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  • 1
    Language: English
    In: Wiener Medizinische Wochenschrift, 2012, Vol.162(15), pp.354-366
    Description: Fingolimod is the first oral treatment of multiple sclerosis. It is the first-in-class sphingosine 1-phosphate receptor modulator that binds to sphingosine 1-phophate receptors on lymphocytes and via downregulation of the receptor prevents lymphocyte egress from lymphoid tissues into the circulation. This mechanism reduces the infiltration of potentially auto-aggressive lymphocytes into the central nervous system. Two large phase III studies with fingolimod have shown superior efficacy of the drug in two dosages compared to placebo and to weekly intramuscular injections of Interferon beta-1a. Among possible side effects of the drug is a transient bradycardia after the first dose of fingolimod including possible AV blockade and therefore monitoring of pulse rate and blood pressure for 6 h following the first application is needed. During treatment, attention has to be given to specific infections, elevated liver enzymes, and ophthalmologic changes. Recommendations on the use of fingolimod including safety aspects are given in this article. Fingolimod ist das erste oral verabreichbare Medikament zur Behandlung der Multiplen Sklerose. Es ist der erste Sphingosin 1-phosphat Rezeptor Modulator seiner Klasse, der sich an Sphingosin 1-phosphat Rezeptoren auf Lymphozyten bindet und über Abregulation den Austritt von Lymphozyten aus dem lymphatischen Gewebe in die Blutbahn verhindert. Dieser Mechanismus reduziert das Einwandern potentiell autoagressiver Lymphozyten in das Zentralnervensystem. Zwei große Phase-III-Studien mit Fingolimod haben überlegene Wirksamkeit dieser Substanz in zwei Dosierungen gegenüber Plazebo sowie wöchentlicher intramuskulärer Injektion von Interferon beta-1a gezeigt. Zu den möglichen Nebenwirkungen des Medikamentes gehört eine transiente Bradykardie nach der ersten Dosis Fingolimod einschließlich möglicher AV-Blockierung, weshalb über einen Zeitraum von 6 Stunden nach der ersten Verabreichung Pulsrate und Blutdruck monitiert werden sollen. Während der Behandlung müssen spezifische Infektionen, erhöhte Leberenzyme und ophthalmologische Veränderungen Beachtung finden. Dieser Artikel gibt Empfehlungen zum Einsatz von Fingolimod einschließlich der notwendigen Sicherheitsaspekte während der Behandlung mit diesem Medikament.
    Keywords: Multiple sclerosis ; Treatment ; Immunomodulation ; Immunosuppression ; Fingolimod
    ISSN: 0043-5341
    E-ISSN: 1563-258X
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  • 2
    Language: English
    In: Wiener Medizinische Wochenschrift, 2013, Vol.163(9), pp.251-251
    Description: Byline: Franz Fazekas (1) Author Affiliation: (1) Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria Article History: Registration Date: 11/03/2013 Online Date: 09/04/2013 Article note: The online version of the original article can be found under doi: 10.1007/s10354-012-0123-y The online version of the original article can be found at http://dx.doi.org/10.1007/s10354-012-0123-y.
    Keywords: Algorithms ; Multiple Sclerosis;
    ISSN: 0043-5341
    E-ISSN: 1563-258X
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  • 3
    In: Stroke, 2013, Vol.44(4), pp.951-952
    Description: See related article, p 1037. Incidental areas of high signal intensity on T2-weighted MRI of older individuals termed white matter hyperintensities or white matter lesions (WML) have sparked scientific and clinical interest over the past 25 years. Extensive research has provided compelling evidence that at least more extensive forms of WMLs are a consequence of and indicative for small vessel disease,1 and thus are associated with a higher risk for stroke, dementia, and mortality.2 Furthermore, the longitudinal Leukoaraiosis And Disability (LADIS) study confirmed that severe WML strongly predict global functional decline in general beyond individual associations of WML extent with cognitive functioning as well as gait, balance, and mood disorders.3 Similar data come from several other cohorts. The exact mechanism(s) of WML formation, however, are still much less clear. In this issue of the Journal, de Groot et al4 report on a very elegant study which provides convincing evidence for the gradual development of WMLs both regarding the formation of new WMLs and also their expansion and growth over time. Using diffusion tensor imaging and the fluid-attenuated inversion recovery sequence, they searched for subtle changes that might have …
    Keywords: Medicine;
    ISSN: 0039-2499
    E-ISSN: 15244628
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  • 4
    In: Neurology, 2016, Vol.87(18), pp.1854-1855
    Keywords: Amyloid Beta-Peptides -- Metabolism ; Cerebral Amyloid Angiopathy -- Complications ; Cerebral Hemorrhage -- Etiology;
    ISSN: 0028-3878
    E-ISSN: 1526632X
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  • 5
    In: Neurology, 2018, Vol.91(20), pp.903-904
    Keywords: Stroke ; Stroke Rehabilitation;
    ISSN: 0028-3878
    E-ISSN: 1526632X
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  • 6
    Language: English
    In: Journal of Neurology, 2015, Vol.262(11), pp.2411-2419
    Description: The concept of cognitive reserve describes differences between individuals in the ability to compensate age-related brain changes or pathology as a result of greater intellectual enrichment. Cerebral small vessel disease (CSVD) is a common age-related vascular disease of the brain associated with slowly accumulating tissue damage and represents a leading cause of functional loss, disability and cognitive decline in the elderly. The promotion of cognitive reserve might be a valuable possibility to moderate the negative impact of accumulating brain changes associated with CSVD on cognitive function and thus limit the functional consequences of CSVD. We here review existing studies investigating this topic in CSVD and provide conceptual considerations why future research is needed. Relevant studies were identified using the electronic databases PubMed and MEDLINE. Six studies including 7893 subjects were found that all focused on a single feature of CSVD only, i.e., white matter hyperintensities (WMH). We also included one study investigating 247 CADASIL patients. In general, they confirm that higher cognitive reserve (i.e., educational attainment) attenuates the negative impact of WMH on cognition. Further studies should attempt to replicate this association for all features of CSVD and to expand the concept to other areas of functional loss like disordered gait. Finally intervention studies will be needed to define when and how we can still increase our cognitive reserve and what kind and magnitude of protective effects this may offer.
    Keywords: Cerebral small vessel disease (CSVD) ; Cognitive reserve ; WMH ; Successful aging ; Aging of the brain ; White matter changes
    ISSN: 0340-5354
    E-ISSN: 1432-1459
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  • 7
    In: Neurology, 2018, Vol.90(21), pp.e1933-e1934
    Keywords: Amnesia, Transient Global -- Diagnostic Imaging ; Subarachnoid Hemorrhage -- Diagnostic Imaging;
    ISSN: 0028-3878
    E-ISSN: 1526632X
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  • 8
    Language: English
    In: NeuroImage, 16 January 2012, Vol.59(2), pp.1413-1419
    Description: MR phase images have shown significantly improved contrast between cortical gray and white matter regions compared to magnitude images obtained with gradient echo sequences. A variety of underlying biophysical mechanisms (including iron, blood, myelin content, macromolecular chemical exchange, and fiber orientation) have been suggested to account for this observation but assessing the individual contribution of these factors is limited in vivo. For a closer investigation of iron and myelin induced susceptibility changes, postmortem MRI of six human corpses (age range at death: 56–80 years) was acquired in situ. Following autopsy, the iron concentrations in the frontal and occipital cortex as well as in white matter regions were chemically determined. The magnetization transfer ratio (MTR) was used as an indirect measure for myelin content. Susceptibility effects were assessed separately by determining R2* relaxation rates and quantitative phase shifts. Contributions of myelin and iron to local variations of the susceptibility were assessed by univariate and multivariate linear regression analysis. Mean iron concentration was lower in the frontal cortex than in frontal white matter (26 ± 6 vs. 45 ± 6 mg/kg wet tissue) while an inverse relation was found in the occipital lobe (cortical gray matter: 41 ± 10 vs. white matter: 34 ± 10 mg/kg wet tissue). Multiple regression analysis revealed iron and MTR as independent predictors of the effective transverse relaxation rate R2* but solely MTR was identified as source of MR phase contrast. R2* was correlated with iron concentrations in cortical gray matter only (r = 0.42, p 〈 0.05). In conclusion, MR phase contrast between cortical gray and white matter can be mainly attributed to variations in myelin content, but not to iron concentration. Both, myelin and iron impact the effective transverse relaxation rate R2* significantly. Magnitude contrast is limited because it only reflects the extent but not the direction of the susceptibility shift. ▶ Myelin is responsible for MRI phase contrast between cortical gray and white matter. ▶ Iron concentration is lower in the frontal cortex than in frontal white matter. ▶ Iron concentration is higher in the occipital cortex than in occipital white matter. ▶ Myelin content and iron are negatively correlated within white matter regions.
    Keywords: Mr Phase Contrast ; Susceptibility Contrast ; Gray–White Matter Contrast ; Brain Iron ; Myelin ; Medicine
    ISSN: 1053-8119
    E-ISSN: 1095-9572
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  • 9
    Language: English
    In: Journal of Neurology, 2013, Vol.260(5), pp.1417-1419
    Description: Byline: Thomas Gattringer (1), Alexander Pichler (1), Nina Homayoon (1), Kurt Niederkorn (1), Christian Enzinger (1,2), Franz Fazekas (1) Author Affiliation: (1) Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria (2) Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria Article History: Registration Date: 19/03/2013 Received Date: 05/02/2013 Accepted Date: 19/03/2013 Online Date: 30/03/2013
    Keywords: Brain Ischemia–Complications ; Cerebral Hemorrhage–Chemically Induced ; Cerebral Hemorrhage–Diagnosis ; Humans–Drug Therapy ; Male–Etiology ; Middle Aged–Adverse Effects ; Stroke–Adverse Effects ; Stroke–Adverse Effects ; Tissue Plasminogen Activator–Adverse Effects ; Tomography, X-Ray Computed–Adverse Effects ; Tissue Plasminogen Activator;
    ISSN: 0340-5354
    E-ISSN: 1432-1459
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  • 10
    In: Neurology, 2017, Vol.89(14), pp.1528-1529
    Description: A 73-year-old woman presented with acute lower back pain and right sensory radicular L4 syndrome. Spinal MRI showed a cranially shifted T2-hypointense mass suspicious for disc herniation in the L3/4 segment with compression of the right nerve root L4 (figure 1). Due to atypical morphology, CT was performed and disclosed an intraspinal epidural gas bubble mimicking disc herniation on MRI (figure 2). In association with coexisting intravertebral vacuum disc phenomenon (figure 2B), it appears likely that the gas gained access to the epidural space after annulus fibrosus rupture.1 Vacuum disc phenomenon results from the accumulation of gas (mostly nitrogen) within the crevices of the disc as it degenerates.1
    Keywords: Medicine;
    ISSN: 0028-3878
    E-ISSN: 1526632X
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