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Braaß H, Feldheim J, Chu Y, Tinnermann A, Finsterbusch J, Büchel C, Schulz R, Gerloff C. Association between activity in the ventral premotor cortex and spinal cord activation during force generation-A combined cortico-spinal fMRI study. Hum Brain Mapp 2023; 44:6471-6483. [PMID: 37873743 PMCID: PMC10681651 DOI: 10.1002/hbm.26523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
Force generation is a crucial element of dexterity and a highly relevant skill of the human motor system. How cerebral and spinal components interact and how spinal activation is associated with the activity in the cerebral primary motor and premotor areas is poorly understood. Here, we conducted combined cortico-spinal functional magnetic resonance imaging during a simple visually guided isometric force generation task in 20 healthy young subjects. Activation was localized in the right cervical spinal cord and left primary motor and premotor areas. The main finding is that spinal activation was negatively correlated with ventral premotor cortex activation. Spinal activation was furthermore significantly correlated with primary motor cortex activation, while increasing target forces led to an increase in the amount of activation. These data indicate that human premotor areas such as the ventral premotor cortex might be functionally connected to the lower cervical spinal cord contributing to distal upper limb functions, a finding that extends our understanding of human motor function beyond the animal literature.
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Affiliation(s)
- Hanna Braaß
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jan Feldheim
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Ying Chu
- Institute of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Alexandra Tinnermann
- Institute of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jürgen Finsterbusch
- Institute of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian Büchel
- Institute of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Robert Schulz
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian Gerloff
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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2
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Rojas Albert A, Backhaus W, Graterol Pérez JA, Braaβ H, Schön G, Choe CU, Feldheim J, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. Cortical thickness of contralesional cortices positively relates to future outcome after severe stroke. Cereb Cortex 2022; 32:5622-5627. [PMID: 35169830 DOI: 10.1093/cercor/bhac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/25/2023] Open
Abstract
Imaging studies have evidenced that contralesional cortices are involved in recovery after motor stroke. Cortical thickness (CT) analysis has proven its potential to capture the changes of cortical anatomy, which have been related to recovery and treatment gains under therapy. An open question is whether CT obtained in the acute phase after stroke might inform correlational models to explain outcome variability. Data of 38 severely impaired (median NIH Stroke Scale 9, interquartile range: 6-13) acute stroke patients of 2 independent cohorts were reanalyzed. Structural imaging data were processed via the FreeSurfer pipeline to quantify regional CT of the contralesional hemisphere. Ordinal logistic regression models were fit to relate CT to modified Rankin Scale as an established measure of global disability after 3-6 months, adjusted for the initial deficit, lesion volume, and age. The data show that CT of contralesional cortices, such as the precentral gyrus, the superior frontal sulcus, and temporal and cingulate cortices, positively relates to the outcome after stroke. This work shows that the baseline cortical anatomy of selected contralesional cortices can explain the outcome variability after severe stroke, which further contributes to the concept of structural brain reserve with respect to contralesional cortices to promote recovery.
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Affiliation(s)
- Alina Rojas Albert
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - José A Graterol Pérez
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Hanna Braaβ
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Jan Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.,Department of Neurology, University Medical Center, Leipzig 04103, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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3
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Lazaridis L, Schmidt T, Agkatsev S, Blau T, Spille D, Heider S, Schulz T, Bumes E, Oster C, Feldheim J, Stummer W, Kessler A, Seidel C, Hau P, Sure U, Keyvani K, Herrlinger U, Kleinschnitz C, Stuschke M, Herrmann K, Deuschl C, Hattingen E, Scheffler B, Kebir S, Glas M. P11.15.B First multicentric real-life experience with the combination of lomustine and temozolomide in newly diagnosed MGMT promoter methylated IDH wildtype glioblastoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.204] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The CeTeG/NOA-09 trial assessed in a randomized phase 3 setting, whether combined treatment of lomustine together with temozolomide was superior to temozolomide treatment alone in newly diagnosed MGMT (O(6)-methylguanine-DNA-methyltransferase) promoter methylated glioblastoma patients. Survival was significantly improved from 31.4 months with temozolomide alone to 48.1 months with the combination of lomustine plus temozolomide. In view of this encouraging data - suggesting this combination could have a significant impact on the survival of newly diagnosed glioblastoma patients - we were curious to assess safety and efficacy of this regimen under real-life conditions.
Material and Methods
We collected clinical and radiographic data from adult newly diagnosed MGMT promoter methylated IDH (isocitrate dehydrogenase) wildtype glioblastoma patients treated at five neuro-oncology centers in Germany. As a requirement for inclusion, first-line treatment with lomustine plus temozolomide had to be performed for at least six weeks (one course). The available radiographic data was independently reviewed by an experienced board-certified neuro-radiologist.
Results
In total, 70 patients were included. Median progression-free survival of the full cohort was 14.4 months and median overall survival was 36.0 months. Patients who received TTFields (Tumor Treating Fields) treatment for eight weeks or longer together with the combination of lomustine plus temozolomide (n=22, 31%) had a prolonged progression-free survival compared to those patients who received TTFields treatment less than eight weeks or did not receive treatment with TTFields (n=48, 69%) (21.5 months versus 11.2 months; HR: 2.118, 95% CI: 1.245-3.605; p=0.0105). In a multivariable Cox regression analysis the use of TTFields for eight weeks or longer together with the combination of lomustine plus temozolomide as well as the application of at least five courses of CeTeG therapy emerged as independent prognostic factors for progression-free survival and overall survival. Pseudoprogression occurred in n=16 (33%) of the patients. We observed no treatment related deaths and high-grade hematotoxicity in n=31 (44%) of the patients.
Conclusion
The results from this multicentric trial that investigated newly diagnosed MGMT promoter methylated IDH wildtype glioblastoma under real-life conditions indicate toxicity and survival estimates comparable to the CeTeG/NOA-09 trial. The use of TTFields for at least eight weeks in combination with this regimen was independently associated with extended progression-free and overall survival.
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Affiliation(s)
- L Lazaridis
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen , Essen , Germany
| | - T Schmidt
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen , Essen , Germany
| | - S Agkatsev
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen , Essen , Germany
| | - T Blau
- Institute of Neuropathology, University Medicine Essen , Essen , Germany
| | - D Spille
- Department of Neurosurgery, University Hospital Münster , Münster , Germany
| | - S Heider
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig , Leipzig , Germany
| | - T Schulz
- Department of Neurosurgery, University Hospital of Würzburg , Würzburg , Germany
| | - E Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg , Regensburg , Germany
| | - C Oster
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen , Essen , Germany
| | - J Feldheim
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen , Essen , Germany
| | - W Stummer
- Department of Neurosurgery, University Hospital Münster , Münster , Germany
| | - A Kessler
- Department of Neurosurgery, University Hospital of Würzburg , Würzburg , Germany
| | - C Seidel
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig , Leipzig , Germany
| | - P Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg , Regensburg , Germany
| | - U Sure
- Department of Neurosurgery and Spine Surgery, University Medicine Essen , Essen , Germany
| | - K Keyvani
- Institute of Neuropathology, University Medicine Essen , Essen , Germany
| | - U Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn , Bonn , Germany
| | - C Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen , Essen , Germany
| | - M Stuschke
- Department of Radiotherapy, University Medicine Essen , Essen , Germany
| | - K Herrmann
- Department of Nuclear Medicine, University Medicine Essen , Essen , Germany
| | - C Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen , Essen , Germany
| | - E Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt , Frankfurt , Germany
| | - B Scheffler
- DKFZ-Division Translational Neurooncology at the West German Cancer Center (WTZ), DKTK Partner Site, University Medicine Essen , Essen , Germany
| | - S Kebir
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen , Essen , Germany
| | - M Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen , Essen , Germany
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4
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Kebir S, Lazaridis L, Schmidt T, Oster C, Feldheim J, Glas M, Pierscianek D, Proescholdt M, Hau P, Grosu A, Krex D, Scheffler B, Kleinschnitz C, Pöttgen C, Stuschke M. OS06.5.A Investigating safety and efficacy of TTFields prior and concomitant to radiotherapy in newly diagnosed glioblastoma - the PriCoTTF phase I/II trial. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.043] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The EF-14 phase III trial demonstrated improved survival for patients with newly diagnosed glioblastoma (nGBM) when TTFields therapy was added to adjuvant temozolomide chemotherapy. TTFields at 200 kHz are applied to the tumor utilizing arrays on the patients’ scalp. In preclinical studies, a synergistic inhibiting effect on glioblastoma cell proliferation was found for the combination of TTFields and radiotherapy. Based on these findings, we conduct the phase I/II PriCoTTF trial in adult nGBM patients to investigate the safety and efficacy of TTFields therapy initiated prior and concomitant to radiochemotherapy.
Material and Methods
Per study protocol, TTFields therapy is initiated following surgery and completed wound healing. Continuing throughout radiochemotherapy and adjuvant chemotherapy, TTFields therapy is used for approximately 9 months in total with TTFields rechallenge allowed at recurrence. Radiotherapy is conducted with arrays applied on the patients’ scalp. A total recruitment of 33 patients was sought, with 20 patients in arm A receiving normo-fractionated radiotherapy, and 13 elderly patients in arm B receiving hypo-fractionated radiotherapy. Safety and tolerance are the study’s primary endpoint, analyzed by a selection of pre-specified treatment-limiting toxicities (TLTs).
Results
A total of 33 patients have been enrolled. Patients' characteristics were mostly typical for glioblastoma, except for a rather low fraction of patients with gross total resection (GTR, 22.5%). The distribution of adverse events of common toxicity criteria (CTC) grade 3 or higher was comparable to that of established glioblastoma trials. Notably, skin toxicity of CTC grade 3 or higher was quite uncommon (n=2, 6%). As no patient developed TLTs, the study's primary endpoint was met. Median TTFields treatment duration was 8.4 months. Overall survival data was not mature enough (event rate 48%) to allow for a definite conclusion. Notably, on multivariable Cox regression, the number of days with TTFields adherence of more than 23 hours was independently associated with overall survival (HR 0.96, 95% confidence interval 0.93 - 0.99, p=0.008).
Conclusion
The PriCoTTF trial met its primary endpoint indicating that combined TTFields and radiotherapy is safe and well tolerated. High-grade skin toxicity was quite uncommon and the patients with high TTFields adherence seem to perform particularly well. An extended follow-up is required to provide first estimates regarding putative efficacy. At that point in time, the reduced overall TTFields duration and fraction of patients with GTR need to be factored in.
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Affiliation(s)
- S Kebir
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - L Lazaridis
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - T Schmidt
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - C Oster
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - J Feldheim
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - M Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - D Pierscianek
- Department of Neurosurgery and Spine Surgery, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - M Proescholdt
- Department of Neurosurgery, University Hospital Regensburg , Regensburg , Germany
| | - P Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg , Regensburg , Germany
| | - A Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg , Freiburg , Germany
| | - D Krex
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany
| | - B Scheffler
- DKFZ-Division Translational Neurooncology at the West German Cancer Center (WTZ), DKTK Partner Site, University Medicine Essen, Germany; German Cancer Consortium (DKTK), Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany , Essen , Germany
| | - C Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - C Pöttgen
- Department of Radiotherapy, University Medicine Essen, University Duisburg-Essen, Essen, Germany , Essen , Germany
| | - M Stuschke
- Department of Radiotherapy, University Medicine Essen, University Duisburg-Essen , Essen , Germany
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5
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Oster C, Lazaridis L, Feldheim J, Schmidt T, Kleinschnitz C, Kebir S, Glas M. P11.14.A Systematic review of phase III trials in newly diagnosed glioblastoma 2005-2021. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.203] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Despite a plethora of studies since the EORTC/NCIC trial in 2005, glioblastoma (GBM) prognosis remains poor. We here identify and compare glioblastoma phase III trials in terms of efficacy and baseline characteristics in an attempt to summarize the experience of the past 16 years.
Methods
A systematic literature search using PubMed and ClinicalTrials.gov was conducted to provide an overview of clinically relevant GBM phase III trials (years 2005-2021) of adult patients younger than 70 years of age. Search results were screened according to predefined inclusion criteria and either excluded or included in further analysis on study design, baseline characteristics, and survival results.
Results
Eleven trials from the literature and clinical trial database fulfilled the search criteria. Among these trials, a total of three GBM phase III trials reported overall survival (OS) benefit, including the EORTC/NCIC study (NCT00006353), EF-14 (NCT00916409) and CeTeG/NOA09 (NCT01149109). All three studies demonstrate similar hazard ratios, which translate into risk reduction of about 40%. Furthermore, low toxicity profile and mostly preserved quality of life were attributed to the treatments tested. Looking at the study designs, eight out of eleven trials were open label randomized trials, including all of the positive ones, and only three negative trials employed treatment blinding and a placebo control. Canonical baseline characteristics (extent of resection, age, gender, MGMT promoter methylation status) did not significantly differ between positive and negative trials. IDH mutation status was analyzed in only two trials, each showing a small percentage of IDH-mutant tumors only.
Conclusion
This analysis on GBM phase III trials conducted between 2005 and 2021 revealed that the majority of trials did not show a significant improvement in overall survival. CeTeG/NOA-09 and EF-14 are the only two studies with positive overall survival outcome since the EORTC/NCIC trial in 2005.
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Affiliation(s)
- C Oster
- University Hospital Essen , Essen , Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS) , Essen , Germany
| | - L Lazaridis
- University Hospital Essen , Essen , Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS) , Essen , Germany
| | - J Feldheim
- University Hospital Essen , Essen , Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS) , Essen , Germany
| | - T Schmidt
- University Hospital Essen , Essen , Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS) , Essen , Germany
| | - C Kleinschnitz
- University Hospital Essen , Essen , Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS) , Essen , Germany
| | - S Kebir
- University Hospital Essen , Essen , Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS) , Essen , Germany
| | - M Glas
- University Hospital Essen , Essen , Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS) , Essen , Germany
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6
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Schmidt T, Agkatsev S, Feldheim J, Oster C, Blau T, Sure U, Keyvani K, Kleinschnitz C, Stuschke M, Hermann K, Deuschl C, Scheffler B, Kebir S, Glas M, Lazaridis L. P17.04.B Combination of Trofosfamide and Etoposide in Recurrent Glioma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.312] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Disease relapse almost inevitably occurs in patients with adult-type diffuse glioma. Standard of care treatment options at tumor relapse are still not well defined. Frequently used drugs for adult-type diffuse glioma recurrence include lomustine (CCNU) and bevacizumab. Few studies indicate that the combination of trofosfamide/etoposide, given their high lipid solubility with good blood-brain barrier penetrance, may be feasible in pediatric glioblastoma patients. In this retrospective analysis, we determined tolerability and feasibility of combined trofosfamide/etoposide treatment at disease recurrence of patients with adult-type diffuse glioma.
Material and Methods
We collected clinicopathological data from adult patients with adult-type diffuse glioma treated with the combination of trofosfamide/etoposide at the Division of Clinical Neurooncology at the University Hospital Essen. Only those patients were considered eligible who received trofosfamide/etoposide treatment for more than four weeks (one course). Trofosfamide (100mg/m2/day) and Etoposide (25mg/m2/day) was administered orally in a “one week on, one week off” scheme. A cohort of patients receiving empiric treatment at the investigators’ discretion balanced for tumor entity and canonical prognostic factors (number of previous treatments, MGMT promoter methylation, IDH mutation status, KPS, age, extent of resection) served as control. We collected toxicity data as it pertained to CTCAE (Common Terminology Criteria for Adverse Events, version 5.0) and survival data to explore putative efficacy.
Results
A total of 33 patients were eligible for this analysis. In the IDH wild-type glioblastoma (n=18) subgroup, median progression-free survival (3.8 months versus 2.9 months, HR: 2.09, 95% CI: 1.010-4.312, p=0.0227; PFS-6: 39% versus 6%) and median overall survival (10.4 months versus 5.7 months, HR: 3.05, 95% CI: 1.393-6.655, p=0.0008) were significantly prolonged as compared to the control cohort. In a multivariable Cox regression analysis, treatment with trofosfamide/etoposide emerged as statistically significant prognostic marker regarding progression-free survival and overall survival. We observed high-grade adverse events (CTCAE grade≥III ) in 21 (64%) of all recurrent glioma patients with hematotoxicity comprising most adverse events (n=18, 86%). Lymphopenia was by far the most observed hematotoxic adverse event (n=13, 62%). Among non-hematologic high-grade adverse events was transaminase elevation (n=3, 14%).
Conclusion
This study provides first indication that the combination of trofosfamide/etoposide is safe in patients with adult-type diffuse gliomas and may be associated with prolonged survival in adult patients with recurrent IDH wildtype glioblastoma. Our data provide a reasonable rationale for follow-up of a larger cohort in a prospective controlled trial.
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Affiliation(s)
- T Schmidt
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, Essen University Hospital , Essen , Germany
| | - S Agkatsev
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, Essen University Hospital , Essen , Germany
| | - J Feldheim
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, Essen University Hospital , Essen , Germany
| | - C Oster
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, Essen University Hospital , Essen , Germany
| | - T Blau
- Institute of Neuropathology, Essen University Hospital , Essen , Germany
| | - U Sure
- Department of Neurosurgery and Spine Surgery, Essen University Hospital , Essen , Germany
| | - K Keyvani
- Institute of Neuropathology, Essen University Hospital , Essen , Germany
| | - C Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, Essen University Hospital , Essen , Germany
| | - M Stuschke
- Department of Radiotherapy, Essen University Hospital , Essen , Germany
| | - K Hermann
- Department of Nuclear Medicine, Essen University Hospital , Essen , Germany
| | - C Deuschl
- Department of Radiotherapy, Essen University Hospital , Essen , Germany
| | - B Scheffler
- DKFZ-Division Translational Neurooncology at the West German Cancer Center (WTZ), DKTK Partner Site, Essen University Hospital , Essen , Germany
| | - S Kebir
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, Essen University Hospital , Essen , Germany
| | - M Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, Essen University Hospital , Essen , Germany
| | - L Lazaridis
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, Essen University Hospital , Essen , Germany
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7
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Nemati PR, Backhaus W, Feldheim J, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. OUP accepted manuscript. Brain Commun 2022; 4:fcac049. [PMID: 35274100 PMCID: PMC8905614 DOI: 10.1093/braincomms/fcac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Analyses of alterations of brain networks have gained an increasing interest in stroke rehabilitation research. Compared with functional networks derived from resting-state analyses, there is limited knowledge of how structural network topology might undergo changes after stroke and, more importantly, if structural network information obtained early after stroke could enhance recovery models to infer later outcomes. The present work re-analysed cross-sectional structural imaging data, obtained within the first 2 weeks, of 45 acute stroke patients (22 females, 24 right-sided strokes, age 68 ± 13 years). Whole-brain tractography was performed to reconstruct structural connectomes and graph-theoretical analyses were employed to quantify global network organization with a focus on parameters of network integration and modular processing. Graph measures were compared between stroke patients and 34 healthy controls (15 females, aged 69 ± 10 years) and they were integrated with four clinical scores of the late subacute stage, covering neurological symptom burden (National Institutes of Health Stroke Scale), global disability (modified Rankin Scale), activity-related disability (Barthel Index) and motor functions (Upper-Extremity Score of the Fugl-Meyer Assessment). The analyses were employed across the complete cohort and, based on clustering analysis, separately within subgroups stratified in mild to moderate (n = 21) and severe (n = 24) initial deficits. The main findings were (i) a significant reduction of network’s global efficiency, specifically in patients with severe deficits compared with controls (P = 0.010) and (ii) a significant negative correlation of network efficiency with the extent of persistent functional deficits at follow-up after 3–6 months (P ≤ 0.032). Specifically, regression models revealed that this measure was capable to increase the explained variance in future deficits by 18% for the modified Rankin Scale, up to 24% for National Institutes of Health Stroke Scale, and 16% for Barthel Index when compared with models including the initial deficits and the lesion volume. Patients with mild to moderate deficits did not exhibit a similar impact of network efficiency on outcome inference. Clustering coefficient and modularity, measures of segregation and modular processing, did not exhibit comparable structure–outcome relationships, neither in severely nor in mildly affected patients. This study provides empirical evidence that structural network efficiency as a graph-theoretical marker of large-scale network topology, quantified early after stroke, relates to recovery. Notably, this contribution was only evident in severely but not mildly affected stroke patients. This suggests that the initial clinical deficit might shape the dependency of recovery on global network topology after stroke.
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Affiliation(s)
- Paul R. Nemati
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jan Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Neurology, University Medical Center, 04103 Leipzig, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Robert Schulz
- Correspondence to: Robert Schulz, MD University Medical Center Hamburg-Eppendorf Martinistraße 52, 20246 Hamburg, Germany E-mail:
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8
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Higgen FL, Ruppel P, Görner M, Kerzel M, Hendrich N, Feldheim J, Wermter S, Zhang J, Gerloff C. Crossmodal Pattern Discrimination in Humans and Robots: A Visuo-Tactile Case Study. Front Robot AI 2020; 7:540565. [PMID: 33501309 PMCID: PMC7805622 DOI: 10.3389/frobt.2020.540565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/02/2020] [Indexed: 12/03/2022] Open
Abstract
The quality of crossmodal perception hinges on two factors: The accuracy of the independent unimodal perception and the ability to integrate information from different sensory systems. In humans, the ability for cognitively demanding crossmodal perception diminishes from young to old age. Here, we propose a new approach to research to which degree the different factors contribute to crossmodal processing and the age-related decline by replicating a medical study on visuo-tactile crossmodal pattern discrimination utilizing state-of-the-art tactile sensing technology and artificial neural networks (ANN). We implemented two ANN models to specifically focus on the relevance of early integration of sensory information during the crossmodal processing stream as a mechanism proposed for efficient processing in the human brain. Applying an adaptive staircase procedure, we approached comparable unimodal classification performance for both modalities in the human participants as well as the ANN. This allowed us to compare crossmodal performance between and within the systems, independent of the underlying unimodal processes. Our data show that unimodal classification accuracies of the tactile sensing technology are comparable to humans. For crossmodal discrimination of the ANN the integration of high-level unimodal features on earlier stages of the crossmodal processing stream shows higher accuracies compared to the late integration of independent unimodal classifications. In comparison to humans, the ANN show higher accuracies than older participants in the unimodal as well as the crossmodal condition, but lower accuracies than younger participants in the crossmodal task. Taken together, we can show that state-of-the-art tactile sensing technology is able to perform a complex tactile recognition task at levels comparable to humans. For crossmodal processing, human inspired early sensory integration seems to improve the performance of artificial neural networks. Still, younger participants seem to employ more efficient crossmodal integration mechanisms than modeled in the proposed ANN. Our work demonstrates how collaborative research in neuroscience and embodied artificial neurocognitive models can help to derive models to inform the design of future neurocomputational architectures.
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Affiliation(s)
- Focko L. Higgen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Ruppel
- Department of Informatics, Universität Hamburg, Hamburg, Germany
| | - Michael Görner
- Department of Informatics, Universität Hamburg, Hamburg, Germany
| | - Matthias Kerzel
- Department of Informatics, Universität Hamburg, Hamburg, Germany
| | - Norman Hendrich
- Department of Informatics, Universität Hamburg, Hamburg, Germany
| | - Jan Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Wermter
- Department of Informatics, Universität Hamburg, Hamburg, Germany
| | - Jianwei Zhang
- Department of Informatics, Universität Hamburg, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Curtaz CJ, Schmitt C, Herbert SL, Feldheim J, Schlegel N, Gossele F, Hagemann C, Roewer N, Meybohm P, Wöckel A, Burek M. Einfluss serumbasierter Faktoren von Brustkrebspatientinnen und Kontrollgruppen auf die Blut-Hirn-Schranke In-Vitro. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- CJ Curtaz
- Universitätsklinikum Würzburg, Frauenklinik und Poliklinik
| | - C Schmitt
- Universitätsklinik Würzburg, Klinik und Poliklinik für Anästhesiologie
| | - SL Herbert
- Universitätsklinikum Würzburg, Frauenklinik und Poliklinik
| | - J Feldheim
- Universitätsklinik Würzburg, Neurochirurgische Klinik und Poliklinik, Tumorbiologie Labor
| | - N Schlegel
- Universitätsklinik Würzburg, Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I)
| | - F Gossele
- Université d’Artois, Blood-Brain Barrier Labor
| | - C Hagemann
- Universitätsklinik Würzburg, Neurochirurgische Klinik und Poliklinik, Tumorbiologie Labor
| | - N Roewer
- Universitätsklinik Würzburg, Klinik und Poliklinik für Anästhesiologie
| | - P Meybohm
- Universitätsklinik Würzburg, Klinik und Poliklinik für Anästhesiologie
| | - A Wöckel
- Universitätsklinikum Würzburg, Frauenklinik und Poliklinik
| | - M Burek
- Universitätsklinik Würzburg, Klinik und Poliklinik für Anästhesiologie
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10
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Bönstrup M, Krawinkel L, Schulz R, Cheng B, Feldheim J, Thomalla G, Cohen LG, Gerloff C. Low-Frequency Brain Oscillations Track Motor Recovery in Human Stroke. Ann Neurol 2019; 86:853-865. [PMID: 31604371 DOI: 10.1002/ana.25615] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The majority of patients with stroke survive the acute episode and live with enduring disability. Effective therapies to support recovery of motor function after stroke are yet to be developed. Key to this development is the identification of neurophysiologic signals that mark recovery and are suitable and susceptible to interventional therapies. Movement preparatory low-frequency oscillations (LFOs) play a key role in cortical control of movement. Recent animal data point to a mechanistic role of motor cortical LFOs in stroke motor deficits and demonstrate neuromodulation intervention with therapeutic benefit. Their relevance in human stroke pathophysiology is unknown. METHODS We studied the relationship between movement-preparatory LFOs during the performance of a visuomotor grip task and motor function in a longitudinal (<5 days, 1 and 3 months) cohort study of 33 patients with motor stroke and in 19 healthy volunteers. RESULTS Acute stroke-lesioned brains fail to generate the LFO signal. Whereas in healthy humans, a transient occurrence of LFOs preceded movement onset at predominantly contralateral frontoparietal motor regions, recordings in patients revealed that movement-preparatory LFOs were substantially diminished to a level of 38% after acute stroke. LFOs progressively increased at 1 and 3 months. This re-emergence closely tracked the recovery of motor function across several movement qualities including grip strength, fine motor skills, and synergies and was frequency band specific. INTERPRETATION Our results provide the first human evidence for a link between movement-preparatory LFOs and functional recovery after stroke, promoting their relevance for movement control. These results suggest that it may be interesting to explore targeted, LFOs-restorative brain stimulation therapy in human stroke patients. ANN NEUROL 2019;86:853-865.
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Affiliation(s)
- Marlene Bönstrup
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Krawinkel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Bönstrup M, Schulz R, Schön G, Cheng B, Feldheim J, Thomalla G, Gerloff C. Parietofrontal network upregulation after motor stroke. Neuroimage Clin 2018; 18:720-729. [PMID: 29876261 PMCID: PMC5987870 DOI: 10.1016/j.nicl.2018.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/04/2018] [Accepted: 03/07/2018] [Indexed: 12/22/2022]
Abstract
Objective Motor recovery after stroke shows a high inter-subject variability. The brain's potential to form new connections determines individual levels of recovery of motor function. Most of our daily activities require visuomotor integration, which engages parietal areas. Compared to the frontal motor system, less is known about the parietal motor system's reconfiguration related to stroke recovery. Here, we tested if functional connectivity among parietal and frontal motor areas undergoes plastic changes after stroke and assessed the behavioral relevance for motor function after stroke. Methods We investigated stroke lesion-induced changes in functional connectivity by measuring high-density electroencephalography (EEG) and assessing task-related changes in coherence during a visually guided grip task with the paretic hand in 30 chronic stroke patients with variable motor deficits and 19 healthy control subjects. Quantitative changes in task-related coherence in sensorimotor rhythms were compared to the residual motor deficit. Results Parietofrontal coupling was significantly stronger in patients compared to controls. Whereas motor network coupling generally increased during the task in both groups, the task-related coherence between the parietal and primary motor cortex in the stroke lesioned hemisphere showed increased connectivity across a broad range of sensorimotor rhythms. Particularly the parietofrontal task-induced coupling pattern was significantly and positively related to residual impairment in the Nine-Hole Peg Test performance and grip force. Interpretation These results demonstrate that parietofrontal motor system integration during visually guided movements is stronger in the stroke-lesioned brain. The correlation with the residual motor deficit could either indicate an unspecific marker of motor network damage or it might indicate that upregulated parietofrontal connectivity has some impact on post-stroke motor function.
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Key Words
- CTC, communication through coherence
- Coherence
- DCM, dynamic causal modelling
- EEG
- LCMV, linear constrained minimum variance
- LME, linear mixed effects
- M1, primary motor cortex
- MVC, maximum voluntary contraction
- Motor recovery
- NHP, Nine-Hole Peg Test performance
- PMv, ventral premotor
- Parietal lobe
- SMA, supplementary motor area
- Stroke
- TR-Coh, task-related coherence
- TR-Pow, task-related spectral power
- UEFM, Fugl–Meyer score upper extremity subsection
- aIPS, anterior intraparietal sulcus
- cIPS, caudal intraparietal sulcus
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Affiliation(s)
- M Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany; Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - R Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - G Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - B Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - J Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - G Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - C Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
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12
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Bönstrup M, Schulz R, Cheng B, Feldheim J, Zimerman M, Thomalla G, Hummel FC, Gerloff C. Evolution of brain activation after stroke in a constant-effort versus constant-output motor task. Restor Neurol Neurosci 2016; 33:845-64. [PMID: 26484697 DOI: 10.3233/rnn-150527] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Recovery of hand function after stroke has been associated with transient overactivation of the cerebral sensorimotor network. One open question has been as to how much this transient overactivation is related to 'true' reorganisation of the network or reflecting the fact that a simple motor task is difficult to perform for a patient with a motor deficit, i.e. reflecting 'effort'. METHODS To address this, we combined a constant-output (varying effort) and constant-effort (varying output) task in a longitudinal (T1 = 3-5 days, T2 = 6 weeks, T3 = 3 months after stroke) multimodal (functional magnetic resonance imaging (FMRI), electroencephalography (EEG)) study of 12 (EEG)/8 (FMRI) patients (7 male, age 67 ± 9 years) showing significant recovery from a hand motor deficit. RESULTS The reduction of sensorimotor activation from T1 to T3 was significant (p = 0.012). But task effort did not exhibit any significant impact on the evolution of task-related brain activation over time. This proved to be equally applicable to FMRI and EEG data. CONCLUSION We conclude that initial up-regulation of brain activity after stroke is not simply a consequence of enhanced effort early after stroke but rather reflects neural processes involved in reorganisation and recovery of function.
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Affiliation(s)
- Marlene Bönstrup
- BrainImaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Robert Schulz
- BrainImaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Bastian Cheng
- Clinical Stroke Imaging Laboratory, University Medical Center, Hamburg-Eppendorf, Department of Neurology, Martinistr. 52, 20246 Hamburg, Germany
| | - Jan Feldheim
- BrainImaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Máximo Zimerman
- BrainImaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Götz Thomalla
- BrainImaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Friedhelm C Hummel
- BrainImaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Gerloff
- BrainImaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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13
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Schulz R, Frey BM, Koch P, Zimerman M, Bönstrup M, Feldheim J, Timmermann JE, Schön G, Cheng B, Thomalla G, Gerloff C, Hummel FC. Cortico-Cerebellar Structural Connectivity Is Related to Residual Motor Output in Chronic Stroke. Cereb Cortex 2015; 27:635-645. [DOI: 10.1093/cercor/bhv251] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Bönstrup M, Schulz R, Feldheim J, Hummel F, Gerloff C. P106. Brain connectivity in a simple motor task characterized by dynamic causal modeling of EEG FMRI signal. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Bönstrup M, Schulz R, Cheng B, Feldheim J, Thomalla G, Hummel F, Gerloff C. P108. The effect of task effort on recovery-related brain activity following motor stroke assessed with FMRI and EEG. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Krawinkel L, Feldheim J, Hummel F. Evaluation eines neuen EEG-Verarbeitungs-Systems zur Echtzeit-Phasendetektion. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1384574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- L. Krawinkel
- Klinik und Poliklinik für Neurologie, BrainImaging and NeuroStimulation (BINS) Labor, Universitätsklinikum Hamburg-Eppendorf
| | - J. Feldheim
- Klinik und Poliklinik für Neurologie, BrainImaging and NeuroStimulation (BINS) Labor, Universitätsklinikum Hamburg-Eppendorf
| | - F. Hummel
- Klinik und Poliklinik für Neurologie, BrainImaging and NeuroStimulation (BINS) Labor, Universitätsklinikum Hamburg-Eppendorf
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17
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Boenstrup M, Feldheim J, Heise K, Gerloff C, Hummel FC. The control of complex finger movements by directional information flow between mesial frontocentral areas and the primary motor cortex. Eur J Neurosci 2014; 40:2888-97. [DOI: 10.1111/ejn.12657] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M. Boenstrup
- BrainImaging and NeuroStimulation (BINS) Laboratory; Department of Neurology; University Medical Center Hamburg-Eppendorf; 20246 Hamburg Germany
| | - J. Feldheim
- BrainImaging and NeuroStimulation (BINS) Laboratory; Department of Neurology; University Medical Center Hamburg-Eppendorf; 20246 Hamburg Germany
| | - K. Heise
- BrainImaging and NeuroStimulation (BINS) Laboratory; Department of Neurology; University Medical Center Hamburg-Eppendorf; 20246 Hamburg Germany
| | - C. Gerloff
- BrainImaging and NeuroStimulation (BINS) Laboratory; Department of Neurology; University Medical Center Hamburg-Eppendorf; 20246 Hamburg Germany
| | - F. C. Hummel
- BrainImaging and NeuroStimulation (BINS) Laboratory; Department of Neurology; University Medical Center Hamburg-Eppendorf; 20246 Hamburg Germany
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Ganos C, Kühn S, Kahl U, Schunke O, Feldheim J, Gerloff C, Roessner V, Bäumer T, Thomalla G, Haggard P, Münchau A. Action inhibition in Tourette syndrome. Mov Disord 2014; 29:1532-8. [DOI: 10.1002/mds.25944] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 04/30/2014] [Accepted: 05/28/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Christos Ganos
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London Institute of Neurology; London United Kingdom
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry; Institute of Neurogenetics, University of Lübeck; Lübeck Germany
| | - Simone Kühn
- Center for Lifespan Psychology, Max Planck Institute for Human Development; Berlin Germany
| | - Ursula Kahl
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Odette Schunke
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Jan Feldheim
- Brain Imaging and Neurostimulation Laboratory; Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Christian Gerloff
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry; University of Dresden Medical School; Dresden Germany
| | - Tobias Bäumer
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry; Institute of Neurogenetics, University of Lübeck; Lübeck Germany
| | - Götz Thomalla
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Patrick Haggard
- Institute of Cognitive Neuroscience; University College London; United Kingdom
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry; Institute of Neurogenetics, University of Lübeck; Lübeck Germany
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Andrews R, Feldheim J, Givney R, Carman J, Murray C, Beers M, Lanser J, Nguyen M, Cameron S, Hall R. Concurrent outbreaks of Salmonella Typhimurium in South Australia. Commun Dis Intell (2018) 1997; 21:61-2. [PMID: 9090166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Communicable Disease Control Branch of the South Australian Health Commission received 45 laboratory notifications of Salmonella between 23 December 1996 and 17 January 1997. A rapid screening test, undertaken by the Institute of Medical and Veterinary Sciences, Adelaide, was the first indication that this was more than one outbreak, prompting the establishment of separate investigations. Three Salmonella Typhimurium (S. Typhimurium) phage types were subsequently identified. Investigations are continuing into an outbreak of S. Typhimurium phage type (PT) 64, while investigations failed to identify any association between four cases of PT 44. As of 12 February 1997, 71 notifications had been confirmed as S. Typhimurium PT 135. Epidemiological investigations found this outbreak was associated with consumption of bread rolls with a meat filling distributed through local Asian grocery stores from a home-based manufacturer. The product was voluntarily withdrawn and there have been no new cases of PT 135.
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Affiliation(s)
- R Andrews
- Department of Health and Family Services, Canberra ACT
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Cameron S, Roder D, Walker C, Feldheim J. Epidemiological characteristics of Legionella infection in South Australia: implications for disease control. Aust N Z J Med 1991; 21:65-70. [PMID: 2036080 DOI: 10.1111/j.1445-5994.1991.tb03007.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
About one third of adults surveyed in South Australia have shown evidence of past silent infection with Legionella pneumophila serogroup 1. However, the annual notification rate for symptomatic disease is only about 0.5 per 100,000 residents in non-epidemic years. The male to female ratio is 2.5 to one and approximately 50% of the cases are at least 60 years of age. Cases have presented more in summer and in the metropolitan areas. Twenty cases of Legionnaires' disease occurred during the summer of 1985-86. A cooling tower was held to be the principal source with aerosols being dispersed up to three kilometers away during an atmospheric thermal inversion. A subsequent outbreak of 22 L. longbeachae serogroup 1 infections had no marked geographic clustering. The outbreak commenced in spring and cases were distinguished as active gardeners. L. longbeachae was found in garden soil and it is hypothesised that this soil inhabitant can become aerosolised and inhaled during gardening. The potential for primary prevention of Legionnaires' disease is discussed in relation to water-handling equipment and the need for early precautionary treatment of all community-acquired pneumonia as suspect Legionnaires' disease is emphasised.
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Affiliation(s)
- S Cameron
- Communicable Disease Control Unit, Public and Environmental Health Division, South Australian Health Commission, Adelaide
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