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Cohen OS, Kahana E, Korczyn AD, Ziv-Baran T, Nitsan Z, Appel S, Rosenmann H, Chapman J. Pseudo-anticipation in Creutzfeldt-Jakob disease is due to a rhomboid-shaped artifact. Eur J Neurol 2020; 27:596-602. [PMID: 31814268 DOI: 10.1111/ene.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have reported conflicting results regarding possible anticipation in familial E200K Creutzfeldt-Jakob disease (fCJD). Our objective was to use a large database to assess the age of disease onset (AODO) in CJD. METHODS The study population included 477 CJD patients [266 with fCJD, 145 with sporadic CJD (sCJD) and 66 patients of Libyan origin but negative family history] from the Israeli registry of CJD conducted since 1954. In all patients, AODO in relatives and family trees was documented. Comparison of AODO was done using a paired t test and regression using Pearson correlation for birth and year of onset. RESULTS The initial analysis in 52/73 families in which more than one generation was affected revealed an AODO of 63.30 ± 9.44 in the first generation compared to 56.96 ± 8.99 in the second generation (P < 0.001). However, inspection of individual AODO values plotted by year of birth showed a clear rhomboid methodological artifact generated by missing data of many young onset CJD patients who died before the database began to function in 1954 and of many late onset CJD patients missing at the present time since they will only develop the disease in the future. The 'generation' effect completely disappears if analysis is performed by year of disease onset or for the periods in which complete data are available. CONCLUSIONS In this very large dataset, true anticipation in fCJD patients was not detected. It is plausible that previous reports supporting the presence of anticipation are biased by a rhomboid-shaped data availability artifact.
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Affiliation(s)
- O S Cohen
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - E Kahana
- Barzilai Medical Center, Ashkelon, Israel.,Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
| | - A D Korczyn
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - T Ziv-Baran
- Departments of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Nitsan
- Barzilai Medical Center, Ashkelon, Israel.,Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
| | - S Appel
- Barzilai Medical Center, Ashkelon, Israel.,Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
| | - H Rosenmann
- Department of Neurology, Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - J Chapman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Robert and Martha Harden Chair in Mental and Neurological Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Kipervasser S, Elger CE, Korczyn AD, Nass RD, Quesada CM, Neufeld MY. Gait instability in valproate-treated patients: Call to measure ammonia levels. Acta Neurol Scand 2017; 136:401-406. [PMID: 28436001 DOI: 10.1111/ane.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Hyperammonemia induced by valproate (VPA) treatment may lead to several neurological and systemic symptoms as well as to seizure exacerbation. Gait instability and recurrent falls are rarely mentioned as symptoms, especially not as predominant ones. METHODS We report five adult patients with frontal lobe epilepsy (FLE) who were treated with VPA and in whom a primary adverse effect was unstable gait and falls. RESULTS There were four males and one female patients with FLE, 25-42-year-old, three following epilepsy surgery. All of them were treated with antiepileptic drug polytherapy. Gait instability with falls was one of the principal sequelae of the treatment. Patients also exhibited mild encephalopathy (all patients) and flapping tremor (three patients) that developed following the addition of VPA (three patients) and with chronic VPA treatment (two patients). VPA levels were within the reference range. Serum ammonia levels were significantly elevated (291-407 μmole/L, normal 20-85) with normal or slightly elevated liver enzymes. VPA dose reduction or discontinuation led to the return of ammonia levels to normal and resolution of the clinical symptoms, including seizures, which disappeared in two patients and either decreased in frequency or became shorter in duration in the other three. CONCLUSIONS Gait instability due to hyperammonemia and VPA treatment is probably under-recognized in many patients. It can develop when the VPA levels are within the reference range and with normal or slightly elevated liver enzymes.
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Affiliation(s)
- S. Kipervasser
- EEG and Epilepsy Unit; Department of Neurology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - C. E. Elger
- Department of Epileptology; University of Bonn; Bonn Germany
| | - A. D. Korczyn
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - R. D. Nass
- Department of Epileptology; University of Bonn; Bonn Germany
| | - C. M. Quesada
- Department of Epileptology; University of Bonn; Bonn Germany
| | - M. Y. Neufeld
- EEG and Epilepsy Unit; Department of Neurology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
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3
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Balash Y, Korczyn AD, Knaani J, Migirov AA, Gurevich T. Quality-of-life perception by Parkinson's disease patients and caregivers. Acta Neurol Scand 2017; 136:151-154. [PMID: 28083960 DOI: 10.1111/ane.12726] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND The quality-of-life (QoL) perception by Parkinson's disease (PD) patients and their caregivers (CG) has not been studied in depth. OBJECTIVE To examine patient/proxy agreements on the PD QoL Questionnaire (PDQ-39), the Scale of Quality of Life of Care-Givers (SQLC) and the Multidimensional Caregiver Strain Index (MCSI). METHODS Patients with PD and their CG completed the above-mentioned questionnaires about themselves and each other. The intraclass correlations between their scores (paired t test) were compared. RESULTS Twelve patient-CG pairs were studied. Agreements for QoL items were strong and comparable for the total scores of the PDQ-39, SQLC and MCSI questionnaires (75.4% ± 14%; 78.1% ± 14.1% and 78.2% ± 14.3%, respectively). Agreements ranged from moderate to strong (0.57-0.88, P≤.05) for the patients' physical condition (PDQ-39 items 3, 5, 6, 8, 12-15, 23, 24, 35), mental concentration (item 31) and depression (item 17). Disagreements were apparent in 20%-25% of the pairs and were particularly significant for PDQ-39 items #33 and #25 (embarrassment of patients in public and distressing dreams or hallucinations), in which the CG gave higher scores than the patients. CONCLUSIONS Agreements between patients with PD and CG were generally good for most, but not all, of the PDQ-39, SQLC and MCSI domains.
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Affiliation(s)
- Y. Balash
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - A. D. Korczyn
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - J. Knaani
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
| | - A. A. Migirov
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
| | - T. Gurevich
- Movement Disorders Unit; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
- Sagol School of Neuroscience; Tel-Aviv University; Tel Aviv Israel
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Ben Assayag E, Tene O, Korczyn AD, Shopin L, Auriel E, Molad J, Hallevi H, Kirschbaum C, Bornstein NM, Shenhar-Tsarfaty S, Kliper E, Stalder T. High hair cortisol concentrations predict worse cognitive outcome after stroke: Results from the TABASCO prospective cohort study. Psychoneuroendocrinology 2017; 82:133-139. [PMID: 28549269 DOI: 10.1016/j.psyneuen.2017.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/19/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE The role of stress-related endocrine dysregulation in the development of cognitive changes following a stroke needs further elucidation. We explored this issue in a longitudinal study on stroke survivors using hair cortisol concentrations (HCC), a measure of integrated long-term cortisol levels. METHODS Participants were consecutive cognitively intact first-ever mild-moderate ischemic stroke/transient ischemic attack (TIA) survivors from the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study. They underwent 3T magnetic resonance imaging (MRI) scanning and were cognitively assessed at admission, and at 6, 12 and 24 months post-stroke. Scalp hair samples were obtained during the initial hospitalization. RESULTS Full data on baseline HCC, MRI scans and 2 years neuropsychological assessments were available for 65 patients. Higher HCC were significantly associated with a larger lesion volume and with worse cognitive results 6, 12 and 24 months post-stroke on most of the neurocognitive tests. 15.4% of the participants went on to develop clinically significant cognitive decline in the follow-up period, and higher HCC at baseline were found to be a significant risk factor for this decline, after adjustment for age, gender, body mass index and APOE e4 carrier status (HR=6.553, p=0.038). CONCLUSIONS Our findings suggest that individuals with higher HCC, which probably reflect higher long-term cortisol release, are prone to develop cognitive decline following an acute stroke or TIA.
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Affiliation(s)
- E Ben Assayag
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - O Tene
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - A D Korczyn
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - L Shopin
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel
| | - E Auriel
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - J Molad
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel
| | - H Hallevi
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - N M Bornstein
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - S Shenhar-Tsarfaty
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel
| | - E Kliper
- Departments of Neurology and Psychiatry, Tel Aviv Sourasky Medical Center, Israel; The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Israel
| | - T Stalder
- Department of Psychology, TU Dresden, Germany; Department of Clinical Psychology, University Siegen, Germany
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Treves TA, Parmet Y, Klimovitzky S, Korczyn AD. The effect of schooling on reported age of onset of cognitive decline: A collaborative study. J Clin Neurosci 2016; 34:86-88. [PMID: 27622604 DOI: 10.1016/j.jocn.2016.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/17/2016] [Accepted: 05/08/2016] [Indexed: 11/30/2022]
Abstract
Higher education has been reported to be a protective factor against dementia. We suggest that the strength of a risk factor may be measured by the length of time by which it delays disease onset; therefore, we examined whether people with lower education develop cognitive decline at an earlier age than people with more schooling. The study population was based on patients referred to our Memory Clinics from 1994 to 2004. Analysis of covariance was used to evaluate the effect of schooling on the reported age of memory decline, in patients with mild cognitive impairment (MCI) and in patients diagnosed with Alzheimer's disease (AD). The mean reported age of onset of cognitive decline was unexpectedly lower in patients with higher education than in patients with fewer schooling years, with a relatively small effect size (beta=-0.6), and the effect was more marked in the MCI group. Every year of schooling advanced the reported age of onset by 6months among patients with MCI (t=-6.18, p<.001) and by 3months among patients with AD (t=-2.4, p=0.017). Education may affect the reported age of onset of cognitive decline, but its magnitude is small. It is possible that increased awareness in more educated people leads them to consult earlier; this could explain the paradoxical finding of earlier reported age of onset of cognitive decline in patients with higher education.
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Affiliation(s)
- T A Treves
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel.
| | - Y Parmet
- Department of Engineering, Bengurion University, Beer Sheva, Israel
| | - S Klimovitzky
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel
| | - A D Korczyn
- Department of Neurology, Tel Aviv Medical Center, Tel Aviv, Israel
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Fride Y, Adamit T, Maeir A, Ben Assayag E, Bornstein NM, Korczyn AD, Katz N. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil 2016; 22:317-25. [PMID: 26461878 DOI: 10.1179/1074935714z.0000000013] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The percentage of working age people with mild stroke has risen. Evidence indicates that even mild stroke impact cognition, executive functioning, and daily functioning, consequently affecting participation, quality of life (QoL) and return to work (RTW). OBJECTIVES (1) Compare cognition, participation and QoL between people 3 months post-mild stroke who RTW and those who did not; and (2) To determine the correlates of these variables to RTW of participants 3 months post-stroke. METHODS We visited at home 163 stroke survivors (117 men, 46 women) 3 months post-mild stroke ranging from 50 to 89 years. Participants who returned to work (n = 114) and those who did not (n = 49). Data collection at home included measures for cognitive status (MoCA), executive functions (EFPT, DEX), depression (GDS), participation (RNL), and QoL (SIS recovery). RESULTS Significant differences were found between RTW participants and those who did not RTW in measures of cognition, depression, participation and QoL (t = 2.36 to - 5.62, P < 0.022-0.001). No difference was found on age or gender. Stepwise regression showed that significant correlates of RTW were participation (RNL), executive functions (EFPT), and QoL (SIS recovery). CONCLUSIONS To enable RTW after mild stroke, participation, executive functions and QoL must be considered in planning interventions.
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Cohen OS, Chapman J, Korczyn AD, Warman-Alaluf N, Nitsan Z, Appel S, Kahana E, Rosenmann H. CSF tau correlates with CJD disease severity and cognitive decline. Acta Neurol Scand 2016; 133:119-123. [PMID: 26014384 DOI: 10.1111/ane.12441] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Creutzfeldt-Jakob disease (CJD) is the most common prion disease in humans. The clinical diagnosis of CJD is supported by a combination of electroencephalogram, MRI, and the presence in the CSF of biomarkers. CSF tau is a marker for neuronal damage and tangle pathology, and is correlated with cognitive status in Alzheimer's disease (AD). OBJECTIVES The aim of this study was to test whether tau levels in the CSF also correlate with the degree of the neurological deficit and cognitive decline in patients with CJD as reflected by various clinical scales that assess disease severity and cognitive performance. METHODS Consecutive patients with familial CJD (fCJD) were examined by a neurologist who performed several tests including minimental status examination (MMSE), frontal assessment battery (FAB), NIH stroke scale (NIHSS), CJD neurological scale (CJD-NS), and the expanded disability status scale (EDSS). CSF tau was tested as part of the workout, and the correlation was tested using Pearson correlation. RESULTS Fifty-two patients with fCJD were recruited to the study (35 males, mean age 59.4 ± 5.7, range 48-75 years). A significant negative correlation was found between CSF tau levels and the cognitive performance of the patients as reflected by their MMSE and FAB scores. In addition, a significant positive correlation was found between tau levels and the clinical disease severity scales of CJD-NS, NIHSS, and EDSS. CONCLUSION The correlation between tau levels and the disease severity and degree of cognitive decline in patients with fCJD suggests that tau can be a biomarker reflecting the extent of neuronal damage.
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Affiliation(s)
- O. S. Cohen
- Department of Neurology; The Sagol Neuroscience Center; Chaim Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - J. Chapman
- Department of Neurology; The Sagol Neuroscience Center; Chaim Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - A. D. Korczyn
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - N. Warman-Alaluf
- Department of Neurology; The Sagol Neuroscience Center; Chaim Sheba Medical Center; Tel-Hashomer Israel
| | - Z. Nitsan
- Barzilai Medical Center; Ashkelon Israel
| | - S. Appel
- Barzilai Medical Center; Ashkelon Israel
| | - E. Kahana
- Barzilai Medical Center; Ashkelon Israel
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Cohen OS, Kimiagar I, Korczyn AD, Nitsan Z, Appel S, Hoffmann C, Rosenmann H, Kahana E, Chapman J. Unusual presentations in patients with E200K familial Creutzfeldt-Jakob disease. Eur J Neurol 2016; 23:871-7. [PMID: 26806765 DOI: 10.1111/ene.12955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/23/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PROPOSE Familial Creutzfeldt-Jakob disease (fCJD) in Jews of Libyan ancestry is caused by an E200K mutation in the PRNP gene. The typical presenting symptoms include cognitive decline, behavioral changes and gait disturbances; however, some patients may have an unusual presentation such as a stroke-like presentation, alien hand syndrome or visual disturbances. The aim of this paper is to describe uncommon presentations in our series of consecutive patients with E200K fCJD. METHODS The study group included consecutive fCJD patients followed up as part of a longitudinal prospective study ongoing since 2003 or hospitalized since 2005. The clinical diagnosis of probable CJD was based on accepted diagnostic criteria and supported by typical magnetic resonance imaging, electroencephalographic findings, elevated cerebrospinal fluid tau protein levels and by genetic testing for the E200K mutation. Disease symptoms and signs were retrieved from the medical files. RESULTS The study population included 77 patients (42 men) with a mean age of disease onset of 60.6 ± 7.2 years. The most prevalent presenting symptoms were cognitive decline followed by gait impairment and behavioral changes. However, six patients had an unusual presentation including auditory agnosia, monoparesis, stroke-like presentation, facial nerve palsy, pseudobulbar syndrome and alien hand syndrome. CONCLUSIONS Our case series illustrates the wide phenotypic variability of the clinical presentation of patients with fCJD and widens the clinical spectrum of the disease. A high level of clinical suspicion may prove useful in obtaining early diagnosis and therefore avoiding costly and inefficient diagnostic and therapeutic strategies.
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Affiliation(s)
- O S Cohen
- Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - I Kimiagar
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A D Korczyn
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Z Nitsan
- Barzilai Medical Center, Ashkelon, Israel
| | - S Appel
- Barzilai Medical Center, Ashkelon, Israel
| | - C Hoffmann
- Department of Radiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - H Rosenmann
- Department of Neurology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - E Kahana
- Barzilai Medical Center, Ashkelon, Israel
| | - J Chapman
- Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Blum I, Korczyn AD. Peptide neurotransmitters and their implications for the treatment of tardive dyskinesia. Mod Probl Pharmacopsychiatry 2015; 21:187-95. [PMID: 6197639 DOI: 10.1159/000408493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Shopin L, Shenhar-Tsarfaty S, Ben Assayag E, Hallevi H, Korczyn AD, Bornstein NM, Auriel E. Cognitive assessment in proximity to acute ischemic stroke/transient ischemic attack: comparison of the montreal cognitive assessment test and mindstreams computerized cognitive assessment battery. Dement Geriatr Cogn Disord 2014; 36:36-42. [PMID: 23712181 DOI: 10.1159/000350035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS Even mild stroke survivors may sometimes experience residual cognitive damage. No consensus has emerged about which cognitive test is most appropriate for the diagnosis of poststroke cognitive impairment. We aim to compare a computerized battery of neuropsychological tests for memory, attention and executive functions (MindStreams®) with the Montreal Cognitive Assessment (MoCA) to detect mild-to-moderate cognitive impairments in poststroke patients. METHODS Subjects enrolled to the TABASCO (Tel Aviv Brain Acute Stroke Cohort) study, a prospective study which includes consecutive first-ever mild-to-moderate stroke patients, were included. All participants underwent neurological and cognitive evaluations. RESULTS A total of 454 patients with transient ischemic attack (TIA) or stroke are reported. Their mean MoCA and MindStreams scores were lower than normal; however, the TIA group presented significantly better scores using either method. The correlation between the MoCA and the computerized global score was 0.6 (p < 0.001). A significant correlation was found between the subcategory scores (executive function, memory and attention). However, the MoCA identified many more subjects with low scores (<26) compared to the MindStreams (70.6 vs. 15.7%). CONCLUSION Our results demonstrate that either of the modalities alone is sensitive enough for identifying subtle cognitive impairment and none picks up substantially more cognitive losses than the other in patients with cerebrovascular disease.
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Affiliation(s)
- L Shopin
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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11
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Balash Y, Mordechovich M, Shabtai H, Giladi N, Gurevich T, Korczyn AD. Subjective memory complaints in elders: depression, anxiety, or cognitive decline? Acta Neurol Scand 2013; 127:344-50. [PMID: 23215819 DOI: 10.1111/ane.12038] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study the association of subjective memory complaints (SMC) with affective state and cognitive performance in elders. MATERIALS AND METHODS We studied community dwelling elderly persons with normal physical examination. Participants completed questionnaires regarding memory difficulties and lifestyle habits, the Geriatric Depression Scale (GDS) and the Spielberger State-Trait Anxiety Inventory (STAI). Depending on their answers to the question about their memory condition, participants were divided into complainers and non-complainers and to five groups according to their MMSE scores. These data have been compared to objective cognitive performance according to Mindstreams - a computerized neuropsychological battery. A logistic regression was performed to evaluate odds ratios (OR) and 95% confidence intervals (CI) for those factors, which were associated with SMС (dependent variable). RESULTS Of 636 consecutive subjects (61% females), 507 participants (79.7%) had SMС. Presence of SMC was inversely correlated with MMSE scores, (r = -0.108; P for trend = 0.007). GDS and STAI scores were higher among subjects with SMC (OR = 1.23: CI 95%: 1.1-1.36 and OR = 1.03: CI 95%: 1.01-1.07, respectively). SMC did not correlate with objective cognitive performance measured by Mindstreams. CONCLUSIONS Subjective memory complaints are associated with sub-syndromal depression and anxiety in healthy cognitively normal elders.
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Affiliation(s)
| | | | - H. Shabtai
- Tel-Aviv Sourasky Medical Center; Tel Aviv; Israel
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Nussbaum M, Treves TA, Inzelberg R, Rabey JM, Korczyn AD. Survival in Parkinson's disease: the effect of dementia. Parkinsonism Relat Disord 2012; 4:179-81. [PMID: 18591108 DOI: 10.1016/s1353-8020(98)00039-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/1998] [Revised: 11/18/1998] [Accepted: 11/18/1998] [Indexed: 11/19/2022]
Abstract
In order to evaluate the effect of dementia on survival in Parkinson 's disease (PD), we followed a series of 250 PD over a period of 5 years. Dementia was determined according to DSM-III-R criteria. Survival analysis of PD patients with dementia vs. without dementia was performed using entry date as starting point. Cox model was used for evaluation of variables associated with mortality in this sample. Upon inclusion to the study, dementia was diagnosed in 38% of our patients. At the end of the follow-up period, the cumulative death rates were 39% among the demented patients and 34% among the non-demented ones (chi(2)=3.2, df=1, p=0.07). Advanced age and, but marginally, cognitive deterioration were associated with reduced survival [Exp(beta)=3.4, p=0.005 and Exp(beta)=1.3, p=0.06, respectively].
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Affiliation(s)
- M Nussbaum
- Department of Neurology, Tel Aviv Medical Center, Sackler Faculty of Medicine and the Sieratzki Chair of Neurology, Tel Aviv University, Ramat Aviv, Israel
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13
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Gur AY, Auriel E, Korczyn AD, Gadoth A, Shopin L, Giladi N, Bornstein NM, Gurevich T. Vasomotor reactivity as a predictor for syncope in patients with orthostatism. Acta Neurol Scand 2012; 126:32-6. [PMID: 21916853 DOI: 10.1111/j.1600-0404.2011.01591.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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
OBJECTIVES Syncope in patients with orthostatic hypotension (OH) may be the result of impaired cerebral autoregulation. Cerebral autoregulation status can be determined by assessing cerebral vasomotor reactivity (VMR). We assessed and compared VMR in patients with OH with and without syncope. MATERIAL AND METHODS Twenty-nine patients with OH underwent transcranial Doppler (TCD) and the Diamox test (1 g acetazolamide IV) for assessing VMR during elaboration of their OH syndrome. The percent difference between cerebral blood flow velocities (BFV) in the middle cerebral (MCA) and vertebral (VA) arteries before and after acetazolamide was defined as VMR%. We considered increases of BFV of ≥ 40% as being indicative of good VMR and classified our study patients as having good or impaired VMRs accordingly. RESULTS Mean VMR% values of the MCA and VA in patients with OH with syncope (n = 12) were significantly lower as compared with patients with OH without syncope (n = 17): 25.2 ± 20.5% and 42.5 ± 18.6%; 20.9 ± 15.5% and 40.8 ± 28.5%, respectively (P < 0.05). CONCLUSIONS Among patients with OH, we found an association between the presence of syncope and impaired VMR. Assessment of VMR among patients with OH may predict those who are at higher risk to faint and fall and to support more aggressive intervention.
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Affiliation(s)
- A Y Gur
- The Department of Neurology, Barzilai Medical Center, Tel-Aviv, Israel
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Lee H, Cohen OS, Rosenmann H, Hoffmann C, Kingsley PB, Korczyn AD, Chapman J, Prohovnik I. Cerebral white matter disruption in Creutzfeldt-Jakob disease. AJNR Am J Neuroradiol 2012; 33:1945-50. [PMID: 22576896 DOI: 10.3174/ajnr.a3125] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Human prion diseases are known to cause gray matter degeneration in specific cerebral structures, but evidence for white matter involvement is scarce. We used DTI to test the hypothesis that white matter integrity is disrupted in human CJD during the early stages of the disease. MATERIALS AND METHODS Twenty-one patients with the E200K variant of CJD and 19 controls participated in DTI studies conducted on a 1.5T MR imaging scanner. The data were quantitatively analyzed and mapped with a voxelwise TBSS method. RESULTS We found significant reductions of FA in patients with CJD in distinct and functionally relevant white matter pathways, including the corticospinal tract, internal capsule, external capsule, fornix, and posterior thalamic radiation. Moreover, these FA deficits increased with disease duration, and were mainly determined by increase of radial diffusivity, suggesting elevated permeability of axonal membranes. CONCLUSIONS The findings suggest that some of the symptoms of CJD may be caused by a functional dysconnection syndrome, and that the leukoencephalopathy is progressive and detectable fairly early in the course of the disease.
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Affiliation(s)
- H Lee
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York 10029, USA
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15
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Goldberg I, Auriel E, Russell D, Korczyn AD. Microembolism, silent brain infarcts and dementia. J Neurol Sci 2012; 322:250-3. [PMID: 22429666 DOI: 10.1016/j.jns.2012.02.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
Cognitive decline becomes more prevalent than ever in parallel with the increasing life expectancy of the population. Alzheimer' disease (AD) and cerebral vascular lesions are common in the elderly and represent, with increased age, the most frequent contributors to cognitive decline. It is now believed that these pathologies frequently coexist in the same brain. The border discriminating vascular dementia from AD is blurred and challenges our understanding of these clinical entities. Further research, at both basic and clinical levels, is mandatory in order to better understand the interactions of vascular ischemic injury and primary degenerative physiopathologies of the brain, in order to prevent and better manage patients with cognitive decline. We review recent published clinical evidence of silent brain ischemia as a contributor to cognitive decline and dementia. Microemboli, from both cardiac and vascular origins, have been shown to be associated with structural changes in the brain. The role of transcranial Doppler as an objective tool for detecting and quantifying microemboli is discussed in light of recent clinical evidence.
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Affiliation(s)
- I Goldberg
- Department of Neurology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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16
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Cohen OS, Prohovnik I, Korczyn AD, Ephraty L, Nitsan Z, Tsabari R, Appel S, Rosenmann H, Kahana E, Chapman J. The Creutzfeldt-Jakob disease (CJD) neurological status scale: a new tool for evaluation of disease severity and progression. Acta Neurol Scand 2011; 124:368-74. [PMID: 21303352 DOI: 10.1111/j.1600-0404.2011.01489.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To develop a scale sensitive for the neurological manifestations of Creutzfeldt-Jakob disease (CJD). METHODS A 26-item CJD neurological status scale (CJD-NS) was created based on characteristic disease manifestations. Each sign was assigned to one of eight neurological systems to calculate a total scale score (TSS) and a system involvement score (SIS). The scale was administered to 37 CJD patients, 101 healthy first-degree relatives of the patients and 14 elderly patients with Parkinson's disease (PD). RESULTS The mean TSS (±SD) was significantly higher in patients with CJD (13.19 ± 5.63) compared with normal controls (0.41 ± 0.78) and PD patients (9.71 ± 3.05). The mean SIS was also significantly different between the CJD (5.19 ± 1.22) and PD (2.78 ± 1.18 P ≤ 0.01) groups reflecting the disseminated nature of neurological involvement in CJD. Using a cutoff of TSS > 4 yielded a sensitivity of 97% for CJD, and specificity of 100% against healthy controls. All individual items showed excellent specificity against healthy subjects, but sensitivity was highly variable. Repeat assessments of CJD patients over 3-9 months revealed a time-dependent increase in both the TSS and the SIS reflecting the scale's ability to track disease progression. CONCLUSIONS The CJD-NS scale is sensitive to neurological signs and their progression in CJD patients.
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Affiliation(s)
- O S Cohen
- Department of Neurology and the Sagol Neuroscience Center, Tel-Hashomer, Israel.
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17
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Bronner G, Korczyn AD. Sexual function in multiple sclerosis. Acta Neurol Scand 2011. [DOI: 10.1111/j.1600-0404.2010.01458.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The incidence of dementia increases steeply with age in older people, although from the tenth decade the slope may be smoother, perhaps reflecting different pathological processes in the oldest old. The prevalence depends upon interaction of age with other factors (e.g., comorbidities, genetic or environmental factors) that in turn are subject to change. If onset of dementia could be postponed by modulating its risk factors, this could significantly affect its incidence. Analysis of risk and protection factors should take into account the critical period during which these factors play a role. For example, the impact of education and diabetes mellitus occurs in early- and midlife, respectively, while maintaining optimal physical and mental activity and controlling vascular factors later in life may slow the rate of cognitive decline. Modifying factors need to be evaluated for different clinical groups, taking into account genetic background, age, and duration at exposure. The aim of the present article is to try to take stock of epidemiological data concerning factors affecting the prevalence of dementia and predict future developments, as well as to look for possible interventions that could affect outcome.
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Affiliation(s)
- T A Treves
- Memory Disorders Clinic, Rabin Medical Center, Petach Tikva, Israel
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19
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Molchadski I, Korczyn AD, Cohen OS, Katzav A, Nitzan Z, Chapman J, Hassin-Baer S. The role of apolipoprotein E polymorphisms in levodopa-induced dyskinesia. Acta Neurol Scand 2011; 123:117-21. [PMID: 21108621 DOI: 10.1111/j.1600-0404.2010.01352.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [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: 11/28/2022]
Abstract
OBJECTIVES To determine the relationship between apolipoprotein E (APOE) polymorphisms to the time to appearance of levodopa-induced dyskinesia (LID) in patients with Parkinson's disease. METHODS The APOE genotype of 155 consecutive patients treated with levodopa was determined and its effect on the time of onset of LID was examined using Cox regression model, controlling for gender, age of disease onset, time to initiation of levodopa treatment and history of smoking. RESULTS Two patients were homozygous for the APOE ε2 allele, 7 had ε2/ε3, 1 had ε2/ε4, 130 had ε3/ε3, 12 had ε3/ε4 and 3 had ε4/ε4; LID appeared in 57.4% of the patients, appearing 4.1 ± 3.5 years after the initiation of levodopa treatment. The survival curve for LID was not affected by the APOE genotype (P = 0.34). CONCLUSION APOE polymorphisms were found not to be associated with either the occurrence or the time to development of LID.
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Affiliation(s)
- I Molchadski
- Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Tel-Aviv, Israel
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20
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Abstract
OBJECTIVES Cerebral hemodynamic features of patients with post-stroke dementia (PSD) are still obscure. We compared cerebral vasomotor reactivity (VMR) assessed in the acute phase of ischemic stroke (IS) in patients with and without PSD. VMR was also assessed and compared in demented and non-demented patients in the late phase of IS. MATERIALS AND METHODS VMR was assessed by transcranial Doppler and the Diamox test (1 g acetazolamide i.v.). PSD was confirmed by the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et I'Enseignement en Neurosciences (NINDS-AIREN) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. VMR% values were compared to verify correlation with dementia. RESULTS Thirty patients with acute IS (AIS) were studied and followed for 3-6 months. An additional group of 37 patients was studied in the late post-stroke period (PIS). VMR% values in the AIS groups with and without PSD were similar (25.3 ± 20.3% and 36.5 ± 22.4%, respectively, NS). The mean VMR% in the PIS groups with and without PSD were similar (32.3 ± 19.5% and 41.2 ± 24.8%, respectively, NS). CONCLUSIONS VMR cannot predict the development of dementia after AIS and cannot identify patients with dementia in the late phase of stroke.
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Affiliation(s)
- Alexander Y Gur
- Stroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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21
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Bluvshtein V, Korczyn AD, Pinhas I, Vered Y, Gelernter I, Catz A. Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation? Spinal Cord 2010; 49:648-52. [PMID: 21042331 DOI: 10.1038/sc.2010.152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Controlled experimental human study. OBJECTIVES To assess insulin resistance (IR) in tetraplegia and paraplegia, and the role of the spinal cord (SC) in glucose regulation. SETTING Laboratory of Spinal Research, Loewenstein Rehabilitation Hospital. METHODS Glucose and insulin levels and the heart rate variation spectral components LF (low frequency), HF (high frequency) and LF/HF were studied at supine rest, head-up tilt and after a standard meal in three groups: 13 healthy subjects, 7 patients with T(4)-T(6) paraplegia and 11 patients with C(4)-C(7) tetraplegia. RESULTS Glucose and insulin increased significantly after the meal in all groups (P<0.001). Glucose increased significantly more in the tetraplegia than in the other groups (P<0.01). Increases in insulin level tended to accompany increases in LF/HF after the meal in the tetraplegia and control groups but not in the paraplegia group. CONCLUSION Post-prandial IR appears in C(4)-C(7) but not in T(4)-T(6) SC injury. The results of the study, combined with previously published findings, are consistent with the hypotheses that IR is related to activation of the sympathetic nervous system, and that below T(4) the mid-thoracic SC is involved in the regulation of glucose and insulin levels.
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Affiliation(s)
- V Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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22
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Bluvshtein V, Korczyn AD, Akselrod S, Pinhas I, Gelernter I, Catz A. Hemodynamic responses to head-up tilt after spinal cord injury support a role for the mid-thoracic spinal cord in cardiovascular regulation. Spinal Cord 2010; 49:251-6. [PMID: 20714335 DOI: 10.1038/sc.2010.98] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Data showing a role for the mid-thoracic spinal cord (SC) in the control of hemodynamic changes is scarce despite existing evidence for its involvement in autonomic regulation. STUDY DESIGN On the basis of the open label prospective series comparing three groups. OBJECTIVE To determine whether the mid-thoracic SC has a role in hemodynamic regulation during head-up tilt (HUT). SETTING Spinal Research Laboratory, Loewenstein Rehabilitation Hospital. METHODS A total of 13 healthy control subjects, 10 patients with T(4)-T(6) paraplegia and 11 with C(4)-C(7) tetraplegia were examined during supine rest and during HUT. Heart rate (HR), blood pressure (BP), HR spectral components (lower frequency fluctuation (LF), higher frequency fluctuations (HF) and LF/HF) and cerebral blood flow velocity (CBFV) were continuously measured or calculated. RESULTS BP response to HUT differed among these groups (P<0.02). During HUT, BP decreased markedly in the tetraplegia group (from a mean value of 81.65 to 67.69 mm Hg), and increased in the control groups (from 92.89 to 95.44 mm Hg) and in the T(4)-T(6) paraplegia group (from 96.24 to 97.86 mm Hg). Significant correlation was found in the control and tetraplegia groups between increases in HR LF/HF and HR at HUT (r>0.7; P<0.01). No such correlation was found in the paraplegia group. HUT effect on HR and CBFV was significant in all groups (P<0.001), but group differences were statistically non-significant. CONCLUSION Findings were generally compatible with those of comparable previously published studies, but they also support a role for the mid-thoracic SC in hemodynamic regulation, which should be considered in clinical setting and in research.
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Affiliation(s)
- V Bluvshtein
- Department of Spinal Rehabiliation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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23
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Abstract
Female sexual functioning is a complex process involving physiological, psychosocial and interpersonal factors. Sexual dysfunction (SD) is frequent (40-74%) among women with multiple sclerosis (MS), reflecting neurological dysfunction, psychological factors, depression, side effects of medications and physical manifestations of the disease, such as fatigue and muscle weakness. A conceptual model for sexual problems in MS characterizes three levels. Primary SD includes impaired libido, lubrication, and orgasm. Secondary SD is composed of limiting sexual expressions due to physical manifestations. Tertiary SD results from psychological, emotional, social, and cultural aspects. Sexual problems cause distress and may affect the family bond. Practical suggestions on initiation of discussion of sexual issues for MS patients are included in this review. Assessment and treatment of sexual problems should combine medical and psychosexual approaches and begin early after MS diagnosis. Intervention can be done by recognizing sexual needs, educating and providing information, by letting patients express their difficulties and referring them to specialists and other information resources.
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Affiliation(s)
- Gila Bronner
- Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel Hashomer, Israel.
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24
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Guekht AB, Korczyn AD, Bondareva IB, Gusev EI. Placebo responses in randomized trials of antiepileptic drugs. Epilepsy Behav 2010; 17:64-9. [PMID: 19919904 DOI: 10.1016/j.yebeh.2009.10.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 11/29/2022]
Abstract
This meta-analysis of published, randomized, controlled trials (RCTs) of antiepileptic drugs in adults with focal drug-resistant epilepsy was performed to estimate a mean placebo effect, to evaluate variability in placebo response rates, to investigate associations between placebo effect rates and study characteristics, and to determine whether there were changes in placebo response rates over recent years in RCTs (so-called "placebo drift"). One hundred ninety-eight potentially appropriate studies were identified after MEDLINE search and carefully reviewed. Twenty-seven RCTs (with 5662 randomized patients, including 1887 patients in placebo arms) were included in the meta-analysis. A random effects meta-analytic model estimated the pooled placebo response at 12.5% (95% CI: 10.03-14.94%). A statistically significant correlation between baseline median seizure frequency and placebo response rates was not observed. "Placebo drift" was not considered statistically significant.
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Affiliation(s)
- A B Guekht
- Department of Neurology and Neurosurgery, Russian State Medical University, Moscow, Russia
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25
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Korczyn AD, Gronseth FAAN GS, French FAAN J. Practice parameters and technology assessments: What they are, what they are not, and why you should care. Neurology 2009; 73:1336; author reply 1336-7. [DOI: 10.1212/wnl.0b013e3181b26b8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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26
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Abstract
Acute meningitis is associated with headache, but the natural history of the headache following recovery is unknown. We addressed this issue in 141 patients admitted during 1990 to 1993 with laboratory-confirmed meningitis. We excluded patients younger than 5 years (n=44), elderly demented patients (n=6), and those with potential causes of headache other than meningitis (n=4). Seventeen candidates could not be traced. The remaining 70 patients were interviewed using a semistructured questionnaire that documented age, sex, type of meningitis, time of headache onset after infection, and headache description as well as any past and/or family history of headache. These patients were compared to age- and sex-matched controls (n=70). Prior to meningitis, 13 patients (19%) had had headaches (migrainous in 8) as did 18 controls (26%; migrainous in 8). Headache first appeared after meningitis in 19 patients (33%; migrainous in 6), increasing the total prevalence to 46%. We found no association between sex, type of meningitis, or family history and the development of postmeningitis headache. Patients who developed postmeningitis headache were significantly younger than those who did not. We conclude that there is an association between meningitis, either bacterial or aseptic, and subsequent persistent recurrent migrainous or nonmigrainous headache.
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Affiliation(s)
- M Y Neufeld
- Department of Neurology, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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27
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Kipervasser S, Palti D, Neufeld MY, Ben Shachar M, Andelman F, Fried I, Korczyn AD, Hendler T. Possible remote functional reorganization in left temporal lobe epilepsy. Acta Neurol Scand 2008; 117:324-31. [PMID: 18005219 DOI: 10.1111/j.1600-0404.2007.00948.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To provide functional magnetic resonance imaging-based insight into the impact of left temporal lobe epilepsy (TLE) on language-related functional re-organization. MATERIALS AND METHODS Ten right-handed patients with left TLE were compared with 10 matched healthy controls. Regional brain activation during the language task was measured in the inferior frontal gyrus (IFG) and in the superior temporal gyrus (STG), and the regional inter-hemispheric lateralization index (LI) was calculated. RESULTS Left language lateralization was documented in all the patients and controls. Reduced lateralization in the IFG was due to decreased activity in the left frontal region rather than to increased activity in the right frontal region. The LI values in the STG correlated with the LI values in the IFG in the controls but not in the patients. CONCLUSIONS The left IFG was most probably involved in the epileptogenesis and concomitant language-related cortical plasticity in patients with left TLE.
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Affiliation(s)
- S Kipervasser
- EEG and Epilepsy Unit, Department of Neurology, Wohl Institute for Advanced Imaging, Tel Aviv, Israel
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28
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Korczyn AD. Ariel Sharon's illness. Isr Med Assoc J 2008; 10:325; author reply 325. [PMID: 18548996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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29
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Kogan EA, Verchovsky RG, Neufeld MY, Klimovitsky SS, Treves TA, Korczyn AD. Long-term tetrahydroaminoacridine treatment and quantitative EEG in Alzheimer's disease. J Neural Transm Suppl 2007:203-6. [PMID: 17982896 DOI: 10.1007/978-3-211-73574-9_26] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The development of therapies for Alzheimer's disease (AD) has focused on drugs designed to correct the loss of cholinergic function within the central nervous system. Quantitative EEG (qEEG) changes associated with AD consist of background slowing. One way to study the effects of cholinergic drugs may be through assessment of their qEEG effects. The aim of the current work was to evaluate the effect of long-term treatment with tetrahydroaminoacridine (THA) on qEEG in AD patients.
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Affiliation(s)
- E A Kogan
- EEG and Epilepsy Unit, Tel-Aviv University, Tel-Aviv, Israel
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30
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Abstract
BACKGROUND To evaluate efficacy and safety of galantamine for patients with vascular dementia (VaD). METHODS In this multinational, randomized, double-blind, placebo-controlled, parallel-group clinical trial, 788 patients with probable VaD who also satisfied strict centrally read MRI criteria were randomized to receive galantamine or placebo. Efficacy was evaluated using measures of cognition, daily function, and behavior. The primary efficacy measures were the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-cog/11) and the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL) total score. Secondary outcomes included the Clinician's Interview Based on Impression of Change-Plus Caregiver Input (CIBIC-plus), Neuropsychiatric Inventory, and EXIT-25 for assessment of executive functioning. Safety and tolerability were also monitored. RESULTS Patients treated with galantamine had a greater improvement in ADAS-cog/11 after 26 weeks compared with placebo (-1.8 vs -0.3; p < 0.001). There was no difference between galantamine and placebo at week 26 on the ADCS-ADL score (0.7 vs 1.3; p = 0.783). Improvement in global functioning measured by the CIBIC-plus associated with galantamine approached significance (p = 0.069). A difference between treatment groups for EXIT-25 favoring galantamine was detected (p = 0.041). Safety data revealed that 13% of galantamine and 6% of placebo patients discontinued treatment because of adverse events. CONCLUSIONS Significance was not reached for both co-primary endpoints. Galantamine was effective for improving cognition, including executive function, in patients with vascular dementia, with good safety and tolerability. However, improvement in activities of daily living with galantamine was similar to that observed with placebo.
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Affiliation(s)
- A P Auchus
- University of Tennessee Health Science Center, Department of Neurology, Memphis, TN 38163, USA.
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31
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Catz A, Bluvshtein V, Pinhas I, Akselrod S, Gelernter I, Nissel T, Vered Y, Bornstein N, Korczyn AD. Cold pressor test in tetraplegia and paraplegia suggests an independent role of the thoracic spinal cord in the hemodynamic responses to cold. Spinal Cord 2007; 46:33-8. [PMID: 17406378 DOI: 10.1038/sj.sc.3102055] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/09/2022]
Abstract
BACKGROUND Cold application to the hand (CAH) is associated in healthy people with increase in heart rate (HR) and blood pressure (BP). OBJECTIVE To study hemodynamic responses to CAH in humans following spinal cord injuries of various levels, and examine the effect of spinal cord integrity on the cold pressor response. DESIGN An experimental controlled study. SETTING The spinal research laboratory, Loewenstein Hospital, Raanana, Israel. SUBJECTS Thirteen healthy subjects, 10 patients with traumatic T(4-6) paraplegia and 11 patients with traumatic C(4-7) tetraplegia. MAIN OUTCOME MEASURES HR, BP, HR and BP spectral components (low frequency, LF; high frequency, HF; LF/HF), cerebral blood flow velocity (CBFV) and cerebrovascular resistance index (CVRi). METHODS The outcome measures of the three subject groups monitored for HR, BP and CBFV were compared from 5 min before to 5 min after 40-150 s of CAH. The recorded signals were digitized online and analyzed offline in both the time and frequency domains. RESULTS During CAH, HR and CVRi increased significantly in all subject groups (P<0.001), and BP in control subjects and in the tetraplegia group (P<0.01). BP increase was not statistically significant in paraplegia, and CBFV, HR LF, HR HF and BP LF did not change significantly during CAH in any group. CONCLUSIONS The CAH effect in tetraplegia and the suppressed BP increase in paraplegia, supported by the other findings, suggest a contribution of an independent thoracic spinal mechanism to the cold pressor response.
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Affiliation(s)
- A Catz
- The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel.
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32
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Korczyn AD, Reichmann H, Boroojerdi B, Häck HJ. Rotigotine transdermal system for perioperative administration. J Neural Transm (Vienna) 2006; 114:219-21. [PMID: 17177076 DOI: 10.1007/s00702-006-0606-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 11/06/2006] [Indexed: 10/23/2022]
Abstract
We present a series of patients participating in clinical trials with the rotigotine transdermal system. All patients were scheduled for surgery with general anaesthesia unrelated to the trial procedure or to rotigotine. Perioperative administration of rotigotine appeared to be feasible and efficacious. No safety issues emerged from these observations.
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Affiliation(s)
- A D Korczyn
- Tel-Aviv University Medical School, Ramat-Aviv, Israel.
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Suhanov AV, Pilipenko PI, Korczyn AD, Hofman A, Voevoda MI, Shishkin SV, Simonova GI, Nikitin YP, Feigin VL. Risk factors for Alzheimer's disease in Russia: a case-control study. Eur J Neurol 2006; 13:990-5. [PMID: 16930366 DOI: 10.1111/j.1468-1331.2006.01391.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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
No reliable data on risk factors of Alzheimer's disease (AD) are available in Russia. We aimed to evaluate the relative importance of various putative environmental and medical risk factors of AD in a Russian population. We conducted a hospital-based case-control study. Two hundred and sixty consecutive AD patients and an equal number of cognitive impairment-free control subjects matched for sex, age, level of education and place of birth selected from nursing homes and other long-term healthcare facilities in the Novosibirsk region for the period from 1998 to 2002 were examined. A conditional logistic regression analysis was employed to calculate odds ratios (OR) and corresponding 95% confidence intervals (CI) for various putative risk factors. Of the 260 patients with AD, 187 (72%) were females. Patients' age varied from 40 to 89 years (mean +/- SD: 69.2 +/- 7.7 years). The majority of the patients (77%) had secondary education and 12% had university education. Risk factors independently associated with AD were family history of parkinsonism among first-degree relatives (OR = 4.2; 95% CI 1.2-15.1), hypothyroidism (OR = 2.7; 95% CI 1.1-6.7), and history of head trauma with loss of consciousness (OR = 1.7; 95% CI 1.0-2.8). The most important risk factors for AD in the Russian community are family history of parkinsonism, hypothyroidism and a history of head trauma with loss of consciousness. These findings have implications for developing preventive strategies of AD.
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Affiliation(s)
- A V Suhanov
- Institute of Internal Medicine Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia
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Catz A, Bluvshtein V, Pinhas I, Akselrod S, Gelernter I, Nissel T, Vered Y, Bornstein NM, Korczyn AD. Hemodynamic effects of liquid food ingestion in mid-thoracic paraplegia: is supine postprandial hypotension related to thoracic spinal cord damage? Spinal Cord 2006; 45:96-103. [PMID: 16850007 DOI: 10.1038/sj.sc.3101939] [Citation(s) in RCA: 27] [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: 11/10/2022]
Abstract
BACKGROUND Postprandial hypotension (PPH) appears in various conditions with autonomic failure and was symptomatic in a patient with thoracic paraplegia, but was not remarkable in patients with tetraplegia. OBJECTIVE To determine whether the pathology causing PPH may include a thoracic but not a cervical spinal cord lesion (SCL). DESIGN An experimental controlled study. SETTING The spinal research laboratory, Loewenstein Hospital, Raanana, Israel. SUBJECTS Thirteen healthy subjects, 10 patients with traumatic T(4)-T(6) paraplegia, and 11 patients with traumatic C(4)-C(7) tetraplegia. MAIN OUTCOME MEASURES Heart rate (HR), blood pressure (BP), HR and BP spectral components (LF, HF, LF/HF), cerebral blood flow velocity (CBFV), and cerebrovascular resistance index (CVRi). METHODS The effects of a standard liquid meal on the outcome measures were compared between the three subject groups monitored for HR, BP, and CBFV, from 55 min before to 45 min after the start of the meal. The recorded signals were digitized online and analyzed off-line in the time and frequency domains. RESULTS After meal, BP decreased only in the paraplegia group (P<0.01), HR increased more prominently in this group (P<0.01), CVRi tended to decrease only in the paraplegia group, CBFV did not change significantly in any group, and HR LF/HF increased (P<0.001) in all groups but tended to increase more in paraplegia. CONCLUSIONS Patients with mid-thoracic SCL may develop PPH. The pathology causing PPH can include a thoracic but not a cervical SCL. The normal hemodynamic reaction to liquid meal ingestion is mediated through the mid-thoracic spinal cord. The sympathovagal balance increases after food ingestion, more prominently in patients with PPH, and cerebrovascular resistance changes during PPH may help maintain the cerebral circulation.
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Affiliation(s)
- A Catz
- Department IV, Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, 278 Achuza Street, Raanana 43100, Israel
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Abstract
BACKGROUND Psychosis is one of the most serious complications of advanced parkinsonism, but many patients are spared. The genetic factors predisposing to psychosis are unclear. OBJECTIVES To assess the association between apolipoprotein E (APOE) polymorphism and the development of psychosis in patients with Parkinson's disease (PD). METHODS Eighty-seven patients with advanced PD were assessed. Psychosis was diagnosed in 50 patients who manifested paranoid delusions, hallucinations without insight, or disorders of perception. Time of onset of psychosis was retrieved from the medical records and caregivers' recall. APOE genotype was determined by restriction enzyme digests of amplified alleles. Cox models of logistic regression and Kaplan-Meier survival curves were used to assess factors determining early development of psychosis. RESULTS APOE epsilon3/epsilon4 allele was carried by 20 patients (14 with psychosis), epsilon2/epsilon3 by 11 patients (10 with psychosis), epsilon3/epsilon3 by 55 patients (25 with psychosis) and epsilon2/epsilon4 by one patient who had psychosis. The mean age of onset of PD symptoms was 60.0 +/- 12.5 years. The mean duration of motor symptoms at the onset of psychosis was 7.3 +/- 4.3 years for the 15 patients harboring an APOE epsilon4 allele and 10.1 +/- 6.2 years among those who did not carry APOE epsilon4 (n = 35). The APOE epsilon4 allele was significantly associated with earlier onset of psychosis (P < 0.05) when the age of onset of motor symptoms and presence of dementia were included in the Cox regression model. Carrying the APOE epsilon4 allele was a significant risk factor for earlier appearance of psychosis with a hazard ratio of 3.24 (95% CI 1.62-6.46) while dementia by itself did not increase the risk. CONCLUSION Parkinson's disease patients who carry the APOE epsilon4 allele develop psychosis earlier.
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Affiliation(s)
- B Feldman
- Be'er Yakov Mental Health Center, Be'er Yakov, Israel
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Chapman J, Soloveichick L, Shavit S, Shoenfeld Y, Korczyn AD. Antiphospholipid antibodies bind ATP: a putative mechanism for the pathogenesis of neuronal dysfunction. Clin Dev Immunol 2005; 12:175-80. [PMID: 16295522 PMCID: PMC2275418 DOI: 10.1080/17402520500217844] [Citation(s) in RCA: 11] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Antiphospholipid antibodies (aPL) generated in experimental animals
cross-react with ATP. We therefore examined the possibility that aPL IgG from
human subjects bind to ATP by affinity column and an enzyme linked
immunosorbent assay (ELISA). Sera with high levels of aPL IgG were collected
from 12 patients with the antiphospholipid syndrome (APS). IgG fractions from
10 of 12 APS patients contained aPL that could be affinity-bound to an ATP
column and completely eluted with NaCl 0.5 M. A significant (>50%) inhibition
of aPL IgG binding by ATP 5 mM was found in the majority. Similar inhibition
was obtained with ADP but not with AMP or cAMP. All the affinity purified
anti-ATP antibodies also bound β2-glycoprotein-I (β2-GPI, also known as
apolipoprotein H) suggesting that, similar to most pathogenic aPL, their binding
depends on this serum cofactor. We further investigated this possibility and found
that the binding of β2-GPI to the ATP column was similar to that of aPL IgG in
that most was reversed by NaCl 0.5 M. Furthermore, addition of β2-GPI to aPL
IgG significantly increased the amount of aPL binding to an ATP column. We
conclude that aPL IgG bind ATP, probably through β2-GPI. This binding could
interfere
with the normal extracellular function of ATP and similar neurotransmitters.
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Affiliation(s)
- J Chapman
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
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Abstract
Long-term prognosis and visual outcome of 54 patients with idiopathic intracranial hypertension (IIH) was studied. Mean observation period was 6.2 years; 33 patients had two or more recurrences. Visual acuity was preserved in all patients without recurrence and in 86% of patients with recurrences. Recurrences did not occur while patients were maintained on acetazolamide. No statistical difference was found between IIH patients who had only one event, compared to the recurrent group.
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Affiliation(s)
- A Kesler
- Neuro-Ophthalmology Unit, Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.
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Paran D, Chapman J, Korczyn AD, Elkayam O, Hilkevich O, Groozman GB, Levartovsky D, Litinsky I, Caspi D, Segev Y, Drory VE. Evoked potential studies in the antiphospholipid syndrome: differential diagnosis from multiple sclerosis. Ann Rheum Dis 2005; 65:525-8. [PMID: 16107510 PMCID: PMC1798093 DOI: 10.1136/ard.2005.040352] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/04/2022]
Abstract
BACKGROUND The CNS manifestations of the antiphospholipid syndrome (APS) can mimic multiple sclerosis both clinically and radiologically. OBJECTIVE To compare evoked potential studies in APS patients and patients with multiple sclerosis with similar neurological disability. METHODS 30 APS patients with CNS manifestations and 33 patients with definite multiple sclerosis and similar neurological disability underwent studies of visual evoked potentials (VEP), somatosensory evoked potentials (SSEP) in the upper and lower limbs (UL, LL), and sympathetic skin responses (SSR) in the upper and lower limbs. RESULTS The neurological manifestations in the APS patients included stroke (n = 17), transient ischaemic attacks (n = 10), and severe headache with multiple white matter lesions on brain MRI (n = 3). Abnormal SSEP (LL), and SSR (UL; LL) were seen in APS patients (37%, 27%, and 30%, respectively) but VEP and UL SSEP were rarely abnormal (10% and 6%, respectively in APS v 58% and 33% in multiple sclerosis; p = 0.0005, p = 0.008). Mean VEP latencies were more prolonged in multiple sclerosis (116 ms v 101 ms, p<0.001). Only one APS patient had abnormal findings in all three evoked potential studies, compared with seven patients in the multiple sclerosis group (p = 0.04) CONCLUSIONS Abnormal VEPs are uncommon in APS in contrast to multiple sclerosis. Coexisting abnormalities in all other evoked potentials were similarly rare in APS. In patients with brain MRI findings compatible either with multiple sclerosis or APS, normal evoked potential tests, and especially a normal VEP, may support the diagnosis of APS.
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Affiliation(s)
- D Paran
- Department of Rheumatology, Tel-Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Abstract
BACKGROUND The risk of developing dementia by elderly patients with only subjective memory complaints (SMC) is unclear. Our objective was to assess the prognosis of such patients regarding subsequent development of dementia. METHODS From 1992 to 1996, 211 consecutive patients (age 67.4 +/- 9.4 years, mean +/- SD) were diagnosed as having SMC. These patients were followed for 3 years or to the time they were diagnosed with dementia, whichever came first. A survival analysis was performed for occurrence of dementia within 3 years. RESULTS The duration of memory decline was shorter among patients who developed dementia than among those who did not (32.6 vs. 49.9 months, F = 3.3, p = 0.07). Patients who developed dementia tended to be older at the reported onset of memory decline (71 vs. 66.2 years, F = 3.2, p = 0.07). Lower risk of dementia was associated with higher cognitive performance at entry [odds ratio (OR) = 0.74 (0.59-0.92)] and longer time from onset of memory decline to referral [OR = 0.91 (0.85-0.98)]. CONCLUSION Subjects with SMC have an increased risk of developing dementia, particularly those with lower cognitive status at entry and with older age at onset of memory complaints, and shorter duration of their memory complaints.
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Affiliation(s)
- T A Treves
- Department of Neurology, Rabin Medical Center, Petah Tikva 49100, Israel
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Stav A, Rabinowitz R, Korczyn AD. Action of opioid agonist-antagonist drugs on the pupil and nociceptive responses in mice. J Anesth 2005; 6:439-45. [PMID: 15278517 DOI: 10.1007/s0054020060439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/1991] [Accepted: 02/06/1992] [Indexed: 11/28/2022]
Abstract
Opioid derivatives with mixed agonist-antagonist activities are becoming increasingly more popular in analgesia. We tested the mydriatic and analgesic activity of morphine in mice in comparison with similar effects of three agonist-antagonist agents: buprenorphine, butorphanol and nalbuphine. We also examined the antagonistic action of these three drugs by evaluating the analgesia and mydriasis in animals pretreated with morphine. The analgesic effect was assayed using the hot plate method while the pupillary responses were measured with a binocular operating microscope. Morphine produced dose-dependent mydriasis and analgesia in mice. The morphine-type agent buprenorphine and two nalorphine-type agonist-antagonists, butorphanol and nalbuphine, caused agonistic mydriatic and analgesic effects, usually less effective then morphine. Buprenorphine proved to have higher agonist activity than butorphanol and nalbuphine. The difference between butorphanol and nalbuphine was not statistically significant. A correlation between the mydriatic and the analgesic activity, known to exist among opioid derivatives with agonist activity only, was also demonstrated in the three investigated agonist-antagonist agents. Morphine-induced mydriasis and analgesia were reversed by all three agonist-antagonist drugs, but buprenorphine is a significantly weak antagonist in comparison with butorphanol and nalbuphine. An antagonistic property (antimydriatic and antianalgesic effects after pretreatment with morphine) of both nalorphine-type investigated drugs was not statistically significant, except for the antianalgesic effect of nalbuphine in doses 1 and 3 mg.kg(-1), which was higher in comparison with butorphanol.
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Affiliation(s)
- A Stav
- Department of Anesthesiology, Hillel Jaffe Medical Center, 38100, Hadera, Israel
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Merims D, Shabtai H, Korczyn AD, Peretz C, Weizman N, Giladi N. Antiparkinsonian medication is not a risk factor for the development of hallucinations in Parkinson's disease. J Neural Transm (Vienna) 2005; 111:1447-53. [PMID: 15480845 DOI: 10.1007/s00702-004-0209-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Accepted: 07/28/2004] [Indexed: 12/16/2022]
Abstract
BACKGROUND It was commonly assumed that psychotic phenomena in Parkinson's disease (PD) are mainly drug related. Accumulating evidence suggests the existence of other risk factors for psychosis in PD. Aims. To evaluate the contribution of the drug profile of patients with PD to emergence of hallucinations. METHODS We compared patients with and without hallucinations, using Cox proportional hazards model, concerning drug profile at the time of hallucinations emergence. RESULTS Of 422 consecutive patients, 113 had dementia, while 90 patients experienced hallucinations (46 had both dementia and hallucinations). The mean levodopa dose for the group of patients with hallucinations was 650 +/- 279 mg/day at the time of hallucinations onset, which was not significantly different from the levodopa dose at last visit for the group without hallucinations (621 +/- 326 mg/day). Supplementary treatment with amantadine, selegiline, dopamine agonists, entacapone and anticholinergics did not increase the risk for the development of hallucinations. CONCLUSIONS We did not confirm drug treatment as a risk factor for hallucinations in PD. Our study suggests the existence of "endogenic" factors as substantial contributors in the genesis of PD hallucinations. The clinical implications may be earlier administration of antipsychotic treatment and not as traditionally accepted, dose reduction of antiparkinsonian drugs.
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Affiliation(s)
- D Merims
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Mizrahi EH, Bowirrat A, Jacobsen DW, Korczyn AD, Traore F, Petot GJ, Lerner AJ, Debanne SM, Adunsky A, Dibello PM, Friedland RP. Plasma homocysteine, vitamin B12 and folate in Alzheimer's patients and healthy Arabs in Israel. J Neurol Sci 2004; 227:109-13. [PMID: 15546600 DOI: 10.1016/j.jns.2004.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Revised: 08/26/2004] [Accepted: 08/26/2004] [Indexed: 11/26/2022]
Abstract
High plasma homocysteine (tHcy) is a risk factor for cardiovascular disease and stroke and Alzheimer's disease (AD). An inverse relationship has been reported between tHcy and plasma B12 and folate levels. Seventy-nine AD patients and 156 controls from three Arab villages in northern Israel participated. Plasma tHcy, B12 and folate levels were determined. Data were analyzed using univariate statistical tests and logistical regression with confounders. tHcy was significantly higher in AD patients (20.6+/-8.7 micromol/l) than in controls (16.4+/-6.5 micromol/l) (p=0.03) after correction for year of birth, gender and smoking status. Plasma B12 (322.9+/-136.0/350.5+/-175.3 pmol/l) and plasma folate (4.5+/-3.8/4.9+/-2.6 nmol/l) levels did not differ significantly between AD patients and controls. Subjects in the highest tHcy tertile or in the lowest B12 and folate tertiles did not have greater risk to develop AD. In this population residing in Arab villages in northern Israel, tHcy levels were significantly higher among AD patients than in controls. Plasma B12 and folate levels were lower among cases but were not significant. There was not a significant association between plasma tHcy, B12 and folate levels in controls or AD patients. High levels of tHcy may suggest the need for folate and vitamin B12 supplementation in this population.
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Affiliation(s)
- E H Mizrahi
- Department of Geriatric Medicine, Chaim Sheba Medical Center, Affiliated to the Tel-Aviv University, Sackler School of Medicine, Tel Hashomer, Israel.
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Abstract
OBJECTIVE To test the effect of different forearm postures on tremor characteristics. We hypothesized that changes in tremor characteristics in relation to posture can subclassify essential tremor (ET) patients. METHODS Fourteen ET patients were tested while seated and holding a full cup in three well-defined arm postures: 15 cm above the armrest, elbow at 90 degrees flexion and when the cup was near the mouth. Hand movements were recorded using a triaxial accelerometer. Concomitantly, we recorded surface electromyogram (EMG) signals from the wrist extensor muscles. Hand acceleration and the primary tremor frequency from the power spectrum were calculated for each posture in two independent trials. The coherence at the primary tremor frequency between the EMG and the accelerometry signals was calculated. RESULTS ET patients could be classified into two groups: ET-1 (nine patients) had position-dependent peak frequencies while ET-2 (five patients) had position-independent peak frequencies. The latter group had significantly higher coherencies between EMG and accelerometry of tremor and insignificantly higher tremor amplitudes compared with ET-1. In both groups tremor amplitude increased when the hand was near the mouth. CONCLUSION The results suggest that ET patients can be classified based on the position dependence of frequency and other physiologic properties.
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Affiliation(s)
- D Golan
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Berkovic SF, Izzillo P, McMahon JM, Harkin LA, McIntosh AM, Phillips HA, Briellmann RS, Wallace RH, Mazarib A, Neufeld MY, Korczyn AD, Scheffer IE, Mulley JC. LGI1mutations in temporal lobe epilepsies. Neurology 2004; 62:1115-9. [PMID: 15079010 DOI: 10.1212/01.wnl.0000118213.94650.81] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [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: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A number of familial temporal lobe epilepsies (TLE) have been recently recognized. Mutations in LGI1 (leucine-rich, glioma-inactivated 1 gene) have been found in a few families with the syndrome of autosomal dominant partial epilepsy with auditory features (ADPEAF). The authors aimed to determine the spectrum of TLE phenotypes with LGI1 mutations, to study the frequency of mutations in ADPEAF, and to examine the role of LGI1 paralogs in ADPEAF without LGI1 mutations. METHODS The authors performed a clinical and molecular analysis on 75 pedigrees comprising 54 with a variety of familial epilepsies associated with TLE and 21 sporadic TLE cases. All were studied for mutations in LGI1. ADPEAF families negative for LGI1 mutations were screened for mutations in LGI2, LGI3, and LGI4. RESULTS Four families had ADPEAF, 22 had mesial TLE, 11 had TLE with febrile seizures, two had TLE with developmental abnormalities, and 15 had various other TLE syndromes. LGI1 mutations were found in two of four ADPEAF families, but in none of the other 50 families nor in the 21 individuals with sporadic TLE. The mutations were novel missense mutations in exons 1 (c.124T-->G; C42G) and 8 (c.1418C-->T; S473L). No mutations in LGI2, LGI3, or LGI4 were found in the other two ADPEAF families. CONCLUSION In TLE, mutations in LGI1 are specific for ADPEAF but do not occur in all families. ADPEAF is genetically heterogeneous, but mutations in LGI2, LGI3, or LGI4 did not account for families without LGI1 mutations.
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Affiliation(s)
- S F Berkovic
- Epilepsy Research Institute and Department of Medicine, University of Melbourne, Victoria, Australia.
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Abstract
OBJECTIVE To investigate whether the cardiac R-R interval variation (RRIV) is of value in differentiating patients with Parkinson's disease (PD) from multiple system atrophy (MSA). BACKGROUND RRIV assessment is a simple procedure, reflecting mainly vagal efferent activity. Reduced RRIV was reported in MSA. METHODS RRIV at rest and after 120 s of deep breathing was assessed blindly to clinical diagnosis in 22 PD and 20 MSA patients. The results were compared with data from 23 age-matched healthy subjects. RESULTS RRIV at rest was 7.1 +/- 2.7% in PD and 9.7 +/- 7.2% in MSA, increasing after deep breathing to 11.2 +/- 6.3 and 12.3 +/- 6.6% correspondingly. The frequency of the RRIV abnormalities in the PD group (4/22, 18.2%) and MSA (6/20, 30%) were higher than among controls (P < 0.004). CONCLUSIONS RRIV, either at rest or after deep breathing, may be abnormal both in PD and MSA, but does not distinguish between these disorders.
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Affiliation(s)
- T Yu Gurevich
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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46
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Benbunan BR, Korczyn AD, Giladi N. Parkin mutation associated parkinsonism and cognitive decline, comparison to early onset Parkinson?s disease. J Neural Transm (Vienna) 2004; 111:47-57. [PMID: 14714215 DOI: 10.1007/s00702-003-0079-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 10/01/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) have cognitive changes resulting, presumably, from a progressive disruption of the functional integrity of frontostriatal circuitry. OBJECTIVE To assess the cognitive state of two brothers with early onset autosomal recessive (EO-AR) parkinsonism and a large deletion in the parkin gene, and to compare it to that of patients with sporadic young onset PD (YOPD). METHOD Two brothers with parkinsonism and deletion of axons 4-6 of the parkin gene (ages 51, 55 years; duration of symptoms, 22, 29 years respectively) and 4 randomly selected patients with YOPD (mean age 47.8+/-4.9 years; mean duration of symptoms, 11.5+/-1.9 years) were administered a neuropsychological battery at "on" state. We assessed global cognitive state using the Mini-Mental State Examination (MMSE), orientation, attention, memory, language, ideational praxis, constructive praxis and executive functions (shifting aptitude, verbal fluency, sequencing). RESULTS The older of the two brothers with EO-AR parkinsonism had dementia according to DSM IV criteria, and MMSE score of 24, whereas the other had normal global cognitive status with mild cognitive changes (MMSE=29). The older brother had impaired memory tasks. Storage and retrieval capacities were defective on both immediate and delayed recalls, naming, constructional praxis, selective attention, shifting aptitude and phonemic and semantic fluency were also affected. The younger brother had difficulties in retrieval on delayed recall, selective attention, phonetic fluency, shifting aptitude and sequencing. This neuropsychological profile clearly differs from that of the YOPD patients, none of whom displayed cognitive dysfunction. CONCLUSIONS Our patients with parkin mutation performed poorly on neuropsychological tests compared to those with YOPD. This difference could reflect the longer disease duration or the nature of the degenerative process.
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Affiliation(s)
- B R Benbunan
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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Kipervasser S, Fried I, Korczyn AD, Segev Y, Neufeld MY. Cortical lesions associated with transient neurological symptoms - not always a matter of cause and effect. Eur J Neurol 2003; 10:721-5. [PMID: 14641519 DOI: 10.1046/j.1468-1331.2003.00666.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/20/2022]
Abstract
The occurrence of transient recurrent stereotypical neurological events mandates the exclusion of an underlying brain lesion. When imaging studies demonstrate the presence of a structural brain lesion, a cause and effect relationship between the two entities is assumed, and the decision for surgical intervention may then follow almost automatically. We describe five patients with transient neurological events suspected as being seizures that were referred for surgery because of an associated structural brain lesion. Video electroencephalographic recordings revealed that the events that brought these patients to neurosurgical attention were non-epileptic seizures. None of these patients underwent surgical intervention, and all were referred for behavioral therapy. Therefore, even in the presence of a confirmed brain lesion, the presenting paroxysmal events may be of a non-organic origin and should not necessarily be assumed to be caused by the concomitantly existing structural abnormality.
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Affiliation(s)
- S Kipervasser
- EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
OBJECTIVES To study the efficacy of cholinesterase inhibitors in the treatment of dementia in patients with Parkinson's disease (PD). METHODS We treated twenty-eight demented patients with PD openly for 26 weeks with rivastigmine (mean daily dose 7.2 +/- 3.3 mg/day). Baseline scores were compared with those at weeks 12, 26 and after 8 weeks of washout. RESULTS Twenty patients completed 26 weeks of treatment and eight dropped out because of side effects. The Unified Parkinson's Disease Rating Scale mental subscore improved significantly at week 26 (P < 0.01) while the motor score (part III) did not change. The mean ADAScog total score improved by 7.3 points at week 26 (P < 0.002). The subscores for recognition, word finding, remembering instructions and concentration items of the ADAScog improved significantly as well (P < 0.02, P < 0.05, P < 0.005 and P < 0.003, respectively). CONCLUSIONS Rivastigmine may improve the cognitive functions in PD patients with dementia with no worsening of motor function.
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Affiliation(s)
- N Giladi
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Israel
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Shoenfeld Y, Nahum A, Korczyn AD, Dano M, Rabinowitz R, Beilin O, Pick CG, Leider-Trejo L, Kalashnikova L, Blank M, Chapman J. Neuronal-binding antibodies from patients with antiphospholipid syndrome induce cognitive deficits following intrathecal passive transfer. Lupus 2003; 12:436-42. [PMID: 12873044 DOI: 10.1191/0961203303lu409oa] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [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: 11/05/2022]
Abstract
Antiphospholipid antibodies (aPL) have been suggested to play a role in causing cognitive and behavioral impairments. In the present study we investigated the pathogenic potential of aPL by intracerebro-ventricular (ICV) administration of immunoglobulins (IgG) from patients with antiphospholipid syndrome (APS). IgG, purified from the sera of four APS patients, was tested for binding to normal mouse brain by immunohistological staining. These IgG (7.5 microg) were injected ICV unilaterally to male C3H mice. Mice injected with IgG purified from pooled sera derived from healthy subjects served as controls. The mice were examined neurologically for motor function and coordination, and cognitively in a Morris water maze. The cognitive tests were performed with the experimenter blinded to the treatment. The performance of the mice in four separate experiments was compared by analysis of variance with repeated measures. IgG from one APS patient was found to bind best to neuronal structures in the hippocampus and cerebral cortex. Mice (n = 43) injected with this IgG performed worse in the water maze compared to the controls (n = 45) with significant effects of the aPL IgG on the overall performance of the mice (treatment, P < 0.03), on learning throughout the experiment (treatment x day, P < 0.02) and on short term memory (treatment x day xtrial, P < 0.002). IgG injected from two of the three other patients also bound specifically to mouse brain neurons and produced an impairment in performance of the water maze. These results support the hypothesis that aPL that gain access to the central nervous system may play a direct role in the pathogenesis of neurological manifestations of APS.
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Affiliation(s)
- Y Shoenfeld
- Department of Medicine B and Research Center for Autoimmune Diseases,Sheba MedicalCenter, Tel Hashomer, Israel.
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Biswas R, Parajuli R, Naik L, Moodley L, Korczyn AD. A conscientious hypertensive who had seizures after a trek. Int J Clin Pract 2003; 57:449-50. [PMID: 12846359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
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