Matthias Ponfick

Philipps University of Marburg, Marburg, Hesse, Germany

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Publications (12)31.71 Total impact

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    ABSTRACT: Stroke induces structural and functional changes within the cortical motor network of both hemispheres. Repetitive transcranial magnetic stimulation modulates the excitability of the motor cortex and thereby may facilitate motor function and/or recovery of motor function after stroke. Based on a systematic literature search we identified 33 placebo-controlled trials which examined the effectiveness of repetitive transcranial magnetic stimulation in the treatment of impaired hand function following stroke. Despite limitations, the majority of the studies referred to the interhemispheric competition model after stroke to apply repetitive transcranial magnetic stimulation. In a comparative approach, methodology and effectiveness of (a) inhibition of the unaffected hemisphere, (b) facilitation of the affected hemisphere and (c) combined application of repetitive transcranial magnetic stimulation over the affected and unaffected hemispheres to treat impaired hand function after stroke are presented. Problems and limitations of repetitive transcranial magnetic stimulation in stroke rehabilitation are discussed and visions for future clinical research are presented.
    Fortschritte der Neurologie · Psychiatrie 03/2014; 82(3):135-44. · 0.85 Impact Factor
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    ABSTRACT: We investigated if longer weaning is associated with inferior rehabilitative outcome in critical illness polyneuropathy (CIP) and cerebrovascular diseases (CVD). We analysed retrospectively weaning protocols and medical histories of 171 tracheotomized patients with CIP and CVD. We assessed weaning durations (WD), independence in activities of daily living, as assessed by the functional independence measure (FIM), mortality rates and discharge modalities in each cohort. Weaning was performed using synchronized intermittent mandatory ventilation (SIMV) with Autoflow® and assisted spontaneous ventilation (ASV). WD was significantly longer in CIP compared to CVD (p < 0.001). Despite shorter in-patient treatment and longer WD, patients with CIP acquired significantly greater gains of improvement than CVD (p = 0.015). Independent living at home was possible in 43% of patients with CIP and in 26% of CVD. Mortality was equal in both groups (13% vs. 6%, p > 0.05). Chronic obstructive pulmonary disease (COPD) showed a trend towards longer weaning durations in both entities (p = 0.06). Higher age significantly correlated with longer WD (p = 0.038, r = 0.16). Longer rehabilitation duration (RD) positively correlated with higher Delta-FIM (DFIM) in both entities (p = 0.006, r = 0.21). Longer weaning and its partly negative influence on rehabilitative outcome can be compensated by longer in-patient rehabilitation in CIP and CVD.
    Neurorehabilitation 01/2014; · 1.42 Impact Factor
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    ABSTRACT: The diagnosis of intensive care unit acquired weakness (ICUAW) in the setting of neurological rehabilitation is steadily increasing. This is due to the fact that the intensive care of patients with sepsis or after cardiac or abdominal surgery is improving. A longer duration of respiratory weaning and comorbidities frequently complicate rehabilitation. Clinically, patients present with a flaccid (tetra) paresis and electrophysiological studies have shown axonal damage. Besides involvement of peripheral nerves, muscle can also be affected (critical illness myopathy) leading to ICUAW with inconstant myopathic damage patterns found by electrophysiological testing. Mixed forms can also be found. A specific therapy for ICUAW is not available. Early mobilization to be initiated on the intensive care unit and commencing neurological rehabilitation improve the outcome of ICUAW. This review highlights the current literature regarding the etiology and diagnosis of ICUAW. Furthermore, studies about rehabilitation and outcome of ICUAW are discussed.
    Der Nervenarzt 01/2014; · 0.80 Impact Factor
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    ABSTRACT: Ischemic lesions within the territory of the anterior cerebral artery present with a variety of clinical signs and symptoms. Among these, frontal alien hand syndrome is rare and easily overlooked in the acute clinical setting, but significantly impacts on functional activities of daily life. Given its rareness, very little is known about its long-term outcome. To shade some more light onto this issue, clinical presentation, course of rehabilitation and outcome of two illustrative cases of frontal alien hand syndrome following anterior cerebral artery stroke are presented. Within seven and nine months from symptom onset, respectively, the clinical symptoms of frontal alien hand had resolved completely in both cases. We conclude that frontal alien hand syndrome has a favourable long-term outcome.
    Journal of the neurological sciences 01/2014; · 2.32 Impact Factor
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    ABSTRACT: Die Diagnose ,,erworbene Muskelschwäche des kritisch Kranken“ (ICUAW) nimmt in der neurologischen Rehabilitation stetig zu. Ursächlich hierfür ist die verbesserte intensivmedizinische Behandlung von Patienten mit Sepsis oder komplikationsreichen kardio- und viszeralchirurgischen Eingriffen. Die ICUAW erschwert die Rehabilitation durch das verlängerte Weaning vom Respirator sowie die häufigen internistischen Begleiterkrankungen. Die Patienten zeigen klinisch eine schlaffe (Tetra-)Parese sowie elektrophysiologisch Zeichen einer axonalen neuronalen Schädigung. Darüber hinaus kann eine Schädigung der Muskulatur (Critical-illness-Myopathie) zu einer erworbenen Schwäche des kritisch Kranken führen. Elektrophysiologisch lassen sich hierbei teils myopathische Veränderungen finden. Auch Mischformen kommen vor. Aufgrund der bislang nicht eindeutig geklärten Pathogenese sowie deren Komplexität existiert eine spezifische Therapie der ICUAW nicht, die Patienten profitieren jedoch von einer frühzeitigen Mobilisation auf der Intensivstation. Diese Übersichtsarbeit gibt anhand der aktuellen Literatur Einblicke in die Ätiologie sowie die Diagnostik der ICUAW. Darüber hinaus werden Studien zur Rehabilitation und zum Outcome eingehend betrachtet und diskutiert.
    Der Nervenarzt 01/2014; 85(2). · 0.80 Impact Factor
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    ABSTRACT: Since valosin-containing protein mutations were reported as a cause of hereditary inclusion body myositis associated with Paget's disease of the bone and frontotemporal dementia, many new mutations have been described in the last decade. We report on a 46-year-old German male with a progressive tetraparesis and autosomal dominant inheritance pattern. Echocardiography revealed a beginning dilated cardiomyopathy and laboratory analyses showed increased alkaline phosphatase. Decreased verbal memory and an impairment of concept building were observed on neuropsychological examination. Muscle biopsy demonstrated a myopathic pattern, rimmed vacuoles, CD8+ T-cell infiltrates and positive MHC1-muscle fibres. We found a heterozygote mutation in exon 5 of the valosin-containing protein gene (c.464G > T p.Arg155Leu), which until now has been described only in an Australian family. We describe here the first German case with the above-mentioned mutation causing inclusion-body myositis associated with Paget's disease of the bone and fronto-temporal dementia. Here, we recommend regular controls of cardiac and respiratory functions.
    Fortschritte der Neurologie · Psychiatrie 06/2012; 80(6):344-7. · 0.85 Impact Factor
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    ABSTRACT:   Tick-borne encephalitis (TBE) is caused by a RNA-virus and is in about 50% of cases characterized by a biphasic clinical course in adults. Different clinical syndromes have been described, including meningitis, meningoencephalitis, meningoencephalomyelitis and meningoencephaloradiculomyelitis. The latter seems to be the most disabling and severe form of TBE virus infection.   Here we report five cases with meningoencephaloradiculomyelitis. Only in three patients a tick prick was remembered.   Only two patients could be weaned successfully from assisted ventilation; only one patient was able to return to self-dependent life without nursing support. The youngest patient in this case series showed the most favourable outcome.   Polyradiculopathy and/or myelopathy as verified by electrophysiological examination within 4 weeks from symptom onset were indicative of a more severe disease course and a greater likelihood of moderate to serious sequelae even after long-term rehabilitation. Older age at symptom onset seems to be associated with a less favourable outcome. Because of frequent long-term hospitalization with immobilization and invasive ventilation, secondary complications, such as ventilation associated pulmonary infections and decubiti, must be avoided.
    European Journal of Neurology 01/2012; 19(5):776-82. · 4.16 Impact Factor
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    ABSTRACT: Mitochondrial myopathy comprises various clinical subforms of neuromuscular disorders that are characterised by impaired mitochondrial energy metabolism due to dysfunction of the mitochondrial respiratory chain. No comprehensive and targeted cardiovascular magnetic resonance (CMR) studies have been performed so far in patients with mitochondrial disorders. The present study aimed at characterising cardiac disease manifestations in patients with mitochondrial myopathy and elucidating the in vivo cardiac damage pattern of patients with different subforms of mitochondrial disease by CMR studies. In a prospective study, 37 patients with mitochondrial myopathy underwent comprehensive neurological and cardiac evaluations including physical examination, resting ECG and CMR. The CMR studies comprised cine-CMR, T2-weighted "edema" imaging and T1-weighted late-gadolinium-enhancement (LGE) imaging. Various patterns and degrees of skeletal myopathy were present in the participants of this study, whereas clinical symptoms such as chest pain symptoms (in eight (22%) patients) and various degrees of dyspnea (in 16 (43%) patients) were less frequent. Pathological ECG findings were documented in eight (22%) patients. T2-weighted "edema" imaging was positive in one (3%) patient with MELAS (mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes) only. LGE imaging demonstrated the presence of non-ischemic LGE in 12 (32%) patients: 10 out of 24 (42%) patients with CPEO (chronic progressive external ophthalmoplegia) or KSS (Kearns-Sayre syndrome) and 2 of 3 (67%) patients with MELAS were LGE positive. All 10 LGE-positive patients with CPEO or KSS demonstrated a potentially typical pattern of diffuse intramural LGE in the left-ventricular (LV) inferolateral segments. Cardiac involvement is a frequent finding in patients with mitochondrial myopathy. A potentially characteristic pattern of diffuse intramural LGE in the LV inferolateral segments was identified in patients suffering from the subforms CPEO or KSS.
    Clinical Research in Cardiology 12/2011; 101(4):255-61. · 3.67 Impact Factor
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    ABSTRACT: A 40-year-old white male received cardio-pulmonary resuscitation after cardiac arrest due to an epileptic status. Four months after the incident he developed an akinetic-rigid syndrome and a postural tremor more pronounced on the right side of the body. Brain imaging revealed bilateral lesions of the putamen and caudate nucleus. Levodopa improved bradykinesia and muscular rigidity, but not the postural tremor.
    Journal of Neurology 10/2011; 259(5):895-7. · 3.58 Impact Factor
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    ABSTRACT: Camptocormia (CC) is defined as a trunkal flexion which worsens while standing, sitting and walking and disappears in the supine position. CC is a well-known clinical phenomenon in patients with generalized neuromuscular disorders like polymyositis, myasthenia gravis or motor neuron diseases, and it is also described in the context of movement disorders like Parkinson's disease (PD) or multiple system atrophy. In association with PD, CC seems to be a rare symptom which occurs preferentially in late stages of the disease. Currently, there are 3 main hypotheses on the pathogenesis of CC in PD, i.e. a focal myopathy of the trunk muscles, axial dystonia and a drug-induced etiology. This review gives a synopsis and critical acclaim of these 3 etiologies and refers to the current study data and possible treatment strategies.
    Neurodegenerative Diseases 03/2011; 8(5):283-8. · 3.41 Impact Factor
  • Clinical Research in Cardiology 02/2011; 100(7):611-5. · 3.67 Impact Factor
  • International journal of cardiology 10/2010; 152(1):e25-6. · 6.18 Impact Factor