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Angerer M, Pichler G, Angerer B, Scarpatetti M, Schabus M, Blume C. From dawn to dusk-mimicking natural daylight exposure improves circadian rhythm entrainment in patients with severe brain injury. Sleep 2022; 45:zsac065. [PMID: 35290446 PMCID: PMC9272242 DOI: 10.1093/sleep/zsac065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
STUDY OBJECTIVES While light therapy has proven effective in re-entraining circadian rhythms, the potential of such an intervention has not been evaluated systematically in post-comatose patients with disorders of consciousness (DOC), who often have strongly altered circadian rhythms. METHODS We recorded skin temperature over 7-8 days in patients with DOC in each of two conditions: habitual light (HL), and dynamic daylight (DDL) condition. While patients were in a room with usual clinic lighting in the HL condition, they were in an otherwise comparable room with biodynamic lighting (i.e. higher illuminance and dynamic changes in spectral characteristics during the day) in the DDL condition. To detect rhythmicity in the patients' temperature data, we computed Lomb-Scargle periodograms and analyzed normalized power, and peak period. Furthermore, we computed interdaily stability and intradaily variability, which provide information about rhythm entrainment and fragmentation. RESULTS We analyzed data from 17 patients with DOC (i.e. unresponsive wakefulness syndrome [n = 15] and minimally conscious state [n = 2]). The period length of the patients' temperature rhythms was closer to 24 h in the DDL as compared to the HL condition (median median deviation from 24 h: DDL = 0.52 h, HL = 3.62 h). Specifically, in 11/17 (65%) patients the period length was closer to 24 h in the DDL condition. Furthermore, the patients' rhythm was more pronounced, more stable, and less variable in the DDL condition. CONCLUSIONS Our results indicate that DDL stimulation entrains and stabilizes circadian rhythms. This highlights the importance of adequate room lighting as an adjunct therapeutic approach for improving circadian rhythms in severely brain-injured patients. TRIAL REGISTRATION INFORMATION German Clinical Trials Register (DRKS00016041); registration: 18.01.2019; recording start: 04.06.2019 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016041.
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Affiliation(s)
- Monika Angerer
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
| | - Gerald Pichler
- Apallic Care Unit, Albert Schweitzer Hospital, Geriatric Health Care Centres of the City of Graz, Graz, Austria
| | - Birgit Angerer
- Private Practice for General Medicine and Neurology, Leibnitz, Austria
| | - Monika Scarpatetti
- Apallic Care Unit, Albert Schweitzer Hospital, Geriatric Health Care Centres of the City of Graz, Graz, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
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Angerer M, Wilhelm FH, Liedlgruber M, Pichler G, Angerer B, Scarpatetti M, Blume C, Schabus M. Does the Heart Fall Asleep?—Diurnal Variations in Heart Rate Variability in Patients with Disorders of Consciousness. Brain Sci 2022; 12:brainsci12030375. [PMID: 35326331 PMCID: PMC8946070 DOI: 10.3390/brainsci12030375] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023] Open
Abstract
The current study investigated heart rate (HR) and heart rate variability (HRV) across day and night in patients with disorders of consciousness (DOC). We recorded 24-h electrocardiography in 26 patients with DOC (i.e., unresponsive wakefulness syndrome (UWS; n = 16) and (exit) minimally conscious state ((E)MCS; n = 10)). To examine diurnal variations, HR and HRV indices in the time, frequency, and entropy domains were computed for periods of clear day- (forenoon: 8 a.m.–2 p.m.; afternoon: 2 p.m.–8 p.m.) and nighttime (11 p.m.–5 a.m.). The results indicate that patients’ interbeat intervals (IBIs) were larger during the night than during the day, indicating HR slowing. The patients in UWS showed larger IBIs compared to the patients in (E)MCS, and the patients with non-traumatic brain injury showed lower HRV entropy than the patients with traumatic brain injury. Additionally, higher HRV entropy was associated with higher EEG entropy during the night. Thus, cardiac activity varies with a diurnal pattern in patients with DOC and can differentiate between patients’ diagnoses and etiologies. Moreover, the interaction of heart and brain appears to follow a diurnal rhythm. Thus, HR and HRV seem to mirror the integrity of brain functioning and, consequently, might serve as supplementary measures for improving the validity of assessments in patients with DOC.
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Affiliation(s)
- Monika Angerer
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, 5020 Salzburg, Austria;
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, 5020 Salzburg, Austria
| | - Frank H. Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, University of Salzburg, 5020 Salzburg, Austria; (F.H.W.); (M.L.)
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, Department of Psychology, University of Salzburg, 5020 Salzburg, Austria; (F.H.W.); (M.L.)
| | - Gerald Pichler
- Apallic Care Unit, Albert Schweitzer Hospital, Geriatric Health Care Centres of the City of Graz, 8020 Graz, Austria; (G.P.); (M.S.)
| | - Birgit Angerer
- Private Practice for General Medicine and Neurology, 8430 Leibnitz, Austria;
| | - Monika Scarpatetti
- Apallic Care Unit, Albert Schweitzer Hospital, Geriatric Health Care Centres of the City of Graz, 8020 Graz, Austria; (G.P.); (M.S.)
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland;
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, 4055 Basel, Switzerland
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, 5020 Salzburg, Austria;
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, 5020 Salzburg, Austria
- Correspondence:
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Stadlbauer V, Engertsberger L, Komarova I, Feldbacher N, Leber B, Pichler G, Fink N, Scarpatetti M, Schippinger W, Schmidt R, Horvath A. Dysbiosis, gut barrier dysfunction and inflammation in dementia: a pilot study. BMC Geriatr 2020; 20:248. [PMID: 32690030 PMCID: PMC7372911 DOI: 10.1186/s12877-020-01644-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Dementia is an increasing public health threat worldwide. The pathogenesis of dementia has not been fully elucidated yet. Inflammatory processes are hypothesized to play an important role as a driver for cognitive decline but the origin of inflammation is not clear. We hypothesize that disturbances in gut microbiome composition, gut barrier dysfunction, bacterial translocation and resulting inflammation are associated with cognitive dysfunction in dementia. METHODS To test this hypothesis, a cohort of 23 patients with dementia and 18 age and sex matched controls without cognitive impairments were studied. Gut microbiome composition, gut barrier dysfunction, bacterial translocation and inflammation were assessed from stool and serum samples. Malnutrition was assessed by Mini Nutritional Assessment Short Form (MNA-SF), detailed information on drug use was collected. Microbiome composition was assessed by 16S rRNA sequencing, QIIME 2 and Calypso 7.14 tools. RESULTS Dementia was associated with dysbiosis characterized by differences in beta diversity and changes in taxonomic composition. Gut permeability was increased as evidenced by increased serum diamine oxidase (DAO) levels and systemic inflammation was confirmed by increased soluble cluster of differentiation 14 levels (sCD14). BMI and statin use had the strongest impact on microbiome composition. CONCLUSION Dementia is associated with changes in gut microbiome composition and increased biomarkers of gut permeability and inflammation. Lachnospiraceae NK4A136 group as potential butyrate producer was reduced in dementia. Malnutrition and drug intake were factors, that impact on microbiome composition. Increasing butyrate producing bacteria and targeting malnutrition may be promising therapeutic targets in dementia. TRIAL REGISTRATION NCT03167983 .
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Affiliation(s)
- Vanessa Stadlbauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Center of Biomarker Research in Medicine (CBmed), Graz, Austria.
| | - Lara Engertsberger
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Irina Komarova
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Nicole Feldbacher
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center of Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Bettina Leber
- Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Pichler
- Department of Neurology, Geriatric Health Centers Graz, Albert Schweitzer Hospital, Graz, Austria
| | - Nicole Fink
- Department of Neurology, Geriatric Health Centers Graz, Albert Schweitzer Hospital, Graz, Austria
| | - Monika Scarpatetti
- Department of Neurology, Geriatric Health Centers Graz, Albert Schweitzer Hospital, Graz, Austria
| | - Walter Schippinger
- Department of Neurology, Geriatric Health Centers Graz, Albert Schweitzer Hospital, Graz, Austria
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Angela Horvath
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center of Biomarker Research in Medicine (CBmed), Graz, Austria
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Zollner-Schwetz I, Scarpatetti M, Pichler G, Pux C, Klymiuk I, Trajanoski S, Krause R. Effect of a Multispecies Probiotic on Intestinal and Skin Colonization by Multidrug-Resistant Gram-Negative Bacteria in Patients in a Long-Term Care Facility: A Pilot Study. Nutrients 2020; 12:nu12061586. [PMID: 32481668 PMCID: PMC7352861 DOI: 10.3390/nu12061586] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 01/02/2023] Open
Abstract
Residents in long-term care facilities (LTCFs) are frequently colonized by multidrug-resistant Gram-negative bacteria, putting them at risk for subsequent infections. We aimed to evaluate the effect of the multispecies probiotic Omnibiotic10AAD® on the intestinal and inguinal skin colonization of patients by multidrug-resistant Gram-negative bacteria in LTCFs. Patients colonized by multidrug-resistant Gram-negative bacteria received a 12 week oral course of Omnibiotic10AAD®. Inguinal swabs and stool samples were collected during and after treatment for microbiological and microbiome analysis. The median age of patients was 76 years. Twelve patients completed the pilot study. Intestinal colonization was reduced to 42% of patients 8 weeks after the end of treatment, but increased to 66% 24 weeks after the end of probiotic treatment. Colonization of inguinal skin was lowest during probiotic treatment and increased thereafter. Fecal microbiome analysis revealed statistically significant increases of the genus Enterococcus comparing start and end of probiotic treatment. In conclusion, a 12 week course of a multispecies probiotic led to a transient reduction of intestinal colonization 8 weeks after the end of treatment. The findings of our pilot study warrant further research in the area of probiotics and intestinal colonization by multidrug-resistant bacteria.
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Affiliation(s)
- Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
- Correspondence:
| | - Monika Scarpatetti
- Geriatric Health Centres of the City of Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria; (M.S.); (G.P.); (C.P.)
| | - Gerald Pichler
- Geriatric Health Centres of the City of Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria; (M.S.); (G.P.); (C.P.)
| | - Christian Pux
- Geriatric Health Centres of the City of Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria; (M.S.); (G.P.); (C.P.)
| | - Ingeborg Klymiuk
- Core Facility Molecular Biology, Centre for Medical Research, Medical University of Graz, Stiftingtalstraße 24/1, 8010 Graz, Austria; (I.K.); (S.T.)
| | - Slave Trajanoski
- Core Facility Molecular Biology, Centre for Medical Research, Medical University of Graz, Stiftingtalstraße 24/1, 8010 Graz, Austria; (I.K.); (S.T.)
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
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Angerer M, Schabus M, Raml M, Pichler G, Kunz AB, Scarpatetti M, Trinka E, Blume C. Actigraphy in brain-injured patients - A valid measurement for assessing circadian rhythms? BMC Med 2020; 18:106. [PMID: 32393256 PMCID: PMC7216424 DOI: 10.1186/s12916-020-01569-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/19/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Actigraphy has received increasing attention in classifying rest-activity cycles. However, in patients with disorders of consciousness (DOC), actigraphy data may be considerably confounded by passive movements, such as nursing activities and therapies. Consequently, this study verified whether circadian rhythmicity is (still) visible in actigraphy data from patients with DOC after correcting for passive movements. METHODS Wrist actigraphy was recorded over 7-8 consecutive days in patients with DOC (diagnosed with unresponsive wakefulness syndrome [UWS; n = 19] and [exit] minimally conscious state [MCS/EMCS; n = 11]). The presence and actions of clinical and research staff as well as visitors were indicated using a tablet in the patient's room. Following removal and interpolation of passive movements, non-parametric rank-based tests were computed to identify differences between circadian parameters of uncorrected and corrected actigraphy data. RESULTS Uncorrected actigraphy data overestimated the interdaily stability and intradaily variability of patients' activity and underestimated the deviation from a circadian 24-h rhythm. Only 5/30 (17%) patients deviated more than 1 h from 24 h in the uncorrected data, whereas this was the case for 17/30 (57%) patients in the corrected data. When contrasting diagnoses based on the corrected dataset, stronger circadian rhythms and higher activity levels were observed in MCS/EMCS as compared to UWS patients. Day-to-night differences in activity were evident for both patient groups. CONCLUSION Our findings indicate that uncorrected actigraphy data overestimates the circadian rhythmicity of patients' activity, as nursing activities, therapies, and visits by relatives follow a circadian pattern itself. Therefore, we suggest correcting actigraphy data from patients with reduced mobility.
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Affiliation(s)
- Monika Angerer
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
| | - Marion Raml
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Gerald Pichler
- Apallic Care Unit, Albert Schweitzer Clinic, Geriatric Health Centres of the City of Graz, Graz, Austria
| | - Alexander B. Kunz
- Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Center, Salzburg, Austria
- Gunther Ladurner Nursing Home, Salzburg, Austria
| | - Monika Scarpatetti
- Apallic Care Unit, Albert Schweitzer Clinic, Geriatric Health Centres of the City of Graz, Graz, Austria
| | - Eugen Trinka
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
- Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Center, Salzburg, Austria
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
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Blume C, Angerer M, Raml M, Del Giudice R, Santhi N, Pichler G, Kunz AB, Scarpatetti M, Trinka E, Schabus M. Healthier rhythm, healthier brain? Integrity of circadian melatonin and temperature rhythms relates to the clinical state of brain-injured patients. Eur J Neurol 2019; 26:1051-1059. [PMID: 30770613 PMCID: PMC6766891 DOI: 10.1111/ene.13935] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 10/15/2018] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Abstract
Background Healthy circadian rhythmicity has been suggested to relate to a better state of brain‐injured patients and to support the emergence of consciousness in patient groups characterized by a relative instability thereof such as patients with disorders of consciousness (DOC). Methods Going beyond earlier studies, a systems‐level perspective was adopted and, using multilevel modelling, the joint predictive value of three indices of circadian rhythm integrity derived from skin temperature variations, melatoninsulfate secretion, and physical activity (wrist actigraphy) patterns was evaluated for the behaviourally assessed state [Coma Recovery Scale ‐ Revised (CRS‐R) score] of DOC patients [13 unresponsive wakefulness syndrome; seven minimally conscious (exit) state]. Additionally, it was assessed in a subset of 16 patients whether patients’ behavioural repertoire (CRS‐R score) varied (i) with time of day or (ii) offset from the body temperature maximum (BTmax), i.e. when cognitive performance is expected to peak. Results The results reveal that better integrity of circadian melatoninsulfate and temperature rhythms relate to a richer behavioural repertoire. Moreover, higher CRS‐R scores are, by trend, related to assessments taking place at a later daytime or deviating less from the pre‐specified time of occurrence of BTmax. Conclusions In conclusion, the results suggest that therapeutic approaches aimed at improving circadian rhythms in brain‐injured patients are promising and should be implemented in hospitals or nursing homes. Beyond this, it might be helpful to schedule diagnostic procedures and therapies around the (pre‐assessed) BTmax (≈4 pm in healthy individuals) as this is when patients should be most responsive.
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Affiliation(s)
- C Blume
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria.,University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria
| | - M Angerer
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria
| | - M Raml
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria
| | - R Del Giudice
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria
| | - N Santhi
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - G Pichler
- Geriatric Health Centres of the City of Graz, Albert Schweitzer Clinic, Apallic Care Unit, Graz, Austria
| | - A B Kunz
- Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Center, Salzburg, Austria.,Gunther Ladurner Nursing Home, Salzburg, Austria
| | - M Scarpatetti
- Geriatric Health Centres of the City of Graz, Albert Schweitzer Clinic, Apallic Care Unit, Graz, Austria
| | - E Trinka
- University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria.,Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Center, Salzburg, Austria
| | - M Schabus
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria.,University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria
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Blume C, Lechinger J, Santhi N, del Giudice R, Gnjezda MT, Pichler G, Scarpatetti M, Donis J, Michitsch G, Schabus M. Significance of circadian rhythms in severely brain-injured patients: A clue to consciousness? Neurology 2017; 88:1933-1941. [PMID: 28424270 PMCID: PMC5444311 DOI: 10.1212/wnl.0000000000003942] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/24/2017] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate the relationship between the presence of a circadian body temperature rhythm and behaviorally assessed consciousness levels in patients with disorders of consciousness (DOC; i.e., vegetative state/unresponsive wakefulness syndrome or minimally conscious state). Methods: In a cross-sectional study, we investigated the presence of circadian temperature rhythms across 6 to 7 days using external skin temperature sensors in 18 patients with DOC. Beyond this, we examined the relationship between behaviorally assessed consciousness levels and circadian rhythmicity. Results: Analyses with Lomb-Scargle periodograms revealed significant circadian rhythmicity in all patients (range 23.5–26.3 hours). We found that especially scores on the arousal subscale of the Coma Recovery Scale–Revised were closely linked to the integrity of circadian variations in body temperature. Finally, we piloted whether bright light stimulation could boost circadian rhythmicity and found positive evidence in 2 out of 8 patients. Conclusion: The study provides evidence for an association between circadian body temperature rhythms and arousal as a necessary precondition for consciousness. Our findings also make a case for circadian rhythms as a target for treatment as well as the application of diagnostic and therapeutic means at times when cognitive performance is expected to peak.
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Affiliation(s)
- Christine Blume
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria.
| | - Julia Lechinger
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Nayantara Santhi
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Renata del Giudice
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Maria-Teresa Gnjezda
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Gerald Pichler
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Monika Scarpatetti
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Johann Donis
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Gabriele Michitsch
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Manuel Schabus
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
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8
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Sperl D, Benesch M, Urban C, Lackner H, Sovinz P, Speicher M, Uhrig S, Schwarzbraun T, Schwinger W, zur Stadt U, Beutel K, Janka G, Scarpatetti M, Seidel M. Fatal EBV Infection and Variable Clinical Manifestations in an XLP-1 Pedigree – Rapid Diagnosis of Primary Immunodeficiencies may Save Lives. Klin Padiatr 2012; 224:386-9. [DOI: 10.1055/s-0032-1323836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D. Sperl
- Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Austria
| | - M. Benesch
- Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Austria
| | - C. Urban
- Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Austria
| | - H. Lackner
- Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Austria
| | - P. Sovinz
- Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Austria
| | - M. Speicher
- Institut für Humangenetik, Medizinische Universität Graz, Graz, Austria
| | - S. Uhrig
- Institut für Humangenetik, Medizinische Universität Graz, Graz, Austria
| | - T. Schwarzbraun
- Institut für Humangenetik, Medizinische Universität Graz, Graz, Austria
| | - W. Schwinger
- Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Austria
| | - U. zur Stadt
- Klinik und Poliklinik für pädiatrische Hämatologie and Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - K. Beutel
- Klinik und Poliklinik für pädiatrische Hämatologie and Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - G. Janka
- Klinik und Poliklinik für pädiatrische Hämatologie and Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - M. Scarpatetti
- Institut für Pathologie, Medizinische Universität Graz, Graz, Austria
| | - M. Seidel
- Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Austria
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9
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Schweiger M, Stiegler P, Scarpatetti M, Wasler A, Sereinigg M, Prenner G, Tscheliessnigg K. Case of Paracoccus yeei infection documented in a transplanted heart. Transpl Infect Dis 2010; 13:200-3. [PMID: 20854281 DOI: 10.1111/j.1399-3062.2010.00571.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
After a successful cardiac transplantation, routine endomyocardial biopsies showed severe infiltrates comparable with myocarditis. Polymerase chain reaction analysis of native myocardial samples revealed infection with Paracoccus yeei, and the clinical condition of the patient deteriorated. After administration of ciprofloxacin, his clinical condition improved, and further biopsies showed no infiltrates in the cardiac specimens. To our knowledge this is the first documented case of P. yeei infection in a heart transplant patient.
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Affiliation(s)
- M Schweiger
- Division of Transplantation Surgery, Department of Surgery, Medical University Graz, Graz, Austria.
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10
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Eicher W, Kau T, Scarpatetti M, Hausegger KA. [Image of an aorto-left ventricular tunnel in infectious endocarditis with dual source multidetector CT angiography]. ROFO-FORTSCHR RONTG 2009; 181:1084-6. [PMID: 19676021 DOI: 10.1055/s-0028-1109620] [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: 10/20/2022]
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11
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Hermann J, Reittner P, Scarpatetti M, Graninger W. Successful treatment of meningeal involvement in Wegener's granulomatosis with infliximab. Ann Rheum Dis 2006; 65:691-2. [PMID: 16611871 PMCID: PMC1798150 DOI: 10.1136/ard.2005.043885] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Abstract
We report the case of a 61-year-old man, who underwent transsphenoidal surgery for a pituitary macroadenoma. The presence of tough fibrous septa dividing the tumour permitted only a partial resection. Progressive loss of consciousness soon after surgery occurred, an emergency CT scan showed no evidence of haemorrhage. Twenty hours later, MRI revealed compression of both internal carotid arteries with arrest of arterial flow resulting in stroke by an enlarged haemorrhagic mass consistent with a pituitary apoplexy. On the second postoperative day, the patient died as a result of this extensive stroke. The mechanisms of this rare complication after transsphenoidal surgery are theorized and the sensitivity of imaging methods is discussed.
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Affiliation(s)
- S Kurschel
- Department of Neurosurgery, Medical University, Graz, Austria.
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13
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Ardjomand N, Faschinger C, Haller-Schober EM, Scarpatetti M, Faulborn J. [A clinico-pathological case report of necrotizing ulcerating keratopathy due to topical anaesthetic abuse]. Ophthalmologe 2002; 99:872-5. [PMID: 12430041 DOI: 10.1007/s00347-002-0623-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Topical anesthetic abuse is rare, but difficult to diagnose since most patients deny its use and the clinical changes are very similar to other corneal diseases. CASE REPORT A 45-year-old medical doctor with a 30-year history of soft contact lens wear and recurrent corneal erosion was admitted to our clinic with a ring-shaped keratitis and intense ocular pain. A corneal smear was negative for bacterial infections and acanthamoeba but the contact lens box contained a few dead acanthamoeba and many cocci. Due to the clinical findings and the acanthamoeba found in the contact lens box acanthamoeba keratitis was diagnosed and treatment with gentamycin, pentamidine isethionat (Brolene((R))) and hexamidine (Desomedine((R))) was started. The clinical appearance did not change for 6 weeks after onset of treatment and a perforating corneal transplantation was performed for pain relief and visual rehabilitation. An iris ectropion lacking iris motility and dense cataract developed within 5 weeks and the patient admitted on direct questioning to having taken topical anesthetic (oxybuprocain) by self-medication. The histological investigation revealed few inflammatory cells. The epithelium was largely missing and few vital cells could be found in the stroma and the endothelial cell layer. Acanthamoeba could not be detected in the tissue. CONCLUSION Topical anesthetic abuse can mimic different corneal diseases and be difficult to diagnose if the patient denies its use. In cases of keratitis with no response to treatment and strong ocular pain, topical anesthetic abuse should be considered.
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Affiliation(s)
- N Ardjomand
- Universitäts-Augenklinik, Karl-Franzens-Universität, Graz, Germany.
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14
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Ardjomand N, Can B, Schaffler G, Eustacchio S, Scarpatetti M, Pendl G. [Therapy of neurotrophic keratopathy in trigeminal schwannoma with radiosurgery]. Wien Klin Wochenschr 2001; 113:605-9. [PMID: 11571839] [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: 02/21/2023]
Abstract
BACKGROUND We present a patient with neurotrophic keratopathy due to a trigeminal nerve neurinoma, who was successfully treated by radiosurgery. PATIENT A patient was referred to us with recurrent corneal erosions of unknown origin in his left eye. In addition, he suffered from mild hypoesthesia in the distribution of the first branch of the trigeminal nerve. He was started on topical lubricants (hyaluronic acid 0.5%) and antibiotic ointments (gentamycin), but since no corneal healing occurred, a soft contact lens was applied. The patient developed severe corneal neovascularization within four weeks and the contact lens had to be removed. Three months later an MRI scan was performed, which showed an intracranial tumor originating from the first branch of the trigeminal nerve. Neurinoma of the trigeminal nerve was suspected, and this presumed diagnosis was confirmed by fine needle biopsy. The patient underwent radiosurgery seven weeks later. The epithelium closed, the cornea recovered and stayed stable until the last examination 18 months after radiosurgery. CONCLUSION Radiosurgery is a promising alternative to conventional microsurgery in cases of neurinomas of the trigeminal nerve including neurotrophic keratopathy, to keep or restore vision.
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Affiliation(s)
- N Ardjomand
- Universitäts-Augenklinik, Karl-Franzens-Universität, Graz, Osterreich.
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15
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Neumeister P, Eibl M, Zinke-Cerwenka W, Scarpatetti M, Sill H, Linkesch W. Hepatic veno-occlusive disease in two patients with relapsed acute myeloid leukemia treated with anti-CD33 calicheamicin (CMA-676) immunoconjugate. Ann Hematol 2001; 80:119-20. [PMID: 11261323 DOI: 10.1007/s002770000239] [Citation(s) in RCA: 35] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Monoclonal antibodies recognizing hematopoietic antigens are increasingly being used to target therapy directly at leukemic cells, with the aim of achieving sustained remission with little systemic toxicity. Administration of anti-CD33 calicheamicin immunoconjugate is commonly regarded as being safe, with only moderate systemic non-hematological side effects. We report on two cases of hepatic veno-occlusive disease in heavily pretreated patients presenting with relapsed acute myeloid leukemia (AML). Since significant liver toxicity prevented further specific therapy in both patients, we recommend that antibody therapy with anti-CD33 immunoconjugate should be applied with caution in patients presenting with risk factors for the development of hepatic veno-occlusive disease.
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Affiliation(s)
- P Neumeister
- Institute of Cancer Genetics, Columbia University, 1150 St. Nicholas Ave, Room 307 New York, NY 10032, USA.
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