Dirk Dressler
Hannover Medical School, Neurology, Faculty Member
Research Interests:
Research Interests:
Research Interests:
Research Interests: Cognitive Science, Chemistry, Biology, Medicine, Autonomic Nervous System, and 15 moreGlutamate, Humans, Blood brain barrier, Animals, Central Nervous System, Acetylcholine, Electromyography, Dystonia, Clinical Sciences, Mode of action, Mechanism of action, Botulinum Toxin, Intracortical Inhibition, Axonal transport, and Calcitonin Gene Related Peptide
Research Interests:
Research Interests:
Idiopathic cervical dystonia (ICD) is the largest subgroup of dystonia. Psychological stress as a triggering factor has long been discussed, but detailed descriptions are lacking. We report on a group of 13 patients with ICD and preceding... more
Idiopathic cervical dystonia (ICD) is the largest subgroup of dystonia. Psychological stress as a triggering factor has long been discussed, but detailed descriptions are lacking. We report on a group of 13 patients with ICD and preceding excessive psychological stress (age at ICD onset 39.0 ± 13.9 years, 7 females, 6 males). The observation period was 7.8 ± 5.0 years. Excessive psychological stress included partner conflicts (divorce and separation, domestic violence), special familial burdens, legal disputes and migration. It started 8.3 ± 3.9 months before ICD onset. In 85% of our patients (typical cases), ICD developed within 5.8 ± 4.4 weeks, then lasted 18.5 ± 8.3 months, before it started to remit 2.7 ± 0.8 years after its onset to 54.5 ± 35.3% of its maximal severity. Idiopathic dystonia is thought to be based upon a genetic predisposition triggered by epigenetic factors. Our study suggests that excessive psychological stress could be one of them. Pathophysiologic elements ar...
Research Interests:
Research Interests:
Botulinum toxin is used with remarkable success to treat various muscle and exocrine gland hyperactivity syndromes. Rarely, treatment failure due to formation of botulinum toxin antibodies (ABF) occurs. To reduce the risk of ABF, a new... more
Botulinum toxin is used with remarkable success to treat various muscle and exocrine gland hyperactivity syndromes. Rarely, treatment failure due to formation of botulinum toxin antibodies (ABF) occurs. To reduce the risk of ABF, a new formulation of Botox (in the following "current Botox"; Allergan, Irvine, California, USA) with increased specific biological potency was introduced. Here we report the case of a 50-year-old woman who developed ABF despite receiving current Botox.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Botulinum toxin (BT) therapy is a complex and highly individualised therapy defined by treatment algorithms and injection schemes describing its target muscles and their dosing. Various consensus guidelines have tried to standardise and... more
Botulinum toxin (BT) therapy is a complex and highly individualised therapy defined by treatment algorithms and injection schemes describing its target muscles and their dosing. Various consensus guidelines have tried to standardise and to improve BT therapy. We wanted to update and improve consensus guidelines by: (1) Acknowledging recent advances of treatment algorithms. (2) Basing dosing tables on statistical analyses of real-life treatment data of 1831 BT injections in 36 different target muscles in 420 dystonia patients and 1593 BT injections in 31 different target muscles in 240 spasticity patients. (3) Providing more detailed dosing data including typical doses, dose variabilities, and dosing limits. (4) Including total doses and target muscle selections for typical clinical entities thus adapting dosing to different aetiologies and pathophysiologies. (5) In addition, providing a brief and concise review of the clinical entity treated together with general principles of its B...
Research Interests:
To explore the correlations of botulinum toxin (BT) therapy with dysphagia, we wanted to study a group of cervical dystonia (CD) patients with optimised BT therapy during a prolonged period of time to record their dysphagia frequency,... more
To explore the correlations of botulinum toxin (BT) therapy with dysphagia, we wanted to study a group of cervical dystonia (CD) patients with optimised BT therapy during a prolonged period of time to record their dysphagia frequency, severity and duration, to study potential risk factors and try to avoid it by BT application with ultrasound guidance. BT therapy of 75 CD patients (23 males, 52 females, age 60 ± 12 years, BT total dose 303.5 ± 101.5 uMU) was retrospectively analysed for 1 year. BT therapy was optimised prior to the observation period. Dysphagia was noticed by one fifth of the patients. In those patients, it only occurred in about one third of the injection series. It was never associated with a functional deficit and lasted several days to 2 weeks. It was not related to patient age or gender, BT total dose, BT dose in the sternocleidomastoid muscle, BT dose in the sternocleidomastoid and scalenii muscles, by BT therapy with bilateral sternocleidomastoid muscle inject...
Research Interests:
ObjectiveTo investigate the risk factors of neutralizing antibody (NAB)–induced complete secondary treatment failure (cSTF) during long-term botulinum neurotoxin (BoNT) treatment in various neurologic indications.MethodsThis monocenter... more
ObjectiveTo investigate the risk factors of neutralizing antibody (NAB)–induced complete secondary treatment failure (cSTF) during long-term botulinum neurotoxin (BoNT) treatment in various neurologic indications.MethodsThis monocenter retrospective cohort study analyzed the data of 471 patients started on BoNT therapy between 1995 and 2015. Blood samples of 173 patients were investigated for NABs using the mouse hemidiaphragm test (93 with suspected therapy failure, 80 prospective study participants). The frequency of NAB-cSTF was assessed for various indications: hemifacial spasm, blepharospasm, cervical dystonia, other dystonia, and spasticity. A priori defined potential risk factors for NAB-cSTF were evaluated, and a stepwise binary logistic regression analysis was performed to identify independent risk factors.ResultsTreatment duration was 9.8 ± 6.2 years (range, 0.5–30 years; adherence, 70.6%) and number of treatment cycles 31.2 ± 22.5 (3–112). Twenty-eight of 471 patients (5....
Research Interests:
Background We evaluated quality of life among subjects with upper- and lower-limb spasticity who received escalating doses of incobotulinumtoxinA (total body doses up to 800 U) in the prospective, single-arm, dose-titration TOWER study.... more
Background We evaluated quality of life among subjects with upper- and lower-limb spasticity who received escalating doses of incobotulinumtoxinA (total body doses up to 800 U) in the prospective, single-arm, dose-titration TOWER study. Methods In this exploratory trial, subjects (N = 155; 18–80 years of age) with upper- and lower-limb spasticity due to cerebral causes who were deemed to require total body doses of up to 800 U incobotulinumtoxinA received three consecutive injection cycles of incobotulinumtoxinA (400, 600, and up to 800 U), each with 12 to 16 weeks’ follow-up. QoL was assessed using the EuroQol 5-dimensions questionnaire, three-level (EQ-5D), before and 4 weeks post-injection in each injection cycle and at the end of injection cycle 3. Results The mean EQ-5D visual analog scale scores of 155 participants continuously improved from study baseline to 4 weeks post-injection in all injection cycles (mean [standard deviation] change 6.7 [14.1], 9.6 [16.3], and 8.6 [17.0]...
Research Interests:
Parkinson’s disease (PD) is a chronic progressive movement disorder with severe reduction in patients’ health-related quality of life (HR-QoL). Motor and cognitive symptoms are especially linked with decreased PD patients’ HR-QoL.... more
Parkinson’s disease (PD) is a chronic progressive movement disorder with severe reduction in patients’ health-related quality of life (HR-QoL). Motor and cognitive symptoms are especially linked with decreased PD patients’ HR-QoL. However, the relationship of these symptoms to caregiver burden is relatively unclear. Influence of the Montreal Cognitive Assessment scale (MoCA) as a cognitive screening tool and Movement Disorders Society Unified Parkinson’s disease Rating Scale MDS-UPDRS symptoms in relation to patients’ HR-QoL and caregivers` burden was analyzed. PD patients (n = 124) completed MDS-UPDRS, MoCA, and the PD questionnaire 8 (PDQ-8) as a measure of quality of life. Caregivers (n = 78) were assessed by the PD caregiver burden inventory (PDCB). PDQ-8 and PDCB scores were regressed on MDS-UPDRS subscales and MoCA subscores. PDQ-8 correlated with attention (R2 0.1282; p<0.001) and executive (R2 0.0882; p 0.001) MoCA subscores and all parts of the MDS-UPDRS. PDCB correlated...
Research Interests:
Research Interests:
ABSTRACTBackground:Advanced Parkinson’s disease (PD) may place a high burden on patients and their caregivers. Understanding the determinants of caregiver burden is of critical importance. This understanding requires the availability of... more
ABSTRACTBackground:Advanced Parkinson’s disease (PD) may place a high burden on patients and their caregivers. Understanding the determinants of caregiver burden is of critical importance. This understanding requires the availability of adequate assessment tools. Recently, the Parkinson’s disease caregiver burden questionnaire (PDCB) has been developed as a PD-specific measure of caregiver burden. However, the PDCB has only been evaluated in a sample of Australian caregivers of patients at a less advanced stage of the disease.Objective:We tested whether a German translation of the PDCB qualifies as an adequate measure of caregiver burden in a German sample of caregivers of advanced patients with PD.Methods:We collected PDCB data from 65 caregivers of advanced patients with PD. Reliability of the scale was assessed and compared against the original version. To validate the German version of the PDCB, we examined the correlations with the caregiver burden inventory (CBI), the short fo...
Research Interests:
Research Interests:
Dystonia is a syndrome characterized by “sustained or intermittent muscle contractions causing abnormal, often repetitive movements, postures, or both. Dystonic movements are typically patterned, twisting, and may be tremulous. It is... more
Dystonia is a syndrome characterized by “sustained or intermittent muscle contractions causing abnormal, often repetitive movements, postures, or both. Dystonic movements are typically patterned, twisting, and may be tremulous. It is usually classified according to its location within the body. Other classifications are based on the age at manifestation, the continuity of occurrence (continuous, intermittent, paroxysmal) and the conditions of occurrence (task-specific, action-induced, spontaneous). Causal factors may also be considered for classification: idiopathic, symptomatic owing to structural lesions, pharmacological interactions, metabolic disorders and psychogenic reactions. Dystonia may occur as an isolated symptom or in the context of other symptoms or conditions arising from basal ganglia dysfunction.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
9 Cranial dystonia Dirk Dressler and Fereshte Adib Saberi INTRODUCTION ANATOMY Cranial muscles form a highly complex network that provides an amazing multitude of ... CRANIAL DYSTONIA 83 F CS OOc-PP P N LLSAN OOc-PO LLS ZMn ZMa OOr DLI M... more
9 Cranial dystonia Dirk Dressler and Fereshte Adib Saberi INTRODUCTION ANATOMY Cranial muscles form a highly complex network that provides an amazing multitude of ... CRANIAL DYSTONIA 83 F CS OOc-PP P N LLSAN OOc-PO LLS ZMn ZMa OOr DLI M R DAO Key CS ...
Research Interests:
Botulinum toxin (BT) therapy may be blocked by antibodies (BT-AB) resulting in BT-AB induced therapy failure (ABF). BT-AB may be detected by the mouse lethality assay (MLA), the mouse diaphragm assay (MDA) and the sternocleidomastoid test... more
Botulinum toxin (BT) therapy may be blocked by antibodies (BT-AB) resulting in BT-AB induced therapy failure (ABF). BT-AB may be detected by the mouse lethality assay (MLA), the mouse diaphragm assay (MDA) and the sternocleidomastoid test (SCMT). For the first time, we wanted to compare all three BT-AB tests and correlate them to subjective complaint of complete or partial secondary therapy failure in 37 patients with cervical dystonia (25 females, 12 males, age 51.2 ± 11.4 years, disease duration 12.4 ± 6.3 years). Complaint of therapy failure was not correlated with any of the BT-AB tests. MDA and MLA are closely correlated, indicating that the MDA might replace the MLA as the current gold standard for BT-AB measurement. The SCMT is closely correlated with MDA and MLA confirming that BT-AB titres and BT's paretic effect are in a functional balance: low BT-AB titres are reducing BT's paretic effect only marginally, whereas high BT-AB titres may completely block it. When the...
Research Interests:
Cell-based assays are a novel method to determine potency of botulinum toxin drugs. Manufacturers are working on their acquisition, development and implementation to reduce animal consumption during the manufacturing process. Potency... more
Cell-based assays are a novel method to determine potency of botulinum toxin drugs. Manufacturers are working on their acquisition, development and implementation to reduce animal consumption during the manufacturing process. Potency labelling of botulinum toxin drugs differes principally between Ipsen and the other manufacturers. Reference to a uniform international standard would avoid this potentially dangerous situation. However, this has not been demanded by the registration authorities and has not been persued by the manufacturers for decades.
Research Interests:
The prevalence of dystonia has been studied since the 1980s. Due to different methodologies and due to varying degrees of awareness, resulting figures have been extremely different. We wanted to determine the prevalence of dystonia... more
The prevalence of dystonia has been studied since the 1980s. Due to different methodologies and due to varying degrees of awareness, resulting figures have been extremely different. We wanted to determine the prevalence of dystonia according to its current definition, using quality-approved registries and based on its relevance for patients, their therapy and the health care system. We applied a service-based chart review design with the City of Hannover as reference area and a population of 525,731. Barrier-free comprehensive dystonia treatment in few highly specialised centres for the last 30 years should have generated maximal dystonia awareness, a minimum of unreported cases and a high degree of data homogeneity. Prevalence [n/1mio] and relative frequency is 601.1 (100%) for all forms of dystonia, 251.1 (42%) for cervical dystonia, 87.5 (15%) for blepharospasm, 55.2 (9%) for writer’s cramp, 38.0 (6%) for tardive dystonia, 32.3 (5%) for musician’s dystonia, 28.5 (5%) for psychoge...
Research Interests:
Although botulinum toxin (BT) is now being used in a large number of different indications in numerous medical specialties, there is still dynamic and rapid development. Treatment algorithms were improved by the introduction of BT... more
Although botulinum toxin (BT) is now being used in a large number of different indications in numerous medical specialties, there is still dynamic and rapid development. Treatment algorithms were improved by the introduction of BT short-interval therapy, BT high-dose therapy and improved dosing guidelines. Ultrasound guidance may be helpful in special situations. New indication areas including depression and inflammatory processes are being explored. Drug development projects are mainly focusing on onabotulinumtoxinA analogues, some are addressing liquid preparations and modifications of BT's duration of action. Recombinant BT may simplify production processes. Cell-based assays for potency measurement will soon be required by registration authorities. Treatment algorithms will be further refined and indications will be expanded. New indication areas are still uncertain. BT type A will remain the drug substance of choice. Removal of complexing proteins seems logical. Whether the...
Research Interests:
Continuous intrathecal Baclofen application (ITB) through an intracorporeal pump system is widely used in adults and children with spasticity of spinal and supraspinal origin. Currently, about 1200 new ITB pump systems are implanted in... more
Continuous intrathecal Baclofen application (ITB) through an intracorporeal pump system is widely used in adults and children with spasticity of spinal and supraspinal origin. Currently, about 1200 new ITB pump systems are implanted in Germany each year. ITB is based on an interdisciplinary approach with neurologists, rehabilitation specialists, paediatricians and neurosurgeons. We are presenting the proceedings of a consensus meeting organised by IAB-Interdisciplinary Working Group for Movement Disorders. The ITB pump system consists of the implantable pump with its drug reservoir, the refill port, an additional side port and a flexible catheter. Non-programmable pumps drive the Baclofen flow by the reservoir pressure. Programmable pumps additionally contain a radiofrequency control unit, an electrical pump and a battery. They have major advantages during the dose-finding phase. ITB doses vary widely between 10 and 2000 μg/day. For spinal spasticity, they are typically in the order of 100-300 μg/day. Hereditary spastic paraplegia seems to require particularly low doses, while dystonia and brain injury require particularly high ones. Best effects are documented for tonic paraspasticity of spinal origin and the least effects for phasic muscle hyperactivity disorders of supraspinal origin. Oral antispastics are mainly effective in mild spasticity. Botulinum toxin is most effective in focal spasticity. Myotomies and denervation operations are restricted to selected cases of focal spasticity. Due to its wide-spread distribution within the cerebrospinal fluid, ITB can tackle wide-spread and severe spasticity.
Research Interests:
Most botulinum toxin (BT) drugs are stored as powders which need to be reconstituted with normal saline before clinical use. As botulinum neurotoxin (BNT), the therapeutically active ingredient, is a large double-stranded protein the... more
Most botulinum toxin (BT) drugs are stored as powders which need to be reconstituted with normal saline before clinical use. As botulinum neurotoxin (BNT), the therapeutically active ingredient, is a large double-stranded protein the process of reconstitution should be performed with special attention to mechanical stress applied. We wanted to test the mechanical stability of BNT during the reconstitution process. For this, 100 MU onabotulinumtoxinA (Botox(®), Irvine, CA, USA) was reconstituted with 2.0 ml of NaCl/H2O. Gentle reconstitution (GR) was performed with a 5 ml syringe, a 0.90 × 70 mm injection needle, one cycle of injection-aspiration-injection and two gentle shakes of the vial. Aggressive reconstitution (AR) was performed with a 5 ml syringe, a 0.40 × 40 mm injection needle, ten injection-aspiration-injection cycles and 30 s of continuous shaking of the vial. AR increased the time to paralysis in the mouse hemidiaphragm assay (HDA) from 72.0 ± 4.6 to 106.0 ± 16.0 min (*p...
Research Interests:
Gilles de la Tourette's syndrome, a combination of multiple chronic tics and vocalizations, usually first occurring during childhood, is described in its history, symptomatology, genetics, etiology and therapy. Traditionally TS has... more
Gilles de la Tourette's syndrome, a combination of multiple chronic tics and vocalizations, usually first occurring during childhood, is described in its history, symptomatology, genetics, etiology and therapy. Traditionally TS has been viewed either as an organic or as a psychogenic disorder. We propose an integrative concept combining both aspects. During a vulnerable phase in childhood a hypersensitivity of dopamine 2-receptors, induced by gene defects or perinatal trauma, leads to a lack of suppression of subcortical programs which discharge as tics. Tics are modified by multiple psychological contents (aggressive or sexual impulses, imitation of others) which tend to become independent of their origin. Severity of tics in the course of the illness is often dependent on the emotional status of the patient. Recent research focuses on the search for a major gene locus and the relationship between dopamine-receptor hypersensibility and the disturbances of other neurotransmitter...
A recent consensus update classifies dystonia according to two main axes describing the motor features and the different etiologies. Dystonia with no other neurological signs is called “isolated,” whereas dystonia associated with other... more
A recent consensus update classifies dystonia according to two main axes describing the motor features and the different etiologies. Dystonia with no other neurological signs is called “isolated,” whereas dystonia associated with other neurological signs is called “combined.” Since its first description by Oppenheim, dystonia has been considered a pure motor disorder, but recently non-motor features have been recognized as part of clinical phenotype. In isolated dystonias psychiatric disturbances including depression, anxiety disorders, and obsessive-compulsive disorder have been frequently reported. Also cognitive deficits, mainly of executive and visuospatial domains, have been observed, but no major cognitive impairment or dementia was reported. In combined dystonias, psychiatric and cognitive dysfunctions are described, with differences among specific syndromes. The topic of neuropsychiatric features in dystonia is evolving and further studies are needed to elucidate the observed phenomenological diversities.
Research Interests:
Research Interests: Psychology, Depression, Treatment Outcome, Medicine, Humans, and 13 moreFemale, Male, Follow-up studies, Aged, Middle Aged, Adult, Analysis of Variance, Time Factors, Randomized Controlled Trial, Psychiatric, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and Medical and Health Sciences
The SARS-CoV-2 virus pandemic has provoked drastic countermeasures including shutdowns of public services. We wanted to describe the effects of a 6 week shutdown of a large German botulinum toxin (BT) outpatient clinics on patients and... more
The SARS-CoV-2 virus pandemic has provoked drastic countermeasures including shutdowns of public services. We wanted to describe the effects of a 6 week shutdown of a large German botulinum toxin (BT) outpatient clinics on patients and their well-being. 45 patients (age 61.9 ± 9.8 years, 29 females, 16 males) receiving BT therapy (319.3 ± 201.9MU-equivalent, treatment duration 8.3 ± 5.5 years) were surveyed with a standardised questionnaire. The shutdown delayed BT therapy by 6.6 ± 2.3 weeks. 93% of the patients noticed increased muscle cramps and 82% increased pain reducing their quality of life by 40.2 ± 19.5%. For 23 patients with cervical dystonia this reduction was 41.1 ± 18.3%, for 3 patients with blepharospasm 33.3 ± 15.3%, for 9 patients with spasticity 37.8 ± 15.6%, for 4 patients with pain conditions 37.4 ± 35.7% and for 3 patients with hemifacial spasm 27.5 ± 17.1%. After the shutdown 66% of patients perceived BT therapy as more important than before, 32% perceived it as ...
Research Interests:
IntroductionAntibodies against botulinum neurotoxin (BNT-AB) can be detected by the mouse protection assay (MPA), the hemidiaphragm assay (HDA), and by enzyme-linked immunosorbent assays (ELISA). Both MPA and HDA require sacrifice of... more
IntroductionAntibodies against botulinum neurotoxin (BNT-AB) can be detected by the mouse protection assay (MPA), the hemidiaphragm assay (HDA), and by enzyme-linked immunosorbent assays (ELISA). Both MPA and HDA require sacrifice of experimental animals, and they are technically delicate and labor intensive. We introduce a specially developed ELISA for detection of BNT-A-AB and evaluate it against the HDA.Methods Thirty serum samples were tested by HDA and by the new ELISA. Results were compared, and receiver operating characteristic analyses were used to optimize ELISA parameter constellation to obtain either maximal overall accuracy, maximal test sensitivity, or maximal test specificity. When the ELISA is optimized for sensitivity, a sensitivity of 100% and a specificity of 55% can be reached. When it is optimized for specificity, a specificity of 100% and a sensitivity of 90% can be obtained.ResultsWe present an ELISA for BNT-AB detection that can be—for the first time—customize...
Research Interests:
Research Interests:
Research Interests:
The therapeutic efficacy of botulinum toxin (BT) can be completely blocked by formation of BT antibodies (BTAB), thus producing antibody-induced therapy failure (ABTF). One of the risk factors for this is the interval between two... more
The therapeutic efficacy of botulinum toxin (BT) can be completely blocked by formation of BT antibodies (BTAB), thus producing antibody-induced therapy failure (ABTF). One of the risk factors for this is the interval between two subsequent injection series. To prevent BTAB formation it is universally recommended not to use interinjection intervals of less than 12 weeks. However, BT&#39;s therapeutic efficacy may be considerably shorter than this interval, thus causing substantial reduction of quality of life. We wanted to study whether BT therapy with interinjection intervals of less than 12 weeks (short interval therapy, SIT) would be immunologically and otherwise safe. To minimise the risk of BTAB formation we used incobotulinumtoxin A which has a particularly low antigenicity. Altogether 30 patients (age 59.2 ± 13.5 years. 19 females, 11 males) with different dystonias were included in this study. They received SIT with incobotulinumtoxinA (Xeomin, Merz Pharmaceuticals, Frankfurt/M, Germany) at interinjection intervals of 69.0 ± 8.1 days (equal 9.9 weeks or 2.2 months, min 48.9 ± 2.4 days) for 14.3 ± 2.9 injection series (equal 906 ± 169 days or 2.5 ± 0.5 years) in a dose of 259 ± 159 MU (max 670 ± 144.4 MU). None of the patients showed signs of ABTF, unusual BT effects or increased adverse effects. Information provided by this study confirms safety of SIT. With a considerable percentage of patients hitherto undertreated for prolonged periods of time with BT therapy applying 12 weeks intervals, SIT may substantially improve the quality of life for those patients. Whether SIT is also safe with other BT drugs needs to be tested.
Research Interests:
Research Interests:
AbstractBotulinum toxin (BT) has long been infamous in food safety and biological warfare. In the early 1970s, Alan B Scott of San Francisco invented its therapeutic use originally in extraocular eye muscles to treat strabismus using a... more
AbstractBotulinum toxin (BT) has long been infamous in food safety and biological warfare. In the early 1970s, Alan B Scott of San Francisco invented its therapeutic use originally in extraocular eye muscles to treat strabismus using a therapeutic BT type A preparation provided by Edward J Schantz and Eric A Johnson. Subsequently a large number of medical indications based on motor and glandular hyperactivity and—most recently—chronic migraine are now treated by BT therapy. BT’s highly specific and elaborate mechanism of action represents a completely novel therapeutic principle which will have consequences far beyond existing indications. BT therapy entered neurology through Stanley Fahn in New York from where C David Marsden brought it to London. From here neurological BT therapy came to Germany through Reiner Benecke and Dirk Dressler. Ophthalmological BT therapy was brought directly to Germany by Peter Roggenkämper, a fellow of Scott. By the early 1990s, several users in Germany had learned about BT therapy and made the country one of the most productive countries in clinical BT science—backed up by a long tradition of solid basic BT research. For several years now, however, BT therapy in Germany has been stagnating due to a lack of reimbursement for the medical treatment and due to off-label use challenges.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Gilles de la Tourette's syndrome, a combination of multiple chronic tics and vocalizations, usually first occurring during childhood, is described in its history, symptomatology, genetics, etiology and therapy. Traditionally TS has... more
Gilles de la Tourette's syndrome, a combination of multiple chronic tics and vocalizations, usually first occurring during childhood, is described in its history, symptomatology, genetics, etiology and therapy. Traditionally TS has been viewed either as an organic or as a psychogenic disorder. We propose an integrative concept combining both aspects. During a vulnerable phase in childhood a hypersensitivity of dopamine 2-receptors, induced by gene defects or perinatal trauma, leads to a lack of suppression of subcortical programs which discharge as tics. Tics are modified by multiple psychological contents (aggressive or sexual impulses, imitation of others) which tend to become independent of their origin. Severity of tics in the course of the illness is often dependent on the emotional status of the patient. Recent research focuses on the search for a major gene locus and the relationship between dopamine-receptor hypersensibility and the disturbances of other neurotransmitter systems (norepinephrine, serotonin, endorphin).
Research Interests: Psychology and Medicine
Research Interests:
To investigate the effects of positioning on heart rate, breathing frequency and blood pressure in postacute, severely disabled patients with central neurological disorders. Positioning patients is part of the regular nursing routine in... more
To investigate the effects of positioning on heart rate, breathing frequency and blood pressure in postacute, severely disabled patients with central neurological disorders. Positioning patients is part of the regular nursing routine in the care for severely disabled patients. Positioning can be done in a conventional way or in Lagerung in Neutralstellung (Engl.: positioning in neutral), which has recently been shown to have better effects on the passive range of motion and comfort than conventional positioning. While it is thought that positioning influences vital parameters, so far no study has investigated this for a clinically relevant observation period, and no study has compared different positioning concepts in this respect. A multicentre, randomised, controlled, single-blind clinical trial. Two hundred and eighteen patients were randomly assigned to positioning in neutral or conventional positioning. For two hours, they were lying in one of five positions (supine, 30° and 90...