L A Hoffmann

Ludwig-Maximilian-University of Munich, München, Bavaria, Germany

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Publications (13)38.99 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Paraneoplastic neurological syndromes (PNS) are indirect remote effects of cancer on the nervous system, often associated with the presence of specific serum antibodies. The most recently described PNS defining reactivity is anti-Ma/anti-Ta. Here we present 22 newly diagnosed patients with anti-Ma or anti-Ta reactivity, refine the associated clinical picture and review all published patients to date. Patients were identified by testing for PNMA1 and PNMA2 antibodies by western blotting and indirect immunofluorescence. Clinical data were obtained either by referral of the patient or from the referring physicians. Analysis of 22 new patients (14 anti-Ma, eight anti-Ta) confirmed that anti-Ta are usually found in young men with limbic encephalitis and testicular germ cell tumours who stabilise neurologically with long term survival after tumour treatment. Patients with anti-Ma were of either sex, middle-aged, presented with a range of tumours and neurological symptoms and had a limited response to treatment. Furthermore, we expanded the range of associated clinical features: (1) the peripheral nervous system may be involved; (2) an overlap with anti-Hu is possible; and (3) testicular tumour manifestation can be extragonadal or detectable only at orchiectomy. Refining and expanding the range of anti-Ma/anti-Ta associated neurological presentations and tumours clearly demonstrated that the distinction between anti-Ma and anti-Ta associated PNS is of high clinical relevance.
    Journal of neurology, neurosurgery, and psychiatry 08/2008; 79(7):767-73. · 4.87 Impact Factor
  • Journal of Neurology 07/2008; 255(7):1100-1. · 3.58 Impact Factor
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    ABSTRACT: Recently, a new subtype of limbic encephalitis (LE) has been described, serologically characterized by the presence of antibodies against voltage gated potassium channels (VGKC, to be called VGKC-LE). Only little is known about CSF findings in this new disorder. Here we report the results of 29 lumbar punctures in 17 patients with VGKC-LE. Slight pleocytosis, mainly consisting of lymphocytes and monocytes, and elevated total protein concentrations were present in 41 and 47%, respectively. Intrathecal immunoglobulin (Ig) synthesis as defined by the presence of CSF-specific oligoclonal IgG bands, an increased IgG index, or an elevated IgG, IgA, or IgM ratio, was not detected in any of the patients, but dysfunction of the blood-CSF barrier was found in 35%. CSF findings were normal in 23%. Conclusions: Unlike paraneoplastic LE, VGKC-LE is not frequently associated with intrathecal Ig production or markedly elevated white cell counts. Thus, normal CSF findings do not preclude the disease. VGKC-Ab should, therefore, be determined whenever LE is clinically suspected, irrespective of the presence or absence of inflammatory CSF changes.
    Journal of the Neurological Sciences 06/2008; 268(1-2):74-7. · 2.24 Impact Factor
  • Neurology 04/2008; 70(13 Pt 2):1155-6. · 8.25 Impact Factor
  • Archives of Neurology - ARCH NEUROL. 01/2008; 65(6):852-852.
  • Aktuelle Neurologie - AKTUEL NEUROL. 01/2008; 35.
  • L. A Hoffmann, P Lohse, R Hohlfeld, T Kuempfel
    Aktuelle Neurologie - AKTUEL NEUROL. 01/2008; 35.
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    ABSTRACT: Natalizumab is a new therapeutic option for relapsing-remitting multiple sclerosis. As with other antibody therapies, hypersensitivity reactions have been observed. In the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) trial, infusion-related hypersensitivity reactions developed in 4% of patients, usually within 2 hours after starting the infusion. To report a significant, delayed, serum sickness-like, type III systemic allergic reaction to natalizumab. Case report describing clinical follow-up and the serial measurement of antinatalizumab antibodies. Patient: A 23-year-old man with relapsing-remitting multiple sclerosis developed a fever, arthralgias, urticarial exanthema, and a swollen lower lip during several days after his second infusion of natalizumab. The patient developed a delayed, serum sickness-like, type III systemic allergic reaction to natalizumab. Five weeks after initiation of this therapy, he tested positive for antinatalizumab antibodies and exhibited persistent antibody titers 8 and 12 weeks later. His symptoms completely resolved with a short course of oral glucocorticosteroids. Clinicians and patients should be alert not only to immediate but also to significantly delayed substantial allergic reactions to natalizumab.
    JAMA Neurology 10/2007; 64(9):1331-3. · 7.58 Impact Factor
  • Neurology 04/2007; 68(12):958-9. · 8.25 Impact Factor
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    ABSTRACT: Due to its chronic and fluctuating time course, multiple sclerosis (MS), thus far, has not been regarded as a focus of palliative care. However, sometimes we are confronted with severely affected MS patients, who suffer from complex medical, physical and psychosocial problems, which are not fully covered by the current health care services. We present two cases of severely affected MS patients we saw in our outpatient MS clinic, and who, we believe, are candidates for palliative care. The first patient, with primary chronic progressive (pcP) MS for many years (Expanded Disability Status Scale (EDSS): 8.0) presented with complex painful dysaesthesias and a depressive syndrome. He refused any treatment, and finally committed suicide with the help of a euthanasia group in Switzerland. The second patient was also severely affected by a secondary chronic progressive (scP) MS (EDSS: 9.0) and was finally admitted to our palliative care unit due to a complex pain syndrome associated with panic attacks and anxiety. She spent three weeks on the palliative care unit and her symptoms improved gradually after changing and optimising her pain medication. The patient was discharged with home care and is seen regularly on the palliative care unit. Additionally, as a first step, a questionnaire was sent to 53 German MS specialists regarding their general view on the needs for palliative care in MS. Our two cases and the results of the questionnaire demonstrated that MS patients and their caregivers are confronted with a variety of symptoms which are difficult to treat, and are a cause of great suffering for the patients, including ataxia, depression and fatigue. The data of the questionnaire also showed that neurologists usually do not deal with end-of-life care issues in MS.More research is needed to define the role of palliative care in MS and establish appropriate interventions to improve the quality of life in advanced stage MS patients and their relatives.
    Palliative Medicine 04/2007; 21(2):109-14. · 2.61 Impact Factor
  • Aktuelle Neurologie - AKTUEL NEUROL. 01/2007; 34.
  • L A Hoffmann, T Kümpfel, I Heer, R Hohlfeld
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    ABSTRACT: Pregnancy and family planning issues are prominent concerns in the medical care of multiple sclerosis patients, since the disease onset often coincides with a period of life that is decisive in this regard. Multiple sclerosis is a chronic disorder with an unpredictable course and is widely treated with long-term immunomodulatory agents, raising questions regarding the complications and effects of these therapies on pregnancy. This paper gives an overview of the relevant literature and provides a basis for individual counselling of this group of multiple sclerosis patients.
    Der Nervenarzt 07/2006; 77(6):663-4, 666-8, 670. · 0.80 Impact Factor
  • L. A. Hoffmann, T. Kümpfel, I. Heer, R. Hohlfeld
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    ABSTRACT: Familienplanung und Kinderwunsch sind hufig diskutierte Fragen in der MS-Sprechstunde. Offensichtliche Grnde hierfr sind u.a., dass die Erstmanifestation der MS hufig in eine fr eine Familiengrndung entscheidende Lebensphase fllt. Wie bei anderen chronischen Erkrankungen mit schwierig abschtzbarer Prognose und der Notwendigkeit einer langfristigen medikamentsen Therapie ergeben sich Fragen ber mgliche Komplikationen und Konsequenzen der immunmodulatorischen Therapie im Rahmen einer Schwangerschaft. Diese bersicht soll als Grundlage dienen fr die individuelle Beratung und Betreuung MS-betroffener Patientinnen und Patienten, die mit Fragen bezglich Schwangerschaft und immunmodulatorischer Therapie in die MS-Sprechstunde kommen.Pregnancy and family planning issues are prominent concerns in the medical care of multiple sclerosis patients, since the disease onset often coincides with a period of life that is decisive in this regard. Multiple sclerosis is a chronic disorder with an unpredictable course and is widely treated with long-term immunomodulatory agents, raising questions regarding the complications and effects of these therapies on pregnancy. This paper gives an overview of the relevant literature and provides a basis for individual counselling of this group of multiple sclerosis patients.
    Der Nervenarzt 05/2006; 77(6):663-670. · 0.80 Impact Factor

Publication Stats

111 Citations
38.99 Total Impact Points

Institutions

  • 2006–2008
    • Ludwig-Maximilian-University of Munich
      • Institute for Clinical Neuroimmunology
      München, Bavaria, Germany
    • University Hospital München
      München, Bavaria, Germany