Publications by authors named "Patricia Krause"

Background: Segmented electrodes for deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) enable directional current steering leading to expanded programming options.

Objective: This retrospective study covering a longitudinal period of up to 7 years compares the efficacy of segmented and non-segmented leads in motor symptom alleviation and reduction of dopaminergic medication in PD patients treated in a specialized center and assesses the long-term use of directional steering in clinical routine.

Methods: Demographic data and clinical scores before surgery and at 12-month follow-up (12MFU) as well as stimulation parameters at 12MFU and last follow-up (LFU) were assessed in all patients implanted with segmented leads between 01/2016 and 12/2019 and non-segmented leads in a corresponding time-period.

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  • Dystonia is a movement disorder linked to an imbalance in brain pathways involving the striatum and internal pallidum, but its neuronal causes are not fully understood.
  • This study conducted invasive recordings from ten dystonia patients using deep brain stimulation electrodes to observe brain activity across different basal ganglia nuclei.
  • Findings showed that low-frequency brain activity between the striatum and internal pallidum correlates with the severity of dystonic symptoms, highlighting the importance of the direct striato-pallidal pathway in the disorder's development.
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  • Recent studies have found a brain network linked to improvement in Parkinson's disease (PD) after deep brain stimulation (DBS), called the PD response network.
  • The study explored how noninvasive multifocal transcranial direct current stimulation (tDCS) affects motor symptoms in PD by targeting this network.
  • Results showed that active tDCS led to a significant reduction in PD symptoms compared to sham stimulation, suggesting noninvasive stimulation can effectively improve motor function in PD patients.
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Minimally invasive biomarkers are urgently needed to detect molecular pathology in frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). Here, we show that plasma extracellular vesicles (EVs) contain quantifiable amounts of TDP-43 and full-length tau, which allow the quantification of 3-repeat (3R) and 4-repeat (4R) tau isoforms. Plasma EV TDP-43 levels and EV 3R/4R tau ratios were determined in a cohort of 704 patients, including 37 genetically and 31 neuropathologically proven cases.

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  • Multiple system atrophy (MSA) is a serious disease that affects movement and is hard to treat.
  • Researchers studied MSA patients to see what other health problems they have and how many medications they take.
  • They found that MSA patients have more health issues, especially related to the bladder and kidneys, and take more medications, which can lead to dangerous drug interactions.
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Aim Of The Study: This study was conducted in a pre-post design with a survey of patients who had undergone deep brain stimulation (DBS) as treatment for a neurological movement disorder. The aim of the study was to compare patients' expectations and beliefs before a DBS intervention with patients' subjective experience of this intervention.

Methodology: The longitudinal study of patients (n=132) with an indication for DBS therapy was based on a written survey at the time points of preoperative screening (pre-op) and one-year follow-up (post-op).

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  • Advanced therapies (ATs) like deep brain stimulation and pump therapies are used for advanced Parkinson's disease but may lose effectiveness or cause side effects, necessitating changes or combinations of treatments.
  • A nationwide study in Germany analyzed data from 22 centers to assess the effects and reasons for modifications in these ATs, using retrospective questionnaires to gather relevant clinical information since 2005.
  • Results showed that 148 modifications across 116 patients led to significant improvements in symptom control and reduced side effects, with the main reasons for changes being inadequate symptom management and side effects from previous treatments.
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Background: Deep brain stimulation (DBS) is an effective treatment option for patients with Parkinson's disease (PD). However, clinical programming remains challenging with segmented electrodes.

Objective: Using novel sensing-enabled neurostimulators, we investigated local field potentials (LFPs) and their modulation by DBS to assess whether electrophysiological biomarkers may facilitate clinical programming in chronically implanted patients.

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  • Progressive supranuclear palsy (PSP) patients, typically older adults, have a distinct pattern of health comorbidities and often take multiple medications compared to those without neurodegenerative diseases.
  • The study analyzed data from over 600 patients, revealing higher rates of circulatory and nervous system diseases in PSP patients, alongside increased occurrences of conditions like diabetes and polyneuropathies.
  • The PSP group showed significantly more polypharmacy, leading to a higher risk of severe drug interactions, highlighting the need for careful management of treatment in these patients.
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Brain computer interfaces (BCI) provide unprecedented spatiotemporal precision that will enable significant expansion in how numerous brain disorders are treated. Decoding dynamic patient states from brain signals with machine learning is required to leverage this precision, but a standardized framework for identifying and advancing novel clinical BCI approaches does not exist. Here, we developed a platform that integrates brain signal decoding with connectomics and demonstrate its utility across 123 hours of invasively recorded brain data from 73 neurosurgical patients treated for movement disorders, depression and epilepsy.

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Background And Purpose: Over-sedation may confound neurologic assessment in critically ill neurologic patients and prolong duration of mechanical ventilation (MV). Decreased sedative use may facilitate early functional independence when combined with early mobility. The objective of this study was to evaluate the impact of a stepwise, multidisciplinary analgesia-first sedation pathway and early mobility protocol on medication use and mobility in the neuroscience intensive care unit (ICU).

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Introduction: Deep brain stimulation (DBS) is an established treatment in patients of various ages with pharmaco-resistant neurological disorders. Surgical targeting and postoperative programming of DBS depend on the spatial location of the stimulating electrodes in relation to the surrounding anatomical structures, and on electrode connectivity to a specific distribution pattern within brain networks. Such information is usually collected using group-level analysis, which relies on the availability of normative imaging resources (atlases and connectomes).

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Background: Subthalamic nucleus (STN) beta (13 - 35 Hz) activity is a biomarker reflecting motor state in Parkinson's disease (PD). Adaptive deep brain stimulation (DBS) aims to use beta activity for therapeutic adjustments, but many aspects of beta activity in real-life situations are unknown.

Objective: The aim was to investigate Christmas-related influences on beta activity in PD.

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Introduction And Goal: The investigation of gender differences in treatment response is crucial for effective personalized therapies. With only 30%, women are underrepresented in trials for deep brain stimulation (DBS) in Parkinson's disease (PD). It is therefore important to evaluate gender-specific outcomes of DBS in PD in order to improve therapeutic counseling.

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Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly effective in controlling motor symptoms in patients with Parkinson's disease. However, correct selection of stimulation parameters is pivotal to treatment success and currently follows a time-consuming and demanding trial-and-error process. We aimed to assess treatment effects of stimulation parameters suggested by a recently published algorithm (StimFit) based on neuroimaging data.

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Introduction: Subthalamic Deep Brain Stimulation (STN-DBS) is a safe and well-established therapy for the management of motor symptoms refractory to best medical treatment in patients with Parkinson's disease (PD). Early intervention is discussed especially for Early-onset PD (EOPD) patients that present with an age of onset ≤ 45-50 years and see themselves often confronted with high psychosocial demands.

Methods: We retrospectively assessed the effect of STN-DBS at 12 months follow-up (12-MFU) in 46 EOPD-patients.

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Background: Inpatient as well as outpatient care does often not meet PD-patients' individual needs.

Introduction: Day-clinic concepts encompassing a multidisciplinary team as well as therapy adjustments accompanying everyday demands aim at filling this gap.

Methods: This is a retrospective study on short-term effects of a 3 week multidisciplinary rehabilitation program in patients with Parkinson´s disease (PD) embedded in a specialized movement disorder day-clinic.

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Current efforts to optimise subthalamic deep brain stimulation in Parkinson's disease patients aim to harness local oscillatory activity in the beta frequency range (13-35 Hz) as a feedback-signal for demand-based adaptive stimulation paradigms. A high prevalence of beta peak activity is prerequisite for this approach to become routine clinical practice. In a large dataset of postoperative rest recordings from 106 patients we quantified occurrence and identified determinants of spectral peaks in the alpha, low and high beta bands.

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Introduction: Pallidal DBS is an established treatment for severe isolated dystonia. However, its use in disabling and treatment-refractory tardive syndromes (TS) including tardive dyskinesia and tardive dystonia (TD) is less well investigated and long-term data remain sparse. This observational study evaluates long-term effects of deep brain stimulation (DBS) of the globus pallidus internus (GPi) in patients with medically refractory TS.

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Background And Purpose: Biomarkers for future adaptive deep brain stimulation still need evaluation in clinical routine. Here, we aimed to assess stimulation-induced modulation of beta-band activity and clinical symptoms in a Parkinson's disease patient during chronic neuronal sensing using a novel implantable pulse generator.

Methods: Subthalamic activity was recorded OFF and ON medication during a stepwise increase of stimulation amplitude.

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Objective: Observational study to evaluate long-term effects of deep brain stimulation (DBS) of the globus pallidus internus (GPi) and the ventral intermediate thalamic nucleus (VIM) on patients with medically refractory myoclonus dystonia (MD).

Background: More recently, pallidal as well as thalamic DBS have been applied successfully in MD but long-term data are sparse.

Methods: We retrospectively analyzed a cohort of seven MD patients with either separate (n = 1, VIM) or combined GPi- DBS and VIM-DBS (n = 6).

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In patients with ischemic stroke who receive systemic recombinant tissue plasminogen activator (rt-PA), the risk of secondary hemorrhage is 1-7%. Fibrinogen supplementation with cryoprecipitate is recommended in patients with rt-PA-associated symptomatic hemorrhage. We examined whether fibrinogen concentrate can be used safely in this setting.

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Mutations in the ADCY5 gene can cause a complex hyperkinetic movement disorder. Episodic exacerbations of dyskinesia are a particularly disturbing symptom as they occur predominantly during night and interrupt sleep. We present the clinical short- and long-term effects of pallidal deep brain stimulation (DBS) in three patients with a confirmed pathogenic ADCY5 mutation.

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