Gereon R Fink

University of Cologne, Köln, North Rhine-Westphalia, Germany

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Publications (550)2399.51 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: PET using O-(2-(18)F-fluoroethyl)-l-tyrosine ((18)F-FET) provides important diagnostic information in addition to that from conventional MR imaging on tumor extent and activity of cerebral gliomas. Recent studies suggest that perfusion-weighted MR imaging (PWI), especially maps of regional cerebral blood volume (rCBV), may provide similar diagnostic information. In this study, we directly compared (18)F-FET PET and PWI in patients with brain tumors. Fifty-six patients with gliomas were investigated using static (18)F-FET PET and PWI. For comparison, 8 patients with meningiomas were included. We generated a set of tumor and reference volumes of interest (VOIs) based on morphologic MR imaging and transferred these VOIs to the corresponding (18)F-FET PET scans and PWI maps. From these VOIs, tumor-to-brain ratios (TBR) were calculated, and normalized histograms were generated for (18)F-FET PET and rCBV maps. Furthermore, in rCBV maps and in (18)F-FET PET scans, tumor volumes, their spatial congruence, and the distance between the local hot spots were assessed. For patients with glioma, TBR was significantly higher in (18)F-FET PET than in rCBV maps (TBR, 2.28 ± 0.99 vs. 1.62 ± 1.13; P < 0.001). Histogram analysis of the VOIs revealed that (18)F-FET scans could clearly separate tumor from background. In contrast, deriving this information from rCBV maps was difficult. Tumor volumes were significantly larger in (18)F-FET PET than in rCBV maps (tumor volume, 24.3 ± 26.5 cm(3) vs. 8.9 ± 13.9 cm(3); P < 0.001). Accordingly, spatial overlap of both imaging parameters was poor (congruence, 11.0%), and mean distance between the local hot spots was 25.4 ± 16.1 mm. In meningioma patients, TBR was higher in rCBV maps than in (18)F-FET PET (TBR, 5.33 ± 2.63 vs. 2.37 ± 0.32; P < 0.001) whereas tumor volumes were comparable. In patients with cerebral glioma, tumor imaging with (18)F-FET PET and rCBV yields different information. (18)F-FET PET shows considerably higher TBRs and larger tumor volumes than rCBV maps. The spatial congruence of both parameters is poor. The locations of the local hot spots differ considerably. Taken together, our data show that metabolically active tumor tissue of gliomas as depicted by amino acid PET is not reflected by rCBV as measured with PWI.
    Journal of Nuclear Medicine 02/2014; · 5.77 Impact Factor
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    ABSTRACT: A moon near to the horizon is perceived larger than a moon at the zenith, although-obviously-the moon does not change its size. In this study, the neural mechanisms underlying the "moon illusion" were investigated using a virtual 3-D environment and fMRI. Illusory perception of an increased moon size was associated with increased neural activity in ventral visual pathway areas including the lingual and fusiform gyri. The functional role of these areas was further explored in a second experiment. Left V3v was found to be involved in integrating retinal size and distance information, thus indicating that the brain regions that dynamically integrate retinal size and distance play a key role in generating the moon illusion.
    Journal of Cognitive Neuroscience 02/2014; · 4.49 Impact Factor
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    ABSTRACT: Hypokinetic gait is a common and very disabling symptom of Parkinson's disease (PD). Repetitive transcranial magnetic stimulation (rTMS) over the motor cortex has been used with variable effectiveness to treat hypokinesia in PD. Preconditioning rTMS by transcranial direct current stimulation (tDCS) may enhance its effectiveness to treat hypokinetic gait in PD. Three-dimensional kinematic gait analysis was performed (1) prior to, (2) immediately after and (3) 30 min after low-frequency rTMS (1 Hz, 900 pulses, 80 % of resting motor threshold) over M1 contralateral to the more affected body side preconditioned by (1) cathodal, (2) anodal or (3) sham tDCS (amperage: 1 mA, duration: 10 min) in ten subjects with PD (7 females, mean age 63 ± 9 years) and ten healthy subjects (four females, mean age 50 ± 11 years). The effects of tDCS-preconditioned rTMS on gait kinematics were assessed by the following parameters: number of steps, step length, stride length, double support time, cadence, swing and stance phases. Our data suggest a bilateral improvement of hypokinetic gait in PD after 1 Hz rTMS over M1 of the more affected body side preceded by anodal tDCS. In contrast, 1 Hz rTMS alone (preceded by sham tDCS) and 1 Hz rTMS preceded by cathodal tDCS were ineffective to improve gait kinematics in PD. In healthy subjects, gait kinematics was unaffected by either intervention. Preconditioning motor cortex rTMS by tDCS is a promising approach to treat hypokinetic gait in PD.
    Journal of Neural Transmission 02/2014; · 3.05 Impact Factor
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    ABSTRACT: When movements indicate meaningful actions, even nonbiological objects induce the impression of “having a mind” or animacy. This basic social ability was investigated in adults with high-functioning autism (HFA, n = 13, and matched controls, n = 13) by systematically varying motion properties of simple geometric shapes. Critically, trial-by-trial variations of (1) motion complexity of stimuli, and of (2) participants’ individual animacy ratings were separately correlated with neural activity to dissociate cognitive strategies relying more closely on stimulus analysis vs. subjective experience. Increasing motion complexity did not yield any significant group differences, and in both groups, it correlated with neural activity in regions involved in perceptual and evaluative processing, including the ventral medial prefrontal cortex (mPFC), superior temporal gyrus (STG) and posterior cingulate cortex (PCC). In contrast, although there were no significant behavioral differences between the groups, increasing animacy ratings correlated with neural activity in the insula, STG, amygdala, dorsal mPFC and PCC more strongly in controls than in HFA. These results indicate that in HFA the evaluation of stimulus properties cuing for animacy is intact, while increasing subjective ratings do not seem to be robustly related to social processing, including spontaneous mental state inferences and experience of salience.
    Social Neuroscience 02/2014; · 2.79 Impact Factor
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    [show abstract] [hide abstract]
    ABSTRACT: When movements indicate meaningful actions, even nonbiological objects induce the impression of "having a mind" or animacy. This basic social ability was investigated in adults with high-functioning autism (HFA, n = 13, and matched controls, n = 13) by systematically varying motion properties of simple geometric shapes. Critically, trial-by-trial variations of (1) motion complexity of stimuli, and of (2) participants' individual animacy ratings were separately correlated with neural activity to dissociate cognitive strategies relying more closely on stimulus analysis vs. subjective experience. Increasing motion complexity did not yield any significant group differences, and in both groups, it correlated with neural activity in regions involved in perceptual and evaluative processing, including the ventral medial prefrontal cortex (mPFC), superior temporal gyrus (STG) and posterior cingulate cortex (PCC). In contrast, although there were no significant behavioral differences between the groups, increasing animacy ratings correlated with neural activity in the insula, STG, amygdala, dorsal mPFC and PCC more strongly in controls than in HFA. These results indicate that in HFA the evaluation of stimulus properties cuing for animacy is intact, while increasing subjective ratings do not seem to be robustly related to social processing, including spontaneous mental state inferences and experience of salience.
    Social neuroscience 02/2014; · 3.17 Impact Factor
  • Christian Grefkes, Gereon R Fink
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    ABSTRACT: After focal damage, cerebral networks reorganise their structural and functional anatomy to compensate for both the lesion itself and remote effects. Novel developments in the analysis of functional neuroimaging data enable us to assess in vivo the specific contributions of individual brain areas to recovery of function and the effect of treatment on cortical reorganisation. Connectivity analyses can be used to investigate the effect of stroke on cerebral networks, and help us to understand why some patients make a better recovery than others. This systems-level view also provides insights into how neuromodulatory interventions might target pathological network configurations associated with incomplete recovery. In the future, such analyses of connectivity could help to optimise treatment regimens based on the individual network pathology underlying a particular neurological deficit, thereby opening the way for stratification of patients based on the possible response to an intervention.
    The Lancet Neurology 02/2014; 13(2):206-16. · 23.92 Impact Factor
  • Fortschritte der Neurologie · Psychiatrie 01/2014; 82(1):55-56. · 0.85 Impact Factor
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    ABSTRACT: To investigate in patients with essential tremor (ET) treated with thalamic/subthalamic deep brain stimulation (DBS) whether stimulation-induced dysarthria (SID) can be diminished by individualized current-shaping with interleaving stimulation (cs-ILS) while maintaining tremor suppression (TS). Of 26 patients screened, 10 reported SID and were invited for testing. TS was assessed by the Tremor Rating Scale and kinematic analysis of postural and action tremor. SID was assessed by phonetic and logopedic means. Additionally, patients rated their dysarthria on a visual analog scale. In 6 of the 10 patients with ET, DBS-ON (relative to DBS-OFF) led to SID while tremor was successfully reduced. When comparing individualized cs-ILS with a non-current-shaped interleaving stimulation (ILS) in these patients, there was no difference in TS while 4 of the 6 patients showed subjective improvement of speech during cs-ILS. Phonetic analysis (ILS vs cs-ILS) revealed that during cs-ILS there was a reduction of voicing during the production of voiceless stop consonants and also a trend toward an improvement in oral diadochokinetic rate, reflecting less dysarthria. Logopedic rating showed a trend toward deterioration in the diadochokinesis task when comparing ON with OFF but no difference between ILS and cs-ILS. This is a proof-of-principle evaluation of current-shaping in patients with ET treated with thalamic/subthalamic DBS and experiencing SID. Data suggest a benefit on SID from individual shaping of current spread while TS is preserved. This study provides Class IV evidence that in patients with ET treated with DBS with SID, individualized cs-ILS reduces dysarthria while maintaining tremor control.
    Neurology 01/2014; · 8.25 Impact Factor
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    ABSTRACT: Inconsistent findings regarding effects of dopaminergic medication (MED) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) on decision making processes and impulsivity in Parkinson´s disease (PD) patients have been reported. This study investigated the influence of MED and STN-DBS on decision-making under risk. Eighteen non-demented PD patients, treated with both MED and STN-DBS (64.3 ± 10.2years, UPDRS III MED off, DBS off 45.5 ± 17.1) were tested with the Game of Dice Task (GDT) which probes decision-making under risk during four conditions: MED on / DBS on, MED on / DBS off, MED off / DBS on, and MED off / DBS off. Task performance across conditions was compared analyzing two GDT-parameters: (i) the "net score" indicating advantageous decisions, and (ii) the patient's ability to use negative feedback. Significantly higher GDT net scores were observed in Med on in contrast to Med off conditions as well as in DBS on versus DBS off conditions. However, no effect of therapy for the patient's ability to make use of negative feedback could be detected. The data suggest a positive influence of both MED and STN-DBS on making decisions under risk in PD patients, an effect which seems to be mediated by mechanisms other than the use of negative feedback.
    Experimental Neurology 01/2014; · 4.65 Impact Factor
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    ABSTRACT: Cerebral ischemia triggers a cascade of cellular processes, which induce neuroprotection, inflammation, apoptosis and regeneration. At the neural network level, lesions concomitantly induce cerebral plasticity. Yet, many stroke survivors are left with a permanent motor deficit, and only little is known about the neurobiological factors that determine functional outcome after stroke. Transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI) are non-invasive approaches that allow insights into the functional (re-) organization of the cortical motor system. We here combined neuronavigated TMS, MRI and analyses of connectivity to investigate to which degree recovery of hand function depends on corticospinal tract (CST) damage and biomarkers of cerebral plasticity like cortical excitability and motor network effective connectivity. As expected, individual motor performance of 12 stroke patients with persistent motor deficits was found to depend upon the degree of CST damage but also motor cortex excitability and interhemispheric connectivity. In addition, the data revealed a strong correlation between reduced ipsilesional motor cortex excitability and reduced interhemispheric inhibition in severely impaired patients. Interindividual differences in ipsilesional motor cortex excitability were stronger related to the motor deficit than abnormal interhemispheric connectivity or CST damage. Multivariate linear regression analysis combining the three factors accounted for more than 80 % of the variance in functional impairment. The inter-relation of cortical excitability and reduced interhemispheric inhibition provides direct multi-modal evidence for the disinhibition theory of the contralesional hemisphere following stroke. Finally, our data reveal a key mechanism (i.e., the excitability-related reduction in interhemispheric inhibition) accounting for the rehabilitative potential of novel therapeutic approaches which aim at modulating cortical excitability in stroke patients.
    Brain Structure and Function 01/2014; · 7.84 Impact Factor
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    ABSTRACT: Objective To assess the effects of different frequencies of thalamic Deep-Brain-Stimulation (DBS) on cognitive performance of patients suffering from Essential Tremor (ET). Methods In 17 ET-patients with thalamic-DBS, tremor rating scale (TRS), standardized phonemic and semantic verbal fluency (VF), Stroop-Color-Word-Test and Digit-span-test were investigated in three randomized stimulation-settings: i. high-frequency stimulation (HFS), ii. low-frequency stimulation (LFS) and iii. OFF-stimulation (DBS-OFF). Paired-samples t-test for TRS and one-way repeated measures analysis of variance for cognitive performance were calculated. Results Tremor was reduced during HFS (MeanTRS-HFS = 12.9 ± 9.6) compared to DBS-OFF (MeanTRS-OFF = 44.4 ± 19.8, p<.001) and to LFS (MeanTRS-10Hz = 50.0 ± 24.2; p<.001). While performance of Stroop-task and digit-span remained unaffected by stimulation-settings (p>.05), phonemic and semantic VF differed significantly between the three conditions (FPvf = 5.28, FSvf = 3.41, both p<.05). Post-hoc comparisons revealed significant differences for both phonemic and semantic VF between LFS (MeanPvf-10Hz = 54.6 ± 9.2, MeanSvf-10Hz = 56.4 ± 7.9) and HFS (MeanPvf-ON = 48.3 ± 11.4, MeanSvf-ON = 51.1 ± 11.0, both p<.05), while DBS-OFF (MeanPvf-OFF = 51.2 ± 9.3, MeanSvf-OFF = 53.6 ± 12.9) and HFS and DBS-OFF and LFS did not differ significantly (p>.05). Conclusions HFS compared to LFS or DBS-OFF significantly reduced tremor but simultaneously worsened VF while working memory and cognitive inhibition remained unaffected. In contrast, LFS enhanced VF but did not ameliorate tremor. The data emphasize the relevance of thalamocortical loops for verbal fluency but also suggest that more sophisticated DBS-regimes in ET may improve both motor and cognitive performance.
    Brain Stimulation 01/2014; · 4.54 Impact Factor
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    ABSTRACT: Progressive, atrophic, asymmetrically distributed flaccid paresis of arm and hand muscles represents a frequent symptom of neuromuscular diseases that can be attributed to injury of the arm nerves, the plexus or the cervical roots. A timely and exact diagnosis is mandatory; however, the broad spectrum of differential diagnoses often represents a diagnostic challenge. A large variety of neuromuscular disorders need to be considered, encompassing autoimmune mediated inflammatory neuropathic conditions, such as multifocal motor neuropathy, as well as chronic degenerative and nerve compression disorders. This review provides an overview of the most frequent disorders of the upper plexus and cervical roots and summarizes the characteristic clinical features as well as electrodiagnostic and laboratory test results. In addition the diagnostic value of magnetic resonance imaging and sonography is discussed.
    Der Nervenarzt 12/2013; · 0.80 Impact Factor
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    ABSTRACT: The contribution of the medial temporal lobe (MTL) to the retrieval of autobiographical memories is widely accepted. Results of former patient studies and functional imaging studies suggest different involvement of the MTL during the retrieval of autobiographical context information and the remoteness of these. Varying recency, the MTL contribution during chronological and locational autobiographical context information processing was investigated in this study. Thirteen males (mean = 25 years) judged the event's place or time in a two-choice recognition task. Subjects made significantly more errors on chronological judgments. Retrieval of chronological information activated the left MTL, while retrieval of locational information activated the MTL bilaterally. Retrieval of more recent than remote context information activated especially the right MTL. Our results underline different MTL contributions on the retrieval of autobiographical context information, depending on the content and on the remoteness of the event that took place.
    Neurocase 12/2013; · 1.05 Impact Factor
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    ABSTRACT: The improvement of motor performance through mental strategies has been suggested to constitute a promising approach to improve motor abilities in both healthy subjects and patients. This behavioural effect has been shown to be associated with changes of neural activity in premotor areas, not only during movement execution, but also while performing motor imagery or action observation. However, how well such mental tasks are performed is often difficult to assess, especially in patients. We here used a novel mental training paradigm based on the serial prediction task (SPT) in order to activate premotor circuits in the absence of a motor task. We then tested whether this intervention improves motor-related performance such as sensorimotor transformation. Two groups of healthy young participants underwent a single-blinded five-day cognitive training schedule and were tested in four different motor tests on the day before and after training. One group (N=22) received the SPT-training and the other one (N=21) received a control training based on a serial match-to-sample task. The results revealed significant improvements of the SPT-group in a sensorimotor timing task, i.e. synchronization of finger tapping to a visually presented rhythm, as well as improved visuomotor coordination in a sensory-guided pointing task compared to the group that received the control training. However, mental training did not show transfer effects on motor abilities in healthy subjects beyond the trained modalities as evident by non-significant changes in the Jebsen-Taylor test (JTT). In summary, the data suggest that mental training based on the serial prediction task effectively engages sensorimotor circuits and thereby improves motor behaviour.
    Neuropsychologia 12/2013; · 3.48 Impact Factor
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    ABSTRACT: Patients with Parkinson's disease (PD) and freezing of gait (FOG) (freezers) demonstrate high gait variability. The objective of this study was to determine whether freezers display a higher variability of upper limb movements and elucidate if these changes correlate with gait. We were the first group to compare directly objectively measured gait and upper limb movement variability of freezers between freezing episodes. Patients with objectively verified FOG (n = 11) and PD patients without FOG (non-freezers) (n = 11) in a non-randomized medication condition (OFF/ON) were analyzed. Uncued antiphasic finger tapping and forearm diadochokinetic movements were analyzed via three-dimensional ultrasound kinematic measurements. Gait variability of straight gait was assessed using ground reaction forces. Freezers had shorter stride length (p = 0.004) and higher stride length variability (p = 0.005) in the medication OFF condition. Movement variability was not different during finger tapping or diadochokinesia between the groups. There was a trend towards more freezing of the upper limb during finger tapping for the freezers (p = 0.07). Variability in stride length generation and stride timing was not associated with variability of upper limb movement in freezers. Our findings demonstrate that: (1) freezers have a higher spatial gait variability between freezing episodes; (2) freezing-like episodes of the upper limb occur in PD patients, and tend to be more pronounced among freezers than non-freezers for finger tapping; (3) spatial and temporal upper extremity variability is equally affected in freezers and non-freezers in an uncued task. Upper limb freezing is not correlated to lower limb freezing, implicating a different pathophysiology.
    Journal of Neurology 12/2013; · 3.58 Impact Factor
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    ABSTRACT: Gesture processing deficits constitute a key symptom of apraxia, a disorder of motor cognition frequently observed after left-hemispheric stroke. The clinical relevance of apraxia stands in stark contrast to the paucity of therapeutic options available. Transcranial direct current stimulation (tDCS) is a promising tool for modulating disturbed network function after stroke. Here, we investigate the effect of parietal tDCS on gesture processing in healthy human subjects. Neuropsychological and imaging studies suggest that the imitation and matching of hand gestures involve the left inferior parietal lobe (IPL). Using neuronavigation based on cytoarchitectonically defined anatomical probability maps, tDCS was applied over left IPL-areas PF, PFm, or PG in healthy participants (n = 26). Before and after tDCS, subjects performed a gesture matching task and a person discrimination task for control. Changes in error rates and reaction times were analyzed for the effects of anodal and cathodal tDCS (compared with sham tDCS). Matching of hand gestures was specifically facilitated by anodal tDCS applied over the cytoarchitectonically defined IPL-area PFm, whereas tDCS over IPL-areas PF and PG did not elucidate significant effects. Taking into account tDCS electrode size and the central position of area PFm within IPL, it can be assumed that the observed effect is rather the result of a combined stimulation of the supramarginal and angular gyrus than an isolated PFm stimulation. Our data confirm the pivotal role of the left IPL in gesture processing. Furthermore, anatomically guided tDCS of the left IPL may constitute a promising approach to neurorehabilitation of apraxic patients with gesture processing deficits.
    Journal of Neuroscience 12/2013; 33(49):19205-11. · 6.91 Impact Factor
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    ABSTRACT: In patients with low-grade glioma (LGG) of World Health Organization (WHO) grade II, early detection of progression to WHO grade III or IV is of high clinical importance because the initiation of a specific treatment depends mainly on the WHO grade. In a significant number of patients with LGG, however, information on tumor activity and malignant progression cannot be obtained on the basis of clinical or conventional MR imaging findings only. We here investigated the potential of O-(2-(18)F-fluoroethyl)-l-tyrosine ((18)F-FET) PET to noninvasively detect malignant progression in patients with LGG. Twenty-seven patients (mean age ± SD, 44 ± 15 y) with histologically proven LGG (WHO grade II) were investigated longitudinally twice using dynamic (18)F-FET PET and routine MR imaging. Initially, MR imaging and PET scans were performed, and diagnosis was confirmed on the basis of biopsy. Subsequently, PET scans were obtained when clinical findings or contrast-enhanced MR imaging suggested malignant progression. Maximum and mean tumor-to-brain ratios (20-40 min after injection) (TBRmax and TBRmean, respectively) of (18)F-FET uptake as well as tracer uptake kinetics (i.e., time to peak [TTP] and patterns of the time-activity curves) were determined. The diagnostic accuracy of imaging parameters for the detection of malignant progression was evaluated by receiver-operating-characteristic analyses and by Fisher exact test for 2 × 2 contingency tables. In patients with histologically proven malignant progression toward WHO grade III or IV (n = 18), TBRmax and TBRmean increased significantly, compared with baseline (TBRmax, 3.8 ± 1.0 vs. 2.4 ± 1.0; TBRmean, 2.2 ± 0.3 vs. 1.6 ± 0.6; both P < 0.001), whereas TTP decreased significantly (median TTP, 35 vs. 23 min; P < 0.001). Furthermore, time-activity curve patterns changed significantly in 10 of 18 patients (P < 0.001). The combined analysis of (18)F-FET PET parameters (i.e., changes of TBRmax, TTP, or time-activity curve pattern) yielded a significantly higher diagnostic accuracy for the detection of malignant progression than changes of contrast enhancement in MR imaging (accuracy, 81% vs. 63%; P = 0.003). Both tumor-to-brain ratio and kinetic parameters of (18)F-FET PET uptake provide valuable diagnostic information for the noninvasive detection of malignant progression of LGG. Thus, repeated (18)F-FET PET may be helpful for further treatment decisions.
    Journal of Nuclear Medicine 10/2013; · 5.77 Impact Factor
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    ABSTRACT: Background: This study aims at investigating ischaemic stroke therapy in Germany by using secondary data. The focus lies on the performance of thrombolysis.Methods: Statutory quality report data for 2010 were obtained. All hospitals (n = 1302) treating patients suffering from an ischaemic stroke either on a neurological, internal, geriatric or intensive care unit were analysed. The treatment situation, defined as the experience in performing thrombolysis, was displayed cartographically. Potential variables that may influence the thrombolysis rate were analysed. Results: 78 % of the 198,500 ischaemic stroke cases were treated on a ward specialised in the stroke treatment (i. e., a stroke unit). The mean thrombolysis rate in neurological departments was 9.1 %. Thrombolysis rates between departments ranged from 0 to 38 %. Significant factors influencing the thrombolysis rate were the total number of ischaemic strokes treated as well as the existence of a stroke unit. Discussion: In Germany, to date regional differences in the treatment of ischaemic stroke exist. Experience in the treatment of ischaemic stroke patients and the availability of a stroke unit both increase the thrombolysis rate. Data suggest that in Germany there is still room for improvement of appropriate ischaemic stroke treatment.
    Fortschritte der Neurologie · Psychiatrie 10/2013; 81(10):579-585. · 0.85 Impact Factor
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    ABSTRACT: Patients with Parkinson's disease with deep brain stimulation in the subthalamic nucleus postoperatively often display higher impulsivity and therefore may experience difficulties in social interactions. Here, we examined social interactions of patients with Parkinson's disease with and without deep brain stimulation in the subthalamic nucleus in competitive situations. We hypothesized altered self-estimation and risk-seeking behaviour in this patient group induced by deep brain stimulation in the subthalamic nucleus. To test the hypothesis, an experimental setting was used in which participants performed a calculation task and chose their preferred compensation. Based on their actual calculation performance, more patients with Parkinson's disease with deep brain stimulation chose a competitive tournament compensation. Assuming rational behaviour, this self-selection pattern reflects increased risk tolerance. Since patients who performed in the lowest quartile chose the tournament option, the data suggest that deep brain stimulation in the subthalamic nucleus results in a loss of the correct reference frame against which patients with Parkinson's disease evaluate their performance. The stimulation-induced combination of overestimation of their own performance, increased risk-taking, and preference for competitive environments despite poor performance is likely to impact considerably on the patients' social and work life.
    Brain 09/2013; · 9.92 Impact Factor
  • Movement Disorders 07/2013; · 4.56 Impact Factor

Publication Stats

18k Citations
2,399.51 Total Impact Points

Institutions

  • 1991–2014
    • University of Cologne
      • • Department of Neurology
      • • Department of Psychiatry and Psychotherapy
      • • Institute of Anatomy I
      Köln, North Rhine-Westphalia, Germany
  • 2013
    • McGill University
      Montréal, Quebec, Canada
    • Philipps-Universität Marburg
      Marburg, Hesse, Germany
  • 2002–2013
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
    • Radboud University Nijmegen
      Nymegen, Gelderland, Netherlands
  • 1991–2013
    • Max Planck Institute for Neurological Research
      • Group of Neuromodulation und Neurorehabilitation
      Köln, North Rhine-Westphalia, Germany
  • 2012
    • The Children's Hospital of Philadelphia
      • Center for Autism Research
      Philadelphia, PA, United States
    • University of Geneva
      Genève, Geneva, Switzerland
    • South China Normal University
      Shengcheng, Guangdong, China
  • 2011–2012
    • University of Bonn - Medical Center
      Bonn, North Rhine-Westphalia, Germany
  • 2007–2012
    • University College London
      • Wellcome Department of Imaging Neuroscience
      London, ENG, United Kingdom
    • Ludwig-Maximilian-University of Munich
      • Institute of Medical Psychology (IMP)
      München, Bavaria, Germany
    • Lancaster University
      • Department of Psychology
      Lancaster, ENG, United Kingdom
    • University of Leipzig
      • Faculty of Biosciences, Pharmacy and Psychology
      Leipzig, Saxony, Germany
  • 2003–2012
    • RWTH Aachen University
      • • Institut für Psychologie
      • • Department of Neurology
      • • Department of Child and Adolescent Psychiatry and Psychotherapy
      • • Department of Psychiatry, Psychotherapy and Psychosomatics
      Aachen, North Rhine-Westphalia, Germany
  • 2001–2012
    • Forschungszentrum Jülich
      • • Institut für Neurowissenschaften und Medizin (INM)
      • • Kognitive Neurologie (INM-3)
      Düren, North Rhine-Westphalia, Germany
    • Università degli studi di Parma
      • Dipartimento di Neuroscienze
      Parma, Emilia-Romagna, Italy
    • Ruhr-Universität Bochum
      • Allgemeine Zoologie und Neurobiologie
      Bochum, North Rhine-Westphalia, Germany
  • 2003–2010
    • Bielefeld University
      • • Physiologische Psychologie
      • • BINAS - Bielefeld Institute for Biophysics and Nanoscience
      Bielefeld, North Rhine-Westphalia, Germany
  • 2009
    • Park University
      Parkville, Missouri, United States
    • Deutsche Forschungsgemeinschaft
      Bonn, North Rhine-Westphalia, Germany
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
  • 2004–2009
    • Scuola Internazionale Superiore di Studi Avanzati di Trieste
      • Cognitive Neuroscience Group
      Trst, Friuli Venezia Giulia, Italy
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany
  • 1999–2009
    • Heinrich-Heine-Universität Düsseldorf
      • • Klinik und Poliklinik für Psychiatrie und Psychotherapie der HHU, Rheinische Kliniken Düsseldorf
      • • Neurologische Klinik
      • • Institut für Neuropathologie
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2008
    • University of Rostock
      • Klinik und Poliklinik für Psychiatrie und Psychotherapie
      Rostock, Mecklenburg-Vorpommern, Germany
    • University of Bergen
      • Department of Biological and Medical Psychology
      Bergen, Hordaland Fylke, Norway
    • Oxford University Hospitals NHS Trust
      Oxford, England, United Kingdom
  • 2007–2008
    • Christian-Albrechts-Universität zu Kiel
      • Unit of Neurobiology
      Kiel, Schleswig-Holstein, Germany
    • Carl von Ossietzky Universität Oldenburg
      • Department of Biology and Environmental Sciences (IBU)
      Oldenburg, Lower Saxony, Germany
  • 2005
    • Medical Research Council (UK)
      Londinium, England, United Kingdom
    • Neurologische Klinik Westend
      Бад Вилдунген, Hesse, Germany
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
    • University of Cambridge
      • Department of Psychiatry
      Cambridge, ENG, United Kingdom
    • IME Metallurgy
      Aachen, North Rhine-Westphalia, Germany
  • 2002–2004
    • Universitätsklinikum Düsseldorf
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2001–2004
    • University of Bonn
      Bonn, North Rhine-Westphalia, Germany
  • 1997–2003
    • University of Oxford
      • • Nuffield Department of Clinical Neurosciences
      • • Department of Experimental Psychology
      Oxford, ENG, United Kingdom
    • UCL Eastman Dental Institute
      Londinium, England, United Kingdom
    • The University of Arizona
      • Department of Psychiatry
      Tucson, AZ, United States