TY  - JOUR
A1  - Kremer, Naomi I.
A1  - Pauwels, Rik W. J.
A1  - Pozzi, Nicolò G.
A1  - Lange, Florian
A1  - Roothans, Jonas
A1  - Volkmann, Jens
A1  - Reich, Martin M.
T1  - Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions
JF  - Journal of Clinical Medicine
N2  - Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.
KW  - deep brain stimulation
KW  - tremor
KW  - essential tremor
KW  - Parkinson’s disease
KW  - outcomes
KW  - clinical approach
KW  - target considerations
KW  - future directions
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-244982
SN  - 2077-0383
VL  - 10
IS  - 16
ER  - 
TY  - JOUR
A1  - Gabriel, Katharina M. A.
A1  - Jírů-Hillmann, Steffi
A1  - Kraft, Peter
A1  - Selig, Udo
A1  - Rücker, Victoria
A1  - Mühler, Johannes
A1  - Dötter, Klaus
A1  - Keidel, Matthias
A1  - Soda, Hassan
A1  - Rascher, Alexandra
A1  - Schneider, Rolf
A1  - Pfau, Mathias
A1  - Hoffmann, Roy
A1  - Stenzel, Joachim
A1  - Benghebrid, Mohamed
A1  - Goebel, Tobias
A1  - Doerck, Sebastian
A1  - Kramer, Daniela
A1  - Haeusler, Karl Georg
A1  - Volkmann, Jens
A1  - Heuschmann, Peter U.
A1  - Fluri, Felix
T1  - Two years' experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)
JF  - BMC Neurology
N2  - Background 
Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. 

Methods 
The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals. 

Results 
Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. 

Conclusion 
The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.
KW  - pilot project
KW  - care tempis
KW  - ischemic stroke
KW  - thrombolysis
KW  - areas
KW  - time
KW  - hospitals
KW  - mortality
KW  - outcomes
KW  - quality
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229214
VL  - 20
ER  -