Diagnostische Wertigkeit kognitiver Defizite bei fokalen epileptischen Anfällen

Lux S. Diagnostische Wertigkeit kognitiver Defizite bei fokalen epileptischen Anfällen. Bielefeld (Germany): Bielefeld University; 2001.Patienten mit fokalen Epilepsien leiden häufig unter neuropsychologischen Funktionsstörungen. Diese werden zumeist durch eine zugrundeliegende morphologische Läsion hervorgerufen. In unmittelbarer Nähe dieser Läsion befindet sich häufig das epileptogene Areal. Neuropsychologische Untersuchungen werden als Routineverfahren eingesetzt, um auf der Grundlage vorliegender neuropsychologischer Modelle über Hirnfunktionsstörungen auf die Hirnpathologie und somit auf die epileptogene Zone zu schließen. Epilepsiepatienten werden hierzu meist in den Zeiträumen zwischen den Anfällen (interiktal) untersucht. Während des Anfalls (iktal) wurden neuropsychologische Untersuchungen bislang nicht standardisiert durchgeführt. Lokalisationsdiagnostische Wertigkeit und Abhängigkeiten iktal geprüfter neuropsychologischer Funktionen wurden, wenn überhaupt, nur unsystematisch untersucht. Ziel dieser Studie ist es, iktal Abhängigkeiten unterschiedlicher neuropsychologischer Funktionen zu überprüfen und festzustellen, inwieweit durch Funktionsprüfungen Hinweise auf die Lokalisation der Anfallsaktivität gegeben werden können. Außerdem sollte auf dieser Grundlage ein standardisierter iktaler Testablauf für häufige fokale Epilepsien (frontalen und temporalen Ursprungs) entwickelt werden. Nach einer retrospektiven visuellen Analyse von 469 Anfallsereignissen wurden die Anfälle von 184 Patienten in diese Studie eingeschlossen. Bei 116 dieser Patienten war der Ort der Anfallsaktivität durch gleichzeitig durchgeführte elektrische Ableitungen (intrakraniell oder per Elektroencephalogramm) feststellbar. Bei 29 Patienten zeigte sich eine frontale, bei 87 Patienten eine temporale Anfallsaktivität. Die Patientengruppe mit temporaler Anfallsaktivität wurde weiterhin in Gruppen mit links- (n=38), rechts- (n=21) und bitemporaler (n=28) Anfallsaktivität unterteilt. Durch einen eigens entwickelten Beobachtungsbogen mit ausreichender Auswertungsobjektivität wurde die Prüfung der Funktionen Aufmerksamkeit (Orientierungsreflex, Gestische Reaktion = selektive Aufmerksamkeit), Sprache (expressive Sprache, rezeptive Sprache, Lesen, Wortfindung), Gedächtnis (Orientiertheit = Abruf, Gedächtnis für Anfall und Testung = Einspeicherung) und Bewusstsein (Definition in Anlehnung an die der Anfallsklassifikation der Internationalen League against Epilepsy) festgehalten. Zur Prüfung der Fragestellungen wurden Kappa-Koeffizienten berechnet sowie Einzelfallanalysen, [chi]²-Tests, Fischer-Exakt-Tests und eine Mehrstichproben-Konfigurationsfrequenzanalyse vorgenommen. Aufgrund geringer Varianz oder seltener Prüfung konnten ausschließlich die Funktionen Orientierungsreflex, Gestische Reaktion, expressive Sprache, rezeptive Sprache, Lesen, Gedächtnis für Anfall und Testung und Bewusstsein in die Auswertung eingehen. Iktal erwiesen sich als abhängig: Gestische Reaktionen und Lesen vom Orientierungsreflex und rezeptive Sprache von Gestischen Reaktionen. Überzufällig häufig zeigten sich bzw. fehlten außerdem Sprachfunktionen gleichzeitig mit Aufmerksamkeitsfunktionen. Für alle anderen Variablen fanden sich keine Abhängigkeitshinweise. Die nachfolgenden Funktionen fehlten bei folgender Lokalisation der Anfallsaktivität besonders häufig: Orientierungsreflex und expressive Sprache bei frontaler Anfallsaktivität, rezeptive Sprache und Lesen bei frontaler und links temporaler Anfallsaktivität, Gedächtnis und Bewusstsein tendenziell häufiger bei links temporaler Anfallsaktivität. Außerdem fehlten alle beobachteten Funktionen besonders häufig bei bitemporaler Anfallsaktivität. Konfigurationsfrequenzanalytisch ergaben sich für jede der vier untersuchten Patientengruppen spezifische Leistungsprofile durch Orientierungsreflex, expressive und rezeptive Sprache. Nach Abhängigkeitsbetrachtungen und Prüfungen der Lokalisationsaussagen der untersuchten Funktionen ergaben sich Hinweise auf den anzustrebenden Testablauf. Da der Orientierungsreflex die grundlegendste Funktion ist, sollte dieser immer zuerst geprüft werden. Im Anschluss daran sind die expressive und rezeptive Sprache zu prüfen, da diese als abhängig von der selektiven Aufmerksamkeit gelten können und allein durch die Leistungsprofilbetrachtung dieser beiden Funktionen und des Orientierungsreflexes zwischen allen untersuchten Patientengruppen unterschieden werden konnte. Dann ist je nach der Funktionstüchtigkeit der Sprachfunktionen eine verbale oder nonverbale Prüfung weiterer Funktionen vorzunehmen, um die erhaltenen Befunde zu stützen oder zusätzliche Hinweise auf den Ort der Anfallsaktivität zu erlangen. Abschließend sollte immer eine postiktale Gedächtnisprüfung erfolgen

Disentangling ADHD's Presentation-Related Decision-Making-A Meta-Analytic Approach on Predominant Presentations

Background: Deficient decision-making (DM) in attention deficit/hyperactivity disorder (ADHD) is marked by altered reward sensitivity, higher risk taking, and aberrant reinforcement learning. Previous meta-analysis aggregate findings for the ADHD combined presentation (ADHD-C) mostly, while the ADHD predominantly inattentive presentation (ADHD-I) and the predominantly hyperactive/impulsive presentation (ADHD-H) were not disentangled. The objectives of the current meta-analysis were to aggregate findings from DM for each presentation separately. Methods: A comprehensive literature search of the PubMed (Medline) and Web of Science Database took place using the keywords "ADHD," "attention-deficit/hyperactivity disorder," "decision-making," "risk-taking," "reinforcement learning," and "risky." Random-effects models based on correlational effect-sizes were conducted. Heterogeneity analysis and sensitivity/outlier analysis were performed, and publication biases were assessed with funnel-plots and the egger intercept. Results: Of 1,240 candidate articles, seven fulfilled criteria for analysis of ADHD-C (N = 193), seven for ADHD-I (N = 256), and eight for ADHD-H (N = 231). Moderate effect-size were found for ADHD-C (r = 0.34; p = 0.0001; 95% CI = [0.19, 0.49]). Small effect-sizes were found for ADHD-I (r = 0.09; p = 0.0001; 95% CI = [0.008, 0.25]) and for ADHD-H (r = 0.1; p = 0.0001; 95% CI = [-0.012, 0.32]). Heterogeneity was moderate for ADHD-H. Sensitivity analyses show robustness of the analysis, and no outliers were detected. No publication bias was evident. Conclusion: This is the first study that uses a meta-analytic approach to investigate the relationship between the different presentations of ADHD separately. These findings provide first evidence of lesser pronounced impairment in DM for ADHD-I and ADHD-I compared to ADHD-C. While the exact factors remain elusive, the current study can be considered as a starting point to reveal the relationship of ADHD presentations and DM more detailed

Kultursoziologische Stadtforschung: Grundlagen, Analysen, Perspektiven

Dieser Band formuliert die Grundlagen einer kultursoziologisch konzipierten Stadtforschung. Dabei steht die Frage im Zentrum, wie eine kulturwissenschaftliche Sicht auf Städte dabei helfen kann, klassische Fragen der Stadtsoziologie neu zu beantworten. Durch den Fokus ihrer Analyse auf zentrale kulturelle Strukturkategorien wie Geschlecht, Klasse und race gelingt es den Autor_innen, die soziologische Debatte zum Thema Stadt um eine feministische und postkoloniale Perspektive zu erweitern. Des Weiteren zeigen ihre Überlegungen, inwiefern ein kultursoziologischer Ansatz dabei helfen kann, Städte im Kontext aktueller gesellschaftlicher und ökologischer Herausforderungen zu analysieren

Case report: Treatment of congenital lobar emphysema with lung lobectomy in a puppy

An 11-week-old, sexually intact female Catahoula Leopard dog was evaluated for a multiple-week history of exercise intolerance and intermittent periods of respiratory distress. Thoracic radiographs revealed a markedly hyperinflated right lung field, with compression of the surrounding lung lobes. Thoracic computed tomography further localized the hyperinflation to the right middle lung lobe, with suspicion of congenital lobar emphysema. A right intercostal thoracotomy with right middle lung lobectomy was performed successfully. Histopathology results confirmed bronchial cartilage hypoplasia with marked emphysema and pleural fibrosis. The puppy recovered from surgery uneventfully and was discharged from the hospital without any postoperative complications. At 18 months postoperatively, the dog was clinically normal with no return of respiratory distress. This case report describes successful surgical treatment of a large breed puppy with the uncommonly reported condition of congenital lobar emphysema

Effects of a video game intervention on symptoms, training motivation, and visuo-spatial memory in depression

BackgroundPeople with Major Depressive Disorder (MDD) often experience reduced affect, mood, and cognitive impairments such as memory problems. Although there are various treatments for MDD, many of them do not address the cognitive deficits associated with the disorder. Playing 3D video games has been found to improve cognitive functioning in healthy people, but it is not clear how they may affect depressed mood and motivation in people with MDD. The aim of this study was to investigate whether a six-week video game intervention leads to improvements in depressed mood, training motivation, and visuo-spatial (working) memory functions in patients with MDD.MethodsA total of 46 clinically depressed individuals were randomly assigned to one of three groups: an experimental “3D video gaming” group (n = 14) which played a video game, an active control group (n = 16) which trained with a computer program “CogPack,” and a treatment-as-usual group (n = 16) which received a standard clinical treatment including psychotherapy and/or pharmacotherapy. Participants performed a neuropsychological assessment, including self-report questionnaires asking for depressive symptoms, training motivation, and visuo-spatial (working) memory functions before and after the training intervention.ResultsRegarding depressive symptoms, a significant decrease in the proportion of participants who showed clinical levels of depressive symptoms as measured by the Beck Depression Inventory was only found in the 3D video gaming group. Additionally, mean motivational levels of performing the training were significantly higher in the 3D video gaming group when compared with the active control group. Moreover, whereas the 3D Video Gaming group only significantly improved on one visuo-spatial memory test, the active control group improved in all visuo-spatial memory functions. The 3D video gaming group did not perform significantly better than the CogPack group, and the TAU group.ConclusionBesides a standalone cognitive training, the current findings suggest that cognitive trainings using a video game have potential to increase subjective well-being, show higher levels of training motivation, and lead to improvements in visuo-spatial (working) memory functions in MDD. However, given the mixed and unblinded nature of this study, the results should be interpreted with caution. Further research with larger samples and follow-up measurements is needed

Neurochemical Differences in Spinocerebellar Ataxia Type 14 and 1

Autosomal-dominant spinocerebellar ataxias (SCA) are neurodegenerative diseases characterized by progressive ataxia. Here, we report on neurometabolic alterations in spinocerebellar ataxia type 1 (SCA1; SCA-ATXN1) and 14 (SCA14; SCA-PRKCG) assessed by non-invasive 1H magnetic resonance spectroscopy. Three Tesla 1H magnetic resonance spectroscopy was performed in 17 SCA14, 14 SCA1 patients, and in 31 healthy volunteers. We assessed metabolites in the cerebellar vermis, right cerebellar hemisphere, pons, prefrontal, and motor cortex. Additionally, clinical characteristics were obtained for each patient to correlate them with metabolites. In SCA14, metabolic changes were restricted to the cerebellar vermis compared with widespread neurochemical alterations in SCA1. In SCA14, total N-acetylaspartate (tNAA) was reduced in the vermis by 34%. In SCA1, tNAA was reduced in the vermis (24%), cerebellar hemisphere (26%), and pons (25%). SCA14 patients showed 24% lower glutamate+glutamine (Glx) and 46% lower γ-aminobutyric acid (GABA) in the vermis, while SCA1 patients showed no alterations in Glx and GABA. SCA1 revealed a decrease of aspartate (Asp) in the vermis (62%) and an elevation in the prefrontal cortex (130%) as well as an elevation of myo-inositol (Ins) in the cerebellar hemisphere (51%) and pons (46%). No changes of Asp and Ins were detected in SCA14. Beyond, glucose (Glc) was increased in the vermis of both SCA14 (155%) and SCA1 (247%). 1H magnetic resonance spectroscopy revealed differing neurochemical profiles in SCA1 and SCA14 and confirmed metabolic changes that may be indicative for neuronal loss and dysfunctional energy metabolism. Therefore, 1H magnetic resonance spectroscopy represents a helpful tool for in-vivo tracking of disease-specific pathophysiology

P300 Modulation via Transcranial Alternating Current Stimulation in Adult Attention-Deficit/Hyperactivity Disorder: A Crossover Study

ObjectiveA repeated finding regarding event-related potentials (ERPs) is that patients with ADHD show a reduced P300 amplitude. This raises the question of whether the attention of ADHD patients can be increased by stabilizing the P300. Assuming that the P300 is generated by event-related oscillations (EROs) in the low frequency range (0–8 Hz), one approach to increase the P300 could be to stimulate the patient’s P300 underlying ERO by means of transcranial alternating current stimulation (tACS). The aim of this follow-up study was to investigate this hypothesized mechanism of action in adult ADHD patients.Materials and MethodsUndergoing a crossover design, 20 adult ADHD patients (10 female) received an actual stimulation via tACS on one day and a sham stimulation on another day. Before and after each intervention, EEG characteristics (P300 amplitudes, low frequency power) and attention performances (d2 attention test, visual oddball task (VOT)) were recorded.ResultsElectrophysiological analyses revealed no evidence for an enhanced P300 amplitude or low frequency power increase after actual stimulation compared to sham stimulation. Instead, a significant effect was found for a stronger N700 amplitude increase after actual stimulation compared to sham stimulation. Consistent with the P300 null results, none of the examined neuropsychological performance measures indicated a tACS-induced improvement in attentional ability.ConclusionContrary to a previous study using tACS to modulate the P300 in adult ADHD patients, the current study yields no evidence that tACS can increase the P300 amplitude in adult ADHD patients and that such P300 enhancement can directly improve neuropsychological parameters of attention

Altered interaction of physiological activity and behavior affects risky decision-making in ADHD

BackgroundAdult attention-deficit/hyperactivity disorder (ADHD) is often associated with risky decision-making behavior. However, current research studies are often limited by the ability to adequately reflect daily behavior in a laboratory setting. Over the lifespan impairments in cognitive functions appear to improve, whereas affective functions become more severe. We assume that risk behavior in ADHD arises predominantly from deficits in affective processes. This study will therefore aim to investigate whether a dysfunction in affective pathways causes an abnormal risky decision-making (DM) behavior in adult ADHD.MethodsTwenty-eight participants with ADHD and twenty-eight healthy controls completed a battery of questionnaires regarding clinical symptoms, self-assessment of behavior and emotional competence. Furthermore, skin conductance responses were measured during the performance in a modified version of the Balloon Analogue Risk Task. A linear mixed-effects model analysis was used to analyze emotional arousal prior to a decision and after feedback display.ResultsResults showed higher emotional arousal in ADHD participants before decision-making (β = −0.12, SE = 0.05, t = −2.63, p < 0.001) and after feedback display (β = −0.14, SE = 0.05, t = −2.66, p = 0.008). Although risky behavior was greater in HC than in ADHD, we found a significant interaction effect of group and anticipatory skin conductance responses regarding the response behavior (β = 107.17, SE = 41.91, t = 2.56, p = 0.011). Post hoc analyses revealed a positive correlation between anticipatory skin conductance responses and reaction time in HC, whereas this correlation was negative in ADHD. Self-assessment results were in line with the objective measurements.ConclusionWe found altered changes in physiological activity during a risky decision-making task. The results confirm the assumption of an aberrant relationship between bodily response and risky behavior in adult ADHD. However, further research is needed with respect to age and gender when considering physiological activities

Spinocerebellar ataxia type 14: refining clinicogenetic diagnosis in a rare adult‐onset disorder

Objectives: Genetic variant classification is a challenge in rare adult-onset disorders as in SCA-PRKCG (prior spinocerebellar ataxia type 14) with mostly private conventional mutations and nonspecific phenotype. We here propose a refined approach for clinicogenetic diagnosis by including protein modeling and provide for confirmed SCA-PRKCG a comprehensive phenotype description from a German multi-center cohort, including standardized 3D MR imaging. Methods: This cross-sectional study prospectively obtained neurological, neuropsychological, and brain imaging data in 33 PRKCG variant carriers. Protein modeling was added as a classification criterion in variants of uncertain significance (VUS). Results: Our sample included 25 cases confirmed as SCA-PRKCG (14 variants, thereof seven novel variants) and eight carriers of variants assigned as VUS (four variants) or benign/likely benign (two variants). Phenotype in SCA-PRKCG included slowly progressive ataxia (onset at 4-50 years), preceded in some by early-onset nonprogressive symptoms. Ataxia was often combined with action myoclonus, dystonia, or mild cognitive-affective disturbance. Inspection of brain MRI revealed nonprogressive cerebellar atrophy. As a novel finding, a previously not described T2 hyperintense dentate nucleus was seen in all SCA-PRKCG cases but in none of the controls. Interpretation: In this largest cohort to date, SCA-PRKCG was characterized as a slowly progressive cerebellar syndrome with some clinical and imaging features suggestive of a developmental disorder. The observed non-ataxia movement disorders and cognitive-affective disturbance may well be attributed to cerebellar pathology. Protein modeling emerged as a valuable diagnostic tool for variant classification and the newly described T2 hyperintense dentate sign could serve as a supportive diagnostic marker of SCA-PRKCG

The North Atlantic Waveguide and Downstream Impact Experiment

The North Atlantic Waveguide and Downstream Impact Experiment (NAWDEX) explored the impact of diabatic processes on disturbances of the jet stream and their influence on downstream high-impact weather through the deployment of four research aircraft, each with a sophisticated set of remote sensing and in situ instruments, and coordinated with a suite of ground-based measurements. A total of 49 research flights were performed, including, for the first time, coordinated flights of the four aircraft: the German High Altitude and Long Range Research Aircraft (HALO), the Deutsches Zentrum für Luft- und Raumfahrt (DLR) Dassault Falcon 20, the French Service des Avions Français Instrumentés pour la Recherche en Environnement (SAFIRE) Falcon 20, and the British Facility for Airborne Atmospheric Measurements (FAAM) BAe 146. The observation period from 17 September to 22 October 2016 with frequently occurring extratropical and tropical cyclones was ideal for investigating midlatitude weather over the North Atlantic. NAWDEX featured three sequences of upstream triggers of waveguide disturbances, as well as their dynamic interaction with the jet stream, subsequent development, and eventual downstream weather impact on Europe. Examples are presented to highlight the wealth of phenomena that were sampled, the comprehensive coverage, and the multifaceted nature of the measurements. This unique dataset forms the basis for future case studies and detailed evaluations of weather and climate predictions to improve our understanding of diabatic influences on Rossby waves and the downstream impacts of weather systems affecting Europe