Neue Strategie in der Schlaganfallbehandlung?
Neue Studien haben gezeigt, dass interventionelle Thrombektomieverfahren in Ergänzung zur iv Thrombolyse innerhalb eines kurzen Zeitfensters von maximal 6 Stunden und bei strenger Auswahl der individuellen Schlaganfallsituation das Behandlungsergebnis verbessern können - anders als dies bis 2014 in vielen Voruntersuchungen belegt werden konnte. Die aktuellen Daten stehen aber noch im Kreuzfeuer der Kritik und wurden auf der ESC in Wien intensiv und kontrovers diskutiert - auch unsere internationale Zeitschrift Cerebrovascular Diseases ruft ihre Leserschaft aktuell zur Diskussion auf. Letters oder Comments können auf der Webseite von Cerebrovascular Diseases mit der Bemerkung ‘ESC Discussion Forum’ zur Veröffentlichung eingereicht werden.
Wolf ME, Capelle HH, Lütjens G, Ebert A, Hennerici MG, Krauss JK, Blahak C. Body weight gain in patients with bilateral deep brain stimulation for dystonia. J Neural Transm 2015, epub
We aimed to analyse the changes of body weight following deep brain stimulation (DBS) in patients with dystonia. The body mass index (BMI) of 17 consecutive patients with segmental or generalised dystonia with bilateral DBS of the globus pallidus internus (GPi) or the thalamic ventral intermediate nucleus (VIM) was measured preoperatively (pre-OP) and at three follow-up (FU) time points post-DBS surgery. All patients benefited from marked improvement in their dystonia illustrated by the BFM motor score. The mean BMI pre-OP significantly increased post-operatively in particular during the first 6 months post-OP (see figure). This probably is a result of improvement of dystonic motor symptoms and recovery of eating dysfunction rather than a target-specific phenomenon. Patients should be informed pre-OP about this aspect.
Chatzikonstantinou A, Ebert AD, Hennerici MG. Temporal seizure focus and status epilepticus are associated with high-sensitive troponin I elevation after epileptic seizures. Epilepsy Res. 2015;115:77-80
The purpose of this study was to evaluate the association of postictal elevation of troponin I (TNI) with seizure type and focus, as well as vascular risk factors. Postictal TNI elevation was found in about 11% of patients and was significantly more common in older patients with status epilepticus or temporal seizure focus. These data support the concept of relevant cardiac effects of seizures, especially of those with temporal lobe focus.
Okazaki S, Hornberger E, Griebe M, Gass A, Hennerici MG, Szabo K. MRI Characteristics of the Evolution of Supratentorial Recent Small Subcortical Infarcts. Front Neurol. 2015
The purpose of the present study was to describe the MRI characteristics of the evolution of recent small subcortical infarcts. We showed that more than one-third of recent small subcortical infarcts do not lead to cavity formation and 40% of infarct lesions overlap with white matter hyperintensities (WMHs). These data indicate the continuity between recent small subcortical infarcts and WMHs.
The Lancet Neurology, Volume 12, Issue 6, Pages 572 - 584, June 2013
Non-pharmacological strategies for the treatment of acute ischaemic stroke
Prof Michael G Hennerici MD, Rolf Kern MD, Prof Kristina Szabo MD
Summary
Early recanalisation and an increase in collateral blood supply are predictors of favourable outcome in acute ischaemic stroke. Since individual responses to intravenous treatment with alteplase are heterogeneous, additional intra-arterial thrombolytic and mechanical endovascular treatment is increasingly given. Despite encouraging findings from single-centre studies, data from randomised clinical trials have not proven the hypothesis that interventional recanalisation leads to a better outcome. Advanced thrombectomy devices, the effect of ultrasound-enhanced thrombolysis, and imaging-guided selection of patients outside the currently approved time-window are all under investigation. Although neuroprotective agents have not shown benefit in clinical trials, non-pharmacological treatment strategies—such as decompressive surgery, therapeutic hypothermia, transcranial laser treatment, or augmentation of cerebral collateral perfusion by different means (eg, partial aortic occlusion or sphenopalatine ganglion stimulation)—are topics of current research. The future of acute stroke therapy relies on evidence for individually tailored, effective, safe, and rapidly accessible treatment probably consisting of combined pharmacological and improved non-pharmacological approaches. Fulltext
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