Johann Sellner

Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria

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Publications (112)395.75 Total impact

  • O. Györfi · M. Moarcas · P. Balicza · A. Macerollo · W. Struhal · J. Sellner ·
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    ABSTRACT: Background: Whether residency programs in Europe and neighboring countries appropriately prepare one for clinical practice is a matter of discussion. Aims of the study: To assess perceived satisfaction and preparedness for clinical practice among residents and junior neurologists from Europe and neighboring countries. Material and methods: We inquired about the level of satisfaction with the quality of teaching, rotations and research opportunities of their residency program with an anonymous paper-based questionnaire. We assessed different aspects of practical training including clinical examination, diagnostic procedures, and patient management. Results: The survey revealed limited satisfaction with the overall training (47%). The quality of teaching was frequently perceived as good or excellent (73%), whereas supervision for patient care and diagnostic procedures was rated as improvable. Discontent related often to poor proficiency for neurological emergencies, diagnostic considerations, and therapeutic decisions. Whether the working time directive introduced by the European Union (EU) affected patient care or resident education or residents' quality of life remained ambiguous. Conclusions: This cross-sectional survey disclosed shortcomings in current residency curricula. These concerned diagnostic and therapeutic procedures as well as practical skills, regardless of country, region, or institutional background. Initiatives aimed to harmonize postgraduate neurology training across Europe will need to consider these findings.
    Acta Neurologica Scandinavica 11/2015; DOI:10.1111/ane.12533 · 2.40 Impact Factor
  • L. Hauer · Y. Ebner · R. Stelzig-Schöler · E. Trinka · J. Sellner ·

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    ABSTRACT: Fingolimod, an oral sphingosine 1-phosphate (S1P) receptor modulator, is approved for the treatment of relapsing forms of multiple sclerosis (MS). The interference with S1P signaling leads to retention particularly of chemokine receptor-7 (CCR7) expressing T cells in lymph nodes. The immunological basis of varicella zoster virus (VZV) infections during fingolimod treatment is unclear. Here, we studied the dynamics of systemic and intrathecal immune responses associated with symptomatic VZV reactivation including cessation of fingolimod and initiation of antiviral therapy. Key features in peripheral blood were an about twofold increase of VZV-specific IgG at diagnosis of VZV reactivation as compared to the previous months, a relative enrichment of effector CD4+ T cells (36% versus mean 12% in controls), and an accelerated reconstitution of OPEN ACCESS Int. J. Mol. Sci. 2015, 16 21833 absolute lymphocytes counts including a normalized CD4+/CD8+ ratio and reappearance of CCR7+ T cells. In cerebrospinal fluid (CSF) the lymphocytic pleocytosis and CD4+/CD8+ ratios at diagnosis of reactivation and after nine days of fingolimod discontinuation remained unchanged. During this time CCR7+ T cells were not observed in CSF. Further research into fingolimod-associated VZV reactivation and immune reconstitution is mandatory to prevent morbidity and mortality associated with this potentially life-threatening condition.
    International Journal of Molecular Sciences 09/2015; 16(9):21832-21845. DOI:10.3390/ijms160921832 · 2.86 Impact Factor
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    ABSTRACT: Incidence and mortality of ischemic stroke in Croatia is significantly higher than in many other developed European countries. Here, we aimed to evaluate underlying conditions of this unacceptably high ischemic stroke burden. An observational prospective cohort study of ) first-ever ischemic stroke patients identified in a population-based incidence study (N=751) (study 1, S1) and a concurrent case-control trial (215 patients, 125 controls, S2) were conducted in the country of Varazdin from 2007-2010. Atrial fibrillation (AF) was common (36.1% in S1, 40.9% in S2) and mostly (>50%) unrecognized before the index event. In a multivariate analysis, odds of stroke increased with tobacco smoking (OR=3.95, 95%CI 1.33-10.8), unhealthy diet (OR=2.12, 1.12-4.01) and AF (OR=9.40, 4.01-22.0), and decreased with higher education (OR=0.33, 0.11-0.98), moderate alcohol consumption (OR=0.48, 0.25-0.93), higher fasting HDL (OR=0.14, 0.07-0.30) and pre-stroke use of anticoagulants (OR=0.09, 0.01-0.59), antihypertensive drugs (OR=0.52, 0.27-1.00) and statins (OR=0.29, 0.12-0.69. Fourteen-day case fatality was 10.8% (S1) and 6.1% (S2) and the risk was higher with AF, cardioembolic stroke, older age, higher fasting serum glucose, and lower with acute aspirin. Among the acute phase survivors, 30.9% died over the subsequent 1-3 years (p<0.05). We conclude that the incidence of ischemic stroke in Croatia is related to conventional risk factors and largely due to a high rate of unawareness and inadequate treatment of predisposing morbidity.
    Current neurovascular research 07/2015; 12(4). DOI:10.2174/1567202612666150731105554 · 2.25 Impact Factor
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    ABSTRACT: Stroke is a frequent disorder in patients with an antiphospholipid syndrome (APS). Due to a high risk for further thromboembolic events, appropriate anticoagulation therapy in patients with an APS-associated stroke seems mandatory but drug eluting and duration is a matter of debate. A 48-year-old female patient presented with Broca's aphasia and mild hemiparesis on the right side. Diagnostic work-up revealed left middle cerebral artery (MCA) occlusion yet without diffusion-weighted lesions. Due to a thrombocytopenia (67.00 g/l) systemic thrombolysis was not indicated and endovascular treatment was initiated 150 min after symptom onset. After successful clot retrieval, recurrent re-occlusions lead to the necessity of stent implantation and anticoagulation, respectively. On day 5 she developed a new severe right-sided hemiparesis. The magnetic resonance imaging (MRI) showed a subtotal restenosis of the left MCA despite the regular anticoagulation regime leading to a new left MCA ischaemic stroke. In the meantime, the unknown aetiology, the patients' age and the thrombocytopenia let to further diagnostic workup. Elevated blood parameters such as lupus anticoagulant (LA)-1, LA-ratio, positive anti-nuclear antibody (ANA), p-anti-neutrophil cytoplasmic antibodies (ANCA), c-ANCA confirmed the diagnosis of APS. This case report showed the feasibility of mechanical clot retrieval and stent implantation in patients with APS. Due to the elevated risk of in-stent thrombosis a prolonged therapy with glycoprotein (GP)IIb/IIIa receptor antagonists in the initial postoperative period and further anticoagulation with coumarin derivate might be needed. © The Author(s) 2015.
    Interventional Neuroradiology 07/2015; 21(5). DOI:10.1177/1591019915590371 · 0.78 Impact Factor

  • Journal of the neurological sciences 06/2015; DOI:10.1016/j.jns.2015.06.060 · 2.47 Impact Factor
  • P Balicza · O Györfi · V Papp · A Sauerbier · M Moarcas · A Macerollo · J Sellner ·

    European Journal of Neurology 05/2015; DOI:10.1111/ene.12721 · 4.06 Impact Factor

  • Clinical and Experimental Neuroimmunology 05/2015; 6(2). DOI:10.1111/cen3.12194
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    ABSTRACT: Introduction: Reduced working capability is one of the most devastating consequences of multiple sclerosis (MS). We aimed to study working capability and related variables in Swiss MS patients. Materials and methods: A cross-sectional analysis of employment status and risk factors for reduced working capability among MS patients treated at our outpatient clinic. A questionnaire was mailed to 644 MS patients and returned by 69.7%. 405 patients (66% female, mean age 44.2 years (SD ± 10.2), median EDSS 3.0 (SD ± 1.8)) were eligible for subsequent analysis. Results: After a mean disease duration of 12.3 years (SD ± 8.25), full or part time employment was declared by 26.7% and 25.7%, respectively. Incapacity to work was reported by 27.1%. A total of 52.8% specified MS as the cause for altered working capability, whereas 20.5% cited reasons unrelated to the disorder. Even with minimal disability (EDSS < 3) a significant proportion of patients (24%) reported reduced working capability. Among the MS-specific restricting factors were fatigue (47.6%), sensorimotor deficits (31.1%), impaired vision (3.3%) and pain (2.8%). Conclusion: MS continues to takes its toll on the professional life of the patients early in the course. While complete incapacity becomes relevant with moderate to severe disability, many patients scale down to part-time even with minimal impairment.
    PLoS ONE 04/2015; 10(4):e0121856. DOI:10.1371/journal.pone.0121856 · 3.23 Impact Factor
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    ABSTRACT: The future occupations and interests of the medical profession have to be in some respects different from those of the past, and they have to be more various.(1</SUP)
    Neurology 01/2015; 84(4):e20-3. DOI:10.1212/WNL.0000000000001180 · 8.29 Impact Factor
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    ABSTRACT: Strongly decreased leukocyte counts and a reduced CD4/CD8 T cell ratio in the cerebrospinal fluid (CSF) of natalizumab (NZB)-treated multiple sclerosis (MS) patients may have implications on central nervous (CNS) immune surveillance. With regard to NZB-associated progressive multifocal leukoencephalopathy we aimed at delineating a relationship between free NZB, cell-bound NZB, adhesion molecule (AM) expression, and the treatment-associated shift in the CSF T cell ratio. Peripheral blood (PB) and CSF T cells from fifteen NZB-treated MS patients, and CSF T cells from ten patients with non-inflammatory neurological diseases and five newly diagnosed MS patients were studied. Intercellular adhesion molecule-1 (ICAM-1), leukocyte function antigen-1 (LFA-1), very late activation antigen-4 (VLA-4), NZB saturation levels, and T cell ratios were analyzed by flow cytometry. NZB concentrations were measured by ELISA. Lower NZB saturation levels (P <.02) and a higher surface expression of ICAM-1 and LFA-1 (P <.001) were observed on CSF CD8 T cells. CSF T cell ratios (0.3-2.1) and NZB concentrations (0.01-0.42 µg/ml) showed a pronounced interindividual variance. A correlation between free NZB, cell-bound NZB, or AM expression levels and the CSF T cell ratio was not found. Extremely low NZB concentrations and a normalized CSF T cell ratio were observed in one case. The differential NZB saturation and AM expression of CSF CD8 T cells may contribute to their relative enrichment in the CSF. The reduced CSF T cell ratio appeared sensitive to steady-state NZB levels as normalization occurred quickly. Latter may be important concerning a fast reconstitution of CNS immune surveillance. This article is protected by copyright. All rights reserved. © 2015 British Society for Immunology.
    Clinical & Experimental Immunology 01/2015; 180(3). DOI:10.1111/cei.12590 · 3.04 Impact Factor
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    ABSTRACT: Objective: To assess the general interest in and motivation for cross-border mobility among residents and junior neurologists from member states of the European Union and neighboring countries. Methods: Questionnaire-based paper survey among 118 participants of a neurology course. Results: Ninety-seven (82%) participants returned the survey. Most of them had at one point considered relocating within or to the European Union for postgraduate education (87%) or employment (71%). Common motivations were superior prospects for clinical training (85%), resources at work and academic environment (both 80%), and remuneration (70%). Barely half of the surveyed intended to return to their home country. The attractiveness of Europe as a destination for migration was ranked over other continents. The most common reasons that reduce enthusiasm for relocation were the loss of family connection (55%) and uncertain future prospects (41%), whereas language barriers were less relevant (21%). Conclusion: There is keen interest of the upcoming generation of neurologists to relocate within and to the European Union. The motives include regional differences in training and career opportunities as well as economic welfare. Appropriate steps toward the harmonization of educational and career prospects are urgently required to ensure adequate provision of neurology service and patient care throughout Europe.
    Neurology 09/2014; 83(13):e-128-e131. DOI:10.1212/WNL.0000000000000813 · 8.29 Impact Factor
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    Antonella Macerollo · Johann Sellner ·

    Neurology 07/2014; 83(3):e45-7. DOI:10.1212/WNL.0000000000000598 · 8.29 Impact Factor
  • Johann Sellner · Israel Steiner ·
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    ABSTRACT: The clinical spectrum of viral hepatitis ranges from asymptomatic and inapparent to fulminant and fatal acute infection. Both acute and chronic liver dysfunction can lead to hepatic encephalopathy. Further neurological manifestations of hepatic viruses include various disorders of the central and peripheral nervous system (CNS and PNS, respectively). These can develop either as an isolated complication or in the setting of other extrahepatic manifestations. Alternatively, neurological signs and symptoms precede hepatitis, develop in the post-acute phase, or occur with anicteric hepatitis. This chapter summarizes the current knowledge of neurological manifestations of hepatic viruses and also covers conditions related to neurotoxicity caused by different antiviral drugs.
    Handbook of Clinical Neurology 07/2014; 123C:647-661. DOI:10.1016/B978-0-444-53488-0.00031-6
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    O Györfi · M Moarcas · P Balicza · A Macerollo · J Sellner ·

    European Journal of Neurology 07/2014; 21(7):941-5. DOI:10.1111/ene.12355 · 4.06 Impact Factor
  • K. Stadler · J. Sellner · A. Muss · E. Trinka · J. S. Mutzenbach ·

    Joint Congress of European Neurology; 05/2014
  • L. Grassner · H. Novak · A. Zerbs · E. Trinka · J. Sellner ·

    Joint Congress of European Neurology; 05/2014
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    ABSTRACT: Around the world, there are marked differences in neurology training, including training duration and degree of specialization. In the United States, adult neurology residency is composed of 1 year of internal medicine training (preliminary year) and 3 years of neurology-specific training. Child neurology, which is not the focus of this article, is 2 years of pediatrics and 3 years of neurology training. The route to adult neurology residency training in the United States is standardized and is similar to most other US specialties. Whereas US medical graduates often receive stepwise guidance from their medical school regarding application for residency training, international graduates often enter this complex process with little or no such assistance. Despite this discrepancy, about 10%-15% of residency positions in the United States are filled by international medical graduates.(1,2) In adult neurology specifically, 35% of matched positions were filled by international graduates in 2013, 75% of whom were not US citizens.(1) In an effort to provide a preliminary understanding of the application process and related terminology (table 1) and thereby encourage international residency applicants, we describe the steps necessary to apply for neurology residency in the United States.
    Neurology 04/2014; 82(14):e112-5. DOI:10.1212/WNL.0000000000000279 · 8.29 Impact Factor
  • J. Sellner · N. W. Davies · R. S. Howard · A. Petzold ·
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    ABSTRACT: Background and purposeThe neurological outcome of acute encephalitis can be devastating and early prognosis remains difficult. Biomarkers that quantify the extent of early brain injury are needed to improve the prognostic accuracy and aid patient management. Our objective was to assess whether cerebrospinal fluid (CSF) protein biomarkers of neuroaxonal and glial cell injury are elevated in distinct forms of acute encephalitis and predictive of poor outcome.Methods This was a prospective study of patients presenting with acute encephalitis to three teaching hospitals in London, UK. Levels of neurofilament heavy chain (NfH, SMI35) and S100B were quantified in CSF using enzyme-linked immunosorbent assay. The outcome was assessed by the Glasgow Outcome Scale (GOS).ResultsFifty-six patients with acute encephalitis were recruited and classified into the following diagnostic categories: infectious (n = 20), inflammatory (n = 14) and unknown etiology (n = 22). Pathological levels of NfH and S100B were observed in 24/56 (43%) and 54/56 (96%), respectively. Patients with infectious encephalitis had significantly higher NfH levels compared with the other two groups (P < 0.05). A poor outcome (GOS < 5) was associated with significantly higher CSF NfH levels within samples taken 2 weeks after symptom onset.Conclusions This study suggests that longitudinal CSF NfH levels are of superior prognostic value compared with CSF S100B levels. Prolonged release of NfH, a marker of neuroaxonal damage, was associated with poor outcome. Potentially there is a window of opportunity for future neuroprotective treatment strategies in encephalitis.
    European Journal of Neurology 03/2014; 21(6). DOI:10.1111/ene.12390 · 4.06 Impact Factor
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    Martin Rakusa · Walter Struhal · Johann Sellner ·
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    ABSTRACT: "The secret of happiness is freedom. The secret of freedom is courage."(1)-Thucydides (Ancient Greek historian and author, 460-404 bc).
    Neurology 02/2014; 82(6):536-9. DOI:10.1212/WNL.0000000000000098 · 8.29 Impact Factor

Publication Stats

1k Citations
395.75 Total Impact Points


  • 2011-2015
    • Paracelsus Medical University Salzburg
      • Christian Doppler Clinic
      Salzburg, Salzburg, Austria
  • 2012
    • Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel
      Wiener Neustadt, Lower Austria, Austria
  • 2008-2012
    • Technische Universität München
      München, Bavaria, Germany
    • Universität Bern
      Berna, Bern, Switzerland
  • 2009
    • Brussels University Association
      Bruxelles, Brussels Capital Region, Belgium
  • 2007
    • Inselspital, Universitätsspital Bern
      • Department of Neurology
      Berna, Bern, Switzerland
  • 2003-2004
    • Universität Heidelberg
      • • Department of Neurology
      • • Abteilung Neurologie und Poliklinik
      Heidelburg, Baden-Württemberg, Germany