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Cucchi D, Walter SG, Baumgartner T, Menon A, Egger L, Randelli PS, Surges R, Wirtz DC, Friedrich MJ. Poor midterm clinical outcomes and a high percentage of unsatisfying results are reported after seizure-related shoulder injuries, especially after posterior proximal humerus fracture-dislocations. J Shoulder Elbow Surg 2024; 33:1340-1351. [PMID: 37879597 DOI: 10.1016/j.jse.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Treating seizure-related shoulder injuries is challenging, and an evidence-based consensus to guide clinicians is lacking. The aim of this prospective single-center observational clinical trial was to evaluate the clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries, to categorize them according to the lesion's characteristics, with special focus on patients with proximal humerus fracture-dislocations (PHFDs), and to define groups at risk of obtaining unsatisfactory results. We hypothesized that patients with a PHFD, considered the worst-case scenario among these injuries, would report worse clinical results in terms of the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) as compared to the other patients. METHODS Patients referred to a tertiary epilepsy center who have seizure-related shoulder injuries and with a minimum follow-up of 1 year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient-reported outcome measure (qDASH), and a pain assessment tool (visual analog scale [VAS]) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented. Categorization and subgroup analysis according to the presence and features of selected specific lesions were performed. RESULTS A total of 111 patients were deemed eligible and 83 were available for follow-up (median age 38 years, 30% females), accounting for a total of 107 injured shoulders. After a median follow-up of 3.9 (1.6-8.2) years, overall moderate clinical results were reported. In addition, 34.1% of the patients reported a VAS score ≥35 mm, indicating moderate to severe pain, and 34.1% a qDASH score ≥40 points, indicating severe disability of an upper limb. These percentages rose to, respectively, 45.5% and 48.5% in the subgroup of patients with PHFDs and to 68.8% and 68.8% in patients experiencing posterior PHFD. Overall, 46.9% of the patients considered themselves unsatisfied with the treatment and 62.5% reported a persistent fear of a new shoulder injury. CONCLUSIONS Patients with seizure-related shoulder injuries reported only moderate clinical results at their midterm follow-up. Older age, male sex, and absence or discontinuation of antiepileptic drug (AED) treatment were identified as characterizing features of patients with posterior dislocation episodes. In patients with PHFD, a tendency to worse clinical results was observed, with posterior PHFD patients emerging as a definite subgroup at risk of reporting unsatisfying results after treatment.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany.
| | - Sebastian Gottfried Walter
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany; Department of Orthopaedics, Trauma Surgery and Plastic-Reconstructive Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Scuola di Specializzazione in Statistica Sanitaria e Biometria, Università degli Studi di Milano, Milan, Italy
| | - Lisa Egger
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy
| | - Rainer Surges
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy
| | | | - Max Julian Friedrich
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
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Neuhaus E, Bitzer F, Held NR, Bauer T, Gaubatz J, von Wrede R, Baumgartner T, Rácz A, Becker V, Surges R, Rüber T. Volumetric gray matter findings in autonomic network regions of people with focal epilepsy. J Neuroimaging 2024; 34:55-60. [PMID: 37840190 DOI: 10.1111/jon.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND AND PURPOSE Voxel-based morphometry (VBM) studies of people with focal epilepsies revealed gray matter (GM) alterations in brain regions involved in cardiorespiratory regulation, which have been linked to the risk of sudden unexpected death in epilepsy (SUDEP). It remains unclear whether the type and localization of epileptogenic lesions influence the occurrence of such alterations. METHODS To test the hypothesis that VBM alterations of autonomic network regions are independent of epileptogenic lesions and that they reveal structural underpinnings of SUDEP risk, VBM was performed in 100 people with focal epilepsies without an epileptogenic lesion identifiable on MRI (mean age ± standard deviation = 35 ± 11 years, 56 female). The group was further stratified in high (sample size n = 29) and low risk of SUDEP (n = 71). GM volumes were compared between these two subgroups and to 100 matched controls. RESULTS People with epilepsy displayed higher GM volume in both amygdalae and parahippocampal gyri and lower GM volume in the cerebellum and occipital (p<.05, familywise error corrected). There were no significant volumetric differences between high and low SUDEP risk subgroups. CONCLUSION Our findings confirm that autonomic networks are structurally altered in people with focal epilepsy and they question VBM as a suitable method to show structural correlates of the SUDEP risk score.
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Affiliation(s)
- Elisabeth Neuhaus
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Bitzer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Nina R Held
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Jennifer Gaubatz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Atilla Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Vitali Becker
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Stevelink R, Campbell C, Chen S, Abou-Khalil B, Adesoji OM, Afawi Z, Amadori E, Anderson A, Anderson J, Andrade DM, Annesi G, Auce P, Avbersek A, Bahlo M, Baker MD, Balagura G, Balestrini S, Barba C, Barboza K, Bartolomei F, Bast T, Baum L, Baumgartner T, Baykan B, Bebek N, Becker AJ, Becker F, Bennett CA, Berghuis B, Berkovic SF, Beydoun A, Bianchini C, Bisulli F, Blatt I, Bobbili DR, Borggraefe I, Bosselmann C, Braatz V, Bradfield JP, Brockmann K, Brody LC, Buono RJ, Busch RM, Caglayan H, Campbell E, Canafoglia L, Canavati C, Cascino GD, Castellotti B, Catarino CB, Cavalleri GL, Cerrato F, Chassoux F, Cherny SS, Cheung CL, Chinthapalli K, Chou IJ, Chung SK, Churchhouse C, Clark PO, Cole AJ, Compston A, Coppola A, Cosico M, Cossette P, Craig JJ, Cusick C, Daly MJ, Davis LK, de Haan GJ, Delanty N, Depondt C, Derambure P, Devinsky O, Di Vito L, Dlugos DJ, Doccini V, Doherty CP, El-Naggar H, Elger CE, Ellis CA, Eriksson JG, Faucon A, Feng YCA, Ferguson L, Ferraro TN, Ferri L, Feucht M, Fitzgerald M, Fonferko-Shadrach B, Fortunato F, Franceschetti S, Franke A, French JA, Freri E, Gagliardi M, Gambardella A, Geller EB, Giangregorio T, Gjerstad L, Glauser T, Goldberg E, Goldman A, Granata T, Greenberg DA, Guerrini R, Gupta N, Haas KF, Hakonarson H, Hallmann K, Hassanin E, Hegde M, Heinzen EL, Helbig I, Hengsbach C, Heyne HO, Hirose S, Hirsch E, Hjalgrim H, Howrigan DP, Hucks D, Hung PC, Iacomino M, Imbach LL, Inoue Y, Ishii A, Jamnadas-Khoda J, Jehi L, Johnson MR, Kälviäinen R, Kamatani Y, Kanaan M, Kanai M, Kantanen AM, Kara B, Kariuki SM, Kasperavičiūte D, Kasteleijn-Nolst Trenite D, Kato M, Kegele J, Kesim Y, Khoueiry-Zgheib N, King C, Kirsch HE, Klein KM, Kluger G, Knake S, Knowlton RC, Koeleman BPC, Korczyn AD, Koupparis A, Kousiappa I, Krause R, Krenn M, Krestel H, Krey I, Kunz WS, Kurki MI, Kurlemann G, Kuzniecky R, Kwan P, Labate A, Lacey A, Lal D, Landoulsi Z, Lau YL, Lauxmann S, Leech SL, Lehesjoki AE, Lemke JR, Lerche H, Lesca G, Leu C, Lewin N, Lewis-Smith D, Li GHY, Li QS, Licchetta L, Lin KL, Lindhout D, Linnankivi T, Lopes-Cendes I, Lowenstein DH, Lui CHT, Madia F, Magnusson S, Marson AG, May P, McGraw CM, Mei D, Mills JL, Minardi R, Mirza N, Møller RS, Molloy AM, Montomoli M, Mostacci B, Muccioli L, Muhle H, Müller-Schlüter K, Najm IM, Nasreddine W, Neale BM, Neubauer B, Newton CRJC, Nöthen MM, Nothnagel M, Nürnberg P, O’Brien TJ, Okada Y, Ólafsson E, Oliver KL, Özkara C, Palotie A, Pangilinan F, Papacostas SS, Parrini E, Pato CN, Pato MT, Pendziwiat M, Petrovski S, Pickrell WO, Pinsky R, Pippucci T, Poduri A, Pondrelli F, Powell RHW, Privitera M, Rademacher A, Radtke R, Ragona F, Rau S, Rees MI, Regan BM, Reif PS, Rhelms S, Riva A, Rosenow F, Ryvlin P, Saarela A, Sadleir LG, Sander JW, Sander T, Scala M, Scattergood T, Schachter SC, Schankin CJ, Scheffer IE, Schmitz B, Schoch S, Schubert-Bast S, Schulze-Bonhage A, Scudieri P, Sham P, Sheidley BR, Shih JJ, Sills GJ, Sisodiya SM, Smith MC, Smith PE, Sonsma ACM, Speed D, Sperling MR, Stefansson H, Stefansson K, Steinhoff BJ, Stephani U, Stewart WC, Stipa C, Striano P, Stroink H, Strzelczyk A, Surges R, Suzuki T, Tan KM, Taneja RS, Tanteles GA, Taubøll E, Thio LL, Thomas GN, Thomas RH, Timonen O, Tinuper P, Todaro M, Topaloğlu P, Tozzi R, Tsai MH, Tumiene B, Turkdogan D, Unnsteinsdóttir U, Utkus A, Vaidiswaran P, Valton L, van Baalen A, Vetro A, Vining EPG, Visscher F, von Brauchitsch S, von Wrede R, Wagner RG, Weber YG, Weckhuysen S, Weisenberg J, Weller M, Widdess-Walsh P, Wolff M, Wolking S, Wu D, Yamakawa K, Yang W, Yapıcı Z, Yücesan E, Zagaglia S, Zahnert F, Zara F, Zhou W, Zimprich F, Zsurka G, Zulfiqar Ali Q. GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nat Genet 2023; 55:1471-1482. [PMID: 37653029 PMCID: PMC10484785 DOI: 10.1038/s41588-023-01485-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Epilepsy is a highly heritable disorder affecting over 50 million people worldwide, of which about one-third are resistant to current treatments. Here we report a multi-ancestry genome-wide association study including 29,944 cases, stratified into three broad categories and seven subtypes of epilepsy, and 52,538 controls. We identify 26 genome-wide significant loci, 19 of which are specific to genetic generalized epilepsy (GGE). We implicate 29 likely causal genes underlying these 26 loci. SNP-based heritability analyses show that common variants explain between 39.6% and 90% of genetic risk for GGE and its subtypes. Subtype analysis revealed markedly different genetic architectures between focal and generalized epilepsies. Gene-set analyses of GGE signals implicate synaptic processes in both excitatory and inhibitory neurons in the brain. Prioritized candidate genes overlap with monogenic epilepsy genes and with targets of current antiseizure medications. Finally, we leverage our results to identify alternate drugs with predicted efficacy if repurposed for epilepsy treatment.
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Baumgartner T, Paassen B, Klatt S. Extracting spatial knowledge from track and field broadcasts for monocular 3D human pose estimation. Sci Rep 2023; 13:14031. [PMID: 37640789 PMCID: PMC10462612 DOI: 10.1038/s41598-023-41142-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
Collecting large datasets for investigations into human locomotion is an expensive and labor-intensive process. Methods for 3D human pose estimation in the wild are becoming increasingly accurate and could soon be sufficient to assist with the collection of datasets for analysis into running kinematics from TV broadcast data. In the domain of biomechanical research, small differences in 3D angles play an important role. More precisely, the error margins of the data collection process need to be smaller than the expected variation between athletes. In this work, we propose a method to infer the global geometry of track and field stadium recordings using lane demarcations. By projecting estimated 3D skeletons back into the image using this global geometry, we show that current state-of-the-art 3D human pose estimation methods are not (yet) accurate enough to be used in kinematics research.
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Affiliation(s)
- Tobias Baumgartner
- Institute for Exercise Training and Sport Informatics, German Sport University, Cologne, Germany.
| | - Benjamin Paassen
- German Research Center for Artificial Intelligence, Berlin, Germany
| | - Stefanie Klatt
- Institute for Exercise Training and Sport Informatics, German Sport University, Cologne, Germany
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5
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Schuch F, Walger L, Schmitz M, David B, Bauer T, Harms A, Fischbach L, Schulte F, Schidlowski M, Reiter J, Bitzer F, von Wrede R, Rácz A, Baumgartner T, Borger V, Schneider M, Flender A, Becker A, Vatter H, Weber B, Specht-Riemenschneider L, Radbruch A, Surges R, Rüber T. An open presurgery MRI dataset of people with epilepsy and focal cortical dysplasia type II. Sci Data 2023; 10:475. [PMID: 37474522 PMCID: PMC10359264 DOI: 10.1038/s41597-023-02386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
Automated detection of lesions using artificial intelligence creates new standards in medical imaging. For people with epilepsy, automated detection of focal cortical dysplasias (FCDs) is widely used because subtle FCDs often escape conventional neuroradiological diagnosis. Accurate recognition of FCDs, however, is of outstanding importance for affected people, as surgical resection of the dysplastic cortex is associated with a high chance of postsurgical seizure freedom. Here, we make publicly available a dataset of 85 people affected by epilepsy due to FCD type II and 85 healthy control persons. We publish 3D-T1 and 3D-FLAIR, manually labeled regions of interest, and carefully selected clinical features. The open presurgery MRI dataset may be used to validate existing automated algorithms of FCD detection as well as to create new approaches. Most importantly, it will enable comparability of already existing approaches and support a more widespread use of automated lesion detection tools.
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Affiliation(s)
- Fabiane Schuch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Lennart Walger
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmitz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Bastian David
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Antonia Harms
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Laura Fischbach
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Freya Schulte
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Johannes Reiter
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Felix Bitzer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Atilla Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Achim Flender
- Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Albert Becker
- Section of Translational Epilepsy Research, Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | | | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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Harms A, Bauer T, Witt JA, Baumgartner T, von Wrede R, Racz A, Ernst L, Becker AJ, Helmstaedter C, Surges R, Rüber T. Mesiotemporal Volumetry, Cortical Thickness, and Neuropsychological Deficits in the Long-term Course of Limbic Encephalitis. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/4/e200125. [PMID: 37230543 DOI: 10.1212/nxi.0000000000200125] [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] [Received: 11/19/2022] [Accepted: 03/30/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Limbic encephalitis (LE) is an autoimmune disease often associated with temporal lobe epilepsy and subacute memory deficits. It is categorized into serologic subgroups, which differ in clinical progress, therapy response, and prognosis. Using longitudinal MRI analysis, we hypothesized that mesiotemporal and cortical atrophy rates would reveal serotype-specific patterns and reflect disease severity. METHODS In this longitudinal case-control study, all individuals with antibody-positive (glutamic acid decarboxylase 65 [GAD], leucine-rich glioma-inactivated protein 1 [LGI1], contactin-associated protein 2 [CASPR2], and N-methyl-d-aspartate receptor [NMDAR]) nonparaneoplastic LE according to Graus' diagnostic criteria treated between 2005 and 2019 at the University Hospital Bonn were enrolled. A longitudinal healthy cohort was included as the control group. Subcortical segmentation and cortical reconstruction of T1-weighted MRI were performed using the longitudinal framework in FreeSurfer. We applied linear mixed models to examine mesiotemporal volumes and cortical thickness longitudinally. RESULTS Two hundred fifty-seven MRI scans from 59 individuals with LE (34 female, age at disease onset [mean ± SD] 42.5 ± 20.4 years; GAD: n = 30, 135 scans; LGI1: n = 15, 55 scans; CASPR2: n = 9, 37 scans; and NMDAR: n = 5, 30 scans) were included. The healthy control group consisted of 128 scans from 41 individuals (22 female, age at first scan [mean ± SD] 37.7 ± 14.6 years). The amygdalar volume at disease onset was significantly higher in individuals with LE (p ≤ 0.048 for all antibody subgroups) compared with that in healthy controls and decreased over time in all antibody subgroups, except in the GAD subgroup. We observed a significantly higher hippocampal atrophy rate in all antibody subgroups compared with that in healthy controls (all p ≤ 0.002), except in the GAD subgroup. Cortical atrophy rates exceeded normal aging in individuals with impaired verbal memory, while those who were not impaired did not differ significantly from healthy controls. DISCUSSION Our data depict higher mesiotemporal volumes in the early disease stage, most likely due to edematous swelling, followed by volume regression and atrophy/hippocampal sclerosis in the late disease stage. Our study reveals a continuous and pathophysiologically meaningful trajectory of mesiotemporal volumetry across all serogroups and provides evidence that LE should be considered a network disorder in which extratemporal involvement is an important determinant of disease severity.
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Affiliation(s)
- Antonia Harms
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Tobias Bauer
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Juri-Alexander Witt
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Tobias Baumgartner
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Randi von Wrede
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Attila Racz
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Leon Ernst
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Albert J Becker
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Christoph Helmstaedter
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Rainer Surges
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany
| | - Theodor Rüber
- From the Department of Epileptology (A.H., T. Bauer, J.-A.W., T. Baumgartner, R.v.W., A.R., L.E., C.H., R.S., T.R.), and Department of Neuropathology (A.J.B.), Section for Translational Epilepsy Research, University Hospital Bonn, Germany.
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7
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Fischbach L, Bauer T, Diers K, Witt JA, Brugues M, Borger V, Schidlowski M, Rácz A, Baumgartner T, von Wrede R, Paech D, Weber B, Radbruch A, Vatter H, Becker AJ, Huppertz HJ, Helmstaedter C, Surges R, Reuter M, Rüber T. A novel geometry-based analysis of hippocampal morphometry in mesial temporal lobe epilepsy. Hum Brain Mapp 2023. [PMID: 37347650 PMCID: PMC10365234 DOI: 10.1002/hbm.26392] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
Hippocampal volumetry is an essential tool in researching and diagnosing mesial temporal lobe epilepsy (mTLE). However, it has a limited ability to detect subtle alterations in hippocampal morphometry. Here, we establish and apply a novel geometry-based tool that enables point-wise morphometric analysis based on an intrinsic coordinate system of the hippocampus. We hypothesized that this point-wise analysis uncovers structural alterations not measurable by volumetry, but associated with histological underpinnings and the neuropsychological profile of mTLE. We conducted a retrospective study in 204 individuals with mTLE and 57 age- and gender-matched healthy subjects. FreeSurfer-based segmentations of hippocampal subfields in 3T-MRI were subjected to a geometry-based analysis that resulted in a coordinate system of the hippocampal mid-surface and allowed for point-wise measurements of hippocampal thickness and other features. Using point-wise analysis, we found significantly lower thickness and higher FLAIR signal intensity in the entire affected hippocampus of individuals with hippocampal sclerosis (HS-mTLE). In the contralateral hippocampus of HS-mTLE and the affected hippocampus of MRI-negative mTLE, we observed significantly lower thickness in the presubiculum. Impaired verbal memory was associated with lower thickness in the left presubiculum. In HS-mTLE histological subtype 3, we observed higher curvature than in subtypes 1 and 2 (all p < .05). These findings could not be observed using conventional volumetry (Bonferroni-corrected p < .05). We show that point-wise measures of hippocampal morphometry can uncover structural alterations not measurable by volumetry while also reflecting histological underpinnings and verbal memory. This substantiates the prospect of their clinical application.
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Affiliation(s)
- Laura Fischbach
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Kersten Diers
- AI in Medical Imaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Mar Brugues
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Albert J Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | | | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Martin Reuter
- AI in Medical Imaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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8
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Cucchi D, Baumgartner T, Walter SG, Menon A, Ossendorff R, Surges R, Burger C, Wirtz DC, Friedrich MJ. Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures. Arch Orthop Trauma Surg 2023; 143:1999-2009. [PMID: 35347411 PMCID: PMC10030428 DOI: 10.1007/s00402-022-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Epileptic seizures can cause multiple shoulder injuries, the most common of which are dislocations, recurrent instability, fractures, and isolated lesions of the rotator cuff. Currently, only limited literature exists which describes the frequency and types of lesions in cohorts of epileptic patients and the corresponding treatment outcome. This study aims to document the occurrence of shoulder lesions in patients affected by seizures and to provide detailed information on trauma dynamics, specific lesion characteristics and treatment complications. METHODS All patients referring to a tertiary epilepsy center were screened for shoulder injuries and the clinical records of those sustaining them during a seizure were reviewed. Demographic information, lesions' characteristics and trauma dynamics were analysed, as wells as-when carried out-the type of surgical intervention and any postoperative complications. RESULTS The average age at the time of injury of 106 included patients was 39.7 ± 17.5 years and a male predominance was recorded (65%). Bilateral injuries occurred in 29 patients, simultaneously in 17 cases. A younger age, bilateral shoulder injuries and shoulder dislocations were significantly associated with the occurrence of a shoulder injury solely by muscular activation (p = 0.0054, p = 0.011, p < 0.0001). The complication rate in 57 surgically treated patients with follow-up data was 38.7%, with recurring instability being the most frequently reported complication (62.5%). CONCLUSIONS Uncontrolled muscle activation during a seizure is a distinctive but not exclusive dynamic of injury in epileptic patients, accounting for more than the half of all shoulder lesions, especially in the younger. This can lead both to anterior and posterior dislocations or fracture-dislocations and is frequently cause of bilateral lesions and of instability recurrence after surgery. The high complication rates after surgical treatment in this selected subgroup of patients require that appropriate preventative measures are taken to increase the probability of treatment success. LEVEL OF EVIDENCE Cohort study, level III.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Tobias Baumgartner
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Gottfried Walter
- Department for Orthopedic Surgery and Traumatology, University Hospital Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Alessandra Menon
- ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Robert Ossendorff
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christof Burger
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dieter Christian Wirtz
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Max Julian Friedrich
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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9
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Schulte F, Bitzer F, Gärtner FC, Bauer T, von Wrede R, Baumgartner T, Rácz A, Borger V, von Oertzen T, Vatter H, Essler M, Surges R, Rüber T. The diagnostic value of ictal SPECT-A retrospective, semiquantitative monocenter study. Epilepsia Open 2023; 8:183-192. [PMID: 36658093 PMCID: PMC9977750 DOI: 10.1002/epi4.12694] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Ictal single photon emission computed tomography (SPECT) can be used as an advanced diagnostic modality to detect the seizure onset zone in the presurgical evaluation of people with epilepsy. In addition to visual assessment (VSA) of ictal and interictal SPECT images, postprocessing methods such as ictal-interictal SPECT analysis using SPM (ISAS) can visualize regional ictal blood flow differences. We aimed to evaluate and differentiate the diagnostic value of VSA and ISAS in the Bonn cohort. METHODS We included 161 people with epilepsy who underwent presurgical evaluation at the University Hospital Bonn between 2008 and 2020 and received ictal and interictal SPECT and ISAS. We retrospectively assigned SPECT findings to one of five categories according to their degree of concordance with the clinical focus hypothesis. RESULTS Seizure onset zones could be identified more likely on a sublobar concordance level by ISAS than by VSA (31% vs. 19% of cases; OR = 1.88; 95% Cl [1.04, 3.42]; P = 0.03). Both VSA and ISAS more often localized a temporal seizure onset zone than an extratemporal one. Neither VSA nor ISAS findings were predicted by the latency between seizure onset and tracer injection (P = 0.75). In people who underwent successful epilepsy surgery, VSA and ISAS indicated the correct resection site in 54% of individuals, while MRI and EEG showed the correct resection localization in 96% and 33% of individuals, respectively. It was more likely to become seizure-free after epilepsy surgery if ISAS or VSA had been successful. There was no MR-negative case with successful surgery, indicating that ictal SPECT is more useful for confirmation than for localization. SIGNIFICANCE The results of the most extensive clinical study of ictal SPECT to date allow an assessment of the diagnostic value of this elaborate examination and emphasize the importance of postprocessing routines.
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Affiliation(s)
- Freya Schulte
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Felix Bitzer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Tim von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Baumgartner T, Klatt S, Donath L. Revealing the Mutual Information between Body-Worn Sensors and Metabolic Cost in Running. Sensors (Basel) 2023; 23:1756. [PMID: 36850354 PMCID: PMC9959695 DOI: 10.3390/s23041756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Running power is a popular measure to gauge objective intensity. It has recently been shown, though, that foot-worn sensors alone cannot reflect variations in the exerted energy that stems from changes in the running economy. In order to support long-term improvement in running, these changes need to be taken into account. We propose leveraging the presence of two additional sensors worn by the most ambitious recreational runners for improved measurement: a watch and a heart rate chest strap. Using these accelerometers, which are already present and distributed over the athlete's body, carries more information about metabolic demand than a single foot-worn sensor. In this work, we demonstrate the mutual information between acceleration data and the metabolic demand of running by leveraging the information bottleneck of a constrained convolutional neural network. We perform lab measurements on 29 ambitious recreational runners (age = 28 ± 7 years, weekly running distance = 50 ± 25 km, V˙O2max = 60.3 ± 7.4 mL · min-1·kg-1). We show that information about the metabolic demand of running is contained in kinetic data. Additionally, we prove that the combination of three sensors (foot, torso, and lower arm) carries significantly more information than a single foot-worn sensor. We advocate for the development of running power systems that incorporate the sensors in watches and chest straps to improve the validity of running power and, thereby, long-term training planning.
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Affiliation(s)
- Tobias Baumgartner
- Institute of Exercise Training and Sport Informatics, Department of Cognitive and Team/Racket Sport Research, German Sport University Cologne, 50933 Cologne, Germany
| | - Stefanie Klatt
- Institute of Exercise Training and Sport Informatics, Department of Cognitive and Team/Racket Sport Research, German Sport University Cologne, 50933 Cologne, Germany
- School of Sport and Health Sciences, University of Brighton, Eastbourne BN20 7SR, UK
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, 50933 Cologne, Germany
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11
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Bahna M, Hamed M, Ilic I, Salemdawod A, Schneider M, Rácz A, Baumgartner T, Güresir E, Eichhorn L, Lehmann F, Schuss P, Surges R, Vatter H, Borger V. The necessity for routine intensive care unit admission following elective craniotomy for epilepsy surgery: a retrospective single-center observational study. J Neurosurg 2022; 137:1203-1209. [PMID: 35120311 DOI: 10.3171/2021.12.jns211799] [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: 07/26/2021] [Accepted: 12/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, patients who underwent elective craniotomy for epilepsy surgery are monitored postoperatively in an intensive care unit (ICU) overnight in order to sufficiently respond to potential early postoperative complications. In the present study, the authors investigated the frequency of early postoperative events that entailed ICU monitoring in patients who had undergone elective craniotomy for epilepsy surgery. In a second step, they aimed at identifying pre- and intraoperative risk factors for the development of unfavorable events to distinguish those patients with the need for postoperative ICU monitoring at the earliest possible stage. METHODS The authors performed a retrospective observational cohort study assessing patients with medically intractable epilepsy (n = 266) who had undergone elective craniotomy for epilepsy surgery between 2012 and 2019 at a tertiary care epilepsy center, excluding those patients who had undergone invasive diagnostic approaches and functional hemispherectomy. Postoperative complications were defined as any unfavorable postoperative surgical and/or anesthesiological event that required further ICU therapy within 48 hours following surgery. A multivariate analysis was performed to reveal preoperatively identifiable risk factors for postoperative adverse events requiring an ICU setting. RESULTS Thirteen (4.9%) of 266 patients developed early postoperative adverse events that required further postoperative ICU care. The most prevalent event was a return to the operating room because of relevant postoperative intracranial hematoma (5 of 266 patients). Multivariate analysis revealed intraoperative blood loss ≥ 325 ml (OR 6.2, p = 0.012) and diabetes mellitus (OR 9.2, p = 0.029) as risk factors for unfavorable postoperative events requiring ICU therapy. CONCLUSIONS The present study revealed routinely collectable risk factors that would allow the identification of patients with an elevated risk of postsurgical complications requiring a postoperative ICU stay following epilepsy surgery. These findings may offer guidance for a stepdown unit admission policy following epilepsy surgical interventions after an external validation of the results.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lars Eichhorn
- 3Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Felix Lehmann
- 3Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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12
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Lesca G, Baumgartner T, Monin P, De Dominicis A, Kunz WS, Specchio N. Genetic causes of rare and common epilepsies: What should the epileptologist know? Eur J Med Genet 2022; 65:104570. [PMID: 35850153 DOI: 10.1016/j.ejmg.2022.104570] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/04/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
Abstract
In past decades, the identification of genes involved in epileptic disorders has grown exponentially. The pace of gene identification in epileptic disorders began to accelerate in the late 2000s, driven by new technologies such as molecular cytogenetics and next-generation sequencing (NGS). These technologies have also been applied to genetic diagnostics, with different configurations, such as gene panels, whole-exome sequencing and whole-genome sequencing. The clinician must be aware that any technology has its limitations and complementary techniques must still be used to establish a diagnosis for specific diseases. In addition, increasing the amount of genetic information available in a larger patient sample also increases the need for rigorous interpretation steps, when taking into account the clinical, electroclinical, and when available, functional data. Local, multidisciplinary discussions have proven valuable in difficult diagnostic situations, especially in cases where precision medicine is being considered. They also serve to improve genetic counseling in complex situations. In this article, we will briefly review the genetic basis of rare and common epilepsies, the current strategies used for molecular diagnosis, including their limitations, and some pitfalls for data interpretation, in the context of etiological diagnosis and genetic counseling.
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Affiliation(s)
- Gaetan Lesca
- Department of Medical Genetics and Department of Paedaitric Clinical Epileptology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France; University Claude Bernard Lyon 1, Lyon, France.
| | - Tobias Baumgartner
- Department of Epileptology, University Hospital Bonn, Member of the ERN EpiCARE, Bonn, Germany
| | - Pauline Monin
- Department of Medical Genetics and Department of Paedaitric Clinical Epileptology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France; University Claude Bernard Lyon 1, Lyon, France
| | - Angela De Dominicis
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Wolfram S Kunz
- Department of Epileptology, University Hospital Bonn, Member of the ERN EpiCARE, Bonn, Germany
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
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13
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Borger V, Hamed M, Bahna M, Rácz Á, Ilic I, Potthoff AL, Baumgartner T, Rüber T, Becker A, Radbruch A, Mormann F, Surges R, Vatter H, Schneider M. Temporal lobe epilepsy surgery: Piriform cortex resection impacts seizure control in the long-term. Ann Clin Transl Neurol 2022; 9:1206-1211. [PMID: 35776784 PMCID: PMC9380176 DOI: 10.1002/acn3.51620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
Objective Recently, we showed that resection of at least 27% of the temporal part of piriform cortex (PiC) strongly correlated with seizure freedom 1 year following selective amygdalo‐hippocampectomy (tsSAHE) in patients with mesial temporal lobe epilepsy (mTLE). However, the impact of PiC resection on long‐term seizure outcome following tsSAHE is currently unknown. The aim of this study was to evaluate the impact of PiC resection on long‐term seizure outcome in patients with mTLE treated with tsSAHE. Methods Between 2012 and 2017, 64 patients were included in the retrospective analysis. Long‐term follow‐up (FU) was defined as at least 2 years postoperatively. Seizure outcome was assessed according to the International League against Epilepsy (ILAE). The resected proportions of hippocampus, amygdala, and PiC were volumetrically assessed. Results The mean FU duration was 3.75 ± 1.61 years. Patients with ILAE class 1 revealed a significantly larger median proportion of resected PiC compared to patients with ILAE class 2–6 [46% (IQR 31–57) vs. 16% (IQR 6–38), p = 0.001]. Resected proportions of hippocampus and amygdala did not significantly differ for these groups. Among those patients with at least 27% resected proportion of PiC, there were significantly more patients with seizure freedom compared to the patients with <27% resected proportion of PiC (83% vs. 39%, p = 0.0007). Conclusions Our results show a strong impact of the extent of PiC resection on long‐term seizure outcome following tsSAHE in mTLE. The authors suggest the PiC to constitute a key target volume in tsSAHE to achieve seizure freedom in the long term.
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Affiliation(s)
- Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Majd Bahna
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Áttila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Inja Ilic
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | | | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Albert Becker
- Section for Translational Epilepsy Research, Institute of Neuropathology, Medical Faculty, University of Bonn, Bonn, Germany
| | | | - Florian Mormann
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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14
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Baumgartner T, Pitsch J, Olaciregui-Dague K, Hoppe C, Racz A, Rüber T, Becker A, von Wrede R, Surges R. Seizure underreporting in LGI1 and CASPR2 antibody encephalitis. Epilepsia 2022; 63:e100-e105. [PMID: 35735209 DOI: 10.1111/epi.17338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Patients with anti-leucine-rich glioma-inactivated 1 protein (LGI1) or anti-contactin-associated protein 2 (CASPR2) antibody encephalitis typically present with frequent epileptic seizures. The seizures generally respond well to immunosuppressive therapy and the long-term seizure outcome seems to be favorable. Consequentially, diagnosing acute symptomatic seizures secondary to autoimmune encephalitis instead of autoimmune epilepsy was proposed. However, published data on long-term seizure outcomes in CASPR2 and LGI1 antibody encephalitis are mostly based on patient reports and seizure underreporting is a recognized issue. Clinical records from our tertiary epilepsy center were screened retrospectively for patients with LGI1 and CASPR2 antibody encephalitis who reported seizure freedom for at least three months and received video-EEG for >24 hours at follow-up visits. Twenty (LGI1: n=15; CASPR2: n=5) out of thirty-two patients with LGI1 (n=24) and CASPR2 (n=8) antibody encephalitis fulfilled these criteria. We recorded focal aware and impaired awareness seizures in four of these patients (20%) with reported seizure-free intervals ranging from 3 to 27 months. Our results question the favorable seizure outcome in patients with CASPR2 and LGI1 antibody encephalitis and suggest that the proportion of patients who have persistent seizures may be greater. Our findings underline the importance of prolonged video-EEG telemetry in this population.
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Affiliation(s)
| | - Julika Pitsch
- Dept. of Epileptology, University Hospital Bonn, Germany
| | | | | | - Attila Racz
- Dept. of Epileptology, University Hospital Bonn, Germany
| | - Theodor Rüber
- Dept. of Epileptology, University Hospital Bonn, Germany
| | - Albert Becker
- Section for Translational Epilepsy Research, Dept. of Neuropathology, University Hospital Bonn, Germany
| | | | - Rainer Surges
- Dept. of Epileptology, University Hospital Bonn, Germany
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15
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Rácz A, Hummel CA, Becker A, Helmstaedter C, Schuch F, Baumgartner T, von Wrede R, Borger V, Solymosi L, Surges R, Elger CE. Histopathologic Characterization and Neurodegenerative Markers in Patients With Limbic Encephalitis Undergoing Epilepsy Surgery. Front Neurol 2022; 13:859868. [PMID: 35493848 PMCID: PMC9051082 DOI: 10.3389/fneur.2022.859868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Limbic encephalitis is an increasingly recognized cause of medial temporal lobe epilepsy (mTLE) and associated cognitive deficits, potentially resulting in hippocampal sclerosis (HS). For several reasons, these patients usually do not undergo epilepsy surgery. Thus, histopathologic examinations in surgical specimens of clearly diagnosed limbic encephalitis are scarce. The purpose of this study was a detailed histopathologic analysis of surgical tissue alterations, including neurodegenerative markers, in patients with limbic encephalitis undergoing epilepsy surgery. Methods We investigated the surgical specimens of six patients operated on with mTLE related to limbic encephalitis (among them four patients were with GAD65 and one with Ma1/2 antibodies), and compared the findings to a control group with six patients matched according to age at the time of surgery without limbic encephalitis and without early inciting events. Results Histopathologic analysis in the group with limbic encephalitis revealed HS in four patients, while three of them also displayed signs of an active inflammatory reaction with lymphocytes. In one of the patients with GAD65-encephalitis who was suffering from a late-onset mTLE and a long disease course, neurodegenerative protein markers (β-amyloid and hyperphosphorylated tau) were found coexisting with inflammatory reactions and HS. Investigations in the control group did not reveal any inflammatory reaction or neurodegenerative marker. Conclusion Our findings suggest a possible link between long-lasting immune reactions in the medial temporal lobe, HS, and further toward the development of neurodegenerative diseases. Presently, however, a causal relationship between these entities cannot yet be established. Furthermore, our results suggest that an immunological etiology should always be considered in late onset (> 18 years) mTLE, also in cases of long disease duration and the presence of HS.
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Affiliation(s)
- Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- *Correspondence: Attila Rácz
| | - Chiara A. Hummel
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | | | - Fabiane Schuch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - László Solymosi
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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16
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Strippel C, Herrera-Rivero M, Wendorff M, Tietz AK, Degenhardt F, Witten A, Schroeter C, Nelke C, Golombeck KS, Madlener M, Rüber T, Ernst L, Racz A, Baumgartner T, Widman G, Doppler K, Thaler F, Siebenbrodt K, Dik A, Kerin C, Räuber S, Gallus M, Kovac S, Grauer OM, Grimm A, Prüss H, Wickel J, Geis C, Lewerenz J, Goebels N, Ringelstein M, Menge T, Tackenberg B, Kellinghaus C, Bien CG, Kraft A, Zettl U, Ismail FS, Ayzenberg I, Urbanek C, Sühs KW, Tauber SC, Mues S, Körtvélyessy P, Markewitz R, Paliantonis A, Elger CE, Surges R, Sommer C, Kümpfel T, Gross CC, Lerche H, Wellmer J, Quesada CM, Then Bergh F, Wandinger KP, Becker AJ, Kunz WS, Meyer zu Hörste G, Malter MP, Rosenow F, Wiendl H, Kuhlenbäumer G, Leypoldt F, Lieb W, Franke A, Meuth SG, Stoll M, Melzer N. A genome-wide association study in autoimmune neurological syndromes with anti-GAD65 autoantibodies. Brain 2022; 146:977-990. [PMID: 35348614 PMCID: PMC9976967 DOI: 10.1093/brain/awac119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/11/2022] [Accepted: 03/13/2022] [Indexed: 11/15/2022] Open
Abstract
Autoimmune neurological syndromes (AINS) with autoantibodies against the 65 kDa isoform of the glutamic acid decarboxylase (GAD65) present with limbic encephalitis, including temporal lobe seizures or epilepsy, cerebellitis with ataxia, and stiff-person-syndrome or overlap forms. Anti-GAD65 autoantibodies are also detected in autoimmune diabetes mellitus, which has a strong genetic susceptibility conferred by human leukocyte antigen (HLA) and non-HLA genomic regions. We investigated the genetic predisposition in patients with anti-GAD65 AINS. We performed a genome-wide association study (GWAS) and an association analysis of the HLA region in a large German cohort of 1214 individuals. These included 167 patients with anti-GAD65 AINS, recruited by the German Network for Research on Autoimmune Encephalitis (GENERATE), and 1047 individuals without neurological or endocrine disease as population-based controls. Predictions of protein expression changes based on GWAS findings were further explored and validated in the CSF proteome of a virtually independent cohort of 10 patients with GAD65-AINS and 10 controls. Our GWAS identified 16 genome-wide significant (P < 5 × 10-8) loci for the susceptibility to anti-GAD65 AINS. The top variant, rs2535288 [P = 4.42 × 10-16, odds ratio (OR) = 0.26, 95% confidence interval (CI) = 0.187-0.358], localized to an intergenic segment in the middle of the HLA class I region. The great majority of variants in these loci (>90%) mapped to non-coding regions of the genome. Over 40% of the variants have known regulatory functions on the expression of 48 genes in disease relevant cells and tissues, mainly CD4+ T cells and the cerebral cortex. The annotation of epigenomic marks suggested specificity for neural and immune cells. A network analysis of the implicated protein-coding genes highlighted the role of protein kinase C beta (PRKCB) and identified an enrichment of numerous biological pathways participating in immunity and neural function. Analysis of the classical HLA alleles and haplotypes showed no genome-wide significant associations. The strongest associations were found for the DQA1*03:01-DQB1*03:02-DRB1*04:01HLA haplotype (P = 4.39 × 10-4, OR = 2.5, 95%CI = 1.499-4.157) and DRB1*04:01 allele (P = 8.3 × 10-5, OR = 2.4, 95%CI = 1.548-3.682) identified in our cohort. As predicted, the CSF proteome showed differential levels of five proteins (HLA-A/B, C4A, ATG4D and NEO1) of expression quantitative trait loci genes from our GWAS in the CSF proteome of anti-GAD65 AINS. These findings suggest a strong genetic predisposition with direct functional implications for immunity and neural function in anti-GAD65 AINS, mainly conferred by genomic regions outside the classical HLA alleles.
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Affiliation(s)
| | | | - Mareike Wendorff
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anja K Tietz
- Department of Neurology, University of Kiel, Kiel, Germany
| | - Frauke Degenhardt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anika Witten
- Department of Genetic Epidemiology, Institute of Human Genetics, University of Münster, Münster, Germany
| | - Christina Schroeter
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christopher Nelke
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Kristin S Golombeck
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Marie Madlener
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Theodor Rüber
- Department of Epileptology, University of Bonn, Bonn, Germany,Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, and LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Leon Ernst
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Attila Racz
- Department of Epileptology, University of Bonn, Bonn, Germany
| | | | - Guido Widman
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Franziska Thaler
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, and LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Andre Dik
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Constanze Kerin
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Saskia Räuber
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Marco Gallus
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Oliver M Grauer
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Alexander Grimm
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Harald Prüss
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan Wickel
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christian Geis
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
| | - Norbert Goebels
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany,Center for Neurology and Neuropsychiatry, LVR Klinikum, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Til Menge
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany,Center for Neurology and Neuropsychiatry, LVR Klinikum, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Björn Tackenberg
- Department of Neurology, University of Marburg/Gießen, Marburg, Germany
| | | | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Medical School, Campus Bielefeld-Bethel, Bielefeld, Germany
| | | | - Uwe Zettl
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Fatme Seval Ismail
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ilya Ayzenberg
- Department of Neurology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia,Department of Neurology, St Josefs Krankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Christian Urbanek
- Department of Neurology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Kurt-Wolfram Sühs
- Department of Neurology, University Hospital, MHH, Hannover, Germany
| | - Simone C Tauber
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sigrid Mues
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany,Department of Neurology, University Hospital Dresden, Dresden, Germany
| | - Peter Körtvélyessy
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Markewitz
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany
| | | | | | - Rainer Surges
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jörg Wellmer
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Carlos M Quesada
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Klaus-Peter Wandinger
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Albert J Becker
- Section of Translational Epileptology, Institute of Neuropathology, University of Bonn, Bonn, Germany
| | - Wolfram S Kunz
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Gerd Meyer zu Hörste
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Michael P Malter
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, and LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | | | - Frank Leypoldt
- Department of Neurology, University of Kiel, Kiel, Germany,Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Monika Stoll
- Correspondence may also be addressed to: Monika Stoll E-mail:
| | - Nico Melzer
- Correspondence to: Nico Melzer Department of Neurology, Medical Faculty, Heinrich-Heine University of Düsseldorf Moorenstraße 5, 40225 Düsseldorf, Germany E-mail:
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17
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Harms A, Bauer T, Fischbach L, David B, Ernst L, Witt JA, Diers K, Baumgartner T, Weber B, Radbruch A, Becker AJ, Helmstaedter C, Reuter M, Elger CE, Surges R, Rüber T. Shape description and volumetry of hippocampus and amygdala in temporal lobe epilepsy - A beneficial combination with a clinical perspective. Epilepsy Behav 2022; 128:108560. [PMID: 35066389 DOI: 10.1016/j.yebeh.2022.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
Shape-based markers have entered the field of morphometric neuroimaging analysis as a second mainstay alongside conventional volumetric approaches. We aimed to assess the added value of shape description for the analysis of lesional and autoimmune temporal lobe epilepsy (TLE) focusing on hippocampus and amygdala. We retrospectively investigated MRI and clinical data from 65 patients with lesional TLE (hippocampal sclerosis (HS) and astrogliosis) and from 62 patients with limbic encephalitis (LE) with serologically proven autoantibodies. Surface reconstruction and volumetric segmentation were performed with FreeSurfer. For the shape analysis, we used BrainPrint, a tool that utilizes eigenvalues of the Laplace-Beltrami operator on triangular meshes to calculate intra-subject asymmetry. Psychometric tests of memory performance were ascertained, to evaluate clinical relevance of the shape descriptor. The potential benefit of shape in addition to volumetric information for classification was assessed by five-fold repeated cross validation and logistic regression. For the LE group, the best performing classification model consisted of a combination of volume and shape asymmetry (mean AUC = 0.728), the logistic regression model was significantly improved considering both modalities instead of just volume asymmetry. For lesional TLE, the best model only considered volumetric information (mean AUC = 0.867). Shape asymmetry of the hippocampus was largely associated with verbal memory performance only in LE patients (OR = 1.07, p = 0.02). For lesional TLE, shape description is robust, but redundant when compared to volumetric approaches. For LE, in contrast, shape asymmetry as a complementary modality significantly improves the detection of subtle morphometric changes and is further associated with memory performance, which underscores the clinical relevance of shape asymmetry as a novel imaging biomarker.
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Affiliation(s)
- Antonia Harms
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Laura Fischbach
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Bastian David
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Leon Ernst
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Juri-Alexander Witt
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Kersten Diers
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Tobias Baumgartner
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Albert J Becker
- Department of Neuropathology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Christoph Helmstaedter
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Martin Reuter
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Venusberg-Campus 1, 53127 Bonn, Germany; Martinos Center for Biomedical Imaging, MGH/Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Christian E Elger
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
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18
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Taube J, Witt JA, Baumgartner T, Helmstaedter C. All’s well that ends well? Long-term course of a patient with anti-amphiphysin associated limbic encephalitis. Epilepsy Behav Rep 2022; 18:100534. [PMID: 35360257 PMCID: PMC8960971 DOI: 10.1016/j.ebr.2022.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/02/2022] Open
Abstract
Limbic encephalitis due to anti-amphiphysin antibodies can occur without a tumor. Amnesia, delirium, and seizures responded well to autoimmune and antiseizure therapy. Cognition recovered more slowly, behavioral problems persisted. Relapse is common and may even present with different clinical features. This case highlights the need for long-term multimodal monitoring.
Anti-amphiphysin associated limbic encephalitis (LE) is a paraneoplastic autoimmune disorder. The initial clinical presentation features seizures, cognitive and neuropsychiatric symptoms. We present the case of a 25-year-old female patient hospitalized after four consecutive tonic-clonic seizures, followed by confusion, psychotic symptoms, nonconvulsive seizure series, and severe global amnesia. Diagnostic workup revealed anti-amphiphysin associated LE without a tumor. MRI and PET indicated inflammatory processes affecting the bilateral mesial temporal structures more pronounced on the left side. Antiseizure medication, benzodiazepines, and immunotherapy resulted in rapid seizure cessation. Subsequent MRI and PET indicated left hippocampal sclerosis and a left mesial temporal hypometabolism. Executive dysfunction resolved in the following weeks. Global amnesia persisted for almost three months. Two years later, episodic memory was normal with residual visual memory impairments. While this patient’s seizure and cognitive outcome has been favorable, behavioral problems persisted long after disease onset. The persisting behavioral problems and subsequent MRI evidence (13 years after onset) of a swollen right amygdala indicated a possible relapse. This case report illustrates the importance of early diagnosis of LE for best clinical management. Antiseizure medication and immunotherapy led to seizure freedom and almost complete recovery of cognition. However, long-lasting neuropsychiatric symptoms and possible recurrent inflammation highlight the need for a multimodal long-term monitoring of such patients to rule out a relapse.
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19
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Chuquisana O, Strippel C, Tröscher AM, Baumgartner T, Rácz A, Keller CW, Elger CE, Melzer N, Kovac S, Wiendl H, Bauer J, Lünemann JD. Complement activation contributes to GAD antibody-associated encephalitis. Acta Neuropathol 2022; 144:381-383. [PMID: 35697881 PMCID: PMC9288364 DOI: 10.1007/s00401-022-02448-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Omar Chuquisana
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, 48149, Münster, Germany
| | - Christine Strippel
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, 48149, Münster, Germany
| | - Anna M Tröscher
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
- Department of Neurology I, Neuromed Campus, Kepler University Hospital Linz, Linz, Austria
| | | | - Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Christian W Keller
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, 48149, Münster, Germany
| | | | - Nico Melzer
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stjepana Kovac
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, 48149, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, 48149, Münster, Germany
| | - Jan Bauer
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Jan D Lünemann
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, 48149, Münster, Germany.
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20
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Demetrio D, Oliveira M, Baumgartner T, Demetrio C, Santos R. 8 Jersey in vitro embryo production data. Reprod Fertil Dev 2021; 34:237-238. [PMID: 35231208 DOI: 10.1071/rdv34n2ab8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | - C Demetrio
- Universidade de São Paulo, Piracicaba, SP, Brazil
| | - R Santos
- Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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21
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Oliveira M, Demetrio C, Baumgartner T, Santos R, Demetrio D. 12 Factors affecting Jersey in vitro embryo pregnancy rates. Reprod Fertil Dev 2021; 34:240. [PMID: 35231257 DOI: 10.1071/rdv34n2ab12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - C Demetrio
- Universidade de São Paulo, Piracicaba, SP, Brazil
| | | | - R Santos
- Universidade de Uberlândia, Uberlândia, MG, Brazil
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22
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Tietz AK, Angstwurm K, Baumgartner T, Doppler K, Eisenhut K, Elisak M, Franke A, Golombeck KS, Handreka R, Kaufmann M, Kraemer M, Kraft A, Lewerenz J, Lieb W, Madlener M, Melzer N, Mojzisova H, Möller P, Pfefferkorn T, Prüss H, Rostásy K, Schnegelsberg M, Schröder I, Siebenbrodt K, Sühs KW, Wickel J, Wandinger KP, Leypoldt F, Kuhlenbäumer G. Genome-wide Association Study Identifies 2 New Loci Associated With Anti-NMDAR Encephalitis. Neurol Neuroimmunol Neuroinflamm 2021; 8:e1085. [PMID: 34584012 PMCID: PMC8479862 DOI: 10.1212/nxi.0000000000001085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the genetic determinants of the most common type of antibody-mediated autoimmune encephalitis, anti-NMDA receptor (anti-NMDAR) encephalitis. METHODS We performed a genome-wide association study in 178 patients with anti-NMDAR encephalitis and 590 healthy controls, followed by a colocalization analysis to identify putatively causal genes. RESULTS We identified 2 independent risk loci harboring genome-wide significant variants (p < 5 × 10-8, OR ≥ 2.2), 1 on chromosome 15, harboring only the LRRK1 gene, and 1 on chromosome 11 centered on the ACP2 and NR1H3 genes in a larger region of high linkage disequilibrium. Colocalization signals with expression quantitative trait loci for different brain regions and immune cell types suggested ACP2, NR1H3, MADD, DDB2, and C11orf49 as putatively causal genes. The best candidate genes in each region are LRRK1, encoding leucine-rich repeat kinase 1, a protein involved in B-cell development, and NR1H3 liver X receptor alpha, a transcription factor whose activation inhibits inflammatory processes. DISCUSSION This study provides evidence for relevant genetic determinants of antibody-mediated autoimmune encephalitides outside the human leukocyte antigen (HLA) region. The results suggest that future studies with larger sample sizes will successfully identify additional genetic determinants and contribute to the elucidation of the pathomechanism.
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Affiliation(s)
- Anja K. Tietz
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Klemens Angstwurm
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Tobias Baumgartner
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kathrin Doppler
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Katharina Eisenhut
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Martin Elisak
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Andre Franke
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kristin S. Golombeck
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Robert Handreka
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Max Kaufmann
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Markus Kraemer
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Andrea Kraft
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Jan Lewerenz
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Wolfgang Lieb
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Marie Madlener
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Nico Melzer
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Hana Mojzisova
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Peter Möller
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Thomas Pfefferkorn
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Harald Prüss
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kevin Rostásy
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Margret Schnegelsberg
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Ina Schröder
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kai Siebenbrodt
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kurt-Wolfram Sühs
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Jonathan Wickel
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Klaus-Peter Wandinger
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Frank Leypoldt
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Gregor Kuhlenbäumer
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - on behalf of the German Network for Research on Autoimmune Encephalitis (GENERATE)
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
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Motelow JE, Povysil G, Dhindsa RS, Stanley KE, Allen AS, Feng YCA, Howrigan DP, Abbott LE, Tashman K, Cerrato F, Cusick C, Singh T, Heyne H, Byrnes AE, Churchhouse C, Watts N, Solomonson M, Lal D, Gupta N, Neale BM, Cavalleri GL, Cossette P, Cotsapas C, De Jonghe P, Dixon-Salazar T, Guerrini R, Hakonarson H, Heinzen EL, Helbig I, Kwan P, Marson AG, Petrovski S, Kamalakaran S, Sisodiya SM, Stewart R, Weckhuysen S, Depondt C, Dlugos DJ, Scheffer IE, Striano P, Freyer C, Krause R, May P, McKenna K, Regan BM, Bennett CA, Leu C, Leech SL, O’Brien TJ, Todaro M, Stamberger H, Andrade DM, Ali QZ, Sadoway TR, Krestel H, Schaller A, Papacostas SS, Kousiappa I, Tanteles GA, Christou Y, Štěrbová K, Vlčková M, Sedláčková L, Laššuthová P, Klein KM, Rosenow F, Reif PS, Knake S, Neubauer BA, Zimprich F, Feucht M, Reinthaler EM, Kunz WS, Zsurka G, Surges R, Baumgartner T, von Wrede R, Pendziwiat M, Muhle H, Rademacher A, van Baalen A, von Spiczak S, Stephani U, Afawi Z, Korczyn AD, Kanaan M, Canavati C, Kurlemann G, Müller-Schlüter K, Kluger G, Häusler M, Blatt I, Lemke JR, Krey I, Weber YG, Wolking S, Becker F, Lauxmann S, Boßelmann C, Kegele J, Hengsbach C, Rau S, Steinhoff BJ, Schulze-Bonhage A, Borggräfe I, Schankin CJ, Schubert-Bast S, Schreiber H, Mayer T, Korinthenberg R, Brockmann K, Wolff M, Dennig D, Madeleyn R, Kälviäinen R, Saarela A, Timonen O, Linnankivi T, Lehesjoki AE, Rheims S, Lesca G, Ryvlin P, Maillard L, Valton L, Derambure P, Bartolomei F, Hirsch E, Michel V, Chassoux F, Rees MI, Chung SK, Pickrell WO, Powell R, Baker MD, Fonferko-Shadrach B, Lawthom C, Anderson J, Schneider N, Balestrini S, Zagaglia S, Braatz V, Johnson MR, Auce P, Sills GJ, Baum LW, Sham PC, Cherny SS, Lui CH, Delanty N, Doherty CP, Shukralla A, El-Naggar H, Widdess-Walsh P, Barišić N, Canafoglia L, Franceschetti S, Castellotti B, Granata T, Ragona F, Zara F, Iacomino M, Riva A, Madia F, Vari MS, Salpietro V, Scala M, Mancardi MM, Nobili L, Amadori E, Giacomini T, Bisulli F, Pippucci T, Licchetta L, Minardi R, Tinuper P, Muccioli L, Mostacci B, Gambardella A, Labate A, Annesi G, Manna L, Gagliardi M, Parrini E, Mei D, Vetro A, Bianchini C, Montomoli M, Doccini V, Barba C, Hirose S, Ishii A, Suzuki T, Inoue Y, Yamakawa K, Beydoun A, Nasreddine W, Khoueiry Zgheib N, Tumiene B, Utkus A, Sadleir LG, King C, Caglayan SH, Arslan M, Yapıcı Z, Topaloglu P, Kara B, Yis U, Turkdogan D, Gundogdu-Eken A, Bebek N, Uğur-İşeri S, Baykan B, Salman B, Haryanyan G, Yücesan E, Kesim Y, Özkara Ç, Tsai MH, Ho CJ, Lin CH, Lin KL, Chou IJ, Poduri A, Shiedley BR, Shain C, Noebels JL, Goldman A, Busch RM, Jehi L, Najm IM, Ferguson L, Khoury J, Glauser TA, Clark PO, Buono RJ, Ferraro TN, Sperling MR, Lo W, Privitera M, French JA, Schachter S, Kuzniecky RI, Devinsky O, Hegde M, Greenberg DA, Ellis CA, Goldberg E, Helbig KL, Cosico M, Vaidiswaran P, Fitch E, Berkovic SF, Lerche H, Lowenstein DH, Goldstein DB. Sub-genic intolerance, ClinVar, and the epilepsies: A whole-exome sequencing study of 29,165 individuals. Am J Hum Genet 2021; 108:2024. [PMID: 34626584 DOI: 10.1016/j.ajhg.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Olaciregui Dague K, Pukropski J, Hummel C, Becker A, Surges R, Baumgartner T. [Dysphasic seizures due to chronic leptomeningitis : A challenge in differential diagnosis]. Nervenarzt 2021; 93:405-409. [PMID: 34586432 PMCID: PMC9010335 DOI: 10.1007/s00115-021-01190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/01/2022]
Affiliation(s)
- K Olaciregui Dague
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - J Pukropski
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - C Hummel
- Institut für Neuropathologie, Sektion für Translationale Epilepsieforschung, Universitätsklinikum Bonn, Bonn, Deutschland
| | - A Becker
- Institut für Neuropathologie, Sektion für Translationale Epilepsieforschung, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Surges
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T Baumgartner
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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25
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von Wrede R, Pukropski J, Moskau-Hartmann S, Surges R, Baumgartner T. COVID-19 vaccination in patients with epilepsy: First experiences in a German tertiary epilepsy center. Epilepsy Behav 2021; 122:108160. [PMID: 34166950 PMCID: PMC8216683 DOI: 10.1016/j.yebeh.2021.108160] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/21/2021] [Accepted: 06/06/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Due to the high demand for information regarding COVID-19 vaccination in people with epilepsy (PWE), we assessed the symptoms and seizure control of PWE following their COVID-19 vaccination. METHODS All adult patients who were treated at our center were asked to report on their vaccination status and, if vaccinated, about their experiences following their first COVID-19 vaccination with regard to adverse effects and seizure control. RESULTS Fifty-four PWE have already received their first vaccination against COVID-19 (27 female, 20% seizure free, 96<% on antiseizure medication) and were included in the study. Two-thirds tolerated the vaccines generally either very well or well. Thirty-three percent reported general vaccination adverse effects. The most frequently reported general adverse effects were, in descending order, headache, fatigue and fever, and shivering. With regard to epilepsy-related adverse effects, one patient reported increased seizure frequency one day after the first COVID-19 vaccination was administered, and one reported the occurrence of a new seizure type. None of the patients reported a status epilepticus or aggravation of preexisting adverse effects. CONCLUSIONS Our data suggest that vaccination against COVID-19 appears to be well tolerated in PWE, supporting the recommendation of vaccination to PWE.
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Affiliation(s)
- Randi von Wrede
- Department of Epileptology, University Hospital of Bonn, Bonn, Germany.
| | - Jan Pukropski
- Department of Epileptology, University Hospital of Bonn, Bonn, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital of Bonn, Bonn, Germany
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Koeppel MB, Glaser J, Baumgartner T, Spriewald S, Gerlach RG, von Armansperg B, Leong JM, Stecher B. Scalable Reporter Assays to Analyze the Regulation of stx2 Expression in Shiga Toxin-Producing Enteropathogens. Toxins (Basel) 2021; 13:toxins13080534. [PMID: 34437405 PMCID: PMC8402550 DOI: 10.3390/toxins13080534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/02/2022] Open
Abstract
Stx2 is the major virulence factor of EHEC and is associated with an increased risk for HUS in infected patients. The conditions influencing its expression in the intestinal tract are largely unknown. For optimal management and treatment of infected patients, the identification of environmental conditions modulating Stx2 levels in the human gut is of central importance. In this study, we established a set of chromosomal stx2 reporter assays. One system is based on superfolder GFP (sfGFP) using a T7 polymerase/T7 promoter-based amplification loop. This reporter can be used to analyze stx2 expression at the single-cell level using FACSs and fluorescence microscopy. The other system is based on the cytosolic release of the Gaussia princeps luciferase (gluc). This latter reporter proves to be a highly sensitive and scalable reporter assay that can be used to quantify reporter protein in the culture supernatant. We envision that this new set of reporter tools will be highly useful to comprehensively analyze the influence of environmental and host factors, including drugs, small metabolites and the microbiota, on Stx2 release and thereby serve the identification of risk factors and new therapies in Stx-mediated pathologies.
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Affiliation(s)
- Martin B. Koeppel
- Max-von-Pettenkofer Institute, LMU Munich, Pettenkoferstr. 9a, 80336 Munich, Germany; (J.G.); (T.B.); (S.S.); (B.v.A.)
- German Center for Infection Research (DZIF), Partner Site LMU Munich, 80336 Munich, Germany
- Correspondence: (M.B.K.); (B.S.)
| | - Jana Glaser
- Max-von-Pettenkofer Institute, LMU Munich, Pettenkoferstr. 9a, 80336 Munich, Germany; (J.G.); (T.B.); (S.S.); (B.v.A.)
- German Center for Infection Research (DZIF), Partner Site LMU Munich, 80336 Munich, Germany
| | - Tobias Baumgartner
- Max-von-Pettenkofer Institute, LMU Munich, Pettenkoferstr. 9a, 80336 Munich, Germany; (J.G.); (T.B.); (S.S.); (B.v.A.)
- German Center for Infection Research (DZIF), Partner Site LMU Munich, 80336 Munich, Germany
| | - Stefanie Spriewald
- Max-von-Pettenkofer Institute, LMU Munich, Pettenkoferstr. 9a, 80336 Munich, Germany; (J.G.); (T.B.); (S.S.); (B.v.A.)
- German Center for Infection Research (DZIF), Partner Site LMU Munich, 80336 Munich, Germany
| | - Roman G. Gerlach
- Mikrobiologisches Institut-Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Wasserturmstraße 3/5, 91054 Erlangen, Germany;
| | - Benedikt von Armansperg
- Max-von-Pettenkofer Institute, LMU Munich, Pettenkoferstr. 9a, 80336 Munich, Germany; (J.G.); (T.B.); (S.S.); (B.v.A.)
- German Center for Infection Research (DZIF), Partner Site LMU Munich, 80336 Munich, Germany
| | - John M. Leong
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111, USA;
| | - Bärbel Stecher
- Max-von-Pettenkofer Institute, LMU Munich, Pettenkoferstr. 9a, 80336 Munich, Germany; (J.G.); (T.B.); (S.S.); (B.v.A.)
- German Center for Infection Research (DZIF), Partner Site LMU Munich, 80336 Munich, Germany
- Correspondence: (M.B.K.); (B.S.)
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27
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Bonardi CM, Heyne HO, Fiannacca M, Fitzgerald MP, Gardella E, Gunning B, Olofsson K, Lesca G, Verbeek N, Stamberger H, Striano P, Zara F, Mancardi MM, Nava C, Syrbe S, Buono S, Baulac S, Coppola A, Weckhuysen S, Schoonjans AS, Ceulemans B, Sarret C, Baumgartner T, Muhle H, des Portes V, Toulouse J, Nougues MC, Rossi M, Demarquay G, Ville D, Hirsch E, Maurey H, Willems M, de Bellescize J, Altuzarra CD, Villeneuve N, Bartolomei F, Picard F, Hornemann F, Koolen DA, Kroes HY, Reale C, Fenger CD, Tan WH, Dibbens L, Bearden DR, Møller RS, Rubboli G. KCNT1-related epilepsies and epileptic encephalopathies: phenotypic and mutational spectrum. Brain 2021; 144:3635-3650. [PMID: 34114611 DOI: 10.1093/brain/awab219] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/02/2021] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
Variants in KCNT1, encoding a sodium-gated potassium channel (subfamily T member 1), have been associated with a spectrum of epilepsies and neurodevelopmental disorders. These range from familial autosomal dominant or sporadic sleep-related hypermotor epilepsy ((AD)SHE) to epilepsy of infancy with migrating focal seizures (EIMFS) and include developmental and epileptic encephalopathies (DEE). This study aims to provide a comprehensive overview of the phenotypic and genotypic spectrum of KCNT1 mutation-related epileptic disorders in 248 individuals, including 66 unpreviously published and 182 published cases, the largest cohort reported so far. Four phenotypic groups emerged from our analysis: i) EIMFS (152 individuals, 33 previously unpublished); ii) DEE other than EIMFS (non-EIMFS DEE) (37 individuals, 17 unpublished); iii) (AD)SHE (53 patients, 14 unpublished); iv) other phenotypes (6 individuals, 2 unpublished). In our cohort of 66 new cases, the most common phenotypic features were: a) in EIMFS, heterogeneity of seizure types, including epileptic spasms, epilepsy improvement over time, no epilepsy-related deaths; b) in non-EIMFS DEE, possible onset with West syndrome, occurrence of atypical absences, possible evolution to DEE with SHE features; one case of sudden unexplained death in epilepsy (SUDEP); c) in (AD)SHE, we observed a high prevalence of drug-resistance, although seizure frequency improved with age in some individuals, appearance of cognitive regression after seizure onset in all patients, no reported severe psychiatric disorders, although behavioural/psychiatric comorbidities were reported in about 50% of the patients, SUDEP in one individual; d) other phenotypes in individuals with mutation of KCNT1 included temporal lobe epilepsy, and epilepsy with tonic-clonic seizures and cognitive regression. Genotypic analysis of the whole cohort of 248 individuals showed only missense mutations and one inframe deletion in KCNT1. Although the KCNT1 mutations in affected individuals were seen to be distributed among the different domains of the KCNT1 protein, genotype-phenotype considerations showed many of the (AD)SHE-associated mutations to be clustered around the RCK2 domain in the C-terminus, distal to the NADP domain. Mutations associated with EIMFS/non-EIMFS DEE did not show a particular pattern of distribution in the KCNT1 protein. Recurrent KCNT1 mutations were seen to be associated with both severe and less severe phenotypes. Our study further defines and broadens the phenotypic and genotypic spectrums of KCNT1-related epileptic conditions and emphasizes the increasingly important role of this gene in the pathogenesis of early onset DEEs as well as in focal epilepsies, namely (AD)SHE.
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Affiliation(s)
- Claudia M Bonardi
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Centre, member of the ERN EpiCARE, 4293 Dianalund, Denmark.,Department of Woman's and Child's Health, University Hospital of Padua, 35100 Padua, Italy
| | - Henrike O Heyne
- Finnish Institute for Molecular Medicine: FIMM, University of Helsinki, 00290 Helsinki, Finland.,Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, 02142 Cambridge, MA, USA
| | | | - Mark P Fitzgerald
- Division of Neurology, Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA, USA
| | - Elena Gardella
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Centre, member of the ERN EpiCARE, 4293 Dianalund, Denmark.,Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Boudewijn Gunning
- Stichting Epilepsie Instellingen Nederland, Zwolle, 8025 BV, The Netherlands
| | - Kern Olofsson
- Department of Pediatric Neurology, Danish Epilepsy Center, 4293 Dianalund, Denmark
| | - Gaétan Lesca
- Department of Genetics, Hospices Civils de Lyon, 69002 Bron, France.,Institut NeuroMyoGène, CNRS UMR 5310 - INSERM U1217, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Nienke Verbeek
- Department of Genetics, University Medical Center, 3584 CX Utrecht, Netherlands
| | - Hannah Stamberger
- Neurogenetics Group, VIB-Center for Molecular Neurology, B-2610 Antwerp, Belgium.,Department of Neurology, University Hospital, 2650 Antwerp, Belgium
| | - Pasquale Striano
- IRCCS "G. Gaslini" Institute, University of Genoa, 16147 Genoa, Italy
| | - Federico Zara
- IRCCS "G. Gaslini" Institute, University of Genoa, 16147 Genoa, Italy
| | - Maria M Mancardi
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Caroline Nava
- Département de Génétique, APHP, GH Pitié-Salpêtrière, 75013 Paris, France
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Salvatore Buono
- Neurology Division, Hospital of National Relevance (AORN), Santobono Pausilipon, 80122 Naples, Italy
| | - Stephanie Baulac
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, F-75013, Paris, France
| | - Antonietta Coppola
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy
| | - Sarah Weckhuysen
- Neurogenetics Group, VIB-Center for Molecular Neurology, B-2610 Antwerp, Belgium.,Department of Neurology, University Hospital, 2650 Antwerp, Belgium
| | - An-Sofie Schoonjans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, 2650 Edegem, Belgium
| | - Berten Ceulemans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, 2650 Edegem, Belgium
| | - Catherine Sarret
- Service de Neuropédiatrie, CHU de Clermont-Ferrand, 6310 Clermont-Ferrand, France
| | | | - Hiltrud Muhle
- Department of Neuropediatrics, University Medical Center Schleswig Holstein, 24105 Kiel, Germany
| | - Vincent des Portes
- Neuropaediatrics Department, Femme Mère Enfant Hospital, 69500 Lyon, France
| | - Joseph Toulouse
- Epileptology, Sleep Disorders and Functional Pediatric Neurology CHU Lyon, 69500 Bron, France
| | | | - Massimiliano Rossi
- Department of Genetics, Hospices Civils de Lyon, 69002 Bron, France.,Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, GENDEV Team, Claude Bernard Lyon 1 University, 69675 Bron, France
| | - Geneviève Demarquay
- Service de neurologie fonctionnelle et épileptologie, Neurological Hospital, 69677 Bron, France.,Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, NeuroPain, 69677 Bron, France
| | - Dorothée Ville
- Pediatric Neurology Department, Lyon University Hospital, 69500 Bron, France
| | - Edouard Hirsch
- Epilepsy Unit, Hautepierre Hospital, University of Strasbourg, 67100 Strasbourg, France
| | - Hélène Maurey
- Department of Pediatric Neurology, Hopital Bicêtre, Le Kremlin-Bicêtre, 94270 Paris, France
| | - Marjolaine Willems
- Department of Clinical Genetics, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Julitta de Bellescize
- Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hospices Civils de Lyon, 69677 Bron, Lyon, France
| | | | - Nathalie Villeneuve
- Pediatric Neurology Department, Timone Children Hospital, 13005 Marseille, France
| | - Fabrice Bartolomei
- Epileptology Department, Timone Hospital, Public Assistance Hospitals of Marseille, Aix-Marseille University, 13005 Marseille, France
| | - Fabienne Picard
- Department of Clinical Neurosciences, University Hospitals and Faculty of Medicine, CH-1211 Geneva, Switzerland
| | - Frauke Hornemann
- Centre of Pediatric Research, Hospital for Children and Adolescents, 04103 Leipzig, Germany
| | - David A Koolen
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center (Radboudumc), 6525 GA Nijmegen, The Netherlands
| | - Hester Y Kroes
- Department of Genetics, University Medical Center, 3584 CX Utrecht, Netherlands
| | - Chiara Reale
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Centre, member of the ERN EpiCARE, 4293 Dianalund, Denmark.,Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Christina D Fenger
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Centre, member of the ERN EpiCARE, 4293 Dianalund, Denmark
| | - Wen-Hann Tan
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Leanne Dibbens
- Epilepsy Research Group, UniSA Clinical and Health Sciences, University of South Australia, and Australian Centre for Precision Health, SA 5001 Adelaide, Australia
| | - David R Bearden
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, NY14642, USA
| | - Rikke S Møller
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Centre, member of the ERN EpiCARE, 4293 Dianalund, Denmark.,Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Guido Rubboli
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Centre, member of the ERN EpiCARE, 4293 Dianalund, Denmark.,Institute of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Baumgartner T, Kaelin-Friedrich M, Makowski K, Noti F, Schaer B, Haeberlin A, Badertscher P, Baldinger S, Seiler J, Osswald S, Kuehne M, Roten L, Tanner H, Sticherling C, Reichlin T. Gender-related differences in patient selection for and outcomes after pace and ablate for refractory atrial fibrillation: insights from a large multicenter cohort. Europace 2021. [DOI: 10.1093/europace/euab116.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A pace & ablate strategy may be performed in cases of severe refractory atrial arrhythmias.
Purpose
We aimed to assess gender related differences in patient selection and clinical outcomes after pace & ablate.
Methods
In a retrospective multicenter study, patients undergoing AV-junction-ablation between 2011 and 2019 were studied. Gender-related differences in terms of baseline characteristics, device-related complications, heart failure (HF) hospitalisations and death were assessed.
Results
Overall, 513 patients underwent AV-junction-ablation (median age 75 years, 50% males). At baseline, male patients were younger (72 vs. 78 years, p < 0.001), more frequently had non-paroxysmal AF (82% vs. 72%, p = 0.006), a lower LVEF (35% vs. 55%, p < 0.001) and more often received biventricular stimulation (75% vs. 25%, p < 0.001). Interventional complications were rare in both gender (1.2% vs 1.6%, p = 0.72). Following AV-junction-ablation, improvement of EHRA-class by ≥1 and of LVEF by ≥5% occurred in 44% and 19% of patients respectively, without gender differences (p = 0.66 and p = 0.38). Patients were followed for a median of 42 months in survivors (IQR 22-62). Lead-related complications (11 patients, 2.1%), infections (1 patient, 0.2%) and upgrade to ICD or CRT (18 patients, 3.5%) were rare. In Kaplan Meier analysis, HF hospitalisations during 4 years of follow-up were more common in men (22% vs 11%, p = 0.02), as were death (28% vs 21%, p = 0.02) and the combination of death or HF hospitalisation (37% vs. 26%, p = 0.008, Figure). Gender remained an independent predictor of the combined endpoint of death or HF hospitalisation after adjustment for age, LVEF and type of stimulation.
Conclusion
A Pace & Ablate strategy is safe and results in improvement of EHRA class and LVEF in a substantial number of patients. We found significant gender differences in patient selection for pace & ablate. Female patients had a more favorable clinical course after AV-junction-ablation, which was independent of age, EF and type of stimulation. Abstract Figure. Comb. endpoint of death or heart failure
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Affiliation(s)
- T Baumgartner
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | | | - K Makowski
- Military Institute of Medicine, Warsaw, Poland
| | - F Noti
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - B Schaer
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - A Haeberlin
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - P Badertscher
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - S Baldinger
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - S Osswald
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - L Roten
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - H Tanner
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - C Sticherling
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
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29
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Baumgartner T, Carreño M, Rocamora R, Bisulli F, Boni A, Brázdil M, Horak O, Craiu D, Pereira C, Guerrini R, San Antonio‐Arce V, Schulze‐Bonhage A, Zuberi SM, Hallböök T, Kalviainen R, Lagae L, Nguyen S, Quintas S, Franco A, Cross JH, Walker M, Arzimanoglou A, Rheims S, Granata T, Canafoglia L, Johannessen Landmark C, Sen A, Rattihalli R, Nabbout R, Tartara E, Santos M, Rangel R, Krsek P, Marusic P, Specchio N, Braun KPJ, Smeyers P, Villanueva V, Kotulska K, Surges R. A survey of the European Reference Network EpiCARE on clinical practice for selected rare epilepsies. Epilepsia Open 2021; 6:160-170. [PMID: 33681659 PMCID: PMC7918306 DOI: 10.1002/epi4.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022] Open
Abstract
Objective Clinical care of rare and complex epilepsies is challenging, because evidence-based treatment guidelines are scarce, the experience of many physicians is limited, and interdisciplinary treatment of comorbidities is required. The pathomechanisms of rare epilepsies are, however, increasingly understood, which potentially fosters novel targeted therapies. The objectives of our survey were to obtain an overview of the clinical practice in European tertiary epilepsy centers treating patients with 5 arbitrarily selected rare epilepsies and to get an estimate of potentially available patients for future studies. Methods Members of the European Reference Network for rare and complex epilepsies (EpiCARE) were invited to participate in a web-based survey on clinical practice of patients with Dravet syndrome, tuberous sclerosis complex (TSC), autoimmune encephalitis, and progressive myoclonic epilepsies including Unverricht Lundborg and Unverricht-like diseases. A consensus-based questionnaire was generated for each disease. Results Twenty-six of 30 invited epilepsy centers participated. Cohorts were present in most responding centers for TSC (87%), Dravet syndrome (85%), and autoimmune encephalitis (71%). Patients with TSC and Dravet syndrome represented the largest cohorts in these centers. The antiseizure drug treatments were rather consistent across the centers especially with regard to Dravet syndrome, infantile spasms in TSC, and Unverricht Lundborg / Unverricht-like disease. Available, widely used targeted therapies included everolimus in TSC and immunosuppressive therapies in autoimmune encephalitis. Screening for comorbidities was routinely done, but specific treatment protocols were lacking in most centers. Significance The survey summarizes the current clinical practice for selected rare epilepsies in tertiary European epilepsy centers and demonstrates consistency as well as heterogeneity in the treatment, underscoring the need for controlled trials and recommendations. The survey also provides estimates for potential participants of clinical trials recruited via EpiCARE, emphasizing the great potential of Reference Networks for future studies to evaluate new targeted therapies and to identify novel biomarkers.
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Affiliation(s)
| | - Mar Carreño
- Epilepsy UnitChild Neurology DepartmentHospital San Juan de DiosBarcelonaSpain
- Hospital Clinic de BarcelonaBarcelonaSpain
| | - Rodrigo Rocamora
- Epilepsy CentreFaculty of Health and Life SciencesHospital del Mar‐IMIMUniversitat Pompeu FabraBarcelonaSpain
| | | | - Antonella Boni
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Milan Brázdil
- Brno Epilepsy CenterDepartment of NeurologySt. Anne´s University HospitalMedical Faculty of Masaryk UniversityBrnoCzech Republic
| | - Ondrej Horak
- Brno Epilepsy CenterDepartment of Child NeurologyBrno University HospitalMedical Faculty of Masaryk UniversityBrnoCzech Republic
| | - Dana Craiu
- Alexandru Obregia Clinical HospitalBucharestRomania
| | | | - Renzo Guerrini
- Children's Hospital A. Meyer‐University of FlorenceFlorenceItaly
| | - Victoria San Antonio‐Arce
- Epilepsy UnitChild Neurology DepartmentHospital San Juan de DiosBarcelonaSpain
- Epilepsy CenterFaculty of MedicineUniversity Medical CenterFreiburgGermany
| | | | | | - Tove Hallböök
- Department of PediatricsInstitute of Clinical SciencesSahlgrenska AcademyUniversity of Gothenburg and Queen Silvia Children’s HospitalSahlgrenska University HospitalGothenburgSweden
| | - Reetta Kalviainen
- Pohjois‐Savon SairaanhoitopiiriKuopio University Hospital, (KUH)KuopioFinland
| | - Lieven Lagae
- University Hospital Gasthuisberg KULeuvenBelgium
| | | | - Sofia Quintas
- Centro Hospitalar Universitário Lisboa Norte ‐ Hospital de Santa MariaLisboaPortugal
| | - Ana Franco
- Centro Hospitalar Universitário Lisboa Norte ‐ Hospital de Santa MariaLisboaPortugal
| | - J. Helen Cross
- Great Ormond Street Hospital for ChildrenNHS TrustLondonUK
| | - Matthew Walker
- University College London Hospitals NHS Foundation TrustLondonUK
| | - Alexis Arzimanoglou
- Epilepsy UnitChild Neurology DepartmentHospital San Juan de DiosBarcelonaSpain
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional NeurologyUniversity Hospitals of Lyon (HCL)LyonFrance
| | - Sylvain Rheims
- Department of Functional Neurology and EpileptologyHospices Civils de LyonUniversity of LyonLyonFrance
| | - Tiziana Granata
- Department of PediatricNeuroscience FondazioneIRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Laura Canafoglia
- Epilepsy UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Cecilie Johannessen Landmark
- Department of PharmacologyOslo University HospitalThe National Center for EpilepsyOslo Metropolitan UniversityOsloNorway
| | - Arjune Sen
- Oxford Epilepsy Research GroupNIHR Oxford Biomedical Research CentreNuffield Department of Clinical NeurosciencesJohn Radcliffe HospitalOxfordUK
| | - Rohini Rattihalli
- Department of Paediatric NeurologyChildren's HospitalJohn Radcliffe HospitalOxfordUK
| | - Rima Nabbout
- Department of Pediatric NeurologyAPHP, Imagine InstituteReference Centre for Rare EpilepsiesParis Descartes UniversityParisFrance
| | | | | | - Rui Rangel
- Centro Hospitalar Universitário do PortoPortoPortugal
| | - Pavel Krsek
- Departement of NeurologyCharles UniversitySecond Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Petr Marusic
- Departement of NeurologyCharles UniversitySecond Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Nicola Specchio
- Rare and Complex Epilepsy UnitDepartment of NeuroscienceBambino Gesu’ Children’s Hospital, IRCCSRomeItaly
| | - Kees P. J. Braun
- Department of Child NeurologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Patricia Smeyers
- Refractory Epilepsy Unit of Hospital Universitario y Politécnico La FeValenciaSpain
| | - Vicente Villanueva
- Refractory Epilepsy Unit of Hospital Universitario y Politécnico La FeValenciaSpain
| | | | - Rainer Surges
- Department of EpileptologyUniversity Hospital BonnBonnGermany
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30
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von Wrede R, Moskau-Hartmann S, Baumgartner T, Helmstaedter C, Surges R. Counseling of people with epilepsy via telemedicine: Experiences at a German tertiary epilepsy center during the COVID-19 pandemic. Epilepsy Behav 2020; 112:107298. [PMID: 32801068 PMCID: PMC7422810 DOI: 10.1016/j.yebeh.2020.107298] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Driven by the challenges of alternative healthcare supply during the COVID-19 pandemic, acceptance and appreciation of telemedicine were assessed in a German tertiary epilepsy center. METHODS Two hundred thirty-nine patients with epilepsy (53% female, 35% seizure-free, 97% on antiseizure medication) answered a structured audit on telemedical counseling as part of individual outpatients' care. RESULTS Overall 82% of the participants were satisfied with the telemedical appointment. The telemedical appointment was rated equal to onsite appointments in means of time (91%), comprehensibility (94%), and opportunity to get answers to current questions (92%). It was evaluated as good as onsite appointments regarding comprehension of the disease (88%) and impact on following the physician's advice (82%). The participants considered immediate convenience and shortfall of travel expenses as advantages of telemedicine, whereas lack of personal contact and diagnostics (electroencephalogram [EEG] recordings, blood analysis) were seen as disadvantages. About 73% of the participants would appreciate the opportunity of future telemedical counseling, but the majority (75%) wished to have further appointments onsite. CONCLUSIONS Overall, people with epilepsy appear to be satisfied with telemedical counseling. However, patients greatly appreciate the medical services onsite and consider telemedicine as an add-on service rather than a substitute to visits onsite.
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Affiliation(s)
| | | | | | | | - Rainer Surges
- Department of Epileptology, University of Bonn Medical Center, Germany.
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31
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Witt JA, Nass RD, Baumgartner T, von Wrede R, Elger CE, Surges R, Helmstaedter C. Does the accumulated antiepileptic drug load in chronic epilepsy reflect disease severity? Epilepsia 2020; 61:2685-2695. [PMID: 33058192 DOI: 10.1111/epi.16720] [Citation(s) in RCA: 11] [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] [Received: 05/25/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To ascertain factors that are related to the antiepileptic drug load in epilepsy. METHODS In this cross-sectional study, we analyzed a large cohort of conservatively treated patients with epilepsy (n = 1135) and a smaller homogeneous group of presurgical patients with neuropathologically confirmed unilateral hippocampal sclerosis (n = 91). Considered clinical variables comprised (1) presence of an underlying cerebral lesion, (2) onset and (3) duration of epilepsy, (4) seizure frequency, (5) generalized or focal to bilateral tonic-clonic seizures, (6) ictal impairment of awareness, and (7) a history of convulsive status epilepticus. In the presurgical sample, we additionally considered (8) the degree of pathology (hippocampal neuronal cell densities) instead of (1) presence of a cerebral lesion and (9) an overall rating of epilepsy severity (GASE scale). Drug load was quantified as (a) the number of concomitant antiepileptic drugs (AEDs) and (b) the total defined daily dose (DDD). RESULTS Analyses disclosed only small correlations between clinical variables and drug load indices. In the conservatively treated cohort, the multiple regression analyses revealed that epilepsy onset, cerebral lesion, history of convulsive status epilepticus, and seizure frequency combined explained only 6%-10% of variance in drug load. Nearly the same variance (5%-8%) could be explained by duration of epilepsy alone. Degree of hippocampal pathology and the epilepsy severity ratings were not related to drug load indices. SIGNIFICANCE Clinical markers of epilepsy severity were only marginally associated with drug load. Findings rather indicate that patients seem to accumulate drugs due to the chronicity of epilepsy. Overall, the drug load remained largely unexplained. The findings nevertheless call for scrutinizing multidrug therapies in patients with long-lasting epilepsies.
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Affiliation(s)
| | - Robert D Nass
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Tobias Baumgartner
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
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Brenner D, Baumgartner T, von Spiczak S, Lewerenz J, Weis R, Grimmer A, Gaspirova P, Wurster CD, Kunz WS, Wagner J, Minassian BA, Elger CE, Ludolph AC, Biskup S, Döcker D. Genotypes and phenotypes of patients with Lafora disease living in Germany. Neurol Res Pract 2019; 1. [PMID: 32587944 PMCID: PMC7316188 DOI: 10.1186/s42466-019-0040-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Background Lafora progressive myoclonus epilepsy (Lafora disease) is a rare, usually childhood-onset, fatal neurodegenerative disease caused by biallelic mutations in EPM2A (Laforin) or EPM2B (NHLRC1; Malin). The epidemiology of Lafora disease in Germany is largely unknown. The objective of this retrospective case series is to characterize the genotypes and phenotypes of patients with Lafora disease living in Germany. Methods The patients described in this case series initially had the suspected clinical diagnosis of Lafora disease, or unclassified progressive myoclonus epilepsy. Molecular genetic diagnostics including next generation sequencing-based diagnostic panel analysis or whole exome sequencing was performed. Results The parents of four out of the 11 patients are nonconsanguineous and of German origin while the other patients had consanguineous parents. Various variants were found in EPM2A (six patients) and in EPM2B (five patients). Eight variants have not been reported in the literature so far. The patients bearing novel variants had typical disease onset during adolescence and show classical disease courses. Conclusions This is the first larger case series of Lafora patients in Germany. Our data enable an approximation of the prevalence of manifest Lafora disease in Germany to 1,69 per 10 million people. Broader application of gene panel or whole-exome diagnostics helps clarifying unclassified progressive myoclonus epilepsy and establish an early diagnosis, which will be even more important as causal therapy approaches have been developed and are soon to be tested in a phase I study. Electronic supplementary material The online version of this article (10.1186/s42466-019-0040-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Brenner
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Sarah von Spiczak
- DRK-Northern German Epilepsy Center for Children and Adolescents, Schwentinental, Raisdorf, Germany
| | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Roger Weis
- Neuropediatric Center, Rheinhessen-Fachklinik Mainz, Mainz, Germany
| | - Anja Grimmer
- Epilepsie-Zentrum Berlin-Brandenburg, Berlin, Germany
| | | | | | - Wolfram S Kunz
- Department of Neurology, University of Ulm, Ulm, Germany.,Institute of Experimental Epileptology and Cognition Research, University Bonn, Bonn, Germany
| | - Jan Wagner
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Berge A Minassian
- Department of Pediatrics, University of Texas Southwestern, Dallas, USA
| | - Christian E Elger
- Department of Epileptology, University of Bonn Hospital, Bonn, Germany
| | | | - Saskia Biskup
- Center for Genomics and Transcriptomics (CeGaT) GmbH and Practice for Human Genetics, Tübingen, Germany
| | - Dennis Döcker
- Center for Genomics and Transcriptomics (CeGaT) GmbH and Practice for Human Genetics, Tübingen, Germany
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33
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Baumgartner T, Surges R. [How to Distinguish Syncope from Epileptic and Psychogenic Non-Epileptic Seizures]. Dtsch Med Wochenschr 2019; 144:835-841. [PMID: 31212327 DOI: 10.1055/a-0629-0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Transient loss of consciousness (TLOC) is a frequent cause of referral to an emergency room. In view of the impact on treatment and the patients' daily life activities (e. g. profession, driving license), an accurate and timely diagnosis is of uttermost importance. This article provides key features and suggests a practical step-by-step approach of how to differentiate syncope, epileptic and psychogenic non-epileptic seizures as the commonest causes of nontraumatic TLOC.
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34
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Weimann C, Messner A, Baumgartner T, Wolf S, Hoeller F, Freude W, Koos C. Fast high-precision distance metrology using a pair of modulator-generated dual-color frequency combs. Opt Express 2018; 26:34305-34335. [PMID: 30650856 DOI: 10.1364/oe.26.034305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
We demonstrate fast high-precision non-contact distance measurements to technical surfaces using a pair of dual-color electro-optic frequency combs for synthetic-wavelength interferometry (SWI). The dual-color combs are generated from continuous-wave (cw) lasers at 1300 nm and 1550 nm, which are jointly fed to a pair of high-speed dual-drive Mach-Zehnder modulators. The dual-color approach is used for continuous and dead-zone-free compensation of temperature-induced fiber drift. We achieve standard deviations below 2 µm at an acquisition time of 9.1 µs for measurements through 7 m of single-mode fiber. Despite the technical simplicity of our scheme, our concept can well compete with other comb-based distance metrology approaches, and it can maintain its accuracy even under industrial operating conditions. The viability of the concept is demonstrated by attaching the fiber-coupled sensor head to an industrial coordinate measuring machine for acquisition of surface profiles of various technical samples. Exploiting real-time signal processing along with continuous fiber drift compensation, we demonstrate the acquisition of point clouds of up to 5 million data points during continuous movement of the sensor head.
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35
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Maruf M, Jayman J, Kasprenski M, Benz K, Feng Z, Friedlander D, Baumgartner T, Trock BJ, Di Carlo H, Sponseller PD, Gearhart JP. Predictors and outcomes of perioperative blood transfusions in classic bladder exstrophy repair: A single institution study. J Pediatr Urol 2018; 14:430.e1-430.e6. [PMID: 29914824 DOI: 10.1016/j.jpurol.2018.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/25/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Primary bladder closure of classic bladder exstrophy (CBE) is a major operation that occasionally requires intraoperative or postoperative (within 72 h) blood transfusions. OBJECTIVE This study reported perioperative transfusion rates, risk factors for transfusion, and outcomes from a high-volume exstrophy center in primary bladder closure of CBE patients. STUDY DESIGN A prospectively maintained, institutional exstrophy-epispadias complex database of 1305 patients was reviewed for primary CBE closures performed at the authors' institution (Johns Hopkins Hospital) between 1993 and 2017. Patient and surgical factors were analyzed to determine transfusion rates, risk factors for transfusions, and outcomes. Patients were subdivided into two groups based upon the time of closure: neonatal and delayed closure. RESULTS A total of 116 patients had a primary bladder closure during 1993-2017. Seventy-three patients were closed in the neonatal period, and 43 were delayed closures. In total, 64 (55%) patients received perioperative transfusions. No transfusion reactions were observed. Twenty-five transfusions were in the neonatal closure group, yielding a transfusion rate of 34%. In comparison, 39 patients were transfused in the delayed closure group, giving a transfusion rate of 91%. Pelvic osteotomy, delayed bladder closure, higher estimated blood loss (EBL), larger pubic diastasis, and longer operative time were all associated with blood transfusion. In multivariable logistic regression, pelvic osteotomy (OR 5.4; 95% CI 1.3-22.8; P < 0.001), higher EBL-to-weight ratio (OR 1.3; 95% CI 1.1-1.6; P = 0.029), and more recent years of primary closure (OR 1.1; 95% CI 1.0-1.2; P = 0.018) remained independent predictors of receiving a transfusion (Summary Table). No adverse transfusion reactions or complications were observed. DISCUSSION This was the first study from a single high-volume exstrophy center to explore factors that contribute to perioperative blood transfusions. Pelvic osteotomy as a risk factor was unsurprising, as the osteotomy may bleed both during and immediately after closure. However, it is important to use osteotomy for successful closure, despite the increased transfusion risk. The risks accompanying contemporary transfusions are minimal and osteotomies are imperative for successful bladder closure. CONCLUSIONS More than half of CBE patients undergoing primary closure at a single institution received perioperative blood transfusions. While there was an association between transfusions and osteotomy, delayed primary closure, larger diastasis, increased operative time, and increased length of stay, only the use of pelvic osteotomy, higher EBL-to-weight ratio, and recent year of closure independently increased the odds of receiving a transfusion on multivariate analysis.
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Affiliation(s)
- M Maruf
- Robert D. Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - J Jayman
- Robert D. Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - M Kasprenski
- Robert D. Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - K Benz
- Robert D. Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Z Feng
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland MD, USA
| | - D Friedlander
- Robert D. Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - T Baumgartner
- Robert D. Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - B J Trock
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland MD, USA
| | - H Di Carlo
- Robert D. Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - P D Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - J P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.
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Von Seth M, Hillered L, Otterbeck A, Hanslin K, Larsson A, Sjölin J, Lipcsey M, Cove ME, Chew NS, Vu LH, Lim RZ, Puthucheary Z, Hanslin K, Wilske F, Skorup P, Tano E, Sjölin J, Lipcsey M, Derese I, Thiessen S, Derde S, Dufour T, Pauwels L, Bekhuis Y, Van den Berghe G, Vanhorebeek I, Khan M, Dwivedi D, Zhou J, Prat A, Seidah NG, Liaw PC, Fox-Robichaud AE, Von Seth M, Skorup P, Hillered L, Larsson A, Sjölin J, Lipcsey M, Otterbeck A, Hanslin K, Lipcsey M, Larsson A, Von Seth M, Correa T, Pereira J, Takala J, Jakob S, Skorup P, Maudsdotter L, Tano E, Lipcsey M, Castegren M, Larsson A, Sjölin J, Xue M, Xu JY, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB, Kuzovlev A, Moroz V, Goloubev A, Myazin A, Chumachenko A, Pisarev V, Takeyama N, Tsuda M, Kanou H, Aoki R, Kajita Y, Hashiba M, Terashima T, Tomino A, Davies R, O’Dea KP, Soni S, Ward JK, O’Callaghan DJ, Takata M, Gordon AC, Wilson J, Zhao Y, Singer M, Spencer J, Shankar-Hari M, Genga KR, Lo C, Cirstea MS, Walley KR, Russell JA, Linder A, Boyd JH, Sedlag A, Riedel C, Georgieff M, Barth E, Debain A, Jonckheer J, Moeyersons W, Van zwam K, Puis L, Staessens K, Honoré PM, Spapen HD, De Waele E, de Garibay APR, Bracht H, Ende-Schneider B, Schreiber C, Kreymann B, Bini A, Votino E, Giuliano G, Steinberg I, Vetrugno L, Trunfio D, Sidoti A, Essig A, Brogi E, Forfori F, Conroy M, Marsh B, O’Flynn J, Henne-Bruns D, Gebhard F, Orend K, Halatsch M, Weiss M, Chase M, Freinkman E, Uber A, Liu X, Cocchi MN, Donnino MW, Peetermans M, Liesenborghs L, Claes J, Vanassche T, Hoylaerts M, Jacquemin M, Vanhoorelbeke K, De Meyer S, Verhamme P, Vögeli A, Ottiger M, Meier M, Steuer C, Bernasconi L, Huber A, Christ-Crain M, Henzen C, Hoess C, Thomann R, Zimmerli W, Müller B, Schütz P, Hoppensteadt D, Walborn A, Rondina M, Tsuruta K, Fareed J, Tachyla S, Ikeda T, Ono S, Ueno T, Suda S, Nagura T, Damiani E, Domizi R, Scorcella C, Tondi S, Pierantozzi S, Ciucani S, Mininno N, Adrario E, Pelaia P, Donati A, Andersen MS, Lu S, Lopez G, Lassen AT, Ghiran I, Shapiro NI, Trahtemberg U, Sviri S, Beil M, Agur Z, Van Heerden P, Jahaj E, Vassiliou A, Mastora Z, Orfanos SE, Kotanidou A, Wirz Y, Sager R, Amin D, Amin A, Haubitz S, Hausfater P, Huber A, Kutz A, Mueller B, Schuetz P, Sager RS, Wirz YW, Amin DA, Amin AA, Hausfater PH, Huber AH, Haubitz S, Kutz A, Mueller B, Schuetz P, Gottin L, Dell’amore C, Stringari G, Cogo G, Ceolagraziadei M, Sommavilla M, Soldani F, Polati E, Meier M, Baumgartner T, Zurauskaité G, Gupta S, Mueller B, Devendra A, Schuetz P, Mandaci D, Eren G, Ozturk F, Emir N, Hergunsel O, Azaiez S, Khedher S, Maaoui A, Salem M, Chernevskaya E, Beloborodova N, Bedova A, Sarshor YU, Pautova A, Gusarov V, Öveges N, László I, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Spanuth E, Ebelt H, Ivandic B, Thomae R, Werdan K, El-Shafie M, Taema K, El-Hallag M, Kandeel A, Tayeh O, Taema K, Eldesouky M, Omara A, Winkler MS, Holzmann M, Nierhaus A, Mudersbach E, Schwedhelm E, Daum G, Kluge S, Zoellner C, Greiwe G, Sawari H, Schwedhelm E, Nierhaus A, Kluge S, Kubitz J, Jung R, Daum G, Reichenspurner H, Zoellner C, Winkler MS, Groznik M, Ihan A, Andersen LW, Chase M, Holmberg MJ, Wulff A, Cocchi MN, Donnino MW, Balci C, Haliloglu M, Bilgili B, Bilgin H, Kasapoglu U, Sayan I, Süzer M, Mulazımoglu L, Cinel I, Patel V, Shah S, Parulekar P, Minton C, Patel J, Ejimofo C, Choi H, Costa R, Caruso P, Nassar P, Fu J, Jin J, Xu Y, Kong J, Wu D, Yaguchi A, Klonis A, Ganguly S, Kollef M, Burnham C, Fuller B, Mavrommati A, Chatzilia D, Salla E, Papadaki E, Kamariotis S, Christodoulatos S, Stylianakis A, Alamanos G, Simoes M, Trigo E, Silva N, Martins P, Pimentel J, Baily D, Curran LA, Ahmadnia E, Patel BV, Adukauskiene D, Cyziute J, Adukauskaite A, Pentiokiniene D, Righetti F, Colombaroli E, Castellano G, Wilske F, Skorup P, Lipcsey M, Hanslin K, Larsson A, Sjölin J, Man M, Shum HP, Chan YH, Chan KC, Yan WW, Lee RA, Lau SK, Dilokpattanamongkol P, Thirapakpoomanunt P, Anakkamaetee R, Montakantikul P, Tangsujaritvijit V, Sinha S, Pati J, Sahu S, Adukauskiene D, Valanciene D, Dambrauskiene A, Adukauskiene D, Valanciene D, Dambrauskiene A, Hernandez K, Lopez T, Saca D, Bello M, Mahmood W, Hamed K, Al Badi N, AlThawadi S, Al Hosaini S, Salahuddin N, Cilloniz CC, Ceccato AC, Bassi GLL, Ferrer MF, Gabarrus AG, Ranzani OR, Jose ASS, Vidal CGG, de la Bella Casa JPP, Blasi FB, Torres AT, Adukauskiene D, Ciginskiene A, Dambrauskiene A, Simoliuniene R, Giuliano G, Triunfio D, Sozio E, Taddei E, Brogi E, Sbrana F, Ripoli A, Bertolino G, Tascini C, Forfori F, Fleischmann C, Goldfarb D, Schlattmann P, Schlapbach L, Kissoon N, Baykara N, Akalin H, Arslantas MK, Gavrilovic SG, Vukoja MV, Hache MH, Kashyap RK, Dong YD, Gajic OG, Ranzani O, Shankar-Hari M, Harrison D, Rabello L, Rowan K, Salluh J, Soares M, Markota AM, Fluher JF, Kogler DK, Borovšak ZB, Sinkovic AS, László I, Öveges N, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Fareed J, Siddiqui Z, Aggarwal P, Iqbal O, Hoppensteadt D, Lewis M, Wasmund R, Abro S, Raghuvir S, Tsuruta K, Barie PS, Fineberg D, Radford A, Tsuruta K, Casazza A, Vilardo A, Bellazzi E, Boschi R, Ciprandi D, Gigliuto C, Preda R, Vanzino R, Vetere M, Carnevale L, Kyriazopoulou E, Pistiki A, Routsi C, Tsangaris I, Giamarellos-Bourboulis E, Kyriazopoulou E, Tsangaris I, Routsi C, Pnevmatikos I, Vlachogiannis G, Antoniadou E, Mandragos K, Armaganidis A, Giamarellos-Bourboulis E, Allan P, Oehmen R, Luo J, Ellis C, Latham P, Newman J, Pritchett C, Pandya D, Cripps A, Harris S, Jadav M, Langford R, Ko B, Park H, Beumer CM, Koch R, Beuningen DV, Oudelashof AM, Vd Veerdonk FL, Kolwijck E, VanderHoeven JG, Bergmans DC, Hoedemaekers C, Brandt JB, Golej J, Burda G, Mostafa G, Schneider A, Vargha R, Hermon M, Levin P, Broyer C, Assous M, Wiener-Well Y, Dahan M, Benenson S, Ben-Chetrit E, Faux A, Sherazi R, Sethi A, Saha S, Kiselevskiy M, Gromova E, Loginov S, Tchikileva I, Dolzhikova Y, Krotenko N, Vlasenko R, Anisimova N, Spadaro S, Fogagnolo A, Remelli F, Alvisi V, Romanello A, Marangoni E, Volta C, Degrassi A, Mearelli F, Casarsa C, Fiotti N, Biolo G, Cariqueo M, Luengo C, Galvez R, Romero C, Cornejo R, Llanos O, Estuardo N, Alarcon P, Magazi B, Khan S, Pasipanodya J, Eriksson M, Strandberg G, Lipsey M, Larsson A, Rajput Z, Hiscock F, Karadag T, Uwagwu J, Jain S, Molokhia A, Barrasa H, Soraluce A, Uson E, Rodriguez A, Isla A, Martin A, Fernández B, Fonseca F, Sánchez-Izquierdo JA, Maynar FJ, Kaffarnik M, Alraish R, Frey O, Roehr A, Stockmann M, Wicha S, Shortridge D, Castanheira M, Sader HS, Streit JM, Flamm RK, Falsetta K, Lam T, Reidt S, Jancik J, Kinoshita T, Yoshimura J, Yamakawa K, Fujimi S, Armaganidis A, Torres A, Zakynthinos S, Mandragos C, Giamarellos-Bourboulis E, Ramirez P, De la Torre-Prados M, Rodriguez A, Dale G, Wach A, Beni L, Hooftman L, Zwingelstein C, François B, Colin G, Dequin PF, Laterre PF, Perez A, Welte R, Lorenz I, Eller P, Joannidis M, Bellmann R, Lim S, Chana S, Patel S, Higuera J, Cabestrero D, Rey L, Narváez G, Blandino A, Aroca M, Saéz S, De Pablo R, Thiessen S, Vanhorebeek I, Derde S, Derese I, Dufour T, Albert CN, Langouche L, Goossens C, Peersman N, Vermeersch P, Vander Perre S, Holst J, Wouters P, Van den Berghe G, Liu X, Uber AU, Holmberg M, Konanki V, McNaughton M, Zhang J, Donnino MW, Demirkiran O, Byelyalov A, Luengo C, Guerrero J, Cariqueo M, Scorcella C, Domizi R, Damiani E, Tondi S, Pierantozzi S, Rossini N, Falanga U, Monaldi V, Adrario E, Pelaia P, Donati A, Cole O, Scawn N, Balciunas M, Blascovics I, Vuylsteke A, Salaunkey K, Omar A, Salama A, Allam M, Alkhulaifi A, Verstraete S, Vanhorebeek I, Van Puffelen E, Derese I, Ingels C, Verbruggen S, Wouters P, Joosten K, Hanot J, Guerra G, Vlasselaers D, Lin J, Van den Berghe G, Haines R, Zolfaghari P, Hewson R, Offiah C, Prowle J, Park H, Ko B, Buter H, Veenstra JA, Koopmans M, Boerma EC, Veenstra JA, Buter H, Koopmans M, Boerma EC, Taha A, Shafie A, Hallaj S, Gharaibeh D, Hon H, Bizrane M, El Khattate AA, Madani N, Abouqal R, Belayachi J, Kongpolprom N, Sanguanwong N, Sanaie S, Mahmoodpoor A, Hamishehkar H, Biderman P, Van Heerden P, Avitzur Y, Solomon S, Iakobishvili Z, Carmi U, Gorfil D, Singer P, Paisley C, Patrick-Heselton J, Mogk M, Humphreys J, Welters I, Pierantozzi S, Scorcella C, Domizi R, Damiani E, Tondi S, Casarotta E, Bolognini S, Adrario E, Pelaia P, Donati A, Holmberg MJ, Moskowitz A, Patel P, Grossestreuer A, Uber A, Andersen LW, Donnino MW, Malinverni S, Goedeme D, Mols P, Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W, Manzanares W, Szwec C, Langlois P, Aramendi I, Heyland D, Stankovic N, Nadler J, Uber A, Holmberg M, Sanchez L, Wolfe R, Chase M, Donnino M, Cocchi M, Atalan HK, Gucyetmez B, Kavlak ME, Aslan S, Kargi A, Yazici S, Donmez R, Polat KY, Piechota M, Piechota A, Misztal M, Bernas S, Pietraszek-Grzywaczewska I, Saleh M, Hamdy A, Hamdy A, Elhallag M, Atar F, Kundakci A, Gedik E, Sahinturk H, Zeyneloglu P, Pirat A, Popescu M, Tomescu D, Van Gassel R, Baggerman M, Schaap F, Bol M, Nicolaes G, Beurskens D, Damink SO, Van de Poll M, Horibe M, Sasaki M, Sanui M, Iwasaki E, Sawano H, Goto T, Ikeura T, Hamada T, Oda T, Mayumi T, Kanai T, Kjøsen G, Horneland R, Rydenfelt K, Aandahl E, Tønnessen T, Haugaa H, Lockett P, Evans L, Somerset L, Ker-Reid F, Laver S, Courtney E, Dalton S, Georgiou A, Robinson K, Lam T, Haas B, Reidt S, Bartlett K, Jancik J, Bigwood M, Hanley R, Morgan P, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Zampieri FG, Liborio AB, Besen BA, Cavalcanti AB, Dominedò C, Dell’Anna AM, Monayer A, Grieco DL, Barelli R, Cutuli SL, Maddalena AI, Picconi E, Sonnino C, Sandroni C, Antonelli M, Gucyetmez B, Atalan HK, Tuzuner F, Cakar N, Jacob M, Sahu S, Singh YP, Mehta Y, Yang KY, Kuo S, Rai V, Cheng T, Ertmer C, Czempik P, Hutchings S, Watts S, Wilson C, Burton C, Kirkman E, Drennan D, O’Prey A, MacKay A, Forrest R, Oglinda A, Ciobanu G, Casian M, Oglinda C, Lun CT, Yuen HJ, Ng G, Leung A, So SO, Chan HS, Lai KY, Sanguanwit P, Charoensuk W, Phakdeekitcharoen B, Batres-Baires G, Kammerzell I, Lahmer T, Mayr U, Schmid R, Huber W, Spanuth E, Bomberg H, Klingele M, Thomae R, Groesdonk H, Bernas S, Piechota M, Mirkiewicz K, Pérez AG, Silva J, Ramos A, Acharta F, Perezlindo M, Lovesio L, Antonelli PG, Dogliotti A, Lovesio C, Baron J, Schiefer J, Baron DM, Faybik P, Shum HP, Yan WW, Chan TM, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Vicka V, Gineityte D, Ringaitiene D, Sipylaite J, Pekarskiene J, Beurskens DM, Van Smaalen TC, Hoogland P, Winkens B, Christiaans MH, Reutelingsperger CP, Van Heurn E, Nicolaes GA, Schmitt FS, Salgado ES, Friebe JF, Fleming TF, Zemva JZ, Schmoch TS, Uhle FU, Kihm LK, Morath CM, Nusshag CN, Zeier MZ, Bruckner TB, Mehrabi AM, Nawroth PN, Weigand MW, Hofer SH, Brenner TB, Fotopoulou G, Poularas I, Kokkoris S, Brountzos E, Zakynthinos S, Routsi C, Saleh M, Elghonemi M, Nilsson KF, Sandin J, Gustafsson L, Frithiof R, Skorniakov I, Varaksin A, Vikulova D, Shaikh O, Whiteley C, Ostermann M, Di Lascio G, Anicetti L, Bonizzoli M, Fulceri G, Migliaccio ML, Sentina P, Cozzolino M, Peris A, Khadzhynov D, Halleck F, Staeck O, Lehner L, Budde K, Slowinski T, Slowinski T, Kindgen-Milles D, Khadzhynov D, Huysmans N, Laenen MV, Helmschrodt A, Boer W. 37th International Symposium on Intensive Care and Emergency Medicine (part 3 of 3). Crit Care 2017. [PMCID: PMC5374592 DOI: 10.1186/s13054-017-1629-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jahn L, Baumgartner T, Svardal K, Krampe J. The influence of temperature and SRT on high-solid digestion of municipal sewage sludge. Water Sci Technol 2016; 74:836-843. [PMID: 27533858 DOI: 10.2166/wst.2016.264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The influence of temperature and solids retention time (SRT) on high-solid digestion of municipal sewage sludge was investigated in laboratory-scale reactors. Digestion with high-solid concentration reduces the required digestion volume and is advantageous for urban areas. The experimental conditions comprised total suspended solids (TSS) in digested sludge between 4.0 and 4.6%, temperatures in a range of 33 to 41 °C and the SRT between 10 and 25 d. High-solid digestion operates with increased NH4-N concentrations released from organic compounds. The anaerobic process can be limited by high NH4-N concentration and toxic NH3. In this study a stable digestion was observed up to 2,000 mg L(-1) NH4-N and 75 mg L(-1) NH3. Volatile suspended solids (VSS) and chemical oxygen demand removal was 53% and 57% respectively. However, digestion with 10 d SRT led to a declined VSS removal of 49%. The removal at 41 and 37 °C showed minor differences, while reduced NH4-N release and reduced methane production were observed at 33 °C. For economic reasons, high-solid digestion at 41 °C is not recommended, but will not impair VSS removal. The outcomes of this study confirm that digestion with up to 7.8% TSS in the feed is feasible for the tested temperatures and SRT down to 15 d.
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Affiliation(s)
- L Jahn
- Institute for Water Quality, Resource and Waste Management, Vienna University of Technology, Karlsplatz 13/226-1, Vienna 1040, Austria E-mail:
| | - T Baumgartner
- Institute for Water Quality, Resource and Waste Management, Vienna University of Technology, Karlsplatz 13/226-1, Vienna 1040, Austria E-mail:
| | - K Svardal
- Institute for Water Quality, Resource and Waste Management, Vienna University of Technology, Karlsplatz 13/226-1, Vienna 1040, Austria E-mail:
| | - J Krampe
- Institute for Water Quality, Resource and Waste Management, Vienna University of Technology, Karlsplatz 13/226-1, Vienna 1040, Austria E-mail:
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Abstract
BACKGROUND Preparing for potentially threatening events in the future is essential for survival. Anticipating the future to be unpleasant is also a cognitive key feature of depression. We hypothesized that 'pessimism'-related emotion processing would characterize brain activity in major depression.MethodDuring functional magnetic resonance imaging, depressed patients and a healthy control group were cued to expect and then perceive pictures of known emotional valences--pleasant, unpleasant and neutral--and stimuli of unknown valence that could have been either pleasant or unpleasant. Brain activation associated with the 'unknown' expectation was compared with the 'known' expectation conditions. RESULTS While anticipating pictures of unknown valence, activation patterns in depressed patients within the medial and dorsolateral prefrontal areas, inferior frontal gyrus, insula and medial thalamus were similar to activations associated with expecting unpleasant pictures, but not with expecting positive pictures. The activity within a majority of these areas correlated with the depression scores. Differences between healthy and depressed persons were found particularly for medial and dorsolateral prefrontal and insular activations. CONCLUSIONS Brain activation in depression during expecting events of unknown emotional valence was comparable with activation while expecting certainly negative, but not positive events. This neurobiological finding is consistent with cognitive models supposing that depressed patients develop a 'pessimistic' attitude towards events with an unknown emotional meaning. Thereby, particularly the role of brain areas associated with the processing of cognitive and executive control and of the internal state is emphasized in contributing to major depression.
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Affiliation(s)
- U Herwig
- Psychiatric University Hospital Zürich, Switzerland.
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Raba M, Baumgartner T, Hilger D, Klempahn K, Härtel T, Jung K, Jung H. Function of transmembrane domain IX in the Na+/proline transporter PutP. J Mol Biol 2008; 382:884-93. [PMID: 18692508 DOI: 10.1016/j.jmb.2008.07.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 07/23/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
Abstract
Selected residues of transmembrane domain (TM) IX were previously shown to play key roles in ligand binding and transport in members of the Na(+)/solute symporter family. Using the Na(+)/proline transporter PutP as a model, a complete Cys scanning mutagenesis of TM IX (positions 324 to 351) was performed here to further investigate the functional significance of the domain. G328, S332, Q345, and L346 were newly identified as important for Na(+)-coupled proline uptake. Placement of Cys at one of these positions altered K(m(pro)) (S332C and L346C, 3- and 21-fold decreased, respectively; Q345C, 38-fold increased), K(0.5(Na+)) (S332C, 13-fold decreased; Q345C, 19-fold increased), and/or V(max) [G328C, S332C, Q345C, and L346C, 3-, 22-, 2-, and 8-fold decreased compared to PutP(wild type), respectively]. Membrane-permeant N-ethylmaleimide inhibited proline uptake into cells containing PutP with Cys at distinct positions in the middle (T341C) and cytoplasmic half of TM IX (C344, L347C, V348C, and S351C) and had little or no effect on all other single Cys PutP variants. The inhibition pattern was in agreement with the pattern of labeling with fluorescein-5-maleimide. In addition, Cys placed into the cytoplasmic half of TM IX (C344, L347C, V348C, and S351C) was protected from fluorescein-5-maleimide labeling by proline while Na(+) alone had no effect. Membrane-impermeant methanethiosulfonate ethyltrimethylammonium modified Cys in the middle (A337C and T341C) and periplasmic half (L331C) but not in the cytoplasmic half of TM IX in intact cells. Furthermore, Cys at the latter positions was partially protected by Na(+) but not by proline. Based on these results, a model is discussed according to which residues of TM IX participate in the formation of ligand-sensitive, hydrophilic cavities in the protein that may reconstitute part of the Na(+) and/or proline translocation pathway of PutP.
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Affiliation(s)
- Michael Raba
- LMU Munich, Department Biology I, Microbiology, Grosshaderner Strasse 2-4, D-82152 Planegg-Martinsried, Germany
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Stoner BP, Douglas JM, Martin DH, Hook EW, Leone P, McCormack WM, Mroczkowski TF, Jones R, Yang J, Baumgartner T. Single-dose gatifloxacin compared with ofloxacin for the treatment of uncomplicated gonorrhea: a randomized, double-blind, multicenter trial. Sex Transm Dis 2001; 28:136-42. [PMID: 11289194 DOI: 10.1097/00007435-200103000-00003] [Citation(s) in RCA: 12] [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: 11/26/2022]
Abstract
BACKGROUND Treatment of gonorrhea is complicated by widespread resistance of Neisseria gonorrhoeae to antimicrobial agents of choice, including decreased susceptibility to ciprofloxacin. GOAL To demonstrate the efficacy and safety of gatifloxacin, a novel 8-methoxy fluoroquinolone antibiotic, compared with ofloxacin in treating patients with uncomplicated gonococcal infection. STUDY DESIGN In a double-blind, randomized (2:2:1), controlled trial, 340 men and 388 women with uncomplicated gonorrhea who were 16 years or older received a single oral dose of gatifloxacin (400 mg or 600 mg) or ofloxacin (400 mg). Primary analysis of efficacy was based on bacteriologic eradication from sites of infection. Secondary analyses examined clinical response and adverse event profiles. RESULTS Bacteriologic eradication rates for gatifloxacin in evaluable men with urethral gonorrhea were 99% (400 mg) and 100% (600 mg) versus 100% for ofloxacin (n = 117, 122, and 55, respectively; P = ns). Eradication rates in evaluable women with endocervical gonorrhea were 99% for both 400 mg and 600 mg gatifloxacin versus 100% for ofloxacin (n = 101, 104, and 55, respectively; P = ns). Eradication rates were 100% for both rectal (n = 43) and pharyngeal (n = 31) infection across all treatment groups. All three drug regimens were well tolerated and exhibited similar clinical response profiles. CONCLUSION Gatifloxacin is safe and effective as a single 400-mg or 600-mg dose for the treatment of uncomplicated gonorrhea. Similar efficacy rates were observed with the 400-mg and 600-mg doses. A single 400-mg dose can be recommended for treatment of uncomplicated gonorrhea.
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Affiliation(s)
- B P Stoner
- Washington University School of Medicine, St Louis, Missouri 63110, USA.
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Abstract
A long-term follow-up was performed on 22 patients treated for a posterior glenoid osteophyte and symptomatic posterior shoulder pain during either the late cocking, acceleration, or follow-through phases of throwing. Arthroscopic evaluation of these patients revealed undersurface tearing of the rotator cuff in all but one. Fifteen patients also had tearing of the posterior labrum. Anterior labral fraying was noted in four patients. Treatment consisted of debridement of the rotator cuff and labral tears. The posterior glenoid osteophyte was removed arthroscopically in 11 patients. Eighteen of 22 throwers treated were available for long-term follow-up at a mean of 6.3 years (range, 1 to 12). Only 10 of 18 (55%) throwers evaluated had returned to their premorbid level of throwing. All 10 were asymptomatic and had maintained a high level of performance for a mean of 3.6 years (range, 1 to 8). At the time of latest follow-up, five players were still participating at the major league level and five had retired. One patient had recurrence of the exostosis 8 years after surgery. Among our patients a trend existed toward a poorer result and failure of return to activity with a posterior osteophyte greater than 100 mm2. A posterior glenoid exostosis, when identified in the symptomatic shoulder of the throwing athlete, can be considered a definite marker of internal impingement.
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Affiliation(s)
- K Meister
- University of Florida Department of Orthopaedics, Gainesville, USA
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Baumgartner T, Gudat D, Nieger M, Niecke E. Phosphavinylidene-Carbenoids [P]˭C(Li)X (X ˭ Br, Cl, F): Structure and Dynamics. PHOSPHORUS SULFUR 1999. [DOI: 10.1080/10426509908053493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- T. Baumgartner
- a Institute für Anorganische Chemie , Gerhard-Domagk-Straße 1, D-53121 , Bonn , Germany
| | - D. Gudat
- a Institute für Anorganische Chemie , Gerhard-Domagk-Straße 1, D-53121 , Bonn , Germany
| | - M. Nieger
- a Institute für Anorganische Chemie , Gerhard-Domagk-Straße 1, D-53121 , Bonn , Germany
| | - E. Niecke
- a Institute für Anorganische Chemie , Gerhard-Domagk-Straße 1, D-53121 , Bonn , Germany
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Wenk M, Baumgartner T, Dobovsek J, Fuchs T, Kucsera J, Zopfi J, Stucki G. Rapid atrazine mineralisation in soil slurry and moist soil by inoculation of an atrazine-degrading Pseudomonas sp. strain. Appl Microbiol Biotechnol 1998; 49:624-30. [PMID: 9650261 DOI: 10.1007/s002530051224] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [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: 02/08/2023]
Abstract
The evaluation of pesticide-mineralising microorganisms to clean-up contaminated soils was studied with the widely applied and easily detectable compound atrazine, which is rapidly mineralised by several microorganisms including the Pseudomonas sp. strain Yaya 6. The rate of atrazine removal was proportional to the water content of the soil and the amount of bacteria added to the soil. In soil slurry, 6 mg atrazine kg soil-1 was eliminated within 1 day after application of 0.3 g dry weight inoculant biomass kg soil-1 and within 5 days when 0.003 g kg soil-1 was used. In partially saturated soil (60% of the maximal water-holding capacity) 15 mg atrazine kg soil-1 was used. In unsaturated soil, about 60% [U-ring-14C] atrazine was converted to 14CO2 within 14 days. Atrazine was very efficiently removed by the inoculant biomass, not only in soil that was freshly contaminated but also in soil aged with atrazine for up to 260 days. The bacteria exposed to atrazine in unsaturated sterile soil were still active after starvation period of 240 days: 15 mg newly added atrazine kg soil-1 was eliminated within 5 days.
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Affiliation(s)
- M Wenk
- Ciba Specialty Chemicals, Environmental Technology, Pratteln, Switzerland
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Xu X, Kommareddi N, McCormick M, Baumgartner T, John V, McPherson G, Akkara J, Kaplan D. The microstructure of polymers enzymatically synthesized in a self-assembling environment. Materials Science and Engineering: C 1996. [DOI: 10.1016/s0928-4931(96)00148-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Speirs VC, Harrison IW, van Veenendaal JC, Baumgartner T, Josseck HH, Reutter H. Is specific antifungal therapy necessary for the treatment of guttural pouch mycosis in horses? Equine Vet J 1995; 27:151-2. [PMID: 7607150 DOI: 10.1111/j.2042-3306.1995.tb03053.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- V C Speirs
- Klinik für Nutztiere und Pferde, Universität Bern, Switzerland
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Abstract
The purpose of this study was to determine the validity of five field tests (FTs) of upper body muscular strength and endurance (UBMSE) in 9-10-year-old children. Ninety-four children (38 boys, 56 girls) performed five FTs of UBMSE: pull-ups, flexed arm hang, push-ups, Vermont modified pull-ups (VMPU), and New York modified pull-ups. They also performed three criterion tests (CTs) of strength and three CTs of muscular endurance using a supported weight, set-resistance device. Zero-order correlations between the sum of the standard scores on the three CTs of strength (SUM1RM) and the FTs were nonsignificant. However, when SUM1RM was expressed relative to body weight (SUM1RM.kg-1), significant (p < .01) correlation coefficients were obtained for each FT. Highest correlations with SUM1RM.kg-1 were observed for the VMPU, and this same test yielded the smallest percentage of zero scores. Principal components analysis of the CTs, normalized for body weight, and FTs yielded a factor on which both the FTs and CTs of strength loaded significantly. These data indicate that the five FTs, though invalid as measures of absolute strength and muscular endurance, manifest concurrent and construct validity as measures of weight-relative muscular strength.
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Affiliation(s)
- R R Pate
- Department of Exercise Science, University of South Carolina, Columbia 29208
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Baumgartner T. New hospital emphasizes patient accessibility and continuity of care. Interview by Karen Gardner. Trustee 1993; 46:8-10. [PMID: 10124076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
As a 14-year veteran of the board of Lutheran Hospital of Indiana Inc., Fort Wayne, Thomas Baumgartner participated fully in the evolution of Lutheran's new acute care facility, which opened last May after five years of planning and construction. The Lutheran system includes the new not-for-profit, 350-bed hospital; a subsidiary comprising four urgent care clinics; joint ventures with several medical entities that provide clinical services such as rehabilitation and nursing; and a four-year college (the Lutheran College of Health Professionals). Located in a city of approximately 190,000, Lutheran Hospital--one of three tertiary care facilities in Fort Wayne--serves a 20-county region. To update its facilities and better meet the needs of this large service area, the new hospital design features a hospital tower connected to two medical office buildings by a two-story "medical mall." Baumgartner, who is chairman of the Lutheran system board and executive vice president and chief operations officer of Fort Wayne National Bank, recently spoke with Trustee editor Karen Gardner about the process of building a new hospital.
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Spare KW, Craig J, Moore-Nichols J, Hoff GL, Biery RM, Gipson KS, Baumgartner T. Human immunodeficiency virus (HIV) seroprevalence surveys. Mo Med 1992; 89:843-5. [PMID: 1480125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The seroprevalence surveys being conducted in the Kansas City area have to date tested 15,778 persons and resulted in 85 seropositive HIV tests. The sexually transmitted disease (STD) surveys and women's surveys fall in the lowest quartile of the combined national surveys. The drug treatment (IVDU) survey data were comparable to the median national seroprevalence of 3.8%. Seroprevalence rates in the STD surveys were 41 times that of women's surveys, and the IVDU surveys were 104 times that of the women's surveys. Based on three years of data from clinics with stable populations presenting for treatment, no trends in the demographics of those being found seropositive were identified to be statistically significant. This lack of trends has been presented as the normal findings of surveys nationally. The data does not show an acceleration of new infections based on seropositives being identified in the survey sites.
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Affiliation(s)
- K W Spare
- Health Department, Kansas City, Missouri 64109
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