Georg Ebersbach

Movement Disorder Clinic Beelitz-Heilstaetten

Up to 80% of patients with Parkinson’s disease suffer from a wide range of sleep disorders in all stages of the disease. While restless legs syndrome as one contributor to a disturbed night sleep can be present at any stage in the disease, sleep disturbances in the advanced stages of Parkinson’s disease are usually linked to motor impairment during...

Background: Fear of progression (FoP) is a reactive, conscious concern about chronic disease progression and its consequences which may limit quality of life substantially. Only one study has examined FoP in Parkinson's disease (PD), showing the second highest FoP scores among chronic diseases. Objective: To examine FoP prevalence and to explora...

Ten patients with parkinson's disease (PD) were evaluated pre and post to a gait training with a sensor-based music feedback from a smartphone application. All gait measures except cadence improved significantly during the intervention period. This innovative type of training proved to be a safe and feasible intervention for mildly impaired patien...

Introduction: Post-hoc analyses of the BIPARK-I and II trials previously demonstrated that opicapone (OPC) 50 mg was efficacious over the whole trajectory of motor fluctuation evolution in patients with Parkinson's disease (PD) and end-of-dose motor fluctuations, with enhanced efficacy in patients who were earlier vs. later in their disease course...

Introduction Advanced Parkinson's disease is characterized by motor and non-motor fluctuations to oral dopamine replacement therapy. The BALANCE study evaluated the clinical practice in Germany and Switzerland, when patients eligible for levodopa/carbidopa intestinal gel (LCIG) therapy decided to either switch to LCIG or to stay on optimized standa...

Background The Parkinson Disease (PD) Home Diary (HD) is a commonly used clinical outcome measure, but it has not been extensively compared to direct assessments by experienced observers.Objective Validation of patient-reported HD by investigating the agreement between motor state assessments by patients and observers.Methods This observational stu...

The Parkinson’s disease (PD) home diary is frequently used in clinical trials to measure efficacy of medical treatments for motor fluctuations in advanced PD. This prospective study in fluctuating PD patients examines the validity of the diary for quantification of motor states in comparison to direct clinical observation. 51 patients (median age:...

Background Gait disturbances are frequent side effects related to chronic thalamic deep brain stimulation (DBS) that may persist beyond cessation of stimulation. Objective We investigate the temporal dynamics and clinical effects of an overnight unilateral withdrawal of DBS on gait disturbances. Methods 10 essential tremor (ET) patients with gait...

Background: Levodopa–entacapone–carbidopa intestinal gel (LECIG) is a device-aided therapy option introduced in 2021 that has received marketing authorisation in several European countries for the treatment of patients with advanced Parkinson’s disease (PD) who have motor complications that cannot be adequately controlled by optimised oral/transder...

Background: Sexual dysfunctions (SD) are common but underreported in Parkinson's disease (PD) and have negative impacts on the quality of life (QoL) and partnership. Methods: We analyzed the data set from the PRISM study for demographics of SD and their influence on quality of life and partnership. Results: 449/861 (52.1%) PD patients reported...

Zusammenfassung Von Kriegszitterern zu Teenies mit TikTok-Tics – funktionelle Bewegungsstörungen galten lange als motorischer Ausdruck seelischer Turbulenzen. Tatsächlich werden psychodynamische Modelle jedoch zunehmend durch neurophysiologische Erkenntnisse ergänzt, sodass die Kombination von Psychotherapie mit spezialisierter Physiotherapie an Be...

Introduction: Opicapone (OPC) was efficacious in reducing OFF-time in two pivotal trials in patients with Parkinson's disease (PD) and end-of-dose motor fluctuations (BIPARK-I and -II). Post-hoc analyses of these trials evaluated the efficacy of OPC following pre-defined segmentation of the wide spectrum of motor fluctuations in PD. Methods: Data f...

Background: Dysphagia is a major clinical concern in multiple system atrophy (MSA). A detailed evaluation of its major endoscopic features compared with Parkinson's disease (PD) is lacking. Objective: This study systematically assessed dysphagia in MSA compared with PD and correlated subjective dysphagia to objective endoscopic findings. Method...

Objective: To characterize socio-demographic and disease-specific data of Parkinson’s disease patients before and 1 year after therapy escalation with subcutaneous apomorphine (APO), levodopa/carbidopa intestinal gel (LCIG), or subthalamic deep brain stimulation (STN-DBS) in an observation trial under real life conditions. Methods: Between 2014-201...

Background: Continuous, subcutaneous (SC) levodopa/carbidopa infusion with ND0612 is under development as a treatment for patients with Parkinson's disease (PD) and motor fluctuations. Objective: Evaluate 1-year safety data. Methods: BeyoND is an open-label study evaluating the long-term safety of two ND0612 dosing regimens. Results: Of the...

Background: Reduction of arm swing during gait is an early and common symptom in Parkinson's disease (PD). By using the technology of a mobile phone, acceleration of arm swing can be converted into a closed-loop musical feedback (musification) to improve gait. Objectives: To assess arm swing in healthy subjects and the effects of musification on...

Background: Functional movement disorders (FMD) are associated with considerable morbidity and impairment of quality of life. Specialized treatment is scarce and data on efficacy of different therapies are limited. Objective: To evaluate a multi-modal inpatient treatment program for patients with FMD. Methods: Thirty-one patients with FMD were...

Introduction: Deep brain stimulation (DBS) is a highly efficacious treatment for essential tremor (ET). Still, the optimal anatomical target in the (sub)thalamic area is a matter of debate. The aim of this study was to determine the optimal target of DBS for ET regarding beneficial clinical outcome and impact on activities of daily living as well...

Background: A greater understanding of the everyday experiences of people with Parkinson's disease (PD) and their carers may help improve clinical practice. Objective: The Parkinson's Real-world Impact assesSMent (PRISM) study evaluated medication use, health-related quality of life (HRQoL) and the use of healthcare resources by people with PD a...

Objective: To characterize socio-demographic and disease-specific data of Parkinson's disease patients before and 1 year after therapy escalation with subcutaneous apomorphine (APO), levodopa/carbidopa intestinal gel (LCIG), or subthalamic deep brain stimulation (STN-DBS) in an observation trial under real life conditions. Methods: Between 2014-201...

Background: The efficacy and safety of opicapone, a once-daily catechol-O-methyltransferase inhibitor, have been established in two large randomized, placebo-controlled, multinational pivotal trials. Still, clinical evidence from routine practice is needed to complement the data from the pivotal trials. Methods: OPTIPARK (NCT02847442) was a pros...

The article Diagnostic accuracy of a smartphone bedside test to assess the fixation suppression of the vestibulo‑ocular reflex: when nothing else matters, written by Florin Gandor, Manfred Tesch, Hannelore Neuhauser, Doreen Gruber, Hans‑Jochen Heinze, Georg Ebersbach and Thomas Lempert, was originally published electronically on the publisher's int...

Background Multiple system atrophy (MSA) is a rare neurodegenerative disorder, and its parkinsonian variant can be difficult to delineate from Parkinson's disease (PD). Despite laryngeal dysfunction being associated with decreased life expectancy and quality of life, systematic assessments of laryngeal dysfunction in large cohorts are missing. Obj...

Objective: Validation of a bedside test to objectify the fixation suppression of the vestibulo-ocular reflex (FS-VOR) in patients with a cerebellar syndrome and healthy controls. Methods: The vestibulo-ocular reflex and its fixation suppression were assessed by video-nystagmography (VNG) in 20 healthy subjects (mean age 56 ± 15) and 19 patients...

Zusammenfassung L-Dopa ist das wirksamste Medikament zur Therapie des idiopathischen Parkinson-Syndroms. Im Verlauf der Erkrankung lässt die Speicherfähigkeit dopaminerger Neurone nach, weshalb sich die Wirkdauer der Halbwertszeit angleicht. Daraus resultieren Wirkfluktuationen, und als weitere Konsequenz des engen therapeutischen Fensters treten D...

Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson’s disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly fre...

Background: Optimal management in expert centers for Parkinson's disease (PD) usually involves pharmacological and non-pharmacological interventions, delivered by a multidisciplinary approach. However, there is no guideline specifying how this model should be organized. Consequently, the nature of multidisciplinary care varies widely. Objective:...

Background The development of delirium in patients with idiopathic Parkinson’s disease (IPD) is a feared complication, which is often associated with sustained worsening of motor symptoms and psychopathological sequelae. Little is known regarding the prevalence and incidence rates, course and prognosis. Clinical studies from which recommendations f...

Background: Parkinson's disease (PD) is an age dependent neurodegenerative disorder with increasing prevalence. Digital technologies like computers and smartphones offer mobile telecommunication, diagnostic and monitoring and may connect the patient continuously with his healthcare team, providing disease related information, and support healthcar...

Delirium is an acute and fluctuating disturbance of attention and awareness. Pre-existing cognitive disturbances or dementia are the most significant risk factors for developing delirium and precipitating factors such as drug treatment, infections, trauma, or surgery may trigger delirium. Patients with Parkinson’s disease (PD) are at an increased r...

Cannabis and synthetic cannabinoid formulations have now been legally approved in several countries for treatment of patients with Parkinson’s disease (PD). Hence, PD patients consult physicians more frequently for prescription of cannabinoids to alleviate symptoms that might not respond well to dopaminergic treatment. Despite the increasing volume...

Recent data suggested a decrease in non-motor fluctuations in late-stage Parkinson’s disease (PD), but systematic data on non-motor fluctuations over the whole disease course are mainly lacking. We performed a meta-analysis of two studies with very similar cross-sectional cohort designs, namely the German multicenter Non Motor Fluctuation in PD stu...

Irregular arytenoid cartilages movements during postural maneuver in MSA patient.

Irregular arytenoid cartilages movements at rest in MSA patient.

In its early stages multiple system atrophy (MSA), a neurodegenerative movement disorder, can be difficult to differentiate from idiopathic Parkinson's disease (PD), and emphasis has been put on identifying premotor symptoms to allow for its early identification. The occurrence of vegetative symptoms in addition to motor impairment, such as orthost...

BACKGROUND: Progressive supranuclear palsy (PSP) -Richardson's Syndrome and Corticobasal Syndrome (CBS) are the two classic clinical syndromes associated with underlying four repeat (4R) tau pathology. The PSP Rating Scale is a commonly used assessment in PSP clinical trials; there is an increasing interest in designing combined 4R tauopathy clinic...

Objective Real‐life observational report of clinical efficacy of bilateral subthalamic stimulation (STN‐DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality of life, motor, and nonmotor symptoms (NMS) in Parkinson's disease (PD). Methods In this prospective, multicenter, international, real‐life cohort observation study of...

Zusammenfassung Im Verlauf der Behandlung des idiopathischen Parkinson-Syndroms (IPS) kann es dazu kommen, dass L-Dopa-induzierte motorische Komplikationen (Wirkfluktuationen und Dyskinesien) nicht mehr suffizient durch Anpassung der oralen oder transdermalen Medikation beherrschbar sind. Diese Situation wird unter anderem mit dem Begriff „medikame...

Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of P...

Background The pedunculopontine nucleus has been suggested as a potential deep brain stimulation target for axial symptoms such as gait and balance impairment in idiopathic Parkinson's disease as well as atypical Parkinsonian disorders. Methods Seven consecutive patients with progressive supranuclear palsy received bilateral pedunculopontine nucle...

Zusammenfassung Aufgrund der Legalisierung von medizinischem Cannabis und Derivaten in zahlreichen Ländern gelangt diese Behandlungsoption zunehmend in die wissenschaftliche und öffentliche Debatte. Zunehmend häufig werden Behandler von Patienten mit idiopathischer Parkinson-Erkrankung mit der Frage nach Cannabis als Behandlungsalternative insbeson...

Due to the changing legal status of medical cannabis and derivatives in numerous countries, this therapeutic option has moved into the field of public debate. Neurologists treating patients with idiopathic Parkinson’s disease are increasingly confronted with questions regarding cannabis as a treatment alternative, especially for levodopa-resistant...

Nichtmedikamentöse Therapien zur Behandlung der Parkinson-Erkrankung beinhalten Physio-, Ergotherapie, Logopädie, kognitive Trainingsverfahren sowie die tiefe Hirnstimulation und nichtinvasive Hirnstimulationsverfahren. Mit der Diagnose der Parkinson-Krankheit können aktivierende Therapien, wie die Bewegungstherapien und die Logopädie – angepasst a...

Background: Nonmotor symptoms (NMS) are known to fluctuate together with motor oscillations in advanced PD, but their timing and kinetics remains enigmatic. Objective: To evaluate timing and kinetics of NMS fluctuations. Methods: Analysis of diary data from 17 fluctuating PD patients. Diaries were completed by rating NMS as absent (defined her...

To document specific learning mechanisms in patients with Parkinson's disease (PD) with and without impulse control disorder (ICD). Thirty-two PD patients receiving dopamine replacement therapy (DRT) were investigated. Sixteen were diagnosed with ICD (ICD (+) ) and 16 PD patients matched for levodopa equivalence dosage, and DRT duration and severit...

Impairments of speech, swallowing, posture, gait and balance become increasingly prevalent in the course of Parkinson's (PD) disease and often respond poorly to pharmacologic treatment. Rehabilitative therapies including physiotherapy, speech training and occupational therapies are used to counteract these progressive pharmacoresistant motor distur...

Over the past 20 years, amplitude oriented therapies, also known as LSVT (Lee Silverman Voice Treatment), have been developed and researched for people with Parkinson's disease. Beginning with a focus on the speech motor system (LSVT-LOUD), the concept has recently been expanded to address limb motor systems (LSVT-BIG). The unique aspects of LSVT p...

Postural instability and supranuclear gaze palsy represent the key symptoms of Richardson’s syndrome, the most frequent clinical manifestation of progressive supranuclear palsy (PSP). However, a proportion of PSP patients never develops ocular motor symptoms, which prevents clinicians from establishing the diagnosis during lifetime according to cur...

Introduction: Effective management and development of new treatment strategies for response fluctuations in advanced Parkinson's disease (PD) largely depends on clinical rating instruments such as the PD home diary. The Parkinson's kinetigraph (PKG) measures movement accelerations and analyzes the spectral power of the low frequencies of the accel...

Frequencies of motor states from diaries, raw PKG and calibrated PKG data per day on the patient level. Displayed are the mean number of hours per day per patient collected during the five days from each patient (n = 24) in motor Off state (A), motor On state without dyskinesia (B) and dyskinetic state (C) as per the diaries, PKG raw and calibrated...

Types of motor complications. (DOCX)

Matching between calibrated PKG and diary data in identification of bradykinesia. (DOCX)

Demographic and clinical data. (DOCX)

Data of PKG recordings and PD home diary entries. (DOCX)

Correlation of diary data with PKG results (per day on the patient level). (DOCX)

Matching between calibrated PKG and diary data in identification of dyskinesia. (DOCX)

Patients with advanced Parkinson's disease and motor complications undergoing optimized oral therapy can significantly benefit from continuous intrajejunal levodopa/carbidopa infusion applied by means of a medication pump. However, this requires a correctly positioned PEG-J tube and finely adjusted pump settings. Although this method is a routine p...

Background: Since previous studies aimed to study nonmotor symptom (NMS) fluctuations in direct conjunction with motor oscillations, there are no data available on the temporal context of NMS fluctuations and motor oscillations in advanced Parkinson's disease (PD). Objective: To evaluate circadian patterns and temporal connections of NMS and mot...

Lateral trunk flexion (LTF) is a common phenomenon in patients with Parkinson’s disease (PD) and has recently been associated with peripheral vestibular dysfunction. Since deviation of the subjective visual vertical (SVV) is a well-recognized feature of disorders involving vestibular processing, we analyzed SVV angles in 30 PD patients with and wit...

Die Behandlung des idiopathischen Parkinson-Syndroms erfordert im klinischen Alltag eine Anpassung der studienbasierten Empfehlungen an die individuellen Bedürfnisse des einzelnen Patienten. Eine Pharmakotherapie sollte bereits unmittelbar nach Diagnose angeboten werden. Bei Wirkfluktuationen wird in der Regel eine Kombinationstherapie erforderlich...

Nonmotor symptoms (NMS) fluctuate in conjunction with motor oscillations in advanced Parkinson's disease (PD), though little is known about the variability of NMS fluctuations in individual patients. We aimed to assess within-patient variability in frequency and severity of NMS during a series of five patient-perceived motor On and Off periods in 3...

Since 2013, a number of studies have enhanced the literature and have guided clinicians on viable treatment interventions outside of pharmacotherapy and surgery. Thirty-three randomized controlled trials and one large observational study on exercise and physiotherapy were published in this period. Four randomized controlled trials focused on dance...