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Biomedical subjects

A Straube

Publications and source records attributed to A Straube.

At least 37 records · Page 2Linked to original sources
PubMed2004

[A chronic problem-the chronic headache patient].

Chronic daily headache is a frequent problem which affects 3-5% of the population. Until the 2nd edition of the IHS headache classification, the diagnosis of chronic headache was synonymous with the diagnosis of chronic tension type headache. Now one has to differentiate, not only in symptomatic headache, but also between other primary headache syndromes, such as chronic migraine, hemicrania continua and acute persisting daily headache. Epidemiological studies point to a particular importance of chronic migraine and headache due to chronic analgetica use, since both types of headache are responsible for more than 60% of all cases with chronic headache. Although the mechanisms which cause chronification of headache are not well understood, the new headache classification prompts some direct therapeutical consequences: 1) the indication for drug withdrawal and 2) the indication for a migraine preventive therapy. In general, as with other chronic pain syndromes, there is increasing evidence that a multimodal therapy, consisting of patient education, behavioral therapy and pharmacological therapy, is more successful than a singular therapy.

Chronic Disease↗
PubMed2004

Impaired self-perception of the hand in complex regional pain syndrome (CRPS).

To investigate neglect, extinction, and body-perception in patients suffering from complex regional pain syndrome (CRPS). So-called 'neglect-like' symptoms have been reported in CRPS, however no studies have yet analyzed this phenomenon which might substantiate the theory of the central nervous system involvement in the pathophysiology of CRPS. A total of 114 patients with CRPS of the upper limb underwent bedside neurological examination. 'Neglect-like' symptoms were determined by asking all patients what kind of feeling they had toward the affected hand (feeling of foreignness). Hemispatial neglect was tested with the line bisection task in 29 patients and sensory extinction to simultaneous stimulation in 40 patients. The ability to identify fingers after tactile stimulation was tested in 73 patients. Independently of the affected side and disease duration, 54.4% of the patients reported that their hand felt 'foreign' or 'strange'. The ability to identify fingers was impaired in 48% on the affected hand and in 6.5% on the unaffected hand ( X(2) = 33.52, df = 1, p < 0.0001). These findings were related to pain intensity, illness duration and the extent of sensory deficits. No typical abnormalities indicating neglect were found in the line bisection test. Sensory extinction was normal in all patients. A large proportion of CRPS patients have disturbances of the self-perception of the hand, indicating an alteration of higher central nervous system processing. There are no indicators that classic neglect or extinction contribute to these findings. Physical therapy of such patients should take this observation into consideration.

Adolescent↗
PubMed2004

Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs.

STUDY DESIGN: Comparison of spinal lesion subjects and normal subjects. OBJECTIVE: To investigate the effects of a paravertebral repetitive magnetic stimulation on spastic tone increase of the lower limbs. SETTING: Munich, Germany. METHODS: We compared the effects in 15 patients with different spinal lesions and in 16 healthy subjects. The spastic tone increase was evaluated clinically with the Ashworth scale and apparatively with the pendulum test, both at fixed times before and after stimulation. Unilateral stimulation was applied to the lumbar nerve roots L3 and L4 of the clinically more spastic leg. RESULTS: The spastic tone decreased significantly in the interval between 4 and 24 h after stimulation. This effect was slightly more pronounced in the contralateral extremity. Furthermore, the stimulation motor threshold of the patients was significantly raised. CONCLUSION: Repetitive magnetic unilateral stimulation has a positive effect on spastic tone increase due to spinal lesions, causing a decrease that lasts for about 1 day not only on the ipsilateral but also on the contralateral side.

Adult↗
PubMed2004

EFNS task force--therapy of nystagmus and oscillopsia.

An overview of possible treatment options for oculomotor disorders that prevent clear vision is given. Downbeat nystagmus, upbeat nystagmus, seesaw nystagmus, periodic alternating nystagmus, acquired pendular nystagmus, and saccadic oscillations such as opsoclonus/ocular flutter are discussed. In addition, superior oblique myokymia and vestibular paroxysmia are reviewed. All treatment recommendations available in the literature are classified as class C only. In general, only some of the patients benefit from the treatment.

Advisory Committees↗
PubMed2003

Molecular genetic investigations in the CCM1 gene in sporadic cerebral cavernomas.

OBJECTIVE: Cerebral cavernous malformations (CCM) occur in familial and sporadic forms that cannot be distinguished by phenotype. Mutations in Krit1, a gene located at the CCM1 locus on chromosome 7q21, account for the majority of familial CCM cases. The authors investigated the role that mutations at the CCM1 locus play in sporadic cavernomas and the prevalence of occult familial forms among symptomatic cavernomas. METHODS: The authors screened the DNA of cavernomas and adjacent normal brain tissue of 72 consecutive patients treated at the Neurosurgical Department/Ludwig-Maximilian University for mutations in Krit1. Eight of the patients had been suspected to have a mutation at CCM1, as they showed multiple cavernomas or clinically familial forms. RESULTS: None of the patients showed a mutation at the CCM1 site, either in cavernomas or in normal brain tissue. CONCLUSION: Mutations in Krit1 are seldom a cause of sporadic cavernomas.

Adolescent↗
PubMed2003

Prospective evaluation of neurological complications after allogeneic bone marrow transplantation.

OBJECTIVE: To determine the spectrum and frequency of neurologic sequelae after allogeneic bone marrow transplantation (BMT) and to define a risk profile of the patients. METHODS: A prospective follow-up of 71 allogeneic bone marrow recipients 14 +/- 3 months after transplantation. Patients underwent a neurologic examination, a neuropsychological test battery, and cranial MRI before and after BMT. RESULTS: A large proportion of patients (65%) developed sequelae after BMT. Acute complications of defined etiology occurred in 18% of the patients and led to death in 9% of the study population. A total of 47% of the patients developed new neurologic abnormalities of undefined origin that were mild and subacute and predominantly affected the peripheral nervous system. The cognitive and neuroradiologic outcome was favorable in a majority of these patients, but a small subgroup exhibited cognitive deterioration and white matter lesions. Risk factor analysis identified acute graft-versus-host disease (GvHD) and other variables partly related to GvHD such as long-lasting immunosuppression as the main predictors of sequelae after allogeneic BMT. The authors have established an association with various factors but, owing to the observational character of this study, conclusions about the etiology of the findings are unclear. CONCLUSION: Neurologic complications significantly contribute to the morbidity and mortality of patients receiving allogeneic BMT. Subclinical abnormalities, cognitive deficits, and white matter lesions detected 1 year after BMT in a subgroup of patients may be related to more extensive CNS changes observed after transplantation in an earlier retrospective study and may be associated with the risk factor chronic GvHD/immunosuppression.

Adolescent↗
PubMed2003

[Neuromuscular complications after allogeneic bone marrow transplantation].

Neuromuscular syndromes following allogeneic bone marrow transplantation (BMT), although occasionally described,were not the focus of studies concerning neurologic complications following bone marrow transplantation. In this study,we summarize different polyneuropathy syndromes following BMT and report on patients with myasthenia gravis and inflammatory neuromuscular disorders such as myositis or fasciitis. Concerning the etiology of neuropathies, a neurotoxicity of immunosuppressants,a preexisting disorder due to the underlying disease as well as an association with graft-versus-host disease (GVHD) is discussed.GVHD-associated polyneuropathies as well as muscular complications have been found to occur during the early BMT phase, while myasthenia gravis is a late neurologic complication of GVHD.

Adult↗
PubMed2003

Decreased sTNF-RI in migraine patients?

Tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) have recently been found to have a pain-mediating function in addition to their immunological, proinflammatory function. According to the hypothesis of neurovascular inflammation in migraine, these two cytokines could contribute to migraine pain generation. We analysed IL-6 and its soluble receptors sIL-6R and sgp130 as well as TNF-alpha and its soluble receptor sTNF-RI in 27 migraine patients and eight headache-free controls. Migraine patients tended to have less sTNF-RI (794 +/- 158 pg/ml) than controls (945 +/- 137 pg/ml). No differences in cytokine concentrations were observed. If TNF-alpha plays a role in migraine physiopathology, migraine patients may lack sufficient antagonistic sTNF-RI to neutralize hyperalgesic TNF-alpha during a migraine attack.

Adult↗
PubMed2003

Soluble interleukin-2 receptors increase during the active periods in cluster headache.

OBJECTIVE: To investigate whether cytokines are altered during the active period of cluster headache. BACKGROUND: Patients with cluster headache show activation of the hypothalamus in PET studies and via endocrinologic parameters. Data also suggest an inflammatory process occurs in cluster headache. A connection between the presumed inflammatory cause, an immunological activation, and the hypothalamus could be generated by certain cytokines. DESIGN AND METHODS: ELISA was used to determine the serum levels of soluble interleukin-2 receptors, interleukin-1, interleukin-6, and 2 soluble interleukin-6 receptors (sIL-6R and soluble gp130) in 18 patients with cluster headache (6 women and 12 men) during the cluster period and in 17 healthy controls who were headache-free (3 women and 14 men). RESULTS: Patients with cluster headache had significantly increased soluble interleukin-2 receptors (413.6+/-223 U/mL vs. 290.0+/-112 U/mL; P <.05) compared with controls. Serum levels of interleukin-1 (0.29+/-0.30 pg/mL vs. 0.13+/-0.13 pg/mL, n.s.), interleukin-6 (0.87+/-0.6 pg/mL vs. 0.91+/-0.7 pg/ml; n.s.), soluble interleukin-6 receptors (33,131+/-8,349 pg/mL vs. 35,063+/-7,606 pg/mL; n.s.), or soluble gp130 (289+/-59 pg/mL vs. 283+/-20 pg/mL; n.s.) did not differ between the 2 groups, although patients with cluster tended to have higher interleukin-1 values. CONCLUSIONS: Because elevated soluble interleukin-2 receptors indicate T cell activation, our findings suggest immune activation during cluster headache. Because interleukin-2 can activate the hypothalamus and stimulate the release of Corticotropin-releasing Factor (CRF), interleukin-2 could link a putative immunological cause of cluster headache with the observed hypothalamic activation. Systemic changes of interleukin-1 or the interleukin-6 system do not seem to play a role in cluster headache, as no alterations of serum levels were observed. Even so, unchanged serum levels do not exclude limited local production.

Adult↗
PubMed2002

Interferon beta but not glatiramer acetate therapy aggravates headaches in MS.

Type and frequency of headaches during immunomodulatory therapy in MS were determined in 167 consecutive patients. In a prospective group of 65 patients beginning interferon beta therapy, headache frequency and duration increased in 18% of all and in 35% of patients with pre-existing headache by more than 50% during the first 6 months. In two retrospective groups, increased headache frequency was reported by 34% of 53 patients on interferon beta, but by only 6% of 49 patients during at least 6 months of glatiramer acetate therapy.

Adjuvants, Immunologic↗
PubMed2002

Effects of intravenous opioids on eye movements in humans: possible mechanisms.

Oculomotor symptoms such as downbeat nystagmus can be due to side effects of drugs. We investigated the clinical effects as well as the eye movement symptoms after intravenous administration of opiates (pethidine and fentanyl). Eye movements were recorded with the magnetic search coil technique. All four normal subjects showed a transient disturbance of eye fixation with downbeat nystagmus, a range of saccadic intrusions and oscillations, including square wave jerks and saccadic pulses, lasting from 10 to 15 minutes. The gain of sinusoidal VOR and smooth pursuit was moderately decreased; in particular the vertical pursuit showed an upward velocity offset. On the basis of the clinical findings and of recent diprenorphine PET findings in humans, which detected opiod binding sites in the cerebellum and the known inhibitory action of opiates, we hypothesized that a cerebellar dysfunction occurs after opiate administration which could possibly be mediated by inhibition of the parallel fiber activation of the Purkinje cells. Furthermore, opiate binding sites in the vestibular nuclei could be responsible for the vertical vestibular tonus imbalance involved in the pathophysiolgy of downbeat nystagmus.

Analgesics, Opioid↗
PubMed2002

Differential effect of a distractor on primary saccades and perceptual localization.

A distractor presented nearby the target of a goal-directed short latency saccade leads to spatial averaging, that is, the saccade lands between the target and the distractor. This so-called global effect is a characteristic feature of the spatial processing underlying the programming of saccadic eye movements. To determine whether this effect of near distractors on saccade metrics is also reflected in perceptual localization, subjects performed a saccade task and a perceptual localization task using identical, briefly flashed visual stimuli. To make the available visual processing time for saccades and perception more similar, we followed the target with a mask. Without the mask, primary saccades with short latency landed between target and distractor. The distractor had less effect on primary saccades with longer latencies (>200 ms) and did not affect the final eye position after late secondary saccades in the dark. This indicates that the oculomotor system can correctly use information about the target location 200 ms after the target flash even if no visual stimulus is present during this period. Likewise the presence of a distractor did not affect perceptual localization. Under the masking condition a similar global effect occurred for primary saccades with short latencies, but the latency dependence of the global effect was weakened. Secondary saccades and perceptual localization still did not show a global effect. The results suggest that the primary saccade is based on a specific target acquisition process that differs from that used for spatial perception and for the programming of memory-guided corrective saccades.

Adult↗
PubMed2002

Treatment of cluster headache with topiramate: effects and side-effects in five patients.

We report on clinical experience with topiramate in the prophylactic treatment of three patients with chronic and two patients with episodic, otherwise therapy-resistant, cluster headache. Patients were treated with daily doses of 75-200 mg topiramate. Topiramate was effective in three patients but proved ineffective and also caused intolerable side-effects in two patients. Topiramate may have prophylactic properties for treating cluster headache at lower doses than needed in epilepsy therapy, but its clinical value is limited due to central nervous system side-effects.

Adult↗