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Maus V, Rogozinski S, Borggrefe J, Barnikol UB, Saklak M, Mpotsaris A. Clinical presentation of posterior cerebral artery occlusions - Clinical rationale for a more aggressive therapeutic strategy? eNeurologicalSci 2021; 25:100368. [PMID: 34765752 PMCID: PMC8571698 DOI: 10.1016/j.ensci.2021.100368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction A proximal occlusion of the posterior cerebral artery (PCA) can affect patients severely and clinical outcome might be poor. Aim of this paper is to describe clinical presentation, diagnostic findings and outcome of patients suffering from ischemia in the PCA territory. Methods We conducted a retrospective analysis of clinically affected patients with imaging-based evidence of ischemia within in the PCA territory at a comprehensive stroke center over a six-year period. Clinical (including demographics, National Institutes of Health Stroke Scale, NIHSS, modified Rankin Sclae, mRS), imaging (including occlusion site and brain infarction) and therapeutic data were evaluated. A favorable outcome was defined as an mRS ≤2. Results Two hundred thirty-five patients were clinically affected with evidence of PCA ischemia detected by cross-sectional imaging. One-hundred fourty-five patients demonstrated an occlusion of the PCA including 43/145 (30%) with P1 occlusion, 80/145 (55%) with P2 and 22/145 (15%) with P3 occlusion. The most frequent symptom was hemi−/ quadrantanopsia (181/235, 77%). Sixty-eight patients (29%) suffered from hemiparesis. The occurrence of a hemiparesis was associated with a P1 occlusion (27/43, 63% vs. 41/192, 21%; p < 0.0001). Hemi−/quadrantanopsia was less frequently associated with a P1 occlusion (26/43, 61% vs. 155/192, 81%; p = 0.0043). P1 occlusions more frequently showed thalamic infarction (28/43, 65% vs. 65/192, 34%; p < 0.0001). At discharge, patients with P1 occlusion more often showed a poor outcome (mRS > 2, 30/43, 70% vs. 55/192, 29%; p < 0.0001). Conclusion Hemiparesis due to P1 occlusion is a common phenomenon in stroke patients and associated with a poor clinical outcome. Hemiparesis in patients with a proximal PCA occlusion is a frequent event. Proximal PCA occlusions are associated with thalamic infarction. The clinical outcome in patients with proximal PCA occlusion is poor.
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Affiliation(s)
- Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany
| | - Sophia Rogozinski
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Hannover, Hannover, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Utako Birgit Barnikol
- Department of Child and Adolescence Psychiatry, Research Unit Ethics in Translational Oncology Clinic1 of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Muharrem Saklak
- Department of Surgery, DRK Hospital Berlin-Mitte, Berlin, Germany
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Abdullayev N, Maus V, Behme D, Barnikol UB, Kutschke S, Stockero A, Goertz L, Celik E, Zaeske C, Borggrefe J, Schlamann M, Liebig T, Kabbasch C, Mpotsaris A. True first-pass effect in basilar artery occlusions: First-pass complete reperfusion improves clinical outcome in stroke thrombectomy patients. J Clin Neurosci 2021; 89:33-38. [PMID: 34119289 DOI: 10.1016/j.jocn.2021.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/20/2021] [Accepted: 04/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete reperfusion (mTICI 3) in anterior circulation ischemic stroke patients after a single mechanical thrombectomy (MT) pass has been identified as a predictor of favorable outcome (modified Rankin Score 0-2) and defined as true first-pass effect recently. This effect has not yet been demonstrated in posterior circulation ischemic stroke. We hypothesized a true first-pass effect for the subgroup of acute basilar artery occlusions (BAO). METHODS Consecutive patients with acute thromboembolic occlusions in the posterior circulation, treated between 2010 and 2017, were screened and all BAO patients with complete angiographic reperfusion and known symptom onset included for unmatched and matched analysis after adjustment for multiple confounding factors (demographics, time intervals, stroke severity, posterior circulation Alberta Stroke Program early computed tomography Score and comorbidity. The primary objective was outcome at 90 days between matched cohorts of single pass vs. multi pass complete reperfusion patients. RESULTS 90 MTs in BAO were analyzed, yielding 56 patients with known symptom onset, in whom we achieved complete reperfusion (mTICI 3), depending on whether complete reperfusion was achieved after a single pass (n = 28) or multiple passes (n = 28). Multivariable analysis of 56 non-matched patients revealed a significant association between first-pass complete reperfusion and favorable outcome (p < 0.01). In matched cohorts (n = 7 vs. n = 7), favorable outcome was only seen if complete reperfusion was achieved after a single pass (86% vs. 0%). CONCLUSION Single pass complete reperfusion in acute basilar artery occlusion is an independent predictor of favorable outcome. Achieving complete reperfusion after multiple passes might impair favorable patient recovery.
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Affiliation(s)
- N Abdullayev
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany.
| | - V Maus
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - D Behme
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - U B Barnikol
- Department of Child and Adolescence Psychiatry, Research Unit Ethics in Translational Oncology Clinica1 of Internal Medicine, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - S Kutschke
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - A Stockero
- Department of Neuroradiology, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - L Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - E Celik
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - C Zaeske
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - J Borggrefe
- Institute of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Klinikum Minden, Hans-Nolte-Straße 1, 32429 Minden, Germany
| | - M Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - T Liebig
- Institute of Neuroradiology, University Hospital Munich (LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - C Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - A Mpotsaris
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
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Maus V, Barnikol UB, Mpotsaris A. Challenge of Attaining Flow Arrest in Anterior Circulation Tandem Occlusions in Large Vessel Ischemic Stroke: Wedged SAVE Technique. Cerebrovasc Dis 2018; 46:211-212. [PMID: 30419561 DOI: 10.1159/000494703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Volker Maus
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany,
| | - Utako Birgit Barnikol
- Department of Child and Adolescence Psychiatry, Research Unit Ethics and University Hospital Cologne, Cologne, Germany
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Maus V, Kalkan A, Kabbasch C, Abdullayev N, Stetefeld H, Barnikol UB, Liebig T, Dohmen C, Fink GR, Borggrefe J, Mpotsaris A. Correction to: Mechanical Thrombectomy in Basilar Artery Occlusion : Presence of Bilateral Posterior Communicating Arteries is a Predictor of Favorable Clinical Outcome. Clin Neuroradiol 2018; 29:161-162. [PMID: 29318351 DOI: 10.1007/s00062-017-0661-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Correction to: Clin Neuroradiol 2017 https://doi.org/10.1007/s00062-017-0651-3 The original version of this article unfortunately contained a mistake. The presentation of Fig. 2 was incorrect. The corrected figure is given ….
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Affiliation(s)
- Volker Maus
- Department of Neuroradiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Alev Kalkan
- Department of Neuroradiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Nuran Abdullayev
- Department of Neuroradiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Henning Stetefeld
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Utako Birgit Barnikol
- Clearing Unit Ethics, Medical Faculty of Cologne & Research Unit Ethics, Department of Child and Adolescence Psychiatry, University Hospital Cologne, Cologne, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Charité, Berlin, Germany
| | - Christian Dohmen
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Jan Borggrefe
- Department of Neuroradiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Maus V, Mpotsaris A, Dorn F, Möhlenbruch M, Borggrefe J, Stavrinou P, Abdullayev N, Barnikol UB, Liebig T, Kabbasch C. The Use of Flow Diverter in Ruptured, Dissecting Intracranial Aneurysms of the Posterior Circulation. World Neurosurg 2017; 111:e424-e433. [PMID: 29277587 DOI: 10.1016/j.wneu.2017.12.095] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Acute dissecting aneurysms of the posterior circulation are a rare cause of subarachnoid hemorrhage. Established endovascular treatment options include parent artery occlusion and stent-assisted coiling, but appear to be associated with an increased risk of ischemic stroke. Vessel reconstruction with flow diverters is an alternative treatment option; however, its safety and efficacy in the acute stage remains unclear. METHODS This is a multicentric retrospective analysis of 15 consecutive acutely ruptured dissecting posterior circulation aneurysms treated with flow diverters. The primary end point was favorable aneurysm occlusion, defined as OKM C1-3 and D (O'Kelly Marotta scale). Secondary end points were procedure-related complications and clinical outcome. RESULTS Nine of 15 aneurysms (60%) arose from the intradural portion of the vertebral artery, 3 were located on the posterior inferior cerebellar artery and 1 each on the anterior inferior cerebellar artery, posterior cerebral artery, and basilar artery. Flow diverter placement was technically successful in 14 of 15 cases (93%). After endovascular treatment, none of the ruptured aneurysms rebled. Median clinical follow-up was 217 days and median angiographic follow-up was 203 days. Favorable occlusion was observed in 7 of 14 aneurysms (50%) directly after flow diverter placement; of those, 5 were completely occluded (36%). Seven patients (47%) with poor-grade subarachnoid hemorrhage died in the acute phase. Favorable clinical outcome (modified Rankin scale ≤2) was observed in 4 of 15 patients (27%) and a moderate outcome (modified Rankin scale 3/4) was observed in 5 of 15 patients (33%). All aneurysms showed complete occlusion at follow-up. CONCLUSIONS Flow diverters might be a feasible, alternative treatment option for acutely ruptured dissecting posterior circulation aneurysms and may effectively prevent rebleeding. Larger cohort studies are required to validate these results.
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Affiliation(s)
- Volker Maus
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany.
| | | | - Franziska Dorn
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Borggrefe
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Pantelis Stavrinou
- Department of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Nuran Abdullayev
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Utako Birgit Barnikol
- Clearing Unit Ethics, Medical Faculty of Cologne & Research Unit Ethics, Department of Child and Adolescence Psychiatry, University Hospital Cologne, Cologne, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Charite, Berlin, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
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Maus V, Behme D, Borggrefe J, Kabbasch C, Seker F, Hüseyin C, Barnikol UB, Yeo LLL, Brouwer P, Söderman M, Möhlenbruch M, Psychogios MN, Liebig T, Dohmen C, Fink GR, Mpotsaris A. Carotid Artery Stenosis Contralateral to Acute Tandem Occlusion: An Independent Predictor of Poor Clinical Outcome after Mechanical Thrombectomy with Concomitant Carotid Artery Stenting. Cerebrovasc Dis 2017; 45:10-17. [PMID: 29208850 DOI: 10.1159/000484719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Cerebral ischemic strokes due to extra-/intracranial tandem occlusions (TO) of the anterior circulation are responsible for causing mechanical thrombectomy (MT). The impact of concomitant contralateral carotid stenosis (CCS) upon outcome remains unclear in this stroke subtype. METHODS Retrospective analysis of prospectively collected data of 4 international stroke centers between 2011 and 2017. One hundred ninety-seven consecutive patients with anterior TO were treated with MT and acute carotid artery stenting (CAS). Clinical (including demographics and National Institutes of Health Stroke Scale [NIHSS]), imaging (including angiographic evaluation of CCS) and procedural data were evaluated. Favorable clinical outcome was defined as modified Rankin Scale (mRS) ≤2 at 90 days. RESULTS In 186 out of 197 TO patients preinterventional CT angiography was available for analysis, thereof 49 patients (26%) presented with CCS. Median admission NIHSS and procedural timings did not differ between groups. Reperfusion was successful in 38 out of 49 patients (78%) vs. 113 out of 148 patients (76%) without CCS. In stark contrast, rate of favorable outcome at 90 days differed significantly between groups (22 vs. 44%; p < 0.05). The presence of CCS in TO was associated with an unfavorable clinical outcome independent of age and NIHSS in multivariate logistic regression (p < 0.05). Final infarct volume was significantly larger in CCS patients (100 ± 127 vs. 63 ± 77 cm3; p < 0.05). Neither all-cause mortality rates (25 vs. 17%) nor frequency of peri-interventional symptomatic intracranial hemorrhage differed between groups (7 vs. 6%). CONCLUSION For patients with anterior TO undergoing MT with concomitant CAS the presence of CCS >50% is an independent predictor of poor clinical outcome. This most likely cause is due to poorer collateral flow to the affected tissue.
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Affiliation(s)
- Volker Maus
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Borggrefe
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Fatih Seker
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Cicek Hüseyin
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Utako Birgit Barnikol
- Clearing Unit Ethics, Medical Faculty of Cologne and Research Unit Ethics, Department of Child and Adolescence Psychiatry, University Hospital of Cologne, Cologne, Germany
| | - Leonard Leong Litt Yeo
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Patrick Brouwer
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Söderman
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Christian Dohmen
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
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Maus V, You S, Kalkan A, Borggrefe J, Kabbasch C, Barnikol UB, Stetefeld H, Dohmen C, Liebig T, Fink GR, Mpotsaris A. Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke. Cerebrovasc Dis 2017; 44:113-121. [PMID: 28605743 DOI: 10.1159/000477499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Cerebral large vessel occlusion (LVO) in acute ischemic stroke (AIS) may be complete (CLVO) or incomplete (ILVO). The influence of ILVO on clinical outcome after mechanical thrombectomy (MT) remains unclear. We investigated primarily the clinical outcome in patients with AIS due to ILVO or CLVO. METHODS Five hundred three consecutive AIS patients with LVO treated with stent-retriever or direct aspiration-based MT between 2010 and 2016 were analyzed. The primary endpoint was favorable clinical outcome (modified Rankin Scale ≤2) at 90 days; secondary endpoints were periprocedural parameters. RESULTS Forty-nine patients (11.3%) with a median National Institutes of Health Stroke Scale (NIHSS) of 11 presented with ILVO and the remainder presented with CLVO and median NIHSS of 15 (p < 0.001). The median groin puncture-to-reperfusion time was 30 vs. 67 min, respectively (p < 0.001). Successful reperfusion was reached in 47 out of 49 ILVO (95.9%) vs. 298 out of 381 CLVO (78.2%; p < 0.005) with less retrieval maneuvers (1.7 ± 2.2 vs. 3.0 ± 2.5; p < 0.001). The favorable outcome at 90 days was 81% in patients with ILVO vs. 29.1% in CLVO (p < 0.001); respective all-cause mortality rates were 6.4 vs. 28.5% (p < 0.001). Periprocedural complications (6.9%) occurred exclusively in CLVO patients (p < 0.05). ILVO was associated with favorable clinical outcome independent of age and NIHSS in multivariate logistic regression both in the anterior (OR 3.6; 95% CI 1.8-6.9; p < 0.001) and posterior circulation (OR 3.5; 95% CI 1.8-6.9; p < 0.001). CONCLUSIONS AIS due to ILVO is frequent and is associated with a nearly threefold higher chance of favorable clinical outcome at 90 days, independent of age and initial NIHSS compared to CLVO.
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Affiliation(s)
- Volker Maus
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
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Möller HJ, Bandelow B, Volz HP, Barnikol UB, Seifritz E, Kasper S. The relevance of 'mixed anxiety and depression' as a diagnostic category in clinical practice. Eur Arch Psychiatry Clin Neurosci 2016; 266:725-736. [PMID: 27002521 PMCID: PMC5097109 DOI: 10.1007/s00406-016-0684-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/17/2016] [Indexed: 01/04/2023]
Abstract
According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.
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Affiliation(s)
- Hans-Jürgen Möller
- Clinic and Polyclinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Nußbaumstrasse 7, 80336, Munich, Germany
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, von-Siebold-Strasse 5, 37075, Göttingen, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440, Werneck, Germany
| | - Utako Birgit Barnikol
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University Medical Center Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Albertus Magnus University of Cologne, Joseph Stelzmann Strasse 20, 50937, Cologne, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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9
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Jacobi F, Barnikol UB. [Estimation of prevalence and treatment needs of mental disorders. The problem of diagnostic thresholds]. Nervenarzt 2015; 86:42-50. [PMID: 25503066 DOI: 10.1007/s00115-014-4110-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Uncertainties in the context of threshold-based diagnostics represent a theoretically unsolved methodological problem that may require multidimensional solutions. Pragmatically, current research focuses on establishing reliable and valid operationalized criteria within the framework of diagnostic systems, such as the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). AIM AND METHODS By means of model calculations based on epidemiological data we show how exemplified changes in the disorder spectrum and diagnostic criteria influence case numbers. Furthermore, we investigate how threshold-based constructs, such as DSM-IV diagnoses, relate to the general criteria of illness and sickness. RESULTS Variations in the disorder spectrum and thresholds lead to slight to moderate changes in case numbers. Regarding distress and impairment, mental disorders are associated with significantly reduced health-related quality of life and an increased number of days out of role (due to mental and/or physical problems). With increasing distress and impairment, the percentage of mental disorders increases significantly; in the 5 % of the general population with the highest distress and impairment, the proportion is nearly 80 %. DISCUSSION Despite fuzzy boundaries, threshold-based diagnoses (DSM-IV) represent a satisfactory and reproducible disease classification (in terms of illness and sickness) for estimation of prevalence. There is a lack of definitions and instruments to assess treatment needs. It is still debated whether diagnostic symptom criteria always represent pathological disorders (i. e. disease).
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Affiliation(s)
- F Jacobi
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Deutschland,
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10
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes an innovative chapter on neurocognitive disorders (NCD) as a substitute for the dementia, delirium and amnestic disorders chapter in DSM-IV. This NCD chapter promotes a most innovative change compared to DSM-IV. While the term delirium is preserved, the commonly used term dementia does not occur as a diagnostic entity. Neurocognitive disorders are more inclusive than dementias; they also cover early prodromal stages of dementias below the DSM-IV threshold. The diagnosis of NCDs requires essentially neuropsychological testing preferentially with standardized instruments. Special focus is given to etiological subtyping taking former diagnostic consensus processes by expert groups into consideration. The subsequent more extensive concept of NCD also allows the diagnosis of etiological-specific prodromal states of cognitive impairments. The changes from DSM-IV to DSM-5 are critically discussed.
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Affiliation(s)
- W Maier
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Bonn, Sigmund-Freud-Str. 25, 53115, Bonn, Deutschland,
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Hauptmann C, Roulet JC, Niederhauser JJ, Döll W, Kirlangic ME, Lysyansky B, Krachkovskyi V, Bhatti MA, Barnikol UB, Sasse L, Bührle CP, Speckmann EJ, Götz M, Sturm V, Freund HJ, Schnell U, Tass PA. External trial deep brain stimulation device for the application of desynchronizing stimulation techniques. J Neural Eng 2009; 6:066003. [PMID: 19837998 DOI: 10.1088/1741-2560/6/6/066003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [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]
Abstract
In the past decade deep brain stimulation (DBS)-the application of electrical stimulation to specific target structures via implanted depth electrodes-has become the standard treatment for medically refractory Parkinson's disease and essential tremor. These diseases are characterized by pathological synchronized neuronal activity in particular brain areas. We present an external trial DBS device capable of administering effectively desynchronizing stimulation techniques developed with methods from nonlinear dynamics and statistical physics according to a model-based approach. These techniques exploit either stochastic phase resetting principles or complex delayed-feedback mechanisms. We explain how these methods are implemented into a safe and user-friendly device.
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Affiliation(s)
- C Hauptmann
- Institute of Neuroscience and Medicine, Neuromodulation INM-7 and Virtual Institute of Neuromodulation, Forschungszentrum Jülich, Leo-Brandt-Str., D-52425 Jülich, Germany
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Tass PA, Silchenko AN, Hauptmann C, Barnikol UB, Speckmann EJ. Long-lasting desynchronization in rat hippocampal slice induced by coordinated reset stimulation. Phys Rev E Stat Nonlin Soft Matter Phys 2009; 80:011902. [PMID: 19658724 DOI: 10.1103/physreve.80.011902] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 04/08/2009] [Indexed: 05/28/2023]
Abstract
In computational models it has been shown that appropriate stimulation protocols may reshape the connectivity pattern of neural or oscillator networks with synaptic plasticity in a way that the network learns or unlearns strong synchronization. The underlying mechanism is that a network is shifted from one attractor to another, so that long-lasting stimulation effects are caused which persist after the cessation of stimulation. Here we study long-lasting effects of multisite electrical stimulation in a rat hippocampal slice rendered epileptic by magnesium withdrawal. We show that desynchronizing coordinated reset stimulation causes a long-lasting desynchronization between hippocampal neuronal populations together with a widespread decrease in the amplitude of the epileptiform activity. In contrast, periodic stimulation induces a long-lasting increase in both synchronization and amplitude.
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Affiliation(s)
- P A Tass
- Institute of Neuroscience and Medicine-Neuromodulation (INM-7), Research Center Jülich, D-52425 Jülich, Germany
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Schiek M, Silex C, Tass PA, Barnikol UB, Hauptmann C, Freund HJ, Sturm V. Novel Deep Brain Stimulation Techniques based on Stochastic Phase Resetting Principles. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832154] [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: 10/19/2022]
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Silex C, Tass PA, Schiek M, Hermes N, Rongen H, Barnikol UB, Hauptmann C, Freund HJ, Sturm V. Novel Modulating Deep Brain Stimulation Techniques based on Real-Time Model in the Loop Concepts. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832177] [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: 10/19/2022]
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Dammers J, Barnikol UB, Wuttich S, Boers F, Muren A, Mohlberg H, Amunts K, Zilles K, Tass PA. Combined MEG and Cytoarchitectonic Data Imaging. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-831947] [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: 10/19/2022]
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Barnikol UB, Dammers J, Fieseler T, Boers F, Muren A, Wuttich S, Mohlberg H, Hesselmann G, Amunts K, Zilles K, Niedeggen M, Tass PA. Differential Activation of Visual Areas V1 and V5 by Pattern Reversal Stimulation – An MEG Study. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-831922] [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: 10/19/2022]
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