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Biomedical subjects

Wolfgang H Jost

Publications and source records attributed to Wolfgang H Jost.

16 recordsLinked to original sources
PubMed2006

Botulinum toxin: clinical use.

Since its development for the use of blepharospasm and strabismus more than 2.5 decades ago, botulinum neurotoxin (BoNT) has become a versatile drug in various fields of medicine. It is the standard of care in different disorders such as cervical dystonia, hemifacial spasm, focal spasticity, hyperhidrosis, ophthalmological and otolaryngeal disorders. It has also found widespread use in cosmetic applications. Many other indications are currently under investigation, including gastroenterologic and urologic indications, analgesic management and migraine. This paper is an extensive review of the spectrum of BoNT clinical applications.

Animals↗
PubMed2006

Botulinum toxin in multiple sclerosis.

Local administration of botulinum toxin (BoTx) inhibits presynaptic acetylcholine release. All cholinergically innervated muscles and glands can be paralyzed accordingly. Studies on the application of BoTx in multiple sclerosis have shown good results for focal spasticity, in particular, of the extremities. The first promising data were published on bladder disorders, especially with regard to detrusor sphincter dyssynergia and detrusor hyperreflexia. Hyperhidrosis, hypersalivation and proctologic symptoms might be other areas of application. Approval, however, has been greatly restricted which limits the therapeutic range of use.

Botulinum Toxins, Type A↗
PubMed2006

Botulinum toxin in patients with multiple sclerosis.

Nearly all patients with multiple sclerosis (MS) will develop spasticity in the course of their disease. This symptom accounts for most of the handicap and impairment in the quality of life. Treatment with botulinum toxin will enable an efficient and safe alleviation of spasticity and the problems involved, given a realistic definition of the therapeutic target and a graded multimodal approach. Treatment may fail for a great number of reasons that require diligent analysis. Compared with other disorders resulting in spasticity as well, MS does not constitute a monophasic disorder but is influenced by many factors. Treatment of spasticity in MS must therefore be guided by its particular aspects.

Botulinum Toxins, Type A↗
PubMed2006

Early diagnosis of Parkinson's disease.

The clinical methods of olfactory testing and color discrimination as well as apparative methods such as transcranial ultrasound, dopamine transporter imaging and MIBG scintigraphy reveal a high sensitivity concerning the diagnosis of idiopathic Parkinson's disease (PD). The specificity of the presented methods, in particular of the dopamine transporter imaging--seems to be limited. All these methods and primarily their combination allow the detection of PD in early and--probably--preclinical stages. This requires sufficient therapeutic strategies to prevent and treat preclinical and early PD.

Humans↗
PubMed2006

Clinical studies with ropinirole in Parkinson's disease and RLS.

Ropinirole is a modern dopamine agonist with a half-life of medium extent that is highly selective for D(2)-receptors. Ropinirole is an indole derivative and thus does not belong to the group of ergoline dopamine receptor agonists. Its effect has been proved in a number of controlled studies in both monotherapy and combination treatments of Parkinson's disease. We can meanwhile refer to the long-term data of studies that have been run for more than 10 years. The substance has also been approved for the management of restless legs syndrome. A long-acting formula of the substance will be available soon.

Antiparkinson Agents↗
PubMed2005

FP-CIT and MIBG scintigraphy in early Parkinson's disease.

Methods provided by nuclear medicine may be helpful in diagnosis of Parkinson's disease (PD). For that purpose, the sensitivity of iodine-123 metaiodobenzylguanidine ([123I]MIBG) scintigraphy and [123I]FP-CIT single photon emission computed tomography (SPECT) was studied in patients with PD onset (Hoehn and Yahr Stage 1). Cerebral [123I]FP-CIT and cardiac [123I]MIBG scintigraphy were carried out in 18 patients with idiopathic Parkinson's disease, according to Hoehn and Yahr Stage 1. For quantification purposes, we calculated the striatum/posterior lobe binding of FP-CIT and the heart-to-mediastinum (H/M) count ratio regarding MIBG scintigraphy. In 15 of 18 patients, we observed markedly reduced or asymmetric striatal FP-CIT tracer accumulation. FP-CIT binding of the affected striatum was significantly lower as compared with that of the unaffected side. Striatal FP-CIT binding correlated significantly with the motor part of the Unified Parkinson's disease rating scale (UPDRS) but not with age, disease duration, or gender. MIBG scintigraphy delivered significant pathological results in 13 of 18 patients. There was no significant correlation between the H/M ratio relating to MIBG scintigraphy and the motor part of UPDRS, age, disease duration, or gender; however, binding of striatal FP-CIT correlated significantly with cardiac MIBG accumulation. According to the clinical criteria, it might be difficult to prove the diagnosis of PD in patients with slight symptoms and in these cases, FP-CIT SPECT and MIBG scintigraphy may contribute to the early diagnosis of PD. In addition, the functional loss of nigrostriatal and cardiac sympathetic neurons seems to be coupled closely.

3-Iodobenzylguanidine↗
PubMed2005

Ropinirole, a non-ergoline dopamine agonist.

Dopamine agonists have become indispensable in the treatment of Parkinson's disease. In every-day practice, however, the decision to select the best compound for an individual patient is rendered difficult because of the large number of substances available on the market. This review article provides a closer look at the experimental and clinical studies with ropinirole published so far. Ropinirole is a non-ergoline dopamine agonist which has been proven to be effective in both, monotherapy and combination therapy of idiopathic Parkinson's disease. In addition to ameliorating bradykinesia, rigor, and tremor, ropinirole facilitates the daily life and improves depressive moods of patients with Parkinson's disease. The long-term complications of levodopa are avoided, and problems commonly associated with levodopa treatment are reduced. Ropinirole appears to have a neuroprotective effect. In addition to Parkinson's disease, ropinirole has also been used successfully in the treatment of restless legs syndrome.

Animals↗
PubMed2005

Autonomic nervous system dysfunction in lightning and electrical injuries.

Autonomic nervous system (ANS) dysfunction is a serious complication of lightning and electrical trauma (L/ET). The ANS regulates the normal vegetative functioning of many organ systems. When ANS is compromised after lightning and electric trauma, patients are vulnerable to serious medical problems. Three conditions of ANS dysfunction of particular concern for L/ET patients are complex regional pain syndrome (CRPS), cardiovascular abnormalities, and keraunoparalysis (KP). The patient with CRPS presents with pain, hyperpathia, sweating, and edema hours to days after trauma. Neurorehabilitation is exceedingly important. A primary goal is to keep the affected extremity mobile and functional. Some patients benefit from sympathetic blockade. Cardiovascular abnormalities associated with lightning and electrical trauma can be life threatening. Care for these patients require a multidisciplinary team including a cardiologist. Keraunoparalysis is a frightening and distressing complication of lightning strikes. The syndrome consists of limb paralysis, sensory symptoms, pallor, coolness and absent pulses. Release of excessive catecholamines is said to be responsible for these findings. Fortunately, the condition is transient.

Arrhythmias, Cardiac↗
PubMed2004

Botulinum toxin in neuro-urological disorders.

Botulinum toxin has been used in urology since the end of the 1980s. However, this therapeutic option has not been firmly established yet. Valid studies have merely been conducted on detrusor sphincter dyssynergia (DSD) and on detrusor overactivity (hyperreflexia), but even those findings do not allow final conclusions. Success rates in DSD are between 58% and 88%, in detrusor overactivity approximately 80%. Further possible indications for botulinum toxin are motor and sensory urge, urethrospasm, spasticity of the pelvic floor, neobladder, and even chronic prostatic pain. To reach firmer conclusions, controlled studies with well-defined patient populations and using validated and reproducible outcome measures are needed. In addition, we also need information on repeated injections over a long period of time. These data are not available to date. At present, the application of botulinum toxin should be reserved for experienced users only.

Anti-Dyskinesia Agents↗
PubMed2004

Ropinirole: current status of the studies.

Ropinirole is a modern, non-ergoline dopamine agonist which has been shown to be effective as monotherapy as well as combination therapy against idiopathic Parkinson's disease. In addition to improving bradykinesia, rigor and tremor, it will ameliorate the abilities of daily living as well as depressive mood. The long-term complications of L-dopa are diminished and the existing complications are reduced. A neuroprotective effect is under discussion. In addition to Parkinson's disease, ropinirole is also used successfully in the treatment of restless legs syndrome.

Bromocriptine↗
PubMed2004

Is levodopa toxic?

The objective of this workshop was to review and discuss the debate on neurotoxicity of levodopa in the treatment of Parkinson's disease (PD) with consideration of preclinical and clinical findings. We concluded that in particular preclinical outcomes of in vitro models of neurodegeneration describe neurotoxic effects of levodopa, whereas trials in animal models provided controversial results. To date, clinical trials in PD patients showed no convincing proof of direct neurotoxic effects of levodopa on progression of neurodegeneration with various applied functional imaging techniques particularly with specific radiotracers for nigral dopaminergic neurotransmission. However, the controversy on neurotoxicity of levodopa only partially considered indirect mechanisms, i. e. levodopa-associated homocysteine elevation. But there is accumulating evidence that this long-term side effect of chronic levodopa administration dose dependently individually contributes to progression of neurodegeneration due to increased release of neurotoxins, induction of oxidative stress and mitochondrial dysfunction according to results of in vitro and animal trials and to at least peripheral neuronal degeneration and increased risk for onset of atherosclerosis-related disorders according to clinical trials in PD patients. From this point of view we demand that future research on the efficacy and putative neurotoxicity of antiparkinsonian compounds should also consider putative toxic long-term effects of drug administration and should look for putative peripheral biomarkers and individual, environmental or nutritative risk factors in order to establish a preventive therapy, i. e. folic acid administration in the case of levodopa-associated homocysteine elevation.

Animals↗
PubMed2003

Autonomic dysfunctions in idiopathic Parkinson's disease.

Most patients with Parkinson's disease experience autonomic dysfunction at some point in the course of their disease. In contrast to autonomic dysregulation in multisystem atrophy, they are less severe, and they frequently cause troublesome symptoms only in advanced stages of the disease. The quality of life is nevertheless substantially restricted. Cardiovascular, gastrointestinal and urogenital autonomic dysfunction is predominant. Appropriate diagnosis and treatment can greatly benefit the patient. An interdisciplinary approach is desirable in most cases.

Autonomic Nervous System Diseases↗
PubMed2002

Ten years' experience with botulin toxin in anal fissure.

BACKGROUND AND AIMS: Botulin toxin therapy has become established for various indications over the past 20 years. Treatment of anal fissure with botulin toxin began 10 years ago, and since then numerous studies with more than 300 patients have been published. RESULTS: The healing rate in uncomplicated chronic anal fissure is about 60-80%. The injection is well tolerated, can be administered on an outpatient basis, and causes no chronic lesion of the continence organ. Botulin toxin therefore offers alternative mode for treating uncomplicated anal fissure with increased sphincter tone when conservative measures fail. CONCLUSION: Potential candidates for surgery should be aware not only of the risks involved but should also of the existence of an alternative treatment using with botulin toxin.

Anti-Dyskinesia Agents↗