J T Tans

Medisch Centrum Haaglanden, 's-Gravenhage, South Holland, Netherlands

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Publications (10)49.29 Total impact

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    ABSTRACT: We present the baseline characteristics of 101 patients with normal pressure hydrocephalus (NPH), entering a study that evaluates the diagnostic reliability of CSF outflow resistance. Patients were assessed by a gait scale consisting of 10 features of walking and the number of steps and seconds necessary for 10 m, a dementia scale comprising the 10 word test, trail making, digit span and finger tapping, the modified Mini Mental State Examination (3MSE) and the modified Rankin scale (MRS). Inclusion criteria were a gait and dementia scale ≥ 12 (range 2–40), a MRS ≥ 2 and a communicating hydrocephalus on CT. Gait disorder and dementia varied from mild to severe leading to MRS 2 in 17%, MRS 3 in 34%, MRS 4 in 21%, MRS 5 in 16% and MRS 6, including akinetic mutism, in 12%. Only one patient showed both normal tandem walking and turning. Small steps, reduced foot floor clearance and wide base were also frequently seen in the 67 patients walking independently; 34 needed assistance or could not walk at all. Applying the 3MSE, 64% were demented; the remaining 36% exhibited a milder cognitive deficit. The 10 word test and trail making decreased with increasing dementia. Digit span and finger tapping declined in the most demented patients. This group of elderly patients with NPH, mostly of the idiopathic type, proved to be vulnerable because of considerable disability and comorbidity.
    European Journal of Neurology 01/2011; 4(1):39 - 47. DOI:10.1111/j.1468-1331.1997.tb00297.x · 3.85 Impact Factor
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    ABSTRACT: To evaluate the interobserver agreement on magnetic resonance imaging (MRI) evaluation of herniated discs, spondylotic neuroforaminal stenosis, and root compression in patients with recent onset cervical radiculopathy and in addition, to assess the added value of disclosure of clinical information to interobserver agreement. The MRI images of 82 patients with less than 1 month of symptoms and signs of cervical radiculopathy were evaluated independently by two neuroradiologists who were unaware of clinical findings. MRI analysis was repeated after disclosure of clinical information. Interobserver agreement was calculated using kappa statistics. The kappa score for evaluation of herniated discs and of spondylotic foramen stenosis was 0.59 and 0.63, respectively. A kappa score of 0.67 was found for the presence of root compression. After disclosure of clinical information kappa scores increased slightly: from 0.59 to 0.62 for the detection of herniated discs, from 0.63 to 0.66 for spondylotic foramen stenosis, and from 0.67 to 0.76 for root compression. Interobserver reliability of MRI evaluation in patients with cervical radiculopathy was substantial for root compression, with or without clinical information. Agreement on the cause of the compression, i.e., herniated disc or spondylotic foraminal stenosis, was lower.
    Clinical Radiology 01/2011; 66(1):25-9. DOI:10.1016/j.crad.2010.07.010 · 1.66 Impact Factor
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    ABSTRACT: To evaluate the occurrence of symptomatic and asymptomatic root compression caused by herniated discs and spondylotic foraminal stenosis by MRI in patients with recent onset cervical radiculopathy. 78 patients with symptoms and signs of cervical radiculopathy of less than one month's duration. The authors determined the clinically suspected level of root compression in each patient. Two neuroradiologists independently evaluated MRIs, blinded for the clinical findings. For each patient, the level of root compression on MRI was compared with the clinically affected level. The authors also examined the cause of compression: herniated disc, spondylotic foraminal stenosis or both. In 73% of patients, the clinically affected root was compressed on MRI. In 45%, MRI showed root compression without clinical substrate together with, or to a lesser extent without, the coexistence of compression of the clinically affected root. MRIs were assessed as normal in 13-15% of cases, and in 9-10% only asymptomatic roots were compressed. Herniated discs without spondylosis were more often responsible for root compressions only at the clinically affected level and spondylotic foraminal stenosis for multiple root compression including compression of clinically unaffected roots. MRI findings in patients with cervical radiculopathy should be interpreted together with the clinical findings, as false-positive and false-negative MRIs occur rather frequently.
    Journal of neurology, neurosurgery, and psychiatry 11/2010; 82(5):561-3. DOI:10.1136/jnnp.2010.217182 · 5.58 Impact Factor
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    ABSTRACT: Objective To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy.Design Randomised controlled trial.Setting Neurology outpatient clinics in three Dutch hospitals.Participants 205 patients with symptoms and signs of cervical radiculopathy of less than one month’s durationInterventions Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group).Main outcome measures Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks.Results In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (β=−3.1 mm, 95% confidence interval −4.0 to −2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: β=−1.9 mm, −3.3 to −0.5 mm; physiotherapy: β=−1.9, −3.3 to −0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (β=−0.9 mm, −2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (−4.2 to −1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (−3.9 to −0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (β=−0.9 mm, −1.6 to −0.1) and a non-significant effect with physiotherapy and home exercises.Conclusion A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy.Trial registration Clinical trials NCT00129714.
    BMJ: British medical journal 10/2009; 339:b3883. DOI:10.1136/bmj.b3883 · 16.30 Impact Factor
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    ABSTRACT: Degenerative cervical radiculopathy: clinical diagnosis and conservative treatment. A review. To provide a state-of-the-art assessment of diagnosis and non-surgical treatment of degenerative cervical radiculopathy a literature search for studies on epidemiology, diagnosis including electrophysiological examination and imaging studies, and different types of conservative treatment was undertaken. The most common causes of cervical root compression are spondylarthrosis and disc herniation. Diagnosis is made mainly on clinical grounds, although there are no well-defined criteria. Provocative tests like the foraminal compression test are widely used but not properly evaluated. The clinical diagnosis of degenerative cervical radiculopathy can be confirmed by magnetic resonance imaging. The role of electromyography is mainly to rule out other conditions. Cervical radiculopathy is initially treated conservatively, although no treatment modality has been evaluated in a randomized controlled trial. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review.
    European Journal of Neurology 02/2009; 16(1):15-20. DOI:10.1111/j.1468-1331.2008.02365.x · 3.85 Impact Factor
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    ABSTRACT: To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. Randomised controlled trial. Neurology outpatient clinics in three Dutch hospitals. 205 patients with symptoms and signs of cervical radiculopathy of less than one month's duration Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group). Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks. In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (beta=-3.1 mm, 95% confidence interval -4.0 to -2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: beta=-1.9 mm, -3.3 to -0.5 mm; physiotherapy: beta=-1.9, -3.3 to -0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (beta=-0.9 mm, -2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (-4.2 to -1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (-3.9 to -0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (beta=-0.9 mm, -1.6 to -0.1) and a non-significant effect with physiotherapy and home exercises. A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy. Trial registration Clinical trials NCT00129714.
    BMJ (online) 01/2009; 339:b3883. · 16.38 Impact Factor
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    ABSTRACT: OBJECTIVE: To compare the effectiveness of 3 non-surgical treatment strategies in patients with recent-onset cervical radiculopathy. DESIGN: Randomised controlled trial. METHOD: 205 outpatients with less than 1 month of symptoms and signs of cervical radiculopathy were treated with a semi-hard cervical collar and as much rest as possible for 3-6 weeks, or 12 two-weekly sessions of physiotherapy and home exercises for 6 weeks, or a continuation of daily activities as much as possible without specific treatment (wait-and-see; control treatment). The primary outcome measures were changes in the scores for arm and neck pain on a 100 mm visual analogue scale (VAS) and of the Neck Disability Index (NDI) during the first 6 weeks. Differences in trends between the treatment groups were analysed using generalised estimating equations. RESULTS: In the control group arm pain diminished 3 mm per week on the VAS (19 mm in 6 weeks). Additional pain reduction was achieved with the cervical collar and with physiotherapy: extra reduction of 12 mm in arm pain in 6 weeks compared to the control treatment. In the control group, neck pain did not significantly decrease. Treatment with the cervical collar resulted in a reduction of 2.8 mm per week on the VAS (17 mm in 6 weeks), whereas physiotherapy gave a reduction of 2.4 mm per week (14 mm in 6 weeks). Compared to the control treatment, only treatment with the cervical collar resulted in a significant improvement to the NDI. CONCLUSION: For patients with a recent onset cervical radiculopathy, both treatment with a semi-hard cervical collar and physiotherapy led to a substantial reduction in neck and arm pain in the first 6 weeks compared to a wait-and-see policy.
    Nederlands tijdschrift voor geneeskunde 01/2009; 154(11):A1283.
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    ABSTRACT: In three patients, a 52-year old man, a 54-year old man and a 17-year old woman, sudden neurological signs such as hemiparalysis and hemihypaesthesia developed, with diminished consciousness occurring at a later stage. Imaging revealed total infarction of the area supplied by the right middle cerebral artery with the threat of intracranial hypertension. Once informed consent had been obtained from the patient's representatives, hemicraniectomy with dural augmentation was performed. Although the primary neurological deficit persisted, the three patients assessed their quality of life as valuable with their Barthel scores ranging from 45 to 90. Total infarction of the middle cerebral artery may result in intracranial hypertension and transtentorial herniation owing to the development of cytotoxic oedema, particularly in young patients. The prognosis of this condition is poor partly due to the limited effect of non-surgical treatment. Hemicraniectomy with dural augmentation prevents secondary brain damage caused by the space-occupying effect of the infarct. This operation reduces mortality considerably. The findings in these patients along with the results in the literature warrant a randomised study of the results of hemicraniectomy in patients with malignant middle cerebral artery infarction.
    Nederlands tijdschrift voor geneeskunde 04/2001; 145(13):639-43.
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    ABSTRACT: Comparison of the predictive value of four "diagnostic tests" for the outcome of shunting in patients with normal-pressure hydrocephalus (NPH). Ninety-five NPH patients who received shunts were followed for 1 year. Gait disturbance and dementia were quantified by an NPH scale and handicap by a modified Rankin scale. Primary outcome measures were differences between the preoperative and last scores on both the NPH scale and the modified Rankin scale. Clinical and computed tomographic (CT) findings typical of NPH, absence of cerebrovascular disease, and a resistance to outflow of cerebrospinal fluid (CSF) >/= 18 mmHg/ml/minute were designated as a positive test outcome; clinical and CT findings compatible with NPH, presence of cerebrovascular disease, and an outflow resistance < 18 mmHg/ml/minute as a negative test outcome. For each of the four tests the percentage of patients classified as improved was significantly greater for those with positive than with negative test results. Measurement of CSF outflow resistance was the only significant prognostic factor for the improvement ratio in NPH scale and CT in the modified Rankin scale according to multivariate logistic regression analysis. The accurate predictive value of the combination of typical clinical and CT findings was 0.65, that of the positive test results of outflow resistance, clinical and CT findings was 0.74. The best strategy is to shunt NPH patients if their outflow resistance is >/= 18 mmHg/ml/minute or, when the outflow resistance is lower, if their clinical as well as their CT findings are typical of NPH.
    Surgical Neurology 03/2000; 53(3):201-7. DOI:10.1016/S0090-3019(00)00182-8 · 1.67 Impact Factor
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    ABSTRACT: The value of the measurements of CSF outflow resistance (Rcsf) relative to predicting outcome after shunting was studied. In a group of 101 patients with mainly idiopathic normal pressure hydrocephalus (NPH) Rcsf was obtained by lumbar constant flow infusion. Gait disturbance and dementia were quantified using an NPH scale (NPHS) and disability by the Modified Rankin scale (MRS). Patients were assessed before and at 1, 3, 6, 9 and 12 months after surgery. Outcome measures were differences between the preoperative and last NPHS and MRS scores. Improvement was defined as a change of > or = 15% in NPHS and > or = 1 grade in MRS. Intention-to-treat analysis of all patients at one year yielded improvement of 57% in NPHS and 59% in MRS. Efficacy analysis, excluding comorbidity unrelated to NPH, revealed positive predictive values of around 80% at Rcsf < 18, and between 90% and 100% at Rcsf > or = 18 mm Hg/ml/min. For Rcsf > or = 18, the likelihood ratios were also higher. We conclude that the best predictor of the response to shunting is an Rcsf > or = 18 mm Hg/ml/min. Since two-thirds of the patients with Rcsf < 18 showed improvement as well, these patients should not be denied shunting.
    Acta neurochirurgica. Supplement 02/1998; 71:331-3.