for Neurogenetics Hebrew University Hadassah Medical Center Jerusalem Israel
| | - Ester Kahana
- Department of Neurology Barzilai Medical Center Ashkelon Israel
- Faculty of Health Sciences Ben‐Gurion University of the Negev Beer Sheva Israel
| | - Israel Steiner
- Department of Neurology Rabin Medical Center Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Lotan I, Ganelin-Cohen E, Tartakovsky E, Khasminsky V, Hellmann MA, Steiner I, Ben-Zvi I, Livneh A, Golderman S, Kaplan B. Saliva immunoglobulin free light chain analysis for monitoring disease activity and response to treatment in multiple sclerosis. Mult Scler Relat Disord 2020; 44:102339. [PMID: 32599469 DOI: 10.1016/j.msard.2020.102339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/01/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immunoglobulin free light chains (FLC) have recently gained considerable interest as new promising intrathecal biomarkers of multiple sclerosis (MS). However, lumbar puncture is invasive and not practical for monitoring disease course. This study aimed to assess the utility of saliva FLC as a biomarker of disease activity and response to treatment in MS METHODS: Western blotting was used to study saliva FLC monomers and dimers. The intensity of immunoreactive FLC bands was quantified by electrophoresis analysis, and the obtained values were used as FLC indices to account for kappa and lambda FLC monomer and dimer levels. Firth's logistic regression analysis suitable to study small cohorts was applied to compare FLC levels between M.S. patients in relapse, MS patients in remission, and healthy controls. Association between FLC levels and clinical and radiological parameters was analyzed. RESULTS 55 MS patients and 40 healthy controls were evaluated. Saliva FLC levels were significantly higher in relapse compared to remission. Logistic regression analysis employing a combination of FLC indices confirmed the significant difference between these two groups. The FLC levels were significantly reduced by treatment with corticosteroids. During remission, patients treated with disease-modifying therapies had lower levels of FLC compared to untreated patients. The increased FLC levels were associated with the presence of gadolinium-enhancing lesions, but not with MRI T2 lesion load and EDSS scores. During individual patient follow-up, the changes of the saliva FLC levels were in concordance with the disease activity status. CONCLUSIONS Saliva FLC levels may be a useful biomarker for discriminating between stable remission and active disease. The developed test may serve as a new, non-invasive, and inexpensive tool for monitoring disease activity and response to treatment in MS.
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Affiliation(s)
- Itay Lotan
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Esther Ganelin-Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Institute of Pediatric Neurology, Schneider Children's Medical Center, Petach Tikva 49202, Israel
| | - Evgeny Tartakovsky
- Tartakovsky MLD Consultancy, P.O. Box 71, Rishon Lezion, 7510001, Israel
| | - Vadim Khasminsky
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Department of Radiology, Rabin Medical Center, Beilinson Hospital, Israel
| | - Mark A Hellmann
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Israel; Tartakovsky MLD Consultancy, P.O. Box 71, Rishon Lezion, 7510001, Israel
| | - Ilan Ben-Zvi
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avi Livneh
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel
| | - Sizilia Golderman
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel
| | - Batia Kaplan
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel
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Fellner A, Goldstein L, Lotan I, Keret O, Steiner I. Meningitis without meningeal irritation signs: What are the alerting clinical markers? J Neurol Sci 2020; 410:116663. [DOI: 10.1016/j.jns.2019.116663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/04/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022]
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Khlebtovsky A, Steiner I, Treves T, Djaldetti R. Effect of Repeated Intravenous Amantadine Infusions in Patients with Parkinson's Disease: An Open‐Label Pilot Study. Clin Transl Sci 2019; 12:586-590. [PMID: 31436382 PMCID: PMC6853147 DOI: 10.1111/cts.12684] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022] Open
Abstract
Amantadine is an antiviral drug available in oral and intravenous forms. Oral amantadine is used to treat the motor symptoms of early Parkinson's disease (PD) and to ameliorate dyskinesia in late‐stage disease. However, the long‐term influence of intravenous amantadine on motor symptoms and dyskinesias in PD has not been investigated. The aim of the present study was to examine the long‐term effect of repeated boosts of intravenous amantadine in patients with PD with and without response fluctuations and dyskinesias. Twelve patients diagnosed with PD, six with levodopa intolerance or insufficient response to antiparkinson medications, and six with response fluctuations and dyskinesias, were treated with intravenous amantadine for 6 months: three sequential infusions over 3 days in the first month followed by five once‐monthly infusions. Changes in motor function and involuntary movements were evaluated with the Unified Parkinson Disease Rating Scale (UPDRS) and Abnormal Involuntary Movement Scale (AIMS; dyskinesia group). A significant immediate improvement in motor scores was documented in both groups after amantadine infusion. However, the difference in mean UPDRS motor score from before the first infusion to after 6 months of treatment was not statistically significant. In patients with dyskinesias, there was a significant improvement in AIMS scores between the first and the last visits (6.3 ± 2.7 vs. 1.6 ± 1.3; P = 0.014). In conclusion, continuous treatment with intravenous amantadine can be useful in patients with PD for immediate relief of motor symptoms and in patients with dyskinesias for progressive reduction of involuntary movements.
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Affiliation(s)
- Alexander Khlebtovsky
- Department of Neurology Rabin Medical Center – Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Israel Steiner
- Department of Neurology Rabin Medical Center – Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Therese Treves
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ruth Djaldetti
- Department of Neurology Rabin Medical Center – Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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16
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Steiner I. Reader response: Surgery and risk of Guillain-Barré syndrome: A French nationwide epidemiologic study. Neurology 2019; 93:817-818. [PMID: 31659136 DOI: 10.1212/wnl.0000000000008407] [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: 11/15/2022] Open
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Lotan I, Benninger F, Mendel R, Hellmann MA, Steiner I. Does CSF pleocytosis have a predictive value for disease course in MS? Neurol Neuroimmunol Neuroinflamm 2019; 6:e584. [PMID: 31355320 PMCID: PMC6624148 DOI: 10.1212/nxi.0000000000000584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/26/2019] [Indexed: 12/02/2022]
Abstract
Objective MS is a demyelinating CNS disorder with a spectrum of clinical patterns regarding course and prognosis. Although several prognostic factors are considered in the initial evaluation of patients, biological markers defining the disease course and guiding treatments are currently lacking. It is unknown whether patients with CSF pleocytosis differ in regard to symptoms, disease course, and prognosis from those without. The aim of this study was to evaluate whether CSF pleocytosis during the initial presentation has an impact on the clinical course and progression of MS. Methods We retrospectively evaluated patients attending the MS Clinic at Rabin Medical Center between January 1999 and January 2016 who underwent lumbar puncture (LP) at disease presentation, considering CSF cell count, clinical diagnosis (clinically isolated syndrome [CIS] and relapsing-remitting MS [RRMS]), annualized relapse rate (ARR), paraclinical findings (imaging, CSF oligoclonal bands, and evoked potentials), and disease progression, expressed by the Expanded Disability Status Scale (EDSS). Results One hundred fourteen patients (72 females) underwent LP at disease presentation (RRMS: n = 100, CIS: n = 14). Age at diagnosis was 32.4 ± 12.2 years, and the follow-up time was 9.4 ± 3.8 years. Forty-six patients showed a pleocytic CSF (≥5 cells per μL). Compared with patients with <4 cells per μL, patients with pleocytosis had a higher ARR (0.60 ± 0.09 vs 0.48 ± 0.04; p = 0.0267) and a steeper increase (slope) in the EDSS score throughout the follow-up period (correlation coefficient: r2 = 0.04; p = 0.0251). Conclusions CSF pleocytosis may be considered a biological unfavorable predictive factor regarding disease course and progression in MS.
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Affiliation(s)
- Itay Lotan
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
| | - Felix Benninger
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
| | - Rom Mendel
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
| | - Mark A Hellmann
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
| | - Israel Steiner
- Neuro-Immunology Service and Department of Neurology (I.L., M.A.H.), Rabin Medical Center; Department of Neurology (I.L., F.B., R.M., M.A.H., I.S.), Rabin Medical Center; and Sackler Faculty of Medicine (I.L., F.B., R.M., M.A.H., I.S.), Tel Aviv University, Israel
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Rodgers J, Steiner I, Kennedy PGE. Generation of neuroinflammation in human African trypanosomiasis. Neurol Neuroimmunol Neuroinflamm 2019; 6:6/6/e610. [PMID: 31467039 PMCID: PMC6745723 DOI: 10.1212/nxi.0000000000000610] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Abstract
Human African trypanosomiasis (HAT) is caused by infection due to protozoan parasites of the Trypanosoma genus and is a major fatal disease throughout sub-Saharan Africa. After an early hemolymphatic stage in which the peripheral tissues are infected, the parasites enter the CNS causing a constellation of neurologic features. Although the CNS stage of HAT has been recognized for over a century, the mechanisms generating the neuroinflammatory response are complex and not well understood. Therefore a better understanding of the mechanisms utilized by the parasites to gain access to the CNS compartment is critical to explaining the generation of neuroinflammation. Contrast-enhanced MRI in a murine model of HAT has shown an early and progressive deterioration of blood-CNS barrier function after trypanosome infection that can be reversed following curative treatment. However, further studies are required to clarify the molecules involved in this process. Another important determinant of brain inflammation is the delicate balance of proinflammatory and counterinflammatory mediators. In mouse models of HAT, proinflammatory mediators such as tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and CXCL10 have been shown to be crucial to parasite CNS invasion while administration of interleukin (IL)-10, a counter inflammatory molecule, reduces the CNS parasite burden as well as the severity of the neuroinflammatory response and the clinical symptoms associated with the infection. This review focuses on information, gained from both infected human samples and animal models of HAT, with an emphasis on parasite CNS invasion and the development of neuroinflammation.
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Affiliation(s)
- Jean Rodgers
- From the Institute of Biodiversity (J.R.), Animal Health and Comparative Medicine, University of Glasgow; the Department of Neurology (I.S.), Rabin Medical Center, Campus Beilinson, Petach Tikva, Israel; and the Institute of Infection (P.G.E.K), Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow.
| | - Israel Steiner
- From the Institute of Biodiversity (J.R.), Animal Health and Comparative Medicine, University of Glasgow; the Department of Neurology (I.S.), Rabin Medical Center, Campus Beilinson, Petach Tikva, Israel; and the Institute of Infection (P.G.E.K), Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Peter G E Kennedy
- From the Institute of Biodiversity (J.R.), Animal Health and Comparative Medicine, University of Glasgow; the Department of Neurology (I.S.), Rabin Medical Center, Campus Beilinson, Petach Tikva, Israel; and the Institute of Infection (P.G.E.K), Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
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Abstract
The 3 neurotropic human herpes viruses, herpes simplex virus (HSV) type 1 and 2, and varicella-zoster virus (VZV) are capable of establishment of latent viral infection in trigeminal and dorsal root ganglia. HSV-1, and more rarely HSV-2, carries the potential to cause meningoencephalitis, with devastating clinical consequences. Immediate diagnosis, based on clinical presentation, MRI imaging, and molecular diagnosis by polymerase chain reaction, and initiation of therapy are mandatory to reduce mortality and neurologic permanent sequelae. VZV is associated with postprimary infection and reactivation disorders that may affect anywhere in the neuraxis. Early diagnosis and therapy are required.
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Affiliation(s)
- Israel Steiner
- Department of Neurology, Felsenstein Medical Research Institut, Rabin Medical Center, Beilinson Hospital, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Felix Benninger
- Department of Neurology, Felsenstein Medical Research Institut, Rabin Medical Center, Beilinson Hospital, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Keret O, Brauner R, Beninger F, Steiner I, Glik A. P2-319: NEW UNPROVOKED IDIOPATHIC SEIZURES AND LATER DEVELOPMENT OF DEMENTIA, A CASE SERIES. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ophir Keret
- Cognitive Neurology Clinic, Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
- Department of Neurology, Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
| | - Ran Brauner
- Cognitive Neurology Clinic, Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
- Department of Neurology, Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
| | - Felix Beninger
- Department of Neurology, Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
- Epilepsy Clinic; Rabin Medical Center; Beilinson Campus Petah Tikva Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
| | - Amir Glik
- Cognitive Neurology Clinic, Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
- Department of Neurology, Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
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21
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Goldstein L, Laytman T, Steiner I. Is Head Computerized Tomography Indicated for the Workup of Headache in Patients with Intact Neurological Examination. Eur Neurol 2019; 80:341-344. [DOI: 10.1159/000496805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022]
Abstract
Introduction: The use of neuroimaging as part of the initial workup in the emergency department (ED) for patients with atraumatic headache is increasing, whereas the proportion of cases in which clinically significant intracranial pathology is detected is decreasing. In the last few decades, the exposure to medical ionized radiation from utilization of computer tomography (CT) increased dramatically, raising concern about radiation-induced cancer. Different guidelines were suggested to address the role of neuroimaging in the investigation of adult patients presenting to the ED with nontraumatic headache. Materials and Methods: We retrospectively evaluated data from all consecutive patients who underwent a head CT in the ED for the evaluation of headache during 2015. Patients were included only if a normal neurologic examination was documented. Results: In total, 422 patients were included. About 43.4% of scans were normal. Most abnormal findings were sinusitis (148 patients, 35%) or ischemic changes. Seven CT scans (1.6%) showed clinically significant findings requiring an immediate change in management. Conclusion: A normal neurologic examination, even when performed by a neurologist, does not rule out a significant secondary cause for headache. A CT scan in the ED is indicated for patients presenting with severe nonremitting headache who never had neuroimaging in the past.
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Kab T, Steiner I, Fichman-Horn S. Neuromyelitis Optica with Lesions Involving the Optic Nerves, the Optic Chiasm, and the Optic Tracts. Eur Neurol 2019; 80:333-334. [DOI: 10.1159/000499451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/14/2019] [Indexed: 11/19/2022]
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Goldstein L, Fogel-Grinvald H, Steiner I. Hepatitis B and C virus infection as a risk factor for Parkinson's disease in Israel-A nationwide cohort study. J Neurol Sci 2019; 398:138-141. [PMID: 30710864 DOI: 10.1016/j.jns.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the association between hepatitis C and B viruses and Parkinson's disease (PD) in Israel. METHODS A retrospective cohort study was performed by analyzing the computerized database of Clalit Healthcare Service in Israel. Cohorts of people with hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection and nonalcoholic steatohepatitis (NASH) were constructed and compared to a reference cohort for prevalence of PD. RESULTS The prevalence of PD in Israel was found to be 0.5% in the general population. The M-H (Mantel-Haenszel) odds ratio (OR) of PD for HBV-positive patients was 1.08 (95% CI: 1.00-1.16). The M-H OR of PD for HCV-positive patients was 1.18 (95% CI: 1.04-1.35). The M-H OR of PD for patients infected with both hepatitis C and B was 1.13 (95% CI: 0.87-1.47). The M-H OR of PD for patients diagnosed with nonalcoholic steatohepatitis (NASH) was 1.13 (95% CI: 1.08-1.19). CONCLUSIONS We report evidence supporting a minor increased risk for PD in patients with HCV. Co infection of HCV and HBV was not associated with an increased risk for PD. The increased risk for PD in the group of patients with NASH, raises the possibility that liver disease per se is a risk factor for PD rather than viral infection. In addition, it cannot be ruled out that the association is, at least in part, the result of the occurrence of cirrhosis induced parkinsonism that was misclassified as PD.
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Affiliation(s)
- Lilach Goldstein
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haya Fogel-Grinvald
- School of occupational Therapy, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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24
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Steiner I, Schmutzhard E. Advances on neurological infections in 2018. Lancet Neurol 2018; 18:17-18. [PMID: 30563676 DOI: 10.1016/s1474-4422(18)30432-0] [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] [Received: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Israel Steiner
- Department of Neurology, Rabin Medical Center, Campus Beilinson, 49100 Petach Tikva, Israel.
| | - Erich Schmutzhard
- Division of Neurocritical Care Medicine, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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25
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Abstract
Early-onset Alzheimer's disease (EOAD) accounts for 1-5% of Alzheimer's disease cases and is associated with specific ethnicities. It has been our impression that non-Ashkenazi Jews have a higher rate of EOAD and we therefore explored this hypothesis. We performed a retrospective case control study of EOAD cases referred to our cognitive neurology clinic between January 1999 and December 2016. Patients (n = 129) were compared to age- and geographically-matched controls generated from the Second Israeli National Health Survey (n = 1,811). Data on country of origin, education, dementia family history, depression, and vascular risk factors were compared between the groups. The association of non-Ashkenazi Jewish heritage and country of origin with EOAD was calculated using a logistic multivariate regression model. The EOAD group's mean age was 59.6±4.1 years, with a female predominance (64.3%). The EOAD group had a higher percentage of individuals of non-Ashkenazi Jewish origin (64.3% versus 51.4%, p = 0.003) and of Yemenite descent in particular (16.28% versus 6.24%, p < 0.001). On multiple logistic regression analysis, Yemenite Jewish origin was an independently associated with EOAD (OR 2.54, 95% CI 1.4-4.8). There were no significant differences in parameters between non-Ashkenazi and Ashkenazi Jews. Only 4.6% of EOAD cases had a positive EOAD family history. In conclusion, EOAD is over-represented among non-Ashkenazi Jews. Yemenite origin is independently associated with EOAD and the majority of patients with EOAD have no family history of Alzheimer's disease. Further evaluation with genetic studies is warranted.
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Affiliation(s)
- Ophir Keret
- Cognitive Neurology Clinic, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Department of Neurology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consultancy Service, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Israel Steiner
- Cognitive Neurology Clinic, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Department of Neurology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Glik
- Cognitive Neurology Clinic, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Department of Neurology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Eckl-Dorna J, Fröschl R, Lupinek C, Kiss R, Gattinger P, Marth K, Campana R, Mittermann I, Blatt K, Valent P, Selb R, Mayer A, Gangl K, Steiner I, Gamper J, Perkmann T, Zieglmayer P, Gevaert P, Valenta R, Niederberger V. Intranasal administration of allergen increases specific IgE whereas intranasal omalizumab does not increase serum IgE levels-A pilot study. Allergy 2018; 73:1003-1012. [PMID: 29083477 PMCID: PMC5969304 DOI: 10.1111/all.13343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
Background Administration of the therapeutic anti‐IgE antibody omalizumab to patients induces strong increases in IgE antibody levels. Objective To investigate the effect of intranasal administration of major birch pollen allergen Bet v 1, omalizumab or placebo on the levels of total and allergen‐specific IgE in patients with birch pollen allergy. Methods Based on the fact that intranasal allergen application induces rises of systemic allergen‐specific IgE, we performed a double‐blind placebo‐controlled pilot trial in which birch pollen allergic subjects were challenged intranasally with omalizumab, placebo or birch pollen allergen Bet v 1. Total and allergen‐specific IgE, IgG and basophil sensitivity were measured before and 8 weeks after challenge. For control purposes, total, allergen‐specific IgE levels and omalizumab‐IgE complexes as well as specific IgG levels were studied in subjects treated subcutaneously with either omalizumab or placebo. Effects of omalizumab on IgE production by IL‐4/anti‐CD40‐treated PBMCs from allergic patients were studied in vitro. Results Intranasal challenge with Bet v 1 induced increases in Bet v 1‐specific IgE levels by a median of 59.2%, and this change differed significantly from the other treatment groups (P = .016). No relevant change in allergen‐specific and total IgE levels was observed in subjects challenged with omalizumab. Addition of omalizumab did not enhance IL‐4/anti‐CD40‐induced IgE production in vitro. Significant rises in total IgE (mean IgE before: 131.83 kU/L to mean IgE after: 505.23 kU/L) and the presence of IgE‐omalizumab complexes were observed after subcutaneous administration of omalizumab. Conclusion Intranasal administration of allergen induced rises of allergen‐specific IgE levels, whereas intranasal administration of omalizumab did not enhance systemic total or allergen‐specific IgE levels.
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Affiliation(s)
- J. Eckl-Dorna
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - R. Fröschl
- Clinical Institute for Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - C. Lupinek
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - R. Kiss
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - P. Gattinger
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - K. Marth
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - R. Campana
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - I. Mittermann
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - K. Blatt
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - P. Valent
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - R. Selb
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - A. Mayer
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - K. Gangl
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - I. Steiner
- Center for Medical Statistics, Informatics, and Intelligent Systems; Section for Medical Statistics; Medical University of Vienna; Vienna Austria
| | - J. Gamper
- Center for Medical Statistics, Informatics, and Intelligent Systems; Section for Medical Statistics; Medical University of Vienna; Vienna Austria
| | - T. Perkmann
- Clinical Institute for Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | | | - P. Gevaert
- Upper Airway Research Laboratory (URL); Ghent University Hospital; Ghent Belgium
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - V. Niederberger
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
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Fellner A, Makranz C, Lotem M, Bokstein F, Taliansky A, Rosenberg S, Blumenthal DT, Mandel J, Fichman S, Kogan E, Steiner I, Siegal T, Lossos A, Yust-Katz S. Neurologic complications of immune checkpoint inhibitors. J Neurooncol 2018; 137:601-609. [PMID: 29332184 DOI: 10.1007/s11060-018-2752-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [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: 08/07/2017] [Accepted: 01/07/2018] [Indexed: 01/14/2023]
Abstract
Immune checkpoint inhibitors (ICPIs) have recently emerged as a novel treatment for cancer. These agents, transforming the field of oncology, are not devoid of toxicity and cause immune-related side effects which can involve any organ including the nervous system. In this study, we present 9 patients (7 men and 2 women) with neurologic complications secondary to ICPI treatment. These included meningoencephalitis, limbic encephalitis, polyradiculitis, cranial polyneuropathy, myasthenic syndrome and myositis. Four patients received dual ICPI therapy comprised of programmed cell death-1 and cytotoxic lymphocyte associated protein-4 blocking antibodies. Median time to onset of neurologic adverse event during immune checkpoint inhibitor treatment was 8 weeks (range 5 days-19 weeks). In all patients ICPIs were stopped and corticosteroids were initiated, resulting in a marked improvement in seven out of nine patients. Two patients, one with myositis and one with myasthenic syndrome, died. In two patients ICPI therapy was resumed after resolution of the neurological adverse event with no additional neurologic complications. This series highlights the very broad spectrum of neurological complications of ICPIs, emphasizes the need for expedited diagnosis and suggests that withholding treatment early, accompanied with steroid therapy, carries the potential of complete resolution of the neurological immune-mediated condition. Thus, a high level of suspicion and rapid initiation of corticosteroids are mandatory to prevent uncontrolled clinical deterioration, which might be fatal.
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Affiliation(s)
- Avi Fellner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
| | - Chen Makranz
- Department of Oncology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Lotem
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Felix Bokstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Neuro-Oncology Service, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Shai Rosenberg
- Department of Oncology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Deborah T Blumenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Neuro-Oncology Service, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Suzana Fichman
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Department of Pathology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Elena Kogan
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tali Siegal
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petah Tikva, Israel.,Neuro-Oncology Unit, Davidoff Cancer Center at Rabin Medical Center, Petah Tikva, Israel
| | - Alexander Lossos
- Department of Oncology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shlomit Yust-Katz
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Neuro-Oncology Unit, Davidoff Cancer Center at Rabin Medical Center, Petah Tikva, Israel
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28
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Bertl K, Steiner I, Pandis N, Buhlin K, Klinge B, Stavropoulos A. Statins in nonsurgical and surgical periodontal therapy. A systematic review and meta-analysis of preclinical in vivo trials. J Periodontal Res 2017; 53:267-287. [PMID: 29211309 DOI: 10.1111/jre.12514] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/13/2022]
Abstract
The cholesterol-lowering drugs, statins, possess anti-inflammatory, antimicrobial and pro-osteogenic properties, and thus have been tested as an adjunct to periodontal treatment. The present systematic review aimed to answer the following focused research question: What is the effect of local and/or systemic statin use on periodontal tissues in preclinical in vivo studies of experimentally induced periodontitis (EIP) and/or acute/chronified periodontal defect (ACP) models? A literature search (of Medline/PubMed, Embase/Ovid, CENTRAL/Ovid) using the following main eligibility criteria was performed: (i) English or German language; (ii) controlled preclinical in vivo trials; (iii) local and/or systemic statin use in EIP and/or ACP models; and (iv) quantitative evaluation of periodontal tissues (i.e., alveolar bone level/amount, attachment level, cementum formation, periodontal ligament formation). Sixteen studies in EIP models and 7 studies in ACP models evaluated simvastatin, atorvastatin or rosuvastatin. Thirteen of the EIP (81%) and 2 of the ACP (29%) studies presented significantly better results in terms of alveolar bone level/amount in favor of statins. Meta-analysis based on 14 EIP trials confirmed a significant benefit of local and systemic statin use (P < .001) in terms of alveolar bone level/amount; meta-regression revealed that statin type exhibited a significant effect (P = .014) in favor of atorvastatin. Three studies reported a significantly higher periodontal attachment level in favor of statin use (P < .001). Complete periodontal regeneration was never observed; furthermore, statins did not exert any apparent effect on cementum formation. Neither local nor systemic use of statins resulted in severe adverse effects. Statin use in periodontal indications has a positive effect on periodontal tissue parameters, supporting the positive results already observed in clinical trials. Nevertheless, not all statins available have been tested so far, and further research is needed to identify the maximum effective concentration/dose and optimal carrier.
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Affiliation(s)
- K Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - I Steiner
- Private Practice, Taiskirchen, Austria.,Postgraduate Course Periodontology, Medical University of Vienna, Vienna, Austria
| | - N Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland
| | - K Buhlin
- Division of Periodontology, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - B Klinge
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - A Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
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29
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Fellner A, Makrans C, Bokstein F, Blumenthal DT, Taliansky A, Rosenberg S, Steiner I, Siegal T, Yust-Katz S. NTOX-13. NEUROLOGIC COMPLICATIONS OF IMMUNE CHECKPOINT INHIBITORS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Taba P, Schmutzhard E, Forsberg P, Lutsar I, Ljøstad U, Mygland Å, Levchenko I, Strle F, Steiner I. EAN consensus review on prevention, diagnosis and management of tick‐borne encephalitis. Eur J Neurol 2017; 24:1214-e61. [DOI: 10.1111/ene.13356] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 06/01/2017] [Indexed: 12/30/2022]
Affiliation(s)
- P. Taba
- Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
| | - E. Schmutzhard
- Department of Neurology Medical University Innsbruck Innsbruck Austria
| | - P. Forsberg
- Department of Clinical and Experimental Medicine and Department of Infectious Diseases Linköping University Linköping Sweden
| | - I. Lutsar
- Department of Microbiology University of Tartu Tartu Estonia
| | - U. Ljøstad
- Department of Neurology Sørlandet Hospital Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - Å. Mygland
- Department of Neurology Sørlandet Hospital Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - I. Levchenko
- Institute of Neurology Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine Kharkiv Ukraine
| | - F. Strle
- Department of Infectious Diseases University Medical Centre Ljubljana Ljubljana Slovenia
| | - I. Steiner
- Department of Neurology Rabin Medical Center Petach Tikva Israel
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31
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Fellner A, Barhum Y, Angel A, Perets N, Steiner I, Offen D, Lev N. Toll-Like Receptor-4 Inhibitor TAK-242 Attenuates Motor Dysfunction and Spinal Cord Pathology in an Amyotrophic Lateral Sclerosis Mouse Model. Int J Mol Sci 2017; 18:ijms18081666. [PMID: 28763002 PMCID: PMC5578056 DOI: 10.3390/ijms18081666] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/12/2022] Open
Abstract
Neuroinflammation contributes to amyotrophic lateral sclerosis (ALS) progression. TLR4, a transmembrane protein that plays a central role in activation of the innate immune system, has been shown to induce microglial activation in ALS models. TLR4 is up-regulated in the spinal cords of hSOD1G93A mice. We aimed to examine the effects of specific TLR4 inhibition on disease progression and survival in the hSOD1G93A mouse model of ALS. Immunologic effect of TLR4 inhibition in vitro was measured by the effect of TAK-242 treatment on LPS-induced splenocytes proliferation. hSOD1G93A transgenic mice were treated with TAK-242, a selective TLR4 inhibitor, or vehicle. Survival, body weight, and motor behavior were monitored. To evaluate in vivo immunologic modifications associated with TAK-242 treatment, we measured serum IL-1β in the plasma, as well as IL-1β and TNF-α mRNAs in the spinal cord in wild-type mice and in TAK-242-treated and vehicle-treated early symptomatic hSOD1G93A mice. Immunohistochemical analysis of motor neurons, astrocytes, and microglial reactivity in the spinal cords were performed on symptomatic (100 days old) TAK-242-treated and vehicle-treated hSOD1G93A mice. In vitro, splenocytes taken from 100 days old hSOD1G93A mice showed significantly increased proliferation when exposed to LPS (p = 0.0002), a phenomenon that was reduced by TAK-242 (p = 0.0179). TAK-242 treatment did not attenuate body weight loss or significantly affect survival. However, TAK-242-treated hSOD1G93A mice showed temporary clinical delay in disease progression evident in the ladder test and hindlimb reflex measurements. Plasma IL-1β levels were significantly reduced in TAK-242-treated compared to vehicle-treated hSOD1G93A mice (p = 0.0023). TAK-242 treatment reduced spinal cord astrogliosis and microglial activation and significantly attenuated spinal cord motor neuron loss at early disease stage (p = 0.0259). Compared to wild-type animals, both IL-1β and TNF-α mRNAs were significantly upregulated in the spinal cords of hSOD1G93A mice. Spinal cord analysis in TAK-242-treated hSOD1G93A mice revealed significant attenuation of TNF-α mRNA (p = 0.0431), but no change in IL-1β mRNA. TLR4 inhibition delayed disease progression, attenuated spinal cord astroglial and microglial reaction, and reduced spinal motor neuron loss in the ALS hSOD1G93A mouse model. However, this effect did not result in increased survival. To our knowledge, this is the first report on TAK-242 treatment in a neurodegenerative disease model. Further studies are warranted to assess TLR4 as a therapeutic target in ALS.
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Affiliation(s)
- Avi Fellner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petah Tikva 49100, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel.
| | - Yael Barhum
- Laboratory of Clinical Neuroscience, Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva 49100, Israel.
| | - Ariel Angel
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel.
| | - Nisim Perets
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel.
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petah Tikva 49100, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel.
- Laboratory of Clinical Neuroscience, Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva 49100, Israel.
| | - Daniel Offen
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel.
| | - Nirit Lev
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petah Tikva 49100, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel.
- Laboratory of Clinical Neuroscience, Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva 49100, Israel.
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32
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Palm J, Steiner I, Abramov-Sommariva D, Ammendola A, Mitzenheim S, Steindl H, Wonnemann M, Bachert C. Assessment of efficacy and safety of the herbal medicinal product BNO 1016 in chronic rhinosinusitis. Rhinology 2017; 55:142-151. [PMID: 28214913 DOI: 10.4193/rhin16.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this clinical trial (CRS-02) was to assess the efficacy, safety and tolerability of two dosages of the herbal medicinal product BNO 1016 (Sinupret extract) in patients with chronic rhinosinusitis (CRS). METHODOLOGY 929 patients suffering from CRS were enrolled in this randomised placebo-controlled trial with a treatment period of 12 weeks. The primary endpoint was the mean Major Symptom Score (MSS) in week 8 and week 12 compared to placebo. Secondary endpoints included further MSS related parameters and responder rates over time. Pharmacoeconomic endpoints were also analysed. Finally, safety and tolerability were evaluated. RESULTS Sinupret extract was not superior over placebo regarding the primary endpoint. However, the results of the secondary endpoints showed a clear trend towards superior efficacy. Therefore, additional post-hoc sensitivity analyses were performed in patients with a baseline MSS over 9 and persistence of disease more than 1 year diagnosed by specialists in otorhinolaryngology. Those patients significantly benefited from Sinupret extract. Therapy was superior for the primary endpoint analysis. Patients were less impaired with respect to work and daily activities. A good safety and tolerability of Sinupret extract was assured in all patients. CONCLUSIONS Sinupret extract can safely be administered in patients with CRS. Although the primary endpoint of the study was not significant, a post-hoc subgroup analysis in patients whose disease was diagnosed by a specialist revealed a pronounced treatment effect. Effects in that subgroup were even stronger with longer disease persistence and stronger severity.
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Affiliation(s)
| | | | | | | | | | | | | | - C Bachert
- Ghent University Hospital, Ghent, Belgium
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33
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Trattner H, Blüml S, Steiner I, Plut U, Radakovic S, Tanew A. Quality of life and comorbidities in palmoplantar pustulosis - a cross-sectional study on 102 patients. J Eur Acad Dermatol Venereol 2017; 31:1681-1685. [DOI: 10.1111/jdv.14187] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/06/2017] [Indexed: 01/08/2023]
Affiliation(s)
- H. Trattner
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - S. Blüml
- Department of Rheumatology; Medical University of Vienna; Vienna Austria
| | - I. Steiner
- Center for Medical Statistics, Informatics and Intelligent Systems; Section for Medical Statistics; Medical University of Vienna; Vienna Austria
| | - U. Plut
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - S. Radakovic
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - A. Tanew
- Department of Dermatology; Medical University of Vienna; Vienna Austria
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34
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Scharff I, Asvadurian A, Treves TA, Klimovitzky S, Regev R, Rosenberg M, Gertner‐Saad L, Keret O, Steiner I, Heruti I, Shapira‐Lichter I, Glik A. [P1–308]: PROSPECTIVE MEMORY IMPAIRMENT IN MCI AND EARLY DEMENTIA. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Irad Scharff
- Cognitive Neurology ClinicRabin Medical Center, Beilinson HospitalPetah TikvaIsrael
| | - Anita Asvadurian
- Cognitive Neurology ClinicRabin Medical Center, Beilinson HospitalPetah TikvaIsrael
| | | | | | | | | | | | - Ophir Keret
- Cognitive Neurology ClinicRabin Medical Center, Beilinson HospitalPetah TikvaIsrael
| | - Israel Steiner
- Cognitive Neurology ClinicRabin Medical Center, Beilinson HospitalPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Irit Heruti
- Rabin Medical Center, Beilinson HospitalPetach‐TikvaIsrael
- The Academic College of Tel Aviv‐YaffoTel AvivIsrael
| | | | - Amir Glik
- Cognitive Neurology ClinicRabin Medical Center, Beilinson HospitalPetah TikvaIsrael
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35
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Khlebtovsky A, Yust-Katz S, Kuritzky A, Steiner I. Natural history of headache in patients with lymphocytic meningitis following lumbar puncture. J Clin Neurosci 2017; 41:123-127. [DOI: 10.1016/j.jocn.2017.02.041] [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] [Received: 11/30/2016] [Accepted: 02/12/2017] [Indexed: 11/15/2022]
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36
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Affiliation(s)
- Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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37
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Gross A, Benninger F, Madar R, Illouz T, Griffioen K, Steiner I, Offen D, Okun E. Toll-like receptor 3 deficiency decreases epileptogenesis in a pilocarpine model of SE-induced epilepsy in mice. Epilepsia 2017; 58:586-596. [DOI: 10.1111/epi.13688] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Adi Gross
- The Mina and Everard Goodman Faculty of Life Sciences; Bar-Ilan University; Ramat-Gan Israel
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center; Bar-Ilan University; Ramat-Gan Israel
- The Paul Feder Laboratory on Alzheimer's disease research; Tel-Aviv University; Tel Aviv Israel
| | - Felix Benninger
- The Mina and Everard Goodman Faculty of Life Sciences; Bar-Ilan University; Ramat-Gan Israel
- The Neuroscience Laboratory; Felsenstein Medical Research Center; Tel-Aviv University; Tel Aviv Israel
- Department of Neurology; Rabin Medical Center; Petach Tikva Israel
| | - Ravit Madar
- The Mina and Everard Goodman Faculty of Life Sciences; Bar-Ilan University; Ramat-Gan Israel
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center; Bar-Ilan University; Ramat-Gan Israel
- The Paul Feder Laboratory on Alzheimer's disease research; Tel-Aviv University; Tel Aviv Israel
| | - Tomer Illouz
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center; Bar-Ilan University; Ramat-Gan Israel
- The Paul Feder Laboratory on Alzheimer's disease research; Tel-Aviv University; Tel Aviv Israel
| | - Kathleen Griffioen
- Department of Biology and Chemistry; Liberty University; Lynchburg Virginia U.S.A
| | - Israel Steiner
- Department of Neurology; Rabin Medical Center; Petach Tikva Israel
| | - Daniel Offen
- The Neuroscience Laboratory; Felsenstein Medical Research Center; Tel-Aviv University; Tel Aviv Israel
| | - Eitan Okun
- The Mina and Everard Goodman Faculty of Life Sciences; Bar-Ilan University; Ramat-Gan Israel
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center; Bar-Ilan University; Ramat-Gan Israel
- The Paul Feder Laboratory on Alzheimer's disease research; Tel-Aviv University; Tel Aviv Israel
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Amato MP, Derfuss T, Hemmer B, Liblau R, Montalban X, Soelberg Sørensen P, Miller DH, Alfredsson L, Aloisi F, Amato MP, Ascherio A, Baldin E, Bjørnevik K, Comabella M, Correale J, Cortese M, Derfuss T, D’Hooghe M, Ghezzi A, Gold J, Hellwig K, Hemmer B, Koch-Henricksen N, Langer Gould A, Liblau R, Linker R, Lolli F, Lucas R, Lünemann J, Magyari M, Massacesi L, Miller A, Miller DH, Montalban X, Monteyne P, Mowry E, Münz C, Nielsen NM, Olsson T, Oreja-Guevara C, Otero S, Pugliatti M, Reingold S, Riise T, Robertson N, Salvetti M, Sidhom Y, Smolders J, Soelberg Sørensen P, Sollid L, Steiner I, Stenager E, Sundstrom P, Taylor BV, Tremlett H, Trojano M, Uccelli A, Waubant E, Wekerle H. Environmental modifiable risk factors for multiple sclerosis: Report from the 2016 ECTRIMS focused workshop. Mult Scler 2017; 24:590-603. [DOI: 10.1177/1352458516686847] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative demyelinating disease of the central nervous system (CNS), most likely autoimmune in origin, usually beginning in early adulthood. The aetiology of the disease is not well understood; it is viewed currently as a multifactorial disease which results from complex interactions between genetic predisposition and environmental factors, of which a few are potentially modifiable. Improving our understanding of these factors can lead to new and more effective approaches to patient counselling and, possibly, prevention and management of the disease. The 2016 focused workshop of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) addressed the topic of environmental, modifiable risk factors for MS, gathering experts from around the world, to collate experimental and clinical research into environmental factors that have been associated with the disease onset and, in a few cases, disease activity and progression. A number of factors, including infections, vitamin D deficiency, diet and lifestyle factors, stress and comorbidities, were discussed. The meeting provided a forum to analyse available evidence, to identify inconsistencies and gaps in current knowledge and to suggest avenues for future research.
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Affiliation(s)
- Maria Pia Amato
- Department of NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Tobias Derfuss
- Departments of Neurology and Biomedicine, University Hospital Basel, Basel, Switzerland
| | | | - Roland Liblau
- Faculte de Medecine Purpan, Universite Toulouse III – Paul Sabatier, Toulouse, France
| | | | | | - David H Miller
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK*
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Abstract
Infections of the nervous system are an important and challenging aspect of clinical neurology. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial. Opening pressure, protein and glucose levels, presence of cells and type of the cellular reaction should be monitored. Other tests can also shed light on the causative agent: serology, culture, staining, molecular techniques such as polymerase chain reaction. Specific examination such as panbacterial and panfungal examinations should be examined when relevant. Our chapter is a guide-text that combines clinical presentation and course with CSF findings as a usuaful tool in diagnosis of neuroinfections.
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Affiliation(s)
- Felix Benninger
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
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40
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Szepanowski F, Steiner I, Derksen A, zu Hörste GM, Daldrup T, Hartung HP, Kieseier B. EP 12. Fingolimod promotes nerve regeneration by modulating Lysophospholipid signaling. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Rosenberg G, Steiner I. And why not thrombolysis in the ambulance (at least for some)? Neurology 2016; 87:214-9. [PMID: 27306629 DOI: 10.1212/wnl.0000000000002835] [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: 10/09/2015] [Accepted: 02/21/2016] [Indexed: 11/15/2022] Open
Abstract
The fear that alteplase may aggravate primary intracerebral hemorrhages has led to the mandatory prerequisite for prealteplase imaging in all acute stroke patients in order to exclude such hemorrhages. Consequently, in a situation in which "time is brain," administration of alteplase is delayed until the patients are transferred to a hospital where such imaging is available, at the cost of additional ischemic damage to the brain parenchyma. Yet, theoretical considerations and empirical data suggest that alteplase's effects on primary intracerebral hemorrhages may not be that detrimental. Moreover, at least some of the patients who are at a high risk of having primary cerebral bleeds, or at a high risk of developing symptomatic secondary bleeds, can be excluded from alteplase therapy on clinical grounds, and using nonimaging point-of-care devices, before their hospital arrival. We propose that clinical research should be initiated to define a population of stroke patients in whom alteplase may be administered preimaging, resulting in a greater benefit than harm and in improved functional outcome compared to deferred, postimaging, alteplase treatment.
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Affiliation(s)
- Gilad Rosenberg
- From D-Pharm Ltd. (G.R.), Kiryat Weizman Science Park, Rehovot; and Department of Neurology (I.S.), Rabin Medical Center, Petah Tikva, Israel
| | - Israel Steiner
- From D-Pharm Ltd. (G.R.), Kiryat Weizman Science Park, Rehovot; and Department of Neurology (I.S.), Rabin Medical Center, Petah Tikva, Israel.
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42
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Keret O, Treves TA, Steiner I, Glik A. P2‐191: Early Onset Alzheimer's Disease is Overrepresented in Yemenite Jewish Descendants Compared to Other Ethnic Groups: 20 Years' Experience in a Tertiary Center. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1358] [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: 11/27/2022]
Affiliation(s)
- Ophir Keret
- Rabin Campus, Beilinson HospitalPetach TiqvaIsrael
| | - Therese A. Treves
- Rabin Campus, Beilinson HospitalPetach TiqvaIsrael
- Sackler Faculty of Medicine Tel Aviv UniversityTel AvivIsrael
| | - Israel Steiner
- Rabin Campus, Beilinson HospitalPetach TiqvaIsrael
- Sackler Faculty of Medicine Tel Aviv UniversityTel AvivIsrael
| | - Amir Glik
- Rabin Campus, Beilinson HospitalPetach TiqvaIsrael
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43
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Amor M, Moreno Viedma V, Sarabi A, Grün NG, Itariu B, Leitner L, Steiner I, Bilban M, Kodama K, Butte AJ, Staffler G, Zeyda M, Stulnig TM. Identification of matrix metalloproteinase-12 as a candidate molecule for prevention and treatment of cardiometabolic disease. Mol Med 2016; 22:487-496. [PMID: 27385318 DOI: 10.2119/molmed.2016.00068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 03/15/2016] [Accepted: 06/22/2016] [Indexed: 01/01/2023] Open
Abstract
Obesity is strongly associated with metabolic syndrome, a combination of risk factors that predispose to the development of the cardiometabolic diseases: atherosclerotic cardiovascular disease and type 2 diabetes mellitus. Prevention of metabolic syndrome requires novel interventions to address this health challenge. The objective of this study was the identification of candidate molecules for the prevention and treatment of insulin resistance and atherosclerosis, conditions that underlie type 2 diabetes mellitus and cardiovascular disease, respectively. We used an unbiased bioinformatics approach to identify molecules that are upregulated in both conditions by combining murine and human data from a microarray experiment and meta-analyses. We obtained a pool of eight genes that were upregulated in all the databases analysed. This included well known and novel molecules involved in the pathophysiology of type 2 diabetes mellitus and cardiovascular disease. Notably, matrix metalloproteinase 12 (MMP12) was highly ranked in all analyses and was therefore chosen for further investigation. Analyses of visceral and subcutaneous white adipose tissue from obese compared to lean mice and humans convincingly confirmed the up-regulation of MMP12 in obesity at mRNA, protein and activity levels. In conclusion, using this unbiased approach an interesting pool of candidate molecules was identified, all of which have potential as targets in the treatment and prevention of cardiometabolic diseases.
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Affiliation(s)
- M Amor
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - V Moreno Viedma
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - A Sarabi
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - N G Grün
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - B Itariu
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - L Leitner
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - I Steiner
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Austria
| | - M Bilban
- Core Facility Genomics, Core Facilities, Medical University of Vienna, Vienna, Austria
| | - K Kodama
- Institute for Computational Health Sciences. University of California, San Francisco, EEUU
| | - A J Butte
- Institute for Computational Health Sciences. University of California, San Francisco, EEUU
| | | | - M Zeyda
- Department of Pediatrics and Adolescent Medicine, Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna
| | - T M Stulnig
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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44
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Tsalenchuck Y, Steiner I, Panet A. Innate defense mechanisms against HSV-1 infection in the target tissues, skin and brain. J Neurovirol 2016; 22:641-649. [PMID: 27098517 DOI: 10.1007/s13365-016-0440-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022]
Abstract
Herpes simplex virus type 1 (HSV-1) initiates productive infection in mucocutaneous tissues to cause cold sores and establishes latent infection in the trigeminal ganglia. Under certain circumstances, HSV-1 may cause encephalitis. Here, we compared host innate defenses against HSV-1 in the two clinically relevant tissues, skin and brain, using a unique ex vivo system of organ culture. Upon HSV-1 infection and spread, apoptosis induction was observed in the skin, but not in brain tissues. While the two tissues elicited interferon (IFN-β) response upon HSV1 infection, IFN induction was more robust in the skin compared to the brain. Moreover, antiviral response to exogenous IFNβ treatment was much stronger in the skin compared to brain tissues. This observation was not related to the availability of the IFN receptor on cells' surface. Taken together, our study demonstrates differential innate antiviral responses to HSV-1 infection that may be exploited in future development of selective and tissue-specific anti-viral treatments.
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Affiliation(s)
- Yael Tsalenchuck
- Department of Biochemistry, IMRIC, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Campus Beilinson, Petach Tikva, Israel
| | - Amos Panet
- Department of Biochemistry, IMRIC, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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45
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Keret O, Lev N, Shochat T, Steiner I. Seasonal Changes in the Incidence of Transient Global Amnesia. J Clin Neurol 2016; 12:403-406. [PMID: 27095523 PMCID: PMC5063864 DOI: 10.3988/jcn.2016.12.4.403] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose Transient global amnesia (TGA) is a stereotypic condition characterized by anterograde and retrograde amnesia that typically resolves within 24 hours. The pathophysiology of TGA is still unclear. We noted that patients hospitalized with TGA tend to appear in seasonal clusters, and decided to investigate this phenomenon. Methods Every patient with acute presentation of amnesia at our medical center is hospitalized for observation and evaluation. We reviewed the monthly occurrence of TGA in our patient population between 2000 and 2014, and compared this to non-TGA hospitalizations during the same time period. Results During the analysis period, 154 patients who met the criteria for TGA were hospitalized, as well as 259,007 non-TGA hospitalizations. The annual occurrence of TGA ranged from 5 to 16 hospitalizations. There were 91 TGA events in women and 63 in men, in subjects aged 62.8±10.6 years (mean±SD). The incidence was maximal during December [odds ratio (OR)=2.83, 95% confidence interval (CI)=1.20–6.67] and March (OR=2.77, 95% CI=1.17–6.56), and minimal from April to August. The incidence exhibited an increase followed by a decrease from October to February. A seasonal trend was observed as well, with incidence peaks occurring in winter (OR=1.82, 95% CI=1.12–2.96) and spring (OR=1.80, 95% CI=1.10–2.94). Conclusions Our findings suggest that the incidence of TGA exhibits seasonal variations. This observation may help to improve the understanding of the pathophysiology underlying TGA.
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Affiliation(s)
- Ophir Keret
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel.
| | - Nirit Lev
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
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Yust-Katz S, Fuller G, Fichman-Horn S, Michaeli N, Inbar E, Lukman J, Limon D, Steiner I, Siegal T. Progressive diffuse meningioangiomatosis: Response to bevacizumab treatment. Neurology 2016; 86:1643-4. [PMID: 27029633 DOI: 10.1212/wnl.0000000000002610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/05/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shlomit Yust-Katz
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX.
| | - Gregory Fuller
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX
| | - Suzana Fichman-Horn
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX
| | - Natalia Michaeli
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX
| | - Edna Inbar
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX
| | - Judith Lukman
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX
| | - Dror Limon
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX
| | - Israel Steiner
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX
| | - Tali Siegal
- From Davidoff Cancer Center (S.Y.-K., D.L., T.S.), Rabin Medical Center (S.F.-H., N.M., E.I., J.L., I.S.), Petah Tikva; Tel-Aviv University (S.Y.-K., D.L., T.S.), Israel; and MD Anderson Cancer Center (G.F.), Houston, TX
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Steiner I, Djaldetti R. In memoriam – Prof. Eldad Melamed. Parkinsonism Relat Disord 2016; 24:1-2. [DOI: 10.1016/j.parkreldis.2016.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
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Steiner I, Goldstein L, Hellmann MA, Lotan I. Prior damage to lower motor neuron triggering myasthenia gravis. Muscle Nerve 2016; 54:167-9. [PMID: 26789735 DOI: 10.1002/mus.25026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lilach Goldstein
- Department of Neurology, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Hellmann
- Department of Neurology, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay Lotan
- Department of Neurology, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Benninger F, Glat MJ, Offen D, Steiner I. Glial fibrillary acidic protein as a marker of astrocytic activation in the cerebrospinal fluid of patients with amyotrophic lateral sclerosis. J Clin Neurosci 2015; 26:75-8. [PMID: 26602604 DOI: 10.1016/j.jocn.2015.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 09/17/2015] [Accepted: 10/11/2015] [Indexed: 12/14/2022]
Abstract
Glial fibrillary acidic protein (GFAP) has been shown to be increased in the cerebrospinal fluid (CSF) of patients suffering from neurological diseases involving the activation of astrocytes, but has not been studied in amyotrophic lateral sclerosis (ALS) patients to our knowledge. CSF samples of patients with definite ALS and of those with other neurological diseases were evaluated for their GFAP concentrations. CSF-GFAP concentrations of patients with ALS were significantly elevated by 53% compared to patients with other neurologic diseases. GFAP might serve as a biomarker in ALS. Our findings support the concept that astrocytes play a role in ALS pathogenesis.
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Affiliation(s)
- Felix Benninger
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Felsenstein Medical Research Institut, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Micaela J Glat
- Felsenstein Medical Research Institut, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Offen
- Felsenstein Medical Research Institut, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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50
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Benninger F, Saban T, Steiner I. Central retinal vein occlusion in a migraine patient. J Clin Neurosci 2015; 22:1833-4. [DOI: 10.1016/j.jocn.2015.03.057] [Citation(s) in RCA: 3] [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] [Received: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 01/03/2023]
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