TY  - JOUR
AB  - Objective: The presence and intensity of symptoms vary in patients with unilateral vestibular hypofunction. We aimed to determine which saccadic and vestibulo-ocular reflex parameters best predict the presence of symptoms in unilateral vestibular hypofunction in order to better understand vestibular compensation and its implications for rehabilitation therapy. Methods: Video head impulse test data were analyzed from a subpopulation of 23 symptomatic and 10 currently symptom-free participants with unilateral vestibular hypofunction, embedded in the KORA (Cooperative Health Research in the Region of Augsburg) FF4 study, the second follow-up of the KORA S4 population-based health survey (2,279 participants). Results: A higher number of catch-up saccades, a higher percentage of covert saccades, and a larger retinal error at 200 ms after the onset of the head impulse were associated with relevant symptoms in participants with unilateral vestibular hypofunction (p = 0.028, p = 0.046, and p = 0.038, respectively). After stepwise selection, the number of catch-up saccades and retinal error at 200 ms remained in the final logistic regression model, which was significantly better than a null model (p = 0.014). Age, gender, saccade amplitude, saccade latency, and VOR gain were not predictive of the presence of symptoms. Conclusion: The accuracy of saccadic compensation seems to be crucial for the presence of symptoms in unilateral vestibular hypofunction, highlighting the role of specific gaze stabilization exercises in rehabilitation. Early saccades, mainly triggered by the vestibular system, do not seem to compensate accurately enough, resulting in a relevant retinal error and the need for more as well as more accurate catch-up saccades, probably triggered by the visual system.
AU  - Aubele, M.*
AU  - Grill, E.*
AU  - Eggert, T.*
AU  - Schneider, E.*
AU  - Strobl, R.*
AU  - Jahn, K.*
AU  - Müller, M.*
AU  - Holle, R.*
AU  - Linkohr, B.
AU  - Heier, M.
AU  - Ladwig, K.-H.
AU  - Lehnen, N.*
C1  - 68954
C2  - 53755
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Symptoms in unilateral vestibular hypofunction are associated with number of catch-up saccades and retinal error: Results from the population-based KORA FF4 study.
JO  - Front. Neurol.
VL  - 14
PB  - Frontiers Media Sa
PY  - 2023
SN  - 1664-2295
ER  - 

TY  - JOUR
AB  - INTRODUCTION: The functional burden of vertigo, dizziness, and balance problems (VDB) might depend on the personality traits of the patients affected. The aim of this study thus was to investigate the impact of self-efficacy, risk attitudes, and time preferences on functioning in older patients with VDB before and after treatment in a specialized tertiary care center. METHODS: Data for this study was obtained from the MobilE-TRA2 cohort study, conducted at a specialized tertiary care center in Germany. Patients aged 60 and older were assessed during their initial stay at the care center and 3 months later, using self-administered questionnaires. Self-efficacy was measured on a scale from 1 (very low) to 5 (very high). Health-related risk attitudes were inquired using an 11-point scale. Time preferences were measured by evaluating patients' willingness to postpone a reward in favor of a greater benefit on an 11-point Likert scale. Functioning was evaluated using the Dizziness Handicap Inventory, representing functional, emotional, and physical aspects of functional disability caused by VDB. Mixed-effects regression models were used to analyze the association between the selected personality traits and functioning over time. Interaction terms with time were incorporated for each personality trait, enabling the assessment of their influence on functioning 3 months following the initial observation period. RESULTS: An overall of 337 patients (53% women, median age at baseline = 70 years) were included. Patients with higher self-efficacy (Beta = -3.82, 95%-CI [-6.56; -1.08]) and higher willingness to take risks (Beta = -1.31, 95%-CI [-2.31; -0.31]) reported better functioning during their initial visit at the care center. Self-efficacy significantly predicted functioning after 3 months for overall functioning (Beta = -4.21, 95%-CI [-6.57; -1.84]) and all three domains. CONCLUSION: Our findings suggest that patients with high self-efficacy and high willingness to take risks may exhibit better coping mechanisms when faced with the challenges of VDB. Promoting self-efficacy may help patients to better manage the duties accompanying their treatment, leading to improved functioning. These insights may inform the development of personalized treatment aimed at reducing the functional burden of VDB in older patients.
AU  - Katzenberger, B.*
AU  - Fuchs, S.*
AU  - Schwettmann, L.
AU  - Strobl, R.*
AU  - Hauser, A.*
AU  - Koller, D.*
AU  - Grill, E.*
C1  - 69020
C2  - 53805
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Association of self-efficacy, risk attitudes, and time preferences with functioning in older patients with vertigo, dizziness, and balance disorders in a tertiary care setting-Results from the MobilE-TRA2 cohort.
JO  - Front. Neurol.
VL  - 14
PB  - Frontiers Media Sa
PY  - 2023
SN  - 1664-2295
ER  - 

TY  - JOUR
AB  - Background: Post-stroke fatigue is a common symptom after stroke. However, studies on the factors associated with early and late fatigue are scarce. The objective of this study was to identify variables associated with early and late fatigue. Methods: In the German Stroke Cohort Augsburg (SCHANA) study, participants were interviewed during their hospital stay and completed a postal questionnaire 3 and 12 months post-stroke. Fatigue was assessed using the Fatigue Assessement Scale (FAS). In addition, depression was measured by the Patient Health Questionnaire (PHQ-9), general health status by the EQ-5D visual analog scale, and physical activity by the International Physical Activity Questionnaire (IPAQ). Multivariable regression models were used to determine the associations between FAS scores at 3 and 12 months post-stroke and demographic, psychosocial and health-related covariables. Results: Among 505 participants, the frequency of fatigue was 31.1% 3 months and 29.1% 12 months post-stroke. Prior stroke (ß = 2.37, p = 0.0076), prior diagnosis of depression (ß = 5.04, p = 0.0001), higher NIHSS (ß = 0.25, p = 0.0360) and higher PHQ-9 scores (ß = 0.55, p < 0.0001) were significantly associated with higher fatigue levels 3 months post-stroke. Additionally, younger age (ß = −0.07, p = 0.0219), a worse rating of general health at baseline (ß = −0.04, p = 0.0287) and low pre-stroke physical activity (ß = −0.0004, p = 0.0089) were significantly associated with higher fatigue levels 12 months after stroke. Conclusions: Fatigue is a common and persisting symptom even in patients with mild impairment. Prior depressive disorder and early depressive symptoms were the most relevant predictors of both early and late fatigue.
AU  - Kirchberger, I.
AU  - Wallner, F.*
AU  - Linseisen, J.
AU  - Zickler, P.*
AU  - Ertl, M.*
AU  - Naumann, M.*
AU  - Meisinger, C.*
C1  - 64775
C2  - 52448
TI  - Factors associated with early and late post-stroke fatigue in patients with mild impairment. Results from the stroke cohort study Augsburg.
JO  - Front. Neurol.
VL  - 13
PY  - 2022
SN  - 1664-2295
ER  - 

TY  - JOUR
AB  - Objective: KMT2B-related dystonia is a progressive childhood-onset movement disorder, evolving from lower-limb focal dystonia into generalized dystonia. With increasing age, children frequently show prominent laryngeal or facial dystonia manifesting in dysarthria. Bilateral deep brain stimulation of the globus pallidus internus (GPi-DBS) is reported to be an efficient therapeutic option. Especially improvement of dystonia and regaining of independent mobility is commonly described, but detailed information about the impact of GPi-DBS on dysarthria and speech is scarce. Methods: We report the 16-months outcome after bilateral GPi-DBS in an 8-year-old child with KMT2B-related dystonia caused by a de-novo c.3043C>T (p.Arg1015*) non-sense variant with special emphasis on dysarthria and speech. We compare the outcome of our patient with 59 patients identified through a PubMed literature search. Results: A remarkable improvement of voice, articulation, respiration and prosodic characteristics was seen 16 months after GPi-DBS. The patients' speech intelligibility improved. His speech became much more comprehensible not only for his parents, but also for others. Furthermore, his vocabulary and the possibility to express his feelings and wants expanded considerably. Conclusion: A positive outcome of GPi-DBS on speech and dysarthria is rarely described in the literature. This might be due to disease progression, non-effectiveness of DBS or due to inadvertent spreading of the electrical current to the corticobulbar tract causing stimulation induced dysarthria. This highlights the importance of optimal lead placement, the possibility of horizontal steering of the electrical field by applying directional stimulation with segmented leads as well as the use of the lowest possible effective stimulation intensity.
AU  - Abel, M.*
AU  - Pfister, R.*
AU  - Hussein, I.*
AU  - Alsalloum, F.*
AU  - Onyinzo, C.*
AU  - Kappl, S.*
AU  - Zech, M.
AU  - Demmel, W.*
AU  - Staudt, M.*
AU  - Kudernatsch, M.*
AU  - Berweck, S.*
C1  - 62217
C2  - 50733
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Deep brain stimulation in KMT2B-related dystonia: Case report and review of the literature with special emphasis on dysarthria and speech.
JO  - Front. Neurol.
VL  - 12
PB  - Frontiers Media Sa
PY  - 2021
SN  - 1664-2295
ER  - 

TY  - JOUR
AB  - Introduction: As prospective data on long-term patient-reported outcome measures (PROMs) to assess Health related Quality of Life (HRQoL) after stroke are still scarce, this study examined the long-term course of PROMs and investigated influential factors such as recanalization therapies. Materials and Methods: A total of 945 (mean age 69 years; 56% male) stroke patients were enrolled with a personal interview and chart review performed at index event. One hundred forty (15%) patients received thrombolysis (IVT) and 53 (5%) patients received endovascular therapy (ET) or both treatments as bridging therapy (BT). After 3 and 12 months, a follow-up was conducted using a postal questionnaire including subjective quality of life EQ-5D-5L (European Quality of Life 5 Dimensions). At all time-points, Modified Rankin Scale (mRS) was additionally used to quantify functional stroke severity. Differences between therapy groups were identified using post-hoc-tests. Linear and logistic regression analyses were used to identify predictors of outcomes. Results: Recanalization therapies were associated with significant improvements of NIHSS (National Institutes of Health Stroke Scale [regression coefficient IVT 1.21 (p = 0.01) and ET/BT 7.6; p = 0.001] and mRS (modified Rankin Scale) [regression coefficient IVT 0.83; p = 0.001 and ET/BT 2.0; p = 0.001] between admission and discharge compared to patients with stroke unit therapy only, with a trend toward improvement of EQ-5D after 12 months [regression coefficient 4.67 (p = 0.17)] with IVT. HRQoL was considerably impaired by stroke and increased steadily in 3- and 12-months follow-up in patients with (mean EQ-5D from 56 to 68) and without recanalization therapy (mean EQ-5D from 62 to 68). In severe strokes a major and significant improvement was only detected during period of 3 to 12 months (p = 0.03 in patients with and p = 0.005 in patients without recanalization therapy). Conclusions: Despite significant and continuous improvements after stroke the HRQoL after 12 months remained below the age-matched general population, but was still unexpectedly high in view of the accumulation of permanent disabilities in up to 30% of the patients. Especially in severe strokes, it is important to evaluate HRQoL beyond a 3-months follow-up as improvements became significant only between 3 months and 1 year.
AU  - Kainz, A.*
AU  - Meisinger, C.
AU  - Linseisen, J.
AU  - Kirchberger, I.
AU  - Zickler, P.*
AU  - Naumann, M.*
AU  - Ertl, M.*
C1  - 63331
C2  - 51474
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Changes of health-related quality of life within the 1st year after stroke–results from a prospective stroke cohort study.
JO  - Front. Neurol.
VL  - 12
PB  - Frontiers Media Sa
PY  - 2021
SN  - 1664-2295
ER  - 

TY  - JOUR
AB  - Over the past two decades, our understanding of Parkinson's disease (PD) has been gleaned from the discoveries made in familial and/or sporadic forms of PD in the Caucasian population. The transferability and the clinical utility of genetic discoveries to other ethnically diverse populations are unknown. The Indian population has been under-represented in PD research. The Genetic Architecture of PD in India (GAP-India) project aims to develop one of the largest clinical/genomic bio-bank for PD in India. Specifically, GAP-India project aims to: (1) develop a pan-Indian deeply phenotyped clinical repository of Indian PD patients; (2) perform whole-genome sequencing in 500 PD samples to catalog Indian genetic variability and to develop an Indian PD map for the scientific community; (3) perform a genome-wide association study to identify novel loci for PD and (4) develop a user-friendly web-portal to disseminate results for the scientific community. Our "hub-spoke" model follows an integrative approach to develop a pan-Indian outreach to develop a comprehensive cohort for PD research in India. The alignment of standard operating procedures for recruiting patients and collecting biospecimens with international standards ensures harmonization of data/bio-specimen collection at the beginning and also ensures stringent quality control parameters for sample processing. Data sharing and protection policies follow the guidelines established by local and national authorities.We are currently in the recruitment phase targeting recruitment of 10,200 PD patients and 10,200 healthy volunteers by the end of 2020. GAP-India project after its completion will fill a critical gap that exists in PD research and will contribute a comprehensive genetic catalog of the Indian PD population to identify novel targets for PD.
AU  - Rajan, R.*
AU  - Divya, K.P.*
AU  - Kandadai, R.M.*
AU  - Yadav, R.*
AU  - Satagopam, V.P.*
AU  - Madhusoodanan, U.K.*
AU  - Agarwal, P.*
AU  - Kumar, N.*
AU  - Ferreira, T.*
AU  - Kumar, H.*
AU  - Prasad, A.V.S.*
AU  - Shetty, K.*
AU  - Mehta, S.*
AU  - Desai, S.*
AU  - Kumar, S.*
AU  - Prashanth, L.K.*
AU  - Bhatt, M.*
AU  - Wadia, P.*
AU  - Ramalingam, S.*
AU  - Wali, G.M.*
AU  - Pandey, S.*
AU  - Bartusch, F.*
AU  - Hannussek, M.*
AU  - Krüger, J.*
AU  - Kumar-Sreelatha, A.*
AU  - Grover, S.*
AU  - Lichtner, P.
AU  - Sturm, M.*
AU  - Roeper, J.*
AU  - Busskamp, V.*
AU  - Chandak, G.R.*
AU  - Schwamborn, J.*
AU  - Seth, P.*
AU  - Gasser, T.*
AU  - Riess, O.*
AU  - Goyal, V.*
AU  - Pal, P.K.*
AU  - Borgohain, R.*
AU  - Krüger, R.*
AU  - Kishore, A.*
AU  - Sharma, M.*
C1  - 59681
C2  - 49010
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Genetic architecture of parkinson’s disease in the indian population: Harnessing genetic diversity to address critical gaps in parkinson’s disease research.
JO  - Front. Neurol.
VL  - 11
PB  - Frontiers Media Sa
PY  - 2020
SN  - 1664-2295
ER  - 

TY  - JOUR
AB  - Uni- or bilateral vestibular hypofunction (VH) impairs balance and mobility, and may specifically lead to injury from falls and to disability. The extent of this problem in the general population is still unknown and most likely to be underestimated. Objective of this study was to determine the prevalence, determinants, and consequences of VH in the general population. Data originates from the cross-sectional second follow-up (FF4) in 2013/14 of the KORA (Cooperative Health Research in the Region of Augsburg)-S4 study (1999-2001) from Southern Germany. This was a random sample of the target population consisting of all residents of the region aged 25-74 years in 1999. We included all participants who reported moderate or severe vertigo or dizziness during the last 12 months and a random sub-sample of participants representative for the general population without vertigo or dizziness during the last 12 months were tested. VH was assessed with the Video-Head Impulse Test (vHIT). Trained examiners applied high-acceleration, small-amplitude passive head rotations ("head impulses") to the left and right in the plane of the horizontal semicircular canals while participants fixated a target straight ahead. During head impulses, head movements were measured with inertial sensors, eye movements with video-oculography (EyeSeeCam vHIT). A total of 2,279 participants were included (mean age 60.8 years, 51.6% female), 570 (25.0%) with moderate or severe vertigo or dizziness during the last 12 months. Of these, 450 were assessed with vHIT where 26 (5.8%) had unilateral VH, and 16 (3.6%) had bilateral VH. Likewise, 190 asymptomatic participants were tested. Of these 5 (2.6%) had unilateral VH, and 2 (1.1%) had bilateral VH. Prevalence of uni- or bilateral VH among tested symptomatic participants was 2.4% in those < 48 years, and 32.1% in individuals aged 79 and over. Age-adjusted prevalence was 6.7% (95% CI 4.8%; 8.6%). VH was associated with worse health, falls, hearing loss, hearing impairment, and ear pressure. VH may affect between 53 and 95 million adults in Europe and the US. While not all affected persons will experience the full spectrum of symptoms and consequences, adequate diagnostic and therapeutic measures should become standard of care to decrease the burden of disease.
AU  - Grill, E.*
AU  - Heuberger, M.*
AU  - Strobl, R.*
AU  - Saglam, M.*
AU  - Holle, R.
AU  - Linkohr, B.
AU  - Ladwig, K.-H.
AU  - Peters, A.
AU  - Schneider, E.*
AU  - Jahn, K.*
AU  - Lehnen, N.*
C1  - 55007
C2  - 46010
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
SP  - 1076
TI  - Prevalence, determinants, and consequences of vestibular hypofunction. Results from the KORA-FF4 survey.
JO  - Front. Neurol.
VL  - 9
PB  - Frontiers Media Sa
PY  - 2018
SN  - 1664-2295
ER  - 

TY  - JOUR
AB  - The video head impulse test (vHIT) has become a common examination in the work-up for dizziness and vertigo. However, recent studies suggest a number of pitfalls, which seem to reduce vHIT usability. Within the framework of a population-based prospective study with naïve examiners, we investigated the relevance of previously described technical mistakes in vHIT testing, and the effect of experience and training. Data originates from the KORA (Cooperative Health Research in the Region of Augsburg) FF4 study, the second follow-up of the KORA S4 population-based health survey. 681 participants were selected in a case-control design. Three examiners without any prior experience were trained in video head impulse testing. VHIT quality was assessed weekly by an experienced neuro-otologist. Restrictive mistakes (insufficient technical quality restricting interpretation) were noted. Based on these results, examiners received further individual training. Twenty-two of the 681 vHITs (3.2%) were not interpretable due to restrictive mistakes. Restrictive mistakes could be grouped into four categories: slippage, i.e., goggle movement relative to the head (63.6%), calibration problems (18.2%), noise (13.6%), and low velocity of the head impulse (4.6%). The overall rate of restrictive mistakes decreased significantly during the study (12% / examiner within the first 25 tested participants and 2.1% during the rest of the examinations, < 0.0001). Few categories suffice to explain restrictive mistakes in vHIT testing. With slippage being most important, trainers should emphasize the importance of tight goggles. Experience and training seem to be effective in improving vHIT quality, leading to high usability.
AU  - Heuberger, M.*
AU  - Grill, E.*
AU  - Saglam, M.*
AU  - Ramaioli, C.*
AU  - Müller, M.*
AU  - Strobl, R.*
AU  - Holle, R.
AU  - Peters, A.
AU  - Schneider, E.*
AU  - Lehnen, N.*
C1  - 54178
C2  - 45356
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Usability of the video head impulse test: Lessons from the population-based prospective KORA study.
JO  - Front. Neurol.
VL  - 9
PB  - Frontiers Media Sa
PY  - 2018
SN  - 1664-2295
ER  - 

TY  - JOUR
AB  - Immune responses are important for efficient tumor elimination, also in immune privileged organs such as the brain. Fostering antitumor immunity has therefore become an important challenge in cancer therapy. This cannot only be achieved by immunotherapies as already standard treatments such as radiotherapy and chemotherapy modify the immune system. Consequently, the understanding of how the tumor, the tumor microenvironment, and immune system are modulated by cancer therapy is required for prognosis, prediction, and therapy adaption. The prospective, explorative, and observational IMMO-GLIO-01 trial was initiated to examine the detailed immune status and its modulation of about 50 patients suffering from primary glioblastoma multiforme (GBM) or anaplastic astrocytoma during standard therapy. Prior to the study, a flow cytometry-based assay was established allowing the analysis of 34 immune cell subsets and their activation state. Here, we present the case of the first and longest accompanied patient, a 53-year-old woman suffering from GBM in the front left lobe. In context of tumor progression and therapy, we describe the modulation of the peripheral immune status over 17 months. Distinct immune modulations that were connected to therapy response or tumor progression were identified. Inter alia, a shift of CD4:CD8 ratio was observed that correlated with tumor progression. Twice we observed a unique composition of peripheral immune cells that correlated with tumor progression. Thus, following up these immune modulations in a closely-meshed manner is of high prognostic and predictive relevance for supporting personalized therapy and increasing therapy success.
AU  - Rühle, P.F.*
AU  - Goerig, N.*
AU  - Wunderlich, R.
AU  - Fietkau, R.*
AU  - Gaipl, U.S.*
AU  - Strnad, A.*
AU  - Frey, B.*
C1  - 51474
C2  - 43149
CY  - Lausanne
TI  - Modulations in the peripheral immune system of glioblastoma patient is connected to therapy and tumor progression-A case report from the IMMO-GLIO-01 trial.
JO  - Front. Neurol.
VL  - 8
PB  - Frontiers Media Sa
PY  - 2017
SN  - 1664-2295
ER  -