Diagnostic indices for vertiginous diseases

<p>Abstract</p> <p>Background</p> <p>Vertigo and dizziness are symptoms which are reported frequently in clinical practice. We aimed to develop diagnostic indices for four prevalent vertiginous diseases: benign paroxysmal positional vertigo (BPPV), Menière's disease (MD), vestibular migraine (VM), and phobic postural vertigo (PPV).</p> <p>Methods</p> <p>Based on a detailed questionnaire handed out to consecutive patients presenting for the first time in our dizziness clinic we preselected a set of seven questions with desirable diagnostic properties when compared with the final diagnosis after medical workup. Using exact logistic regression analysis diagnostic scores, each comprising of four to six items that can simply be added up, were built for each of the four diagnoses.</p> <p>Results</p> <p>Of 193 patients 131 questionnaires were left after excluding those with missing consent or data. Applying the suggested cut-off points, sensitivity and specificity were 87.5 and 93.5% for BPPV, 100 and 87.4% for MD, 92.3 and 83.7% for VM, 73.7 and 84.1% for PPV, respectively. By changing the cut-off points sensitivity and specificity can be adjusted to meet diagnostic needs.</p> <p>Conclusions</p> <p>The diagnostic indices showed promising diagnostic properties. Once further validated, they could provide an ease to use and yet flexible tool for screening vertigo in clinical practice and epidemiological research.</p

Sakkaden zu bewegten und stationären Zielen

Die Sakkaden von Affen zu bewegten und stationären Zielen wurden mittels search-coil-Methode aufgezeichnet. Dazu wurde den Affen ausgehend von einer durch einen sichtbaren Fixationspunkt bestimmten Ruhelage in unvorhersehbarer Reihenfolge Ziele dargeboten, auf die sie ihren Blick richten sollten. Letztere befanden sich in drei diskreten Abständen (step), blieben stationär oder bewegten sich von den beiden äußeren Positionen aus mit konstanter Geschwindigkeit (ramp) in (vorwärts) bzw. gegen (rückwärts) Richtung der Sakkade. Die Positionen wurden so gewählt, daß sich die bewegten Ziele nach der mittleren Latenzzeit des jeweiligen Affen am gleichen Ort (mittlere Position) befanden. Der Einfluß langsamer Augenfolgebewegungen, die bei der Fixation bewegter Ziele entstehen, auf die Sakkadengeschwindigkeit war als gering einzuschätzen. Während Sakkaden zu stationären Zielen auf der gleichen main sequence lagen, waren Sakkaden zu vorwärtsbewegten Zielen signifikant langsamer (vmax für Affe A 207, B 191 Grad/s) und dauerten länger (T für Affe A 57,4, B 68,6 ms) als solche zu rückwärtsbewegten (vmax für Affe A 244, B 234 Grad/s. T für Affe A 49,9, B 59,0 ms) bei gleicher Amplitude. Bei Betrachtung der Geschwindikgeitsprofile manifestiert sich der eben genannte Unterschied vorwiegend in der Dezelerationsphase. Die Maximalgeschwindigkeiten korrelierten mit dem retinalen Fehler ca. 40 - 100 ms (individuell verschieden) vor Beginn der Sakkade. Der retinale Fehler ist definiert als Abstand des visuellen Zielpunktes von der Blickposition vor Beginn der Sakkade. Die gleichen Berechnungen für die Amplitude als abhängige Variable erbrachten keine überzeugenden Ergebnisse, da sich hier eine Korrelation mit dem retinalen Fehler zu oder nach Beginn der Sakkade ergab, man aber davon ausgehen kann, daß die Eingangsgrößen zu deren Planung vorliegen, bevor die Bewegung ausgeführt wird. Die Analysen zeigen, daß die Maximalgeschwindigkeit von Sakkaden durch den retinalen Fehler vorhergesagt werden kann, während in die Amplitude noch weitere, von der Geschwindigkeit des Blickzieles abhängige Größen mit eingehen müssen. Diese Anpassung der Amplitude scheint vorwiegend in der Dezelerationsphase der Sakkade zu geschehen. Die Ergebnisse unterstützen gegenwärtige Modelle der Sakkadengenerierung, die die Steuerung von initialer Richtung und Beschleunigungsphase dem Colliculus superior, die Feinabstimmung und Konstanz der Bewegung dem Kleinhirn zuschreiben

Effects of trimester-specific and total gestational weight gain on children's anthropometrics

Background: Gestational weight gain (GWG) has been shown to be a risk factor for overweight in offspring. Aim of this study was to quantify the contributions of trimester-specific and total GWG on offspring's BMI and waist circumference (WC). This is of interest for the design of interventions targeted at women showing a high GWG in early pregnancy. Methods: In a retrospective cohort study data on GWG (total and by trimester, exposure), a number of potential confounders, and children's BMI z-scores and WC (outcomes) were analyzed using structural equation models to disentangle the trimester-specific direct effects of GWG and indirect effects mediated via total GWG. Results: 7313 mother child pairs with a children's mean age of 5.81 years were analyzed. Total effects (indirect + direct) of GWG (kg/week) on children's BMI z-score and WC (cm) were observed in all trimesters, most prominently in the second. The longitudinal effect of GWG is a composite of trimester-specific direct effects (on BMI: 0.105, 0.255, 0.002, on WC: 0.538, 1.64, 0.308) and total GWG (on BMI 0.608, on WC: 1.03) at the end of pregnancy. Conclusions: Both trimester-specific priming and total GWG explained offspring's anthropometrics. The results indicate, that reversal from additional weight gain attained early in pregnancy resulting in normal total GWG at the end of pregnancy might still contribute to a substantial reduction of offspring's BMI and WC

Co-morbidities of vertiginous diseases

<p>Abstract</p> <p>Background</p> <p>Co-morbidities of vertiginous diseases have so far not been investigated systematically. Thus, it is still unclear whether the different vertigo syndromes (e.g. benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD), vestibular migraine and phobic vertigo (PPV)) have also different spectrums of co-morbidities.</p> <p>Methods</p> <p>All patients from a cohort of 131 participants were surveyed using a standardised questionnaire about the co-morbidities hypertension, diabetes mellitus, BMI (body mass index), migraine, other headache, and psychiatric diseases in general and the likelihood of a depression in particular.</p> <p>Results</p> <p>We noted hypertension in 29.0% of the cohort, diabetes mellitus in 6.1%, migraine in 8.4%, other headache in 32.1%, psychiatric diseases in 16.0%, overweight and obesity in 33.6% and 13.7% respectively, as well as a clinical indication for depression in 15.9%.</p> <p>Conclusion</p> <p>In general, we did not detect an increased prevalence of the co-morbidities diabetes mellitus, arterial hypertension, migraine, other headache and obesity compared to the general population. There was an increased prevalence of psychiatric co-morbidity in patients with PPV, and the prevalence of hypertension was elevated in patients with MD.</p

Clinical evaluation of the bed cycling test

Objective: Additionally to the forearm rolling test to detect mild unilateral upper limb dysfunction, the bed cycling test (BCT) for detection of mild to moderate lower limb dysfunction was developed, evaluated and compared to the leg holding test. Methods: In a prospective observer-blinded study, 60 patients with MRI/CT-proven focal cerebral hemisphere lesions and a mild to moderate unilateral paresis of the lower limb (graduated MRC 3-4/5), and 60 control persons with normal imaging were examined and filmed. Nine observers blinded to the diagnosis evaluated these videos. The sensitivity, specificity and the positive and negative predictive values of the clinical tests were analyzed. Results: The observers gave a correct evaluation of BCT in 35.5% of all patients with focal cerebral lesions compared to 26.0% for the leg holding test. On the other hand, observers had false negative results in 29.1% of cases with BCT and 44.7% with leg holding test. In 36.7% of patients, only BCT was pathological while leg holding test was unremarkable. The sensitivity of the combination of both tests was 0.68 (95% CI 0.61-0.75). The BCT is more sensitive (64.3%) than leg holding test (46.2%) while the specificity of leg holding test (85.6%) is higher than of BCT (70.1%) to detect a cerebral lesion affecting the lower limb. The inter-rater variability is high with no differences comparing different types of clinical experience. Conclusions: The BCT is a useful additional clinical bedside test to detect subtle unilateral cerebral lesions. The BCT is easy to perform and can be added to the routine neurological examination

Prenatal and Postnatal Tobacco Exposure and Behavioral Problems in 10-Year-Old Children: Results from the GINI-plus Prospective Birth Cohort Study

BACKGROUND: Prenatal and postnatal tobacco exposure have been reported to be associated with behavioral problems. However, the magnitude of the association with tobacco exposure at specific periods of exposure is unclear. OBJECTIVE: We assessed the relative risk of behavioral problems in children who had been exposed to tobacco smoke in utero and postnatally. METHODS: We analyzed data from a prospective birth cohort study in two cities in Germany: the German Infant Nutrition Intervention. Our sample included 5,991 children born between 1995 and 1998 as well as their parents. We measured behavioral problems using the Strength and Difficulties Questionnaire (SDQ) at follow-up 10 years after birth. According to prespecified SDQ cutoff values, children were classified as &quot;normal,&quot; &quot;borderline,&quot; or &quot;abnormal&quot; according to the subscales &quot;emotional symptoms,&quot; &quot;conduct problems,&quot; &quot;hyperactivity/inattention,&quot; &quot;peer-relationship problems,&quot; and a total difficulties score. Smoke exposure and further covariates were assessed using parent questionnaires. RESULTS: Compared with children not exposed to tobacco smoke, children exposed both pre- and postnatally to tobacco smoke had twice the estimated risk [95% confidence interval (CI), 1.4-3.1] of being classified as abnormal according to the total difficulties score of the SDQ at 10 years of age. Children who were only prenatally exposed had a 90% higher relative risk (95% CI, 0.9-4.0), whereas children who were only postnatally exposed had a 30% higher relative risk (95% CI, 0.9-1.9). These results could not be explained by confounding by parental education, father&#39;s employment, child&#39;s time spent in front of computer or television screen, being a single father or mother, or mother&#39;s age. CONCLUSIONS: Prenatal exposure to tobacco smoke is associated with behavioral problems in school-age children. Although our findings do not preclude the influence of postnatal exposure, prenatal exposure seems to be more important

Effects of acetyl-DL-leucine on cerebellar ataxia (ALCAT trial): study protocol for a multicenter, multinational, randomized, double-blind, placebo-controlled, crossover phase III trial

BACKGROUND: Cerebellar ataxia (CA) is a frequent and often disabling condition that impairs motor functioning and impacts on quality of life (QoL). No medication has yet been proven effective for the symptomatic or even causative treatment of hereditary or non-hereditary, non-acquired CA. So far, the only treatment recommendation is physiotherapy. Therefore, new therapeutic options are needed. Based on three observational studies, the primary objective of the acetyl-DL-leucine on ataxia (ALCAT) trial is to examine the efficacy and tolerability of a symptomatic therapy with acetyl-DL-leucine compared to placebo on motor function measured by the Scale for the Assessment and Rating of Ataxia (SARA) in patients with CA. METHODS/DESIGN: An investigator-initiated, multicenter, European, randomized, double-blind, placebo-controlled, 2-treatment 2-period crossover phase III trial will be carried out. In total, 108 adult patients who meet the clinical criteria of CA of different etiologies (hereditary or non-hereditary, non-acquired) presenting with a SARA total score of at least 3 points will be randomly assigned in a 1:1 ratio to one of two different treatment sequences, either acetyl-DL-leucine (up to 5 g per day) followed by placebo or vice versa. Each sequence consists of two 6-week treatment periods, separated by a 4-week wash-out period. A follow-up examination is scheduled 4 weeks after the end of treatment. The primary efficacy outcome is the absolute change in the SARA total score. Secondary objectives are to demonstrate that acetyl-DL-leucine is effective in improving (1) motor function measured by the Spinocerebellar Ataxia Functional Index (SCAFI) and SARA subscore items and (2) QoL (EuroQoL 5 dimensions and 5 level version, EQ-5D-5 L), depression (Beck Depression Inventory, BDI-II) and fatigue (Fatigue Severity Score, FSS). Furthermore, the incidence of adverse events will be investigated. DISCUSSION: The results of this trial will inform whether symptomatic treatment with the modified amino-acid acetyl-DL-leucine is a worthy candidate for a new drug therapy to relieve ataxia symptoms and to improve patient care. If superiority of the experimental drug to placebo can be established it will also be re-purposing of an agent that has been previously used for the symptomatic treatment of dizziness. TRIAL REGISTRATION: The trial was prospectively registered at www.clinicaltrialsregister.eu (EudraCT no. 2015-000460-34) and at https://www.germanctr.de (DRKS-ID: DRKS00009733 )