TY - JOUR A1 - Luger, Sebastian A1 - Hohmann, Carina A1 - Niemann, Daniela A1 - Kraft, Peter A1 - Gunreben, Ignaz A1 - Neumann-Haefelin, Tobias A1 - Kleinschnitz, Christoph A1 - Steinmetz, Helmuth A1 - Foerch, Christian A1 - Pfeilschifter, Waltraud T1 - Adherence to oral anticoagulant therapy in secondary stroke prevention - impact of the novel oral anticoagulants JF - Patient Preference and Adherence N2 - Background: Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention. Methods: All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients' adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT. Results: In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209). A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence. Conclusion: One-year adherence to OAT after stroke is strong (>90%) and patients who switch therapy most commonly switch toward another OAT. The 1-year adherence rates to VKA and NOAC in secondary stroke prevention do not differ significantly between both therapeutic strategies. KW - transient ischemic attack KW - adherence KW - non-VKA oral anticoagulants KW - vitamin K antagonists KW - prevention KW - stroke KW - atrial fibrillation KW - warfarin KW - guidelines KW - scale Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144477 VL - 9 ER - TY - JOUR A1 - Kohl, S. A1 - Gruendler, T. O. J. A1 - Huys, D. A1 - Sildatke, E. A1 - Dembek, T. A. A1 - Hellmich, M. A1 - Vorderwulbecke, M. A1 - Timmermann, L. A1 - Ahmari, S. E. A1 - Klosterkoetter, J. A1 - Jessen, F. A1 - Sturm, V. A1 - Visser-Vandewalle, V. A1 - Kuhn, J. T1 - Effects of deep brain stimulation on prepulse inhibition in obsessive-compulsive disorder JF - Translational Psychiatry N2 - Owing to a high response rate, deep brain stimulation (DBS) of the ventral striatal area has been approved for treatment-refractory obsessive-compulsive disorder (tr-OCD). Many basic issues regarding DBS for tr-OCD are still not understood, in particular, the mechanisms of action and the origin of side effects. We measured prepulse inhibition (PPI) in treatment-refractory OCD patients undergoing DBS of the nucleus accumbens (NAcc) and matched controls. As PPI has been used in animal DBS studies, it is highly suitable for translational research. Eight patients receiving DBS, eight patients with pharmacological treatment and eight age-matched healthy controls participated in our study. PPI was measured twice in the DBS group: one session with the stimulator switched on and one session with the stimulator switched off. OCD patients in the pharmacologic group took part in a single session. Controls were tested twice, to ensure stability of data. Statistical analysis revealed significant differences between controls and (1) patients with pharmacological treatment and (2) OCD DBS patients when the stimulation was switched off. Switching the stimulator on led to an increase in PPI at a stimulus-onset asynchrony of 200 ms. There was no significant difference in PPI between OCD patients being stimulated and the control group. This study shows that NAcc-DBS leads to an increase in PPI in tr-OCD patients towards a level seen in healthy controls. Assuming that PPI impairments partially reflect the neurobiological substrates of OCD, our results show that DBS of the NAcc may improve sensorimotor gating via correction of dysfunctional neural substrates. Bearing in mind that PPI is based on a complex and multilayered network, our data confirm that DBS most likely takes effect via network modulation. KW - nucleus KW - serotonin KW - schizophrenia KW - dopamine KW - double-blind KW - psychiatric disorders KW - in vivo KW - acoustic startle KW - reflex KW - modulation Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-138300 VL - 5 IS - e675 ER - TY - THES A1 - Dörr, Christina T1 - Retrospektive Analyse zur Bedeutung der Myelographie für die Indikationsstellung zur Dekompressionsoperation bei zervikalen degenerativen Spinalkanalstenosen T1 - Impact of Myelography on Therapeutic Strategies in Degenerative Diseases of the Cervical Spine N2 - Zusammenfassung Dies ist die erste Studie, die geprüft hat, ob eine Myelographie und ein MCT die Behandlungsstrategie bei Patienten mit degenerativen Erkrankungen der Halswirbelsäule in einem Zeitalter qualitativ hochwertiger MRT-Geräte verändert. Die in dieser Studie gewonnenen Daten zeigen, dass eine Myelographie und ein MCT die therapeutische Strategie in einer signifikanten Anzahl von Patienten mit komplexen degenerativen zervikalen Erkrankungen verändert, insbesondere in Fällen von mehrsegmentalen Stenosen. Es handelt sich nicht um eine prospektive Studie, sondern um die Analyse von bereits vorhandenem Bild- und Datenmaterial. Deshalb folgten die nicht-invasiven Untersuchungen auch nicht einem standardisierten Protokoll. Dies ist zwar einerseits eine Schwäche der Studie. Genau diese Heterogenität ließ aber eine Analyse von Untergruppen zu und zeigte, dass eine Komplettierung der nichtinvasiven diagnostischen Maßnahmen – native Röntgenuntersuchungen und native CT – bereits Informationen liefern kann, die ansonsten aus der Myelographie und dem MCT gezogen werden. Aus den Ergebnissen dieser Analyse ergibt sich deshalb unter anderem die Schlussfolgerung, dass zunächst eine Komplettierung der nicht-invasiven Diagnostik erfolgen sollte, bevor eine Myelographie indiziert wird. Eine prospektive Studie mit einem standardisierten nicht-invasiven Protokoll, welches eine umfangreichere MRTUntersuchung, CT und konventionelle Röntgendiagnostik vor der Durchführung einer Myelographie und eines MCT enthält, könnte mehr Informationen über die Bedeutung der Myelographie und des MCT im zeitgemäßen diagnostischen Setup bei degenerativen Erkrankungen der Halswirbelsäule liefern. N2 - Purpose To assess whether myelography and postmyelographic computed tomography (MCT) obtained in addition to magnetic resonance imaging (MRI) influence therapeutic decisions in degenerative diseases of the cervical spine. Methods 3 neurosurgeons were supplied with information about the history and clinical performance of 105 patients who had undergone myelography and MCT of the cervical spine. The investigators reviewed the anonymized clinical data and image files in a randomized order in two rounds based on 1. MRI and, if available, native CT and plain radiographs. 2. MRI and, if available, native CT and plain radiographs and, in addition, myelography and MCT. After each of the 2 assessment rounds, the reviewers determined their treatment decision. The intra-observer variability was the primary end-point. Results In the present patient collective, myelography and MCT had been performed either in cases of multilevel disease or recurrent complaints after previous surgery or if noninvasive examinations had not revealed a clear finding. The intra-observer variability was 26.3 % and varied markedly between the 3 observers (17 – 41 %) and was highest in cases of multilevel disease. If non-invasive imaging included native CT and plain radiographs, the intraobserver variability was significantly reduced to 10.3 %. Conclusion In unclear cases of degenerative disorders of the cervical spine, myelography and MCT add relevant information for therapeutic decisions in more than a quarter of the patients. Particularly in multilevel stenosis it may change the therapeutic strategy. The indication for myelography and MCT may be reduced by a completion of noninvasive diagnostics. KW - Myelographie KW - Wirbelkanalstenose KW - Indikationsstellung KW - Spinalkanalstenose KW - Dekompressionsoperation Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133001 ER - TY - JOUR A1 - El Majdoub, Faycal A1 - Hunsche, Stefan A1 - Igressa, Alhadi A1 - Kocher, Martin A1 - Sturm, Volker A1 - Maarouf, Mohammad T1 - Stereotactic LINAC-Radiosurgery for Glomus Jugulare Tumors: A Long-Term Follow-Up of 27 Patients JF - PLoS ONE N2 - Background The optimal treatment of glomus jugulare tumors (GJTs) remains controversial. Due to the critical location, microsurgery still provides high treatment-related morbidity and a decreased quality of life. Thus, we performed stereotactical radiosurgery (SRS) for the treatment of GJTs and evaluated the long-term outcome. Methods Between 1991 and 2011, 32 patients with GJTs underwent SRS using a linear accelerator (LINAC) either as primary or salvage therapy. Twenty-seven patients (median age 59.9 years, range 28.7-79.9 years) with a follow-up greater than five years (median 11 years, range 5.3-22.1 years) were selected for retrospective analysis. The median therapeutic single dose applied to the tumor surface was 15 Gy (range 11-20 Gy) and the median tumor volume was 9.5 ml (range 2.8-51 ml). Results Following LINAC-SRS, 10 of 27 patients showed a significant improvement of their previous neurological complaints, whereas 12 patients remained unchanged. Five patients died during follow-up due to old age or other, not treatment-related reasons. MR-imaging showed a partial remission in 12 and a stable disease in 15 patients. No tumor progression was observed. The actuarial overall survival rates after five, ten and 20 years were 100%, 95.2% and 79.4%, respectively. Conclusions Stereotactic LINAC-Radiosurgery can achieve an excellent long-term tumor control beside a low rate of morbidity in the treatment of GJTs. It should be considered as an alternative therapy regime to surgical resection or fractionated external beam radiation either as primary, adjuvant or salvage therapy. KW - gamma knife radiosurgery KW - accelerator based radiosurgery KW - radiation therapy KW - temporal bone KW - skull base KW - surgery KW - paragangliomas KW - management KW - radiotherapy KW - head Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151717 VL - 10 IS - 6 ER -