https://hdl.handle.net/20.500.11811/818 2026-04-10T21:49:16Z https://hdl.handle.net/20.500.11811/13629 Quantitative and qualitative tremor evaluation after MR-guided focused ultrasound thalamotomy Purrer, Veronika; Chand, Tara; Pohl, Emily; Weiland, Hannah; Borger, Valeri; Schmeel, Carsten; Boecker, Henning; Wüllner, Ullrich <strong>Introduction:</strong> Tremor syndromes are common neurological disorders, usually distinguished by clinical examination. Ordinal rating scales are widely used to rate tremor severity but are limited by subjective observation, interrater reliability, ceiling effects and lack of knowledge about sensitivity to change emphasizing the relevance of quantitative methods.<br /> <strong>Methods:</strong> To assess tremor characteristics in essential tremor (ET) and Parkinson’s disease tremor (PT) quantitatively, we used a wearable triaxial accelerometer in comparison to a common clinical rating scale. Furthermore, different activation conditions and changes after treatment with MR-guided focused ultrasound (MRgFUS) were examined concomitantly. Patients with disabling, medication-refractory ET (<em>n</em> = 35) or PT (<em>n</em> = 21) undergoing unilateral MRgFUS thalamotomy were assessed before, 1, 6 and 12 months after MRgFUS treatment. Clinical assessments included the Clinical Rating Scale for Tremor (CRST) and accelerometric recordings at rest, posture and kinetic movement. Peak frequencies (fp), frequency width at half maximum (FWHM), tremor stability index (TSI), and half-width power (HWP) were extracted from the power spectrum of acceleration and compared to the CRST.<br /> <strong>Results:</strong> We observed moderate to strong correlations between CRST subscores and log-transformed HWP, whereas significant correlations were only evident in ET when groups were evaluated separately. Fp, FWHM and TSI showed no differences between groups and conditions. Further, repeated measurements after MRgFUS treatment revealed significant changes of tremor severity in both, clinical rating and accelerometric recordings.<br /> <strong>Discussion:</strong> Tremor assessment using accelerometric recordings provided a fast and investigator independent method for tremor characterization and quantitative assessment, which were sensitive to changes after therapeutic interventions. 2025-05-02T00:00:00Z https://hdl.handle.net/20.500.11811/10821 Parameters Associated with the Required Drug Dose of Intravenous Immunoglobulin in Stable Chronic Inflammatory Demyelinating Polyradiculoneuropathy Feyen, Ludger; Schaub, Christina; Zimmermann, Julian; Nitsch, Louisa Background: Intravenous immunoglobulin (IVIg) is efficient and one of very few treatment options for patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). However, finding the optimal dose of IVIg for individual CIDP patients remains challenging. The dose of IVIg needs to be adjusted individually. Considering the high healthcare costs of IVIg therapy, the overtreatment of some patients seen in placebo studies and the shortage of IVIg we recently experienced, as well as identifying factors associated with the required dose of IVIg in maintenance treatment, is extremely important. Thus, in this retrospective study, we analyze characteristics of patients with stable CIDP, which are associated with the required drug dose. Methods: 32 patients with stable CIDP treated with IVIg between July 2021 and July 2022 were identified from our database and included in this retrospective study. Patients’ characteristics were registered, and parameters were identified that were associated with the IVIg dose. Results: Age, cerebrospinal fluid protein elevation, disease duration, delay between symptom onset/diagnosis, Inflammatory Neuropathy Cause and Treatment (INCAT) score, and Medical Research Council Sum Score (MRC SS) were significantly associated with the required drug dose. In addition, an association of age, sex, elevated CSF protein, time interval between symptom onset and diagnosis, and the MRC SS with the required IVIg dose could be demonstrated in the multivariable regression analysis. Conclusions: Our model, which is based on routine parameters that are simple to address in the clinical practice, can be useful in adjusting the IVIg dose in patients with stable CIDP. 2023-03-10T00:00:00Z https://hdl.handle.net/20.500.11811/10801 Additive prognostic impact of the cerebrospinal fluid arginine/ornithine ratio to established clinical scores in aneurysmal subarachnoid hemorrhage Weller, Johannes; Lampmann, Tim; Asoglu, Harun; Schneider, Matthias; Ehrentraut, Stefan Felix; Lehmann, Felix; Güresir, Erdem; Dorn, Franziska; Petzold, Gabor; Vatter, Hartmut; Zimmermann, Julian Cerebrospinal fluid (CSF) metabolites are increasingly recognized as prognostic factors in aneurysmal subarachnoid hemorrhage (SAH). The CSF arginine/ ornithine ratio (Arg/Orn) was shown to predict cerebral vasospasms and clinical outcome in SAH. The additive prognostic value of Arg/Orn over established prognostic scores has not been investigated. CSF Arg/Orn and the established prognostic scores SAH, FRESH, SAH-PDS, HAIR, Rosen–McDonald, Hunt and Hess, WFNS and modified Fisher scale were determined in a prospective cohort of patients with aneurysmal SAH. Logistic regression models to predict a favorable outcome, defined as a modified Rankin Scale score of 0–3 at 3 months follow- up, were constructed for each score, both with and without the addition of Arg/ Orn. The impact of Arg/Orn was assessed comparing logistic regression models containing the respective score with and without Arg/Orn with the likelihood ratio chi-squared test. CSF Arg/Orn and clinical scores were determined in 38 SAH patients. Arg/Orn was an independent predictor of clinical outcome when added to established prognostic scores (p < 0.05) with the exception of HAIR (p=0.078). All models were significantly improved if Arg/Orn was added as a covariable (p<0.05). The results of this study confirm Arg/Orn as an independent prognostic factor and its addition improves established prognostic models in SAH. 2023-04-14T00:00:00Z