Peter Trillenberg

Universitätsklinikum Schleswig - Holstein, Kiel, Schleswig-Holstein, Germany

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Publications (54)157.03 Total impact

  • Journal of the neurological sciences 10/2015; DOI:10.1016/j.jns.2015.09.379 · 2.47 Impact Factor
  • Wolfgang Heide · Peter Trillenberg ·
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    ABSTRACT: Smooth pursuit eye movements (SPEM) and saccades are the 2 basic modes of eye movements. SPEM have their optimal velocity range below 30°/s, much slower than saccades. They are needed for visual discrimination of moving objects, by adjusting eye velocity to target velocity. This requires an exact visuo-motor coordination by integrating visual feeedback (retinal image slip) and non-visual feedback (on eye position, eye velocity and the anticipation of target motion). Neuronally this is accomplished by a cortical projection system that combines visual motion signals from the occipito-temporal cortices with non-visual signals from parietal and frontal cortices towards a motor signal that is transmitted from the frontal eye fields to the pontine nuclei und the cerebellum. Lesions of these structures cause specific deficits of SPEM (direction-specific, retinotopic, omnidirectional). We systematically explain their topical diagnosis and clinical relevance.
    Das Neurophysiologie-Labor 08/2013; 35(s 2–3):98–108. DOI:10.1016/j.neulab.2013.06.003
  • Dr. B. Machner · A. Sprenger · H. Füllgraf · P. Trillenberg · C. Helmchen ·
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    ABSTRACT: Schwindel zählt zu den häufigsten Symptomen, die Patienten in Deutschland zum Arzt führen. Die Diagnosestellung basiert auf einer gezielten Anamnese, klinischen Untersuchung und sinnvollen Zusatzdiagnostik. Zum Nachweis oder Ausschluss einer vestibulären Unterfunktion als Ursache des Schwindels kamen bisher v. a. die kalorische Erregung des Gleichgewichtsorgans, seltener Drehstuhluntersuchungen oder vestibulär-evozierte myogene Potenziale zur Anwendung. Seit Kurzem steht eine vielversprechende neue diagnostische Methode zur Verfügung: der videobasierte Kopfimpulstest (vKIT). Dieser hat aufgrund seiner einfachen und schnellen Anwendbarkeit für den Untersucher, seiner geringen Belastung für den Patienten und seiner hohen Sensitivität für vestibuläre Schädigungen das Potenzial, die Diagnostik und damit auch die Therapie von Schwindelerkrankungen in der breiten medizinischen Versorgung in Deutschland zu verbessern. Im Folgenden wird über erste Erfahrungen mit dieser neuen Methode nach Untersuchung von > 1500 Patienten in der Lübecker Schwindelambulanz berichtet. Prinzip und Anwendung des vKIT in der täglichen Routine werden beschrieben sowie zahlreiche Vorteile, aber auch einige Fallstricke aufgezeigt.
    Der Nervenarzt 08/2013; 84(8). DOI:10.1007/s00115-013-3824-6 · 0.79 Impact Factor
  • B Machner · A Sprenger · H Füllgraf · P Trillenberg · C Helmchen ·
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    ABSTRACT: Dizziness is one of the most common complaints in Germany which leads to medical consultation. Diagnosis is based on patient history, clinical examination and laboratory tests. In order to find or exclude a vestibular lesion, methods such as caloric irrigation, rotational chair tests or vestibular-evoked myogenic potentials were previously applied. Recently, a new diagnostic tool has been made available for application in daily practice: the video head impulse test (vHIT). Due to the easy and fast application for the examiner, good tolerance by the patient and high sensitivity for vestibular lesions, the vHIT has the potential to improve the diagnosis and therapy of patients suffering from vertigo in widespread medical care in Germany. This article reports on experiences with this new method after examination of over1,500 patients in the academic vertigo centre in Lübeck. The principles and application of the vHIT in daily clinical routine are described and the many advantages but also some pitfalls are highlighted. As a consequence of a wider clinical use it is expected that the vHIT will lead to an increased detection of vestibular dysfunctions not only in clinically suspected vestibular diseases but also in other common neurological diseases (e.g. polyneuropathy or cerebellar ataxia). This may change the prevalence of different vestibular diseases, broaden knowledge about other common diseases with gait imbalance as the leading symptom and provide a quantitative measure that can be used to longitudinally assess the effects of therapeutic interventions.
    Der Nervenarzt 07/2013; 84. · 0.79 Impact Factor
  • A Sprenger · P Trillenberg · J Pohlmann · R Lencer · C Helmchen ·

    Klinische Neurophysiologie; 03/2013
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    ABSTRACT: Background: Neurological and psychiatric disorders show clinical overlap suggesting a shared pathophysiological background. We evaluated myoclonus-dystonia, a monogenic movement disorder as a disease model for inherited psychopathology. Method: We investigated 12 SGCE mutation carriers using standardized neurological and psychiatric examinations to assign DSM-IV diagnoses. Furthermore, we analyzed all studies in the Medline database which included psychiatric information on SGCE mutation-positive patients. Results: Of our twelve SGCE mutation carriers, 10 were older than 16 years. Two of them (20%) reported psychiatric diagnoses before our examination, which resulted in at least one psychiatric diagnosis in seven (70%) patients, most frequently anxiety (60%), depression (30%) or both. Substance abuse was observed in 20%, whereas obsessive-compulsive disorders were absent. One mutation carrier showed Axis 2 features. In the literature analysis, the ten studies using standardized tools covering DSM-IV criteria reported prevalences similar to those in our sample. This was three times the frequency of psychiatric disorders detected in 13 studies using clinical history or patient report only. Conclusion: About two thirds of SGCE mutation carriers develop psychiatric comorbidity and >80% are previously undiagnosed.
    Parkinsonism & Related Disorders 01/2013; 19(4). DOI:10.1016/j.parkreldis.2012.12.004 · 3.97 Impact Factor
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    ABSTRACT: Evidence exists that modulation of neuronal activity in nucleus accumbens shell region may re-establish normal function in various neuropsychiatric conditions such as drug-withdrawal, obsessive-compulsive disorder, depression and chronic pain. Here, we study the effects of acute repetitive transcranial magnetic stimulation on monoamine outflow in the nucleus accumbens shell in awake and freely moving rats using in vivo microdialysis. To scale the biochemical results to the induced electric field in the rat brain, we obtained a realistic simulation of the stimulation scenario using a finite element model. Applying 20 Hz repetitive transcranial magnetic stimulation in 6 trains of 50 stimuli with 280 μs pulse width at a magnetic field strength of 130% of the individual motor threshold, dopamine as well as serotonin outflow in the nucleus accumbens shell significantly increased compared to sham stimulation. Since the electric field decays rapidly with depth in the rat brain, we can conclude that the modulation in neurotransmitter outflow from the nucleus accumbens shell is presumably a remote effect of cortical stimulation.
    Neuropharmacology 07/2012; 63(5):898-904. DOI:10.1016/j.neuropharm.2012.06.045 · 5.11 Impact Factor
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    ABSTRACT: Patients with Parkinson's disease (PD) have difficulties in the control of self-guided (i.e., internally driven) movements. The basal ganglia provide a nonspecific internal cue for the development of a preparatory activity for a given movement in the sequence of repetitive movements. Controversy surrounds the question of whether PD patients are capable of (1) anticipating (before an external trigger appears; i.e., anticipation) and (2) predicting movement velocity once a moving target shortly disappears from the visual scene (i.e., prediction). To dissociate between these two components, we examined internally driven (extraretinal generated) smooth pursuit eye movements in PD patients and age-matched healthy controls by systematically varying target blanking periods of a trapezoidally moving target in four paradigms (initial blanking, midramp blanking, blanking after a short ramp, and no blanking). Compared to controls, PD patients showed (1) decreased smooth pursuit gain (without blanking), (2) deficient anticipatory pursuit (prolonged pursuit initiation latency; reduced eye velocity before target onset in the early onset blanking paradigm), and (3) preserved extraretinal predictive pursuit velocity (midramp target blanking). Deficient anticipation of future target motion was not related to either disease duration or the general motor impairment (UPDRS). We conclude that PD patients have difficulties in anticipating future target motion, which may play a role for the mechanisms involved in deficient gait initiation and termination of PD. In contrast, they remain unimpaired in their capacity of building up an internal representation of continuous target motion. This may explain the clinical advantage of medical devices that use visual motion to improve gait initiation (e.g., "PD glasses").
    Movement Disorders 07/2012; 27(8):1012-8. DOI:10.1002/mds.25042 · 5.68 Impact Factor
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    ABSTRACT: Alterations in sensorimotor processing and predictive mechanisms have both been proposed as the primary cause of eye tracking deficits in schizophrenia. 20 schizophrenia patients and 20 healthy controls were assessed on blocks of predictably moving visual targets at constant speeds of 10, 15 or 30°/s. To assess internal drive to the eye movement system based on predictions about the ongoing target movement, targets were blanked off for either 666 or 1,000 ms during the ongoing pursuit movement in additional conditions. Main parameters of interest were eye deceleration after extinction of the visual target and residual eye velocity during blanking intervals. Eye deceleration after target extinction, reflecting persistence of predictive signals, was slower in patients than in controls, implying greater rather than diminished utilization of predictive mechanisms for pursuit in schizophrenia. Further, residual gain was not impaired in patients indicating a basic integrity of internal predictive models. Pursuit velocity gain in patients was reduced in all conditions with visible targets replicating previous findings about a sensorimotor transformation deficit in schizophrenia. A pattern of slower eye deceleration and unimpaired residual gain during blanking intervals implies greater adherence to top-down predictive models for pursuit tracking in schizophrenia. This suggests that predictive modeling is relatively intact in schizophrenia and that the primary cause of abnormal visual pursuit is impaired sensorimotor transformation of the retinal error signal needed for the maintenance of accurate visually driven pursuit. This implies that disruption in extrastriate and sensorimotor systems rather than frontostriatal predictive mechanisms may underlie this widely reported endophenotypes for schizophrenia.
    European Archives of Psychiatry and Clinical Neuroscience 05/2012; 263(3). DOI:10.1007/s00406-012-0332-9 · 3.53 Impact Factor
  • A Sprenger · S Scheffelmeier · P Trillenberg · H Rambold · H Kimmig · S Gais · W Heide · C Helmchen ·

    Klinische Neurophysiologie; 03/2012
  • L. Richter · P. Trillenberg · A. Schweikard · A. Schlaefer ·

    Neurophysiologie Clinique/Clinical Neurophysiology 02/2012; 42(s 1–2):61–62. DOI:10.1016/j.neucli.2011.11.028 · 1.24 Impact Factor
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    ABSTRACT: Externally guided sensory-motor processes deteriorate with increasing age. Internally guided, for example, predictive, behavior usually helps to overcome sensory-motor delays. We studied whether predictive components of visuomotor transformation decline with age. We investigated smooth pursuit eye movements (SPEM) of 45 healthy subjects with paradigms of different degrees of predictability with respect to target motion onset, type (smoothed triangular, ramp stimulation), and direction by blanking the target at various intervals of the ramp stimulation. Using repetitive trials of SPEM stimulation, we could dissociate anticipatory and predictive components of extraretinal smooth pursuit behavior. The main results suggest that basic motor parameters decline with increasing age, whereas both anticipation and prediction of target motion did not change with age. We suggest that the elderly maintain their capability of using prediction in the immediate control of motor behavior, which might be a way to compensate for age-related delays in sensory-motor transformation, even in the absence of sensory signals.
    Annals of the New York Academy of Sciences 09/2011; 1233(1):168-76. DOI:10.1111/j.1749-6632.2011.06114.x · 4.38 Impact Factor

  • Movement Disorders 08/2011; 26(10):1959-60. DOI:10.1002/mds.23717 · 5.68 Impact Factor
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    ABSTRACT: Thrombolysis is a dynamic and time-dependent process influenced by the haemodynamic conditions. Currently there is no model that allows for time-continuous, non-contact measurements under physiological flow conditions. The aim of this work was to introduce such a model. The model is based on a computer-controlled pump providing variable constant or pulsatile flows in a tube system filled with blood substitute. Clots can be fixed in a custom-built clot carrier within the tube system. The pressure decline at the clot carrier is measured as a novel way to measure lysis of the clot. With different experiments the hydrodynamic properties and reliability of the model were analyzed. Finally, the lysis rate of clots generated from human platelet rich plasma (PRP) was measured during a one hour combined application of diagnostic ultrasound (2 MHz, 0.179 W/cm2) and a thrombolytic agent (rt-PA) as it is commonly used for clinical sonothrombolysis treatments. All hydrodynamic parameters can be adjusted and measured with high accuracy. First experiments with sonothrombolysis demonstrated the feasibility of the model despite low lysis rates. The model allows to adjust accurately all hydrodynamic parameters affecting thrombolysis under physiological flow conditions and for non-contact, time-continuous measurements. Low lysis rates of first sonothrombolysis experiments are primarily attributable to the high stability of the used PRP-clots.
    BMC Neurology 05/2011; 11(1):58. DOI:10.1186/1471-2377-11-58 · 2.04 Impact Factor
  • P. Trillenberg · G. Neumann · S. Oung · A. Schweikard · L. Richter ·

    Klinische Neurophysiologie 03/2011; 42(01). DOI:10.1055/s-0031-1272727 · 0.12 Impact Factor
  • Peter Trillenberg · Wolfgang Heide ·
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    ABSTRACT: This chapter discusses that the testing of ocular motor functions is an important step in the diagnosis of vestibular and balance disorders for three reasons: First, most of these disorders are associated with the disorders of eye movements. Second, the classification of the eye movement disorder will often lead to localization of the neural structures involved. Third, eye movement disorders can cause impaired vision or dizziness, and thus might impair balance. The chapter outlines the technology and equipment needed for clinical electronystagmography (ENG), its basic recording and calibration procedures, possible artifacts, and its advantages and disadvantages versus clinical bedside tests. It also describes the testing procedures and interpretation for three categories of ocular motor functions: (1) stability of gaze; (2) smooth pursuit eye movements and optokinetic nystagmus; and (3) saccadic eye movements. For vertical eye movements, positive angles correspond to gaze up and negative angles to gaze down. It is assumed that the eye position is digitally available for numerical differentiation to obtain eye velocities.
    Handbook of Clinical Neurophysiology 12/2010; 9. DOI:10.1016/S1567-4231(10)09007-6
  • Peter Trillenberg · Andreas Sprenger ·

    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 11/2010; 121(11):1969-71. DOI:10.1016/j.clinph.2010.04.017 · 3.10 Impact Factor

  • Klinische Neurophysiologie 03/2009; 40(01):24-29. DOI:10.1055/s-0029-1192006 · 0.12 Impact Factor
  • P Trillenberg · A Hagenow · M Shelhamer ·

    Klinische Neurophysiologie 03/2009; 40(01). DOI:10.1055/s-0029-1216186 · 0.12 Impact Factor
  • L Matthäus · P Trillenberg · T Fadini · M Finke · A Schweikard ·
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    ABSTRACT: Transcranial magnetic stimulation provides a mean to stimulate the brain non-invasively and painlessly. The effect of the stimulation hereby depends on the stimulation coil used and on its placement. This paper presents a mapping algorithm based on the assumption of a monotonous functional relationship between the applied electric field strength at the representation point of a muscle and the evoked motor potential. We combine data from coil characteristics, coil placement, and stimulation outcome to calculate a likelihood map for the representation of stimulated muscles in the brain. Hereby, correlation ratio (CR) and Kendall's rank coefficient τ are used to find areas in the brain where there is most likely a functional or monotonous relationship between electric field strength applied to this area and the muscle response. First results show a good accordance of our method with mapping from functional magnetic resonance imaging. In our case, classical evaluation of CR with binning is impossible, because sample data sets are too small and data are continuous. We therefore introduce a refined CR formula based on a Parzen windowing of the X-data to solve the problem. In contrast to usual windowing approaches, which require numeric integration, it can be evaluated directly in O(n2) time. Hence, its advantage lies in fast evaluation while maintaining robust applicability to small sample sets. We suggest that the presented formula can generally be used in CR-related problems where sample size is small and data range is continuous. Copyright
    Statistics in Medicine 11/2008; 27(25):5252-70. DOI:10.1002/sim.3353 · 1.83 Impact Factor

Publication Stats

745 Citations
157.03 Total Impact Points


  • 2013
    • Universitätsklinikum Schleswig - Holstein
      • Klinik für Neurologie (Kiel)
      Kiel, Schleswig-Holstein, Germany
  • 1998-2013
    • Universität zu Lübeck
      • • Institute of Human Genetics
      • • Klinik für Neurologie
      • • Institut für Robotik und Kognitive Systeme
      Lübeck Hansestadt, Schleswig-Holstein, Germany
  • 2004-2012
    • University Medical Center Schleswig-Holstein
      • Department of Pediatrics
      Kiel, Schleswig-Holstein, Germany
  • 2000-2002
    • Johns Hopkins University
      • Department of Neurology
      Baltimore, Maryland, United States