Background: Idiopathic intracranial hypertension (IIH) is an increasingly prevalent disease beari... more Background: Idiopathic intracranial hypertension (IIH) is an increasingly prevalent disease bearing the risk of visual impairment and affecting quality of life. Clinical presentation and outcome are heterogeneous. Large, well-characterized cohorts are scarce.Here, we describe the Vienna-Idiopathic-Intracranial-Hypertension (VIIH) database aiming to characterize the clinical spectrum, diagnostic findings, therapeutic management, and outcome of IIH.Methods: We identified patients with IIH according to the modified Dandy criteria who were treated at our center between 2014 and 2021. Methodology and structure of the VIIH database are described in detail including demographics, clinical parameters, magnetic resonance imaging, optical coherence tomography, transorbital sonography, treatment, and outcome.Results: Of 113 patients, 89% were female (mean age 32.3 years). Median body mass index (BMI) was 31.8, with 85% overweight (BMI>25). Papilledema was found in 95% with 5% classified as ...
“Intraoperative motor evoked potential monitoring during tethered cord surgery in infants.” by Su... more “Intraoperative motor evoked potential monitoring during tethered cord surgery in infants.” by Suhas Udayakumaran and Mathew George We are sorry that we were unable to include the mentioned publications in the discussion of our study. This was due to the fact that our work was already accepted by the journal before August 2021, i.e., before the publication of both articles. If you consider the large differences between the mean threshold intensities used from 101 ± 20 mA in our study [1] to the mean threshold intensities of 200 mA used by Udayakumaran et al. [2] one thinks primarily of the most obvious difference between the two studies, the anesthetic regimen. Anesthesia plays a decisive role in the implementation of motor evoked potentials (MEPs) and experts in the field often recommend pure intravenous anesthesia for young children [3]. But, combinations of intravenous anesthesia and volatile inhaled anesthesia are also successfully used, if age-related minimum alveolar concentration limits are taken into account [4, 5]. Therefore, we think that the large differences in the stimulation intensities between both studies cannot be explained purely by anesthesia. Rather, we think that differences in stimulation properties are causal. They can be found regarding the used stimulation electrodes (corkscrew vs. subdermal needle electrodes), montage (C1/C2 or C3/C4 vs. Fc3/Fc4), and pulse duration (500 μs vs. 50 μs). While different electrodes can have an influence on threshold intensities because of differences in electrode impedance, we think of pulse duration as the major influencing factor. The lower the selected pulse duration, the greater the required stimulation intensity. To technically enable a long pulse duration of 500 μs, we use the “NIM-Eclipse® Stimulator Extender” and electrical slow charge MEPs with a constant voltage (Medtronic XOMED Inc., Memphis, TN, USA). Table 1 shows the anesthetic regimen as well as important stimulation parameters within a selection of studies that investigated MEPs in infants. Pulse duration and associated intensities used indicate a relationship between these two parameters. The most important message of studies investigating MEPs in infants is that there is a sufficiently high rate of monitorable MEP responses. The adjustment of stimulation parameters and anesthesia protocols to find optimal conditions for MEP monitoring is not yet complete and well-documented studies like that of Udayakumaran et al. [2] take us one step further.
OBJECTIVEGross-total resection (GTR) is the treatment of choice in the majority of patients suffe... more OBJECTIVEGross-total resection (GTR) is the treatment of choice in the majority of patients suffering from spinal ependymal tumors. In such tumors, the extent of resection (EOR) is considered the key factor for tumor recurrence and thus patient prognosis. However, incomplete resection is not uncommon and leads to increased risk of tumor recurrence. One important cause of incomplete resection is insufficient intraoperative visualization of tumor tissue as well as residual tumor tissue. Therefore, the authors investigated the value of 5-aminolevulinic acid (5-ALA)–induced fluorescence in a series of spinal ependymal tumors for improved tumor visualization.METHODSAdult patients who underwent preoperative 5-ALA administration and surgery for a spinal ependymal tumor were included in this study. For each tumor, a conventional white-light microsurgical resection was performed. Additionally, the fluorescence status (strong, vague, or no fluorescence) and fluorescence homogeneity (homogenou...
ZusammenfassungDas Verständnis um das Krankheitsbild des Pseudotumor cerebri hat sich in den letz... more ZusammenfassungDas Verständnis um das Krankheitsbild des Pseudotumor cerebri hat sich in den letzten Jahren insbesondere im pädiatrischen Be-reich sehr erweitert und geändert, dennoch ist die Ätiologie des nun als idiopathische, intrakranielle Hypertension (IIH) bezeichneten Krankheitsbildes unklar. Das Risiko eines permanenten Visusverlustes erfordert speziell im Kindesalter eine rasche und erfahrene inter-disziplinäre Abklärung und ein konsistentes Management von Therapie und Verlaufsevaluation. Prospektive, kollektive Daten sollen das Verständnis der Pathophysiologie, Epidemiologie und der Risikofaktoren der pädiatrischen IIH verbessern und einen Konsens zu diagnostischen und therapeutischen Empfehlungen ermöglichen.
Purpose Feasibility, reliability, and safety assessment of transcranial motor evoked potentials (... more Purpose Feasibility, reliability, and safety assessment of transcranial motor evoked potentials (MEPs) in infants less than 12 months of age. Methods A total of 22 patients with a mean age of 33 (range 13–49) weeks that underwent neurosurgery for tethered cord were investigated. Data from intraoperative MEPs, anesthesia protocols, and clinical records were reviewed. Anesthesia during surgery was maintained by total intravenous anesthesia (TIVA). Results MEPs were present in all patients for the upper extremities and in 21 out of 22 infants for the lower extremities. Mean baseline stimulation intensity was 101 ± 20 mA. If MEPs were present at the end of surgery, no new motor deficit occurred. In the only case of MEP loss, preoperative paresis was present, and high baseline intensity thresholds were needed. MEP monitoring did not lead to any complications. TIVA was maintained with an average propofol infusion rate of 123.5 ± 38.2 µg/kg/min and 0.46 ± 0.17 µg/kg/min for remifentanil. C...
Object Subtotal resection (STR) of spinal tumors can result in tumor recurrence. Currently, no cl... more Object Subtotal resection (STR) of spinal tumors can result in tumor recurrence. Currently, no clinically reliable marker is available for intraoperative visualization of spinal tumor tissue. Protoporphyrin IX (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) is capable of visualizing malignant gliomas. Fluorescence-guided resections of malignant cerebral gliomas using 5-ALA have resulted in an increased rate of complete tumor removal. Recently, the application of 5-ALA has also been described in the first cases of spinal tumors. Therefore, the aim of this observational study was to systematically investigate 5-ALA–induced fluorescence characteristics in different spinal tumor entities. Methods Three hours before the induction of anesthesia, 5-ALA was administered to patients with different intra- and extradural spinal tumors. In all patients a neurosurgical resection or biopsy of the spinal tumor was performed under conventional white-light microscopy. During each surger...
Object Outcomes following functional hemispherotomy in patients with drug-resistant epilepsy have... more Object Outcomes following functional hemispherotomy in patients with drug-resistant epilepsy have been well described. However, studies reporting long-term longitudinal outcomes after subhemispheric disconnective epilepsy surgery are still limited. Methods The authors conducted a retrospective review of prospectively collected data of 10 children who underwent temporoparietooccipital (TPO) disconnective surgery at the Vienna Pediatric Epilepsy Center. Results There were 3 males and 7 females (median age 8.7 years; range 4.2–22.1 years). The affected hemisphere was the left in 3 patients and the right in 7. The patients' median age at seizure onset was 3.0 years (range 0.2–8.3 years). The median duration of epilepsy before surgery was 5.2 years (range 1.3–17.2 years). The underlying pathology was TPO malformation of cortical development in 5 patients, and venous infarction, posterior hemispheric quadrant atrophy, Sturge-Weber syndrome, cortical involvement of a systemic lupus ery...
The current concept for hemispherotomy includes various lateral techniques and the vertical perit... more The current concept for hemispherotomy includes various lateral techniques and the vertical perithalamic hemispherotomy introduced by Delalande in 1992. We have chosen the vertical approach because of advantages that possibly influence outcome: the possibility to completely disconnect the hemisphere at the level of the thalamus obviating both the need to resect the insula and the need to open and dissect the subarachnoid space of the Sylvian fissure. We retrospectively analyzed prospectively collected data of all patients who underwent vertical hemispherotomy at the Vienna pediatric epilepsy center. Seizure outcome was classified according to the International League Against Epilepsy (ILAE) proposal 2001. Follow-up data of 40 patients (22 male/18 female; median age 5.5 years; range 4.4 months to 20.1 years) were analyzed. Hemispherotomy was left in 26 and right in 14 patients. The underlying pathology was ischemic vascular in 19, malformation of cortical development (MCD) in 11, and other pathology in 10. No serious intraoperative complications were encountered. Only two infants (5.0%) needed blood replacement. There was one death on the fourth day after surgery caused by intractable hyponatremic brain edema. Three patients developed cerebrospinal fluid (CSF) disturbances, but only one needed a permanent ventriculoperitoneal (VP) shunt (2.5%). For outcome analysis we included 37 of 40 children with at least 12 months of follow-up. Thirty-four (91.9%) of 37 children were seizure-free (class 1a) after a median follow-up time of 3.7 years (range 12 month to 14.8 years). We confirm the efficacy and safety of vertical parasagittal hemispherotomy as described by Delalande in a consecutive series of patients treated at our center since 1998. In addition, complete disconnection of the hemisphere in patients with MCD and/or patients with significant involvement of the insula was possible without the complications usually reported with other techniques.
Chromogranins are polypeptides which are widely expressed in the central nervous system. They are... more Chromogranins are polypeptides which are widely expressed in the central nervous system. They are stored in dense core vesicles of nerve terminals, from where they are released upon stimulation. Using immunocytochemistry, we investigated the distribution of chromogranin A, chromogranin B, secretoneurin, and, for comparison, dynorphin in hippocampal specimens removed at routine surgery from patients with drug-resistant mesial temporal lobe epilepsy and in autopsy tissues from nonneurologically deceased subjects. In post mortem controls (n = 21), immunoreactivity for all 4 peptides (most prominently for chromogranin B and dynorphin) was observed in the terminal field of mossy fibers. For chromogranins, staining was observed also in sectors CA1 to CA3 and in the subiculum. Chromogranin B immunoreactivity was found in the inner molecular layer of the dentate gyrus, the area of terminating associational-commissural fibers. Secretoneurin and dynorphin immunoreactivity labeled the outer molecular layer and the stratum lacunosum moleculare of sectors CA1 to CA3, where projections from the entorhinal cortex terminate. In specimens with Ammon's horn sclerosis (n = 25), staining for all 3 chromogranins and for dynorphin was reduced in the hilus of the dentate gyrus. Instead, intense staining was observed in the inner molecular layer, presumably delineating terminals of sprouted mossy fibers. Specimens obtained from temporal lobe epilepsy patients without Ammon's horn sclerosis (n = 4) lacked this pronounced rearrangement of mossy fibers. In the stratum lacunosum moleculare of sector CA1, secretoneurin and dynorphin immunoreactivity was reduced in sclerotic, but not in nonsclerotic, specimens, paralleling the partial loss of fibers arising from the entorhinal cortex. Instead, presumably sprouted secretoneurin-immunoreactive fibers were found in the outer dentate molecular layer in sclerotic specimens. These changes in staining patterns for chromogranins and dynorphin mark profound plastic and functional rearrangement of hippocampal circuitry in temporal lobe epilepsy.
ENM is an etiologically heterogeneous disorder clinically evident as brief (less than 500 msec) l... more ENM is an etiologically heterogeneous disorder clinically evident as brief (less than 500 msec) lapses of tonic muscular contraction which seems to be related to lesions or dysfunction of different anatomofunctional levels of the CNS (Fig. 13). ENM can occur in ...
Dynorphin neuropeptides are believed to act as endoge- nous anticonvulsants, though direct eviden... more Dynorphin neuropeptides are believed to act as endoge- nous anticonvulsants, though direct evidence for such a role in humans is sparse. We now report pronounced increases of prodynorphin mRNA expression in the dentate gyrus of patients with temporal lobe epilepsy in comparison to controls. We detected a conspicuously right skewed, bimodal distribution of mRNA levels among patients, suggestive of a dynamic up-regulation of prodynorphin expression in epilepsy. Highest transcript levels were seen postictally. Our data argue for an essential role of dynorphin in the termination of seizures. V C 2009 Wiley-Liss, Inc.
Objective: Precise intraoperative neurophysiological assessment and knowledge of the functional i... more Objective: Precise intraoperative neurophysiological assessment and knowledge of the functional integrity of the nervous system takes a pivotal role in many neurosurgical procedures in the pediatric population. Materials and Methods: Intraoperative neurophysiology consists of methods of monitoring of the functional integrity of the nervous system as well as mapping of neurogenic tissue verified via conducted response to electrical stimulation. The methods of intraoperative neurophysiology applied in resection of spinal cord tumors in the intradural and extradural compartment, in the surgical release of tethered spinal cord, treatment of spasticity via selective dorsal rhizotomy, and in the endovascular treatment of pediatric spinal cord angiomas. Results: Our experience supports the view that IOM considered a standard of care in pediatric spinal tumor surgery, surgery for tethered cord syndrome, and interventional endovascular procedures. In the treatment of Chiari-Malformation, the...
Objective: To evaluate the long-term effects of postoperative comprehensive physiotherapy startin... more Objective: To evaluate the long-term effects of postoperative comprehensive physiotherapy starting one week after lumbar disc surgery. Design: Twelve-year follow-up of a three-armed, randomized, controlled, single-blinded clinical trial. Setting: Department of Physical Medicine & Rehabilitation. Participants: Of 111 patients following first-time, uncomplicated lumbar disc surgery who participated in the original study and completed the treatment originally allocated, 74 ((67%; 29 (73%) physiotherapy, 22 (58%) sham therapy, 23 (68%) no therapy) completed a 12-year follow-up examination. Interventions: In the original study, patients had been randomly assigned to comprehensive physiotherapy, sham intervention (neck massage), or no therapy. Measures: Low Back Pain Rating Scale; best score 0, worst score 130 points). Results: At 12 years after surgery, the group participating in comprehensive physiotherapy had significantly better functional outcomes, as rated on the Low Back Pain Ratin...
Background: Idiopathic intracranial hypertension (IIH) is an increasingly prevalent disease beari... more Background: Idiopathic intracranial hypertension (IIH) is an increasingly prevalent disease bearing the risk of visual impairment and affecting quality of life. Clinical presentation and outcome are heterogeneous. Large, well-characterized cohorts are scarce.Here, we describe the Vienna-Idiopathic-Intracranial-Hypertension (VIIH) database aiming to characterize the clinical spectrum, diagnostic findings, therapeutic management, and outcome of IIH.Methods: We identified patients with IIH according to the modified Dandy criteria who were treated at our center between 2014 and 2021. Methodology and structure of the VIIH database are described in detail including demographics, clinical parameters, magnetic resonance imaging, optical coherence tomography, transorbital sonography, treatment, and outcome.Results: Of 113 patients, 89% were female (mean age 32.3 years). Median body mass index (BMI) was 31.8, with 85% overweight (BMI>25). Papilledema was found in 95% with 5% classified as ...
“Intraoperative motor evoked potential monitoring during tethered cord surgery in infants.” by Su... more “Intraoperative motor evoked potential monitoring during tethered cord surgery in infants.” by Suhas Udayakumaran and Mathew George We are sorry that we were unable to include the mentioned publications in the discussion of our study. This was due to the fact that our work was already accepted by the journal before August 2021, i.e., before the publication of both articles. If you consider the large differences between the mean threshold intensities used from 101 ± 20 mA in our study [1] to the mean threshold intensities of 200 mA used by Udayakumaran et al. [2] one thinks primarily of the most obvious difference between the two studies, the anesthetic regimen. Anesthesia plays a decisive role in the implementation of motor evoked potentials (MEPs) and experts in the field often recommend pure intravenous anesthesia for young children [3]. But, combinations of intravenous anesthesia and volatile inhaled anesthesia are also successfully used, if age-related minimum alveolar concentration limits are taken into account [4, 5]. Therefore, we think that the large differences in the stimulation intensities between both studies cannot be explained purely by anesthesia. Rather, we think that differences in stimulation properties are causal. They can be found regarding the used stimulation electrodes (corkscrew vs. subdermal needle electrodes), montage (C1/C2 or C3/C4 vs. Fc3/Fc4), and pulse duration (500 μs vs. 50 μs). While different electrodes can have an influence on threshold intensities because of differences in electrode impedance, we think of pulse duration as the major influencing factor. The lower the selected pulse duration, the greater the required stimulation intensity. To technically enable a long pulse duration of 500 μs, we use the “NIM-Eclipse® Stimulator Extender” and electrical slow charge MEPs with a constant voltage (Medtronic XOMED Inc., Memphis, TN, USA). Table 1 shows the anesthetic regimen as well as important stimulation parameters within a selection of studies that investigated MEPs in infants. Pulse duration and associated intensities used indicate a relationship between these two parameters. The most important message of studies investigating MEPs in infants is that there is a sufficiently high rate of monitorable MEP responses. The adjustment of stimulation parameters and anesthesia protocols to find optimal conditions for MEP monitoring is not yet complete and well-documented studies like that of Udayakumaran et al. [2] take us one step further.
OBJECTIVEGross-total resection (GTR) is the treatment of choice in the majority of patients suffe... more OBJECTIVEGross-total resection (GTR) is the treatment of choice in the majority of patients suffering from spinal ependymal tumors. In such tumors, the extent of resection (EOR) is considered the key factor for tumor recurrence and thus patient prognosis. However, incomplete resection is not uncommon and leads to increased risk of tumor recurrence. One important cause of incomplete resection is insufficient intraoperative visualization of tumor tissue as well as residual tumor tissue. Therefore, the authors investigated the value of 5-aminolevulinic acid (5-ALA)–induced fluorescence in a series of spinal ependymal tumors for improved tumor visualization.METHODSAdult patients who underwent preoperative 5-ALA administration and surgery for a spinal ependymal tumor were included in this study. For each tumor, a conventional white-light microsurgical resection was performed. Additionally, the fluorescence status (strong, vague, or no fluorescence) and fluorescence homogeneity (homogenou...
ZusammenfassungDas Verständnis um das Krankheitsbild des Pseudotumor cerebri hat sich in den letz... more ZusammenfassungDas Verständnis um das Krankheitsbild des Pseudotumor cerebri hat sich in den letzten Jahren insbesondere im pädiatrischen Be-reich sehr erweitert und geändert, dennoch ist die Ätiologie des nun als idiopathische, intrakranielle Hypertension (IIH) bezeichneten Krankheitsbildes unklar. Das Risiko eines permanenten Visusverlustes erfordert speziell im Kindesalter eine rasche und erfahrene inter-disziplinäre Abklärung und ein konsistentes Management von Therapie und Verlaufsevaluation. Prospektive, kollektive Daten sollen das Verständnis der Pathophysiologie, Epidemiologie und der Risikofaktoren der pädiatrischen IIH verbessern und einen Konsens zu diagnostischen und therapeutischen Empfehlungen ermöglichen.
Purpose Feasibility, reliability, and safety assessment of transcranial motor evoked potentials (... more Purpose Feasibility, reliability, and safety assessment of transcranial motor evoked potentials (MEPs) in infants less than 12 months of age. Methods A total of 22 patients with a mean age of 33 (range 13–49) weeks that underwent neurosurgery for tethered cord were investigated. Data from intraoperative MEPs, anesthesia protocols, and clinical records were reviewed. Anesthesia during surgery was maintained by total intravenous anesthesia (TIVA). Results MEPs were present in all patients for the upper extremities and in 21 out of 22 infants for the lower extremities. Mean baseline stimulation intensity was 101 ± 20 mA. If MEPs were present at the end of surgery, no new motor deficit occurred. In the only case of MEP loss, preoperative paresis was present, and high baseline intensity thresholds were needed. MEP monitoring did not lead to any complications. TIVA was maintained with an average propofol infusion rate of 123.5 ± 38.2 µg/kg/min and 0.46 ± 0.17 µg/kg/min for remifentanil. C...
Object Subtotal resection (STR) of spinal tumors can result in tumor recurrence. Currently, no cl... more Object Subtotal resection (STR) of spinal tumors can result in tumor recurrence. Currently, no clinically reliable marker is available for intraoperative visualization of spinal tumor tissue. Protoporphyrin IX (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) is capable of visualizing malignant gliomas. Fluorescence-guided resections of malignant cerebral gliomas using 5-ALA have resulted in an increased rate of complete tumor removal. Recently, the application of 5-ALA has also been described in the first cases of spinal tumors. Therefore, the aim of this observational study was to systematically investigate 5-ALA–induced fluorescence characteristics in different spinal tumor entities. Methods Three hours before the induction of anesthesia, 5-ALA was administered to patients with different intra- and extradural spinal tumors. In all patients a neurosurgical resection or biopsy of the spinal tumor was performed under conventional white-light microscopy. During each surger...
Object Outcomes following functional hemispherotomy in patients with drug-resistant epilepsy have... more Object Outcomes following functional hemispherotomy in patients with drug-resistant epilepsy have been well described. However, studies reporting long-term longitudinal outcomes after subhemispheric disconnective epilepsy surgery are still limited. Methods The authors conducted a retrospective review of prospectively collected data of 10 children who underwent temporoparietooccipital (TPO) disconnective surgery at the Vienna Pediatric Epilepsy Center. Results There were 3 males and 7 females (median age 8.7 years; range 4.2–22.1 years). The affected hemisphere was the left in 3 patients and the right in 7. The patients' median age at seizure onset was 3.0 years (range 0.2–8.3 years). The median duration of epilepsy before surgery was 5.2 years (range 1.3–17.2 years). The underlying pathology was TPO malformation of cortical development in 5 patients, and venous infarction, posterior hemispheric quadrant atrophy, Sturge-Weber syndrome, cortical involvement of a systemic lupus ery...
The current concept for hemispherotomy includes various lateral techniques and the vertical perit... more The current concept for hemispherotomy includes various lateral techniques and the vertical perithalamic hemispherotomy introduced by Delalande in 1992. We have chosen the vertical approach because of advantages that possibly influence outcome: the possibility to completely disconnect the hemisphere at the level of the thalamus obviating both the need to resect the insula and the need to open and dissect the subarachnoid space of the Sylvian fissure. We retrospectively analyzed prospectively collected data of all patients who underwent vertical hemispherotomy at the Vienna pediatric epilepsy center. Seizure outcome was classified according to the International League Against Epilepsy (ILAE) proposal 2001. Follow-up data of 40 patients (22 male/18 female; median age 5.5 years; range 4.4 months to 20.1 years) were analyzed. Hemispherotomy was left in 26 and right in 14 patients. The underlying pathology was ischemic vascular in 19, malformation of cortical development (MCD) in 11, and other pathology in 10. No serious intraoperative complications were encountered. Only two infants (5.0%) needed blood replacement. There was one death on the fourth day after surgery caused by intractable hyponatremic brain edema. Three patients developed cerebrospinal fluid (CSF) disturbances, but only one needed a permanent ventriculoperitoneal (VP) shunt (2.5%). For outcome analysis we included 37 of 40 children with at least 12 months of follow-up. Thirty-four (91.9%) of 37 children were seizure-free (class 1a) after a median follow-up time of 3.7 years (range 12 month to 14.8 years). We confirm the efficacy and safety of vertical parasagittal hemispherotomy as described by Delalande in a consecutive series of patients treated at our center since 1998. In addition, complete disconnection of the hemisphere in patients with MCD and/or patients with significant involvement of the insula was possible without the complications usually reported with other techniques.
Chromogranins are polypeptides which are widely expressed in the central nervous system. They are... more Chromogranins are polypeptides which are widely expressed in the central nervous system. They are stored in dense core vesicles of nerve terminals, from where they are released upon stimulation. Using immunocytochemistry, we investigated the distribution of chromogranin A, chromogranin B, secretoneurin, and, for comparison, dynorphin in hippocampal specimens removed at routine surgery from patients with drug-resistant mesial temporal lobe epilepsy and in autopsy tissues from nonneurologically deceased subjects. In post mortem controls (n = 21), immunoreactivity for all 4 peptides (most prominently for chromogranin B and dynorphin) was observed in the terminal field of mossy fibers. For chromogranins, staining was observed also in sectors CA1 to CA3 and in the subiculum. Chromogranin B immunoreactivity was found in the inner molecular layer of the dentate gyrus, the area of terminating associational-commissural fibers. Secretoneurin and dynorphin immunoreactivity labeled the outer molecular layer and the stratum lacunosum moleculare of sectors CA1 to CA3, where projections from the entorhinal cortex terminate. In specimens with Ammon's horn sclerosis (n = 25), staining for all 3 chromogranins and for dynorphin was reduced in the hilus of the dentate gyrus. Instead, intense staining was observed in the inner molecular layer, presumably delineating terminals of sprouted mossy fibers. Specimens obtained from temporal lobe epilepsy patients without Ammon's horn sclerosis (n = 4) lacked this pronounced rearrangement of mossy fibers. In the stratum lacunosum moleculare of sector CA1, secretoneurin and dynorphin immunoreactivity was reduced in sclerotic, but not in nonsclerotic, specimens, paralleling the partial loss of fibers arising from the entorhinal cortex. Instead, presumably sprouted secretoneurin-immunoreactive fibers were found in the outer dentate molecular layer in sclerotic specimens. These changes in staining patterns for chromogranins and dynorphin mark profound plastic and functional rearrangement of hippocampal circuitry in temporal lobe epilepsy.
ENM is an etiologically heterogeneous disorder clinically evident as brief (less than 500 msec) l... more ENM is an etiologically heterogeneous disorder clinically evident as brief (less than 500 msec) lapses of tonic muscular contraction which seems to be related to lesions or dysfunction of different anatomofunctional levels of the CNS (Fig. 13). ENM can occur in ...
Dynorphin neuropeptides are believed to act as endoge- nous anticonvulsants, though direct eviden... more Dynorphin neuropeptides are believed to act as endoge- nous anticonvulsants, though direct evidence for such a role in humans is sparse. We now report pronounced increases of prodynorphin mRNA expression in the dentate gyrus of patients with temporal lobe epilepsy in comparison to controls. We detected a conspicuously right skewed, bimodal distribution of mRNA levels among patients, suggestive of a dynamic up-regulation of prodynorphin expression in epilepsy. Highest transcript levels were seen postictally. Our data argue for an essential role of dynorphin in the termination of seizures. V C 2009 Wiley-Liss, Inc.
Objective: Precise intraoperative neurophysiological assessment and knowledge of the functional i... more Objective: Precise intraoperative neurophysiological assessment and knowledge of the functional integrity of the nervous system takes a pivotal role in many neurosurgical procedures in the pediatric population. Materials and Methods: Intraoperative neurophysiology consists of methods of monitoring of the functional integrity of the nervous system as well as mapping of neurogenic tissue verified via conducted response to electrical stimulation. The methods of intraoperative neurophysiology applied in resection of spinal cord tumors in the intradural and extradural compartment, in the surgical release of tethered spinal cord, treatment of spasticity via selective dorsal rhizotomy, and in the endovascular treatment of pediatric spinal cord angiomas. Results: Our experience supports the view that IOM considered a standard of care in pediatric spinal tumor surgery, surgery for tethered cord syndrome, and interventional endovascular procedures. In the treatment of Chiari-Malformation, the...
Objective: To evaluate the long-term effects of postoperative comprehensive physiotherapy startin... more Objective: To evaluate the long-term effects of postoperative comprehensive physiotherapy starting one week after lumbar disc surgery. Design: Twelve-year follow-up of a three-armed, randomized, controlled, single-blinded clinical trial. Setting: Department of Physical Medicine & Rehabilitation. Participants: Of 111 patients following first-time, uncomplicated lumbar disc surgery who participated in the original study and completed the treatment originally allocated, 74 ((67%; 29 (73%) physiotherapy, 22 (58%) sham therapy, 23 (68%) no therapy) completed a 12-year follow-up examination. Interventions: In the original study, patients had been randomly assigned to comprehensive physiotherapy, sham intervention (neck massage), or no therapy. Measures: Low Back Pain Rating Scale; best score 0, worst score 130 points). Results: At 12 years after surgery, the group participating in comprehensive physiotherapy had significantly better functional outcomes, as rated on the Low Back Pain Ratin...
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