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Introduction
Liebe Kolleginnen und Kollegen,
das Deutsche FASD KOMPETENZZENTRUM Bayern ist jetzt auch in den sozialen Medien vertreten: instagram: @fasd_kompetenzzentrum und facebook: Deutsches FASD Kompetenzzentrum
Bayern - wir freuen uns über Ihr Interesse!
Herzliche Grüße,
Mirjam Landgraf
Current institution
Additional affiliations
August 2010 - November 2020
Dr. von Hauner Childrens Hospital, Munich, Germany
Position
- Medical Doctor
January 2006 - July 2010
Education
October 1999 - June 2006
October 1997 - June 2004
Publications
Publications (123)
Prenatal alcohol exposure causes disruptions in brain development. The resulting disorder, fetal alcohol spectrum disorder (FASD), cannot be cured, but interventions can help improve the daily functioning of affected children and adolescents and the quality of life for the entire family.
The aim of the German guideline version 2024 is to provide va...
Zusammenfassung: Hintergrund: Mit einer geschätzten Prävalenz von 1 bis 2 pro 100 Personen sind Fetale Alkoholspektrumstörungen (Fetal Alcohol Spectrum Disorders [FASD]) in Europa häufig und verbunden mit einer hohen Belastung für Menschen mit FASD, deren Angehörige sowie die Gesellschaft. Es handelt sich um komplexe Erkrankungen mit Einschränkunge...
Zusammenfassung: Zielsetzung: Im folgenden Artikel geben wir Ihnen einen Überblick über Pathophysiologie, Screening, Diagnose, Therapie und Prognose bei Kindern und Jugendlichen mit Fetalen Alkoholspektrumstörungen (FASD). Methodik: Für dieses narrative Review wurden internationale Studien der letzten 30 Jahre recherchiert und deren Ergebnisse zusa...
Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1...
Introduction
A neurobiological feature of Fetal Alcohol Spectrum Disorder (FASD) is a global decrease in neuronal connectivity, which leads to significant impairments in everyday functionality. Non-invasive repetitive transcranial magnetic stimulation (rTMS) could potentially positively influence neuronal plasticity but has not yet been studied in...
Background
Tension-type headache (TTH) is the most prevalent primary headache disorder. Neck pain is commonly associated with primary headaches and the trigemino-cervical complex (TCC) refers to the convergence of trigeminal and cervical afferents onto neurons of the brainstem, thus conceptualizes the emergence of headache in relation to neck pain....
Background:
Inadequate coordination between relevant professionals hampers the provision of appropriate care for individuals with fetal alcohol spectrum disorder (FASD). Integrated, multidisciplinary care is thus urgently required. Hence, we aimed at establishing the first university-bound, interdisciplinary specialist centre for FASD in Germany,...
Introduction:
Known protective factors for long-term outcome in children with fetal alcohol spectrum disorders (FASD) are early diagnosis and a stable, non-violent supportive environment. Which factors contribute to the stability of care is not yet known. Thus, the aim of our study was to evaluate whether the age at diagnosis and the complexity of...
Background
Repetitive neuromuscular magnetic stimulation (rNMS) of the trapezius muscles showed beneficial effects in preventing episodic migraine. However, clinical characteristics that predict a favorable response to rNMS are unknown. The objective of this analysis is to identify such predictors.
Methods
Thirty participants with a diagnosis of e...
Repetitive neuromuscular magnetic stimulation (rNMS) for pediatric headache disorders is feasible, safe, and alleviates headache symptoms. This study assesses muscular effects and factors affecting response to rNMS. A retrospective chart review included children with headaches receiving six rNMS sessions targeting the upper trapezius muscles. Press...
Mild traumatic brain injury (MTBI) or concussion is a frequent reason for presentation to a pediatric emergency department. In acute situations priority is initially given to a thorough assessment of the child and the chain of events in order to decide on the further procedures. In this context, clinical decision aids are available, which are prese...
Introduction
Repetitive neuromuscular magnetic stimulation (rNMS) was previously applied in adult patients with episodic migraine, showing beneficial effects on headache characteristics, high safety, and convincing satisfaction. This study aims to assess rNMS as a personalized intervention in pediatric headache.
Methods
Retrospective chart review...
Question To assess clinical and muscular effects of a repetitive neuromuscular magnetic stimulation (rNMS) intervention targeting to the upper trapezius muscles (UTM) in pediatric patients with headache disorders.
Methods A retrospective chart review resulted in 23 patients with migraine, migraine + tension-type headache (TTH), or post-traumatic he...
Question To assess the safety of and satisfaction with a repetitive neuromuscular magnet stimulation (NMS) intervention targeting to the upper trapezius muscles (UTM) in pediatric patients with headache disorders.
Methods Retrospective chart review including 33 patients with migraine, tension-type headache, or post-traumatic headache, who had recei...
Mütterlicher Alkoholkonsum während der Schwangerschaft kann zu neurokognitiven Beeinträchtigungen und morphologischen Veränderungen beim Kind führen, die unter dem Oberbegriff „Fetale Alkoholspektrumstörung“ (FASD) zusammengefasst werden. Die FASD geht mit erheblichen Einschränkungen der selbstständigen Alltags- und Lebensgestaltung einher – im Kin...
Background
Health care costs of migraine constitute a major issue in health economics. Several publications analyzed health care costs for adult migraine patients, based on questionnaires or secondary (health insurance) data. Although migraine often starts already in primary school age, data on migraine related costs in children is scarce. In this...
Background
Migraine is common in childhood, peaks in adolescents and persists into adulthood in at least 40% of patients. There is need for early interventions to improve the burden of disease and, if possible, reduce chronification. The aim of the project is to compare two types of ambulatory treatment strategies regarding their effect on headache...
Introduction
The transition from childhood to adolescence and from adolescence to adulthood are vulnerable phases in life. In these phases, late or insufficient treatment of diseases may lead to chronification and favor development of additional disorders. In adolescents, migraine often has a highly negative impact on school performance and everyda...
Introduction
Brain function deficits in children and adolescents with fetal alcohol spectrum disorders (FASD) have a strong negative impact on their everyday life. Evidence-based intervention programs specifically designed for patients with FASD are therefore needed but still scarce. The aim of the current article is a systematic literature review...
The objective of this study was to assess the burden of disease and prevalence of lifestyle factors for adolescents and young adults with frequent episodic migraine. We conducted a secondary comparative analysis of data collected during two previous studies. Inclusion criteria for this analysis were age 15–35 years, 15 to 44 migraine episodes withi...
Zusammenfassung
Die Fetale Alkoholspektrumstörung ist eine der häufigsten bei Geburt bestehenden chronischen Erkrankungen, die zum Großteil nicht oder fehldiagnostiziert wird. Dies führt zu inadäquater, ineffektiver Förderung und Therapie der erkrankten Kinder sowie mangelnder Unterstützung der betroffenen Familien. Daraus resultiert nicht nur ein...
Introduction
Caring for individuals with fetal alcohol spectrum disorders (FASD) puts a substantial and often life-long burden on affected families. Caregivers’ specific needs and demands are, however, not well understood so far. We thus aimed at systematically collecting data on the needs of individuals caring for children and adolescents with FAS...
Migraine is a common and invalidating disorder worldwide. Patients of all ages experience the disorder as very impairing regarding their personal and occupational lives. The current approach in migraine therapy is multimodal including lifestyle management, psychoeducation and, if available, psychotherapeutic interventions, and pharmacotherapy. The...
Background
Neck pain is frequent in patients with migraine. Likewise, evidence for inflammatory processes in the trapezius muscles is accumulating. However, non-invasive and objectively assessable correlates are missing in vivo.
Methods
Twenty-one subjects with episodic migraine (mean age: 24.6 ± 3.1 years, 18 females) and 22 controls (mean age: 2...
Migraine is a frequent neurological disorder in childhood and adolescence. Its complexity and relevance for everyday life, development and health behavior is regularly underestimated. The prevalence of migraine in childhood and adolescence has been increasing in recent years. The mixed type with overlapping of migraine and tension-type headache is...
Zusammenfassung
Die Migräne ist auch im Kindes- und Jugendalter ein häufiges, aber in klinischer Versorgung und Wissenschaft oft unterrepräsentiertes Krankheitsbild. Gerade im Kindes- und Jugendalter bestehen relevante Einschränkungen der Lebensqualität durch das (häufige) Schmerzerfahren. Bedingt durch die entwicklungsspezifisch hohe Vulnerabilitä...
Objective
The number of studies investigating and understanding the disease mechanisms of Duchenne muscular dystrophy (DMD) in human clinical trials have increased substantially over the last decade. Suitable clinical instruments for the measurement of disease progress and drug efficiency are mandatory, but currently not available, especially in th...
Migraine is a burdensome disease with an especially high prevalence in women between the age of 15 and 49 years. Non-pharmacological, non-invasive therapeutic methods to control symptoms are increasingly in demand to complement a multimodal intervention approach in migraine. Thirty-seven subjects (age: 25.0 ± 4.1 years; 36 females) diagnosed with h...
Objective
Childhood arterial ischaemic stroke (AIS) is rare, but causes significant morbidity and mortality. We aimed to investigate incidence, age-dependent clinical presentation, and risk factors and to discuss the medical care situation in Germany.
Methods
This prospective epidemiological study was conducted via ESPED (Erhebungseinheit für Selt...
Purpose: Repetitive peripheral magnetic stimulation (rPMS) has been successfully applied recently in migraineurs to alleviate migraine symptoms. Symptom relief has been achieved by stimulating myofascial trigger points (mTrPs) of the trapezius muscles, which are considered part of the trigemino-cervical complex (TCC). However, effects on musculatur...
Background:
Migraine in children and adolescents is associated with significant disability and a high risk of persistence into adulthood.
Objective:
Data on migraine incidence in children and adolescents are few and relatively coarse. To tailor interventions starting shortly after disease onset, detailed information on age- and sex-specific inci...
Background
Research in migraine points towards central-peripheral complexity with a widespread pattern of structures involved. Migraine-associated neck and shoulder muscle pain has clinically been conceptualized as myofascial trigger points (mTrPs). However, concepts remain controversial, and the identification of mTrPs is mostly restricted to manu...
Das Schütteltrauma des Säuglings hat durch die Schädigung des Gehirns schwerwiegende, in dem vorgestellten Fallbericht desaströse, neurologische Folgen. Bei unverändert hoher Inzidenz von Schütteltraumata in Deutschland bleibt die grundsätzliche Aufklärung von Eltern, Ärzten und Hebammen eine dringliche Aufgabe. Der Begriff „Schütteltrauma“ ist zu...
Background Time delay between onset of clinical symptoms and diagnosis is a challenge in childhood arterial ischemic stroke. Most previous studies reported cumulative symptoms.
Objective We attempted to identify typical symptom patterns and assessed their emergence in childhood stroke.
Methods Prospective active surveillance in ESPED, a hospital ba...
Objective:
To assess the relative risk, predictive value and population attributable risk fraction of pre-school episodic syndromes for later migraine in primary school age children.
Methods:
This retrospective cohort study used health insurance data on 55,035 children born in 2006 with no diagnosis of migraine up to the age of 5 years. The rela...
Etwa ein Drittel aller werdenden Mütter in Deutschland trinken Alkohol während der Schwangerschaft. Die intrauterine Alkoholexposition kann zu einer toxischen Gehirnschädigung und somit zu einer Fetalen Alkoholspektrumstörung (FASD) führen. Mit einer Prävalenz von mindestens 1 % aller Kinder zählt FASD zu den häufigsten "angeborenen" Erkrankungen....
Objective: Acute childhood stroke is an emergency requiring a high level of awareness among first-line healthcare providers. This survey serves as an indicator of the awareness of, the interest in, and knowledge of childhood stroke of German pediatricians.
Methods: Thousand six hundred and ninety-seven physicians of pediatric in- and outpatient fac...
Objective:
The objective of our study was to evaluate the knowledge about fetal alcohol spectrum disorders (FASD) and the implementation of the German guideline for FASD among different professionals in the health and social system and among parents with children with FASD.
Methods:
A questionnaire about FASD, containing 20 items, was sent by po...
Objective:
Acute treatment of childhood arterial ischaemic stroke and prevention strategies for recurrent stroke episodes depend strongly on each child's individual risk profile. The aim of this study is to characterize risk factors for childhood stroke, their occurrence in isolation or combination, and to identify possible common risk factor patt...
Objectives
To assess potential risk factors for vertigo and dizziness in adolescents and to evaluate their variability by different vertigo types. The role of possible risk factors for vertigo and dizziness in adolescents and their population relevance needs to be addressed in order to design preventive strategies.
Study design
The study populatio...
Questionnaire in English.
(DOC)
Table. Prevalence of vertigo and specific vertigo types in students exposed/unexposed to potential risk factors, that were not significantly associated with vertigo/vertigo types.
(DOCX)
Questionnaire in German (original language).
(DOC)
Die Migräne ist als primäre Kopfschmerzerkrankung eine für die Lebensqualität relevante Lifespan-Erkrankung auf dem Boden einer komplexen Genetik. Häufig beginnt sie schon im Kindesalter. Die Migräne zeigt alterstypische Symptome, Nuancierungen und Vorläufer, die sie deutlich vom späteren Lebensalter unterscheiden – so etwa in Bezug auf die Lokalis...
Background:
The objective was to evaluate a supposed clinical interdependency of myofascial trigger points and migraine in children. Such interdependency would support an interaction of spinal and trigeminal afferences in the trigemino-cervical complex as a contributing factor in migraine.
Methods:
Children ≤18 years with the confirmed diagnosis...
Background:
Idiopathic intracranial hypertension (IIH) in children is a rare condition of unknown etiology and various clinical presentations. The primary aim of this study was to evaluate if our pediatric IIH study group fulfilled the revised diagnostic criteria for IIH published in 2013, particularly with regard to clinical presentation and thre...
Objective This study aims to compare mechanography, measuring force in jumping, and rising, with the 6-minute walk test (6MWT) and time function tests in pediatric patients with hereditary motor and sensory neuropathies.
Methods A cohort of 23 patients performed the 6MWT and time function tests (time to run 10 m, to rise from a supine position, and...
Purpose of review
The goal of this review is to provide an actualized overview on vestibular migraine in childhood and adolescence, with focus on the epidemiology and clinical presentation as well as its treatment.
Recent findings
Vertigo spells in childhood can evolve into other periodic syndromes and/or migraine types and persist even into adult...
HintergrundIntrauterine Alkoholexposition kann zu einer toxischen Schädigung des kindlichen Gehirns und damit zur Fetalen Alkoholspektrumstörung („fetal alcohol spectrum disorder“, FASD) führen. Deren geschätzte Prävalenz beträgt in Deutschland ca. 1 %. Die FASD persistiert lebenslang. Mit dem Krankheitsbild FASD werden neben Kinder-/Jugendärzten u...
Begrenzte Zeit für den Patienten und allgegenwärtige administrative Verpflichtungen kennzeichnen das Arbeitsprofil von klinisch tätigen ÄrztInnen in der Erwachsenenmedizin.
Background:
Repetitive peripheral magnetic stimulation (rPMS) has been applied to musculoskeletal pain conditions. Since recent data show that migraine and tension-type headache (TTH) might be closely related to peripheral muscular pain in the neck and shoulder region (supporting the concept of the trigemino-cervical complex (TCC)), this pilot stu...
Zusammenfassung. Laut den aktuellen Studien zur Gesundheit in Deutschland (GEDA) haben knapp 20 % der schwangeren Frauen einen „moderaten Alkoholkonsum“ und knapp 8 % einen riskanten Alkoholkonsum. 12 % der Schwangeren geben ein Rauschtrinken (≥ 5 Getranke pro Gelegenheit) seltener als einmal pro Monat, knapp 4 % jeden Monat und 0.1 % mindestens je...
Tension-type headache and migraine are among the most prevalent chronic disorders in children/adolescents. Data on health care utilization for headache in this age group, however, are sparse.
In 1399 grammar school students (aged 12-19 years) with headache in the last six months in Germany a) the burden of disease for headache (mean intensity, mean...
Aim:
The aim of this study was to verify the association between self-reported neck/shoulder pain and migraine and to compare findings of chronic and episodic migraine in adolescents.
Methods:
In this cross-sectional study, 601 secondary-school students filled in questionnaires about headache appearance, type and frequency, neck and shoulder pai...
Objectives:
To assess the period prevalence and severity of dizziness and vertigo in adolescents.
Methods:
In 1661 students in 8th-10th grade in twelve grammar schools in Munich, Germany information on vertigo/dizziness was assessed by a questionnaire in the class room setting. Three month prevalence of dizziness/vertigo was estimated; symptoms...
Risk factors for alcohol consumption during pregnancy and for the development of fetal alcohol spectrum disorders
Hintergrund Die meisten Fälle von Kindesmisshandlung werden primär beim Kinderarzt oder in den Notfallambulanzen der Kinderkliniken vorstellig. Fragestellung Welche Maßnahmen sind in der Notfallambulanz bei Verdacht auf Kindesmisshandlung notwendig und welche Regeln sollten dabei beachtet werden? Methode Erläuterung eines möglichen Procedere bei Ve...
Migraine is frequent in young adults and adolescents and often associated with neck muscle tension and pain. Common pathophysiological pathways, such as reciprocal cervico-trigeminal activation, are assumed. Tense areas within the neck muscles can be clinically observed many patients with migraine. The aim of this pilot case study was to visualize...
Biobehavioral pain treatment in children and adolescents consists of relaxation techniques, biofeedback treatment, operant pain treatment, pain coping, cognitive-behavioral treatment, and multimodal treatment. Biobehavioral procedures are highly efficient and may improve headache symptoms up to 50%, in combination up to 75%. These procedures presen...
About 80% of grammar school students report on headaches at least once within the last three months. It is known that an early manifestation of headache is correlated with a higher chance to suffer from headaches in adulthood. Therefore, we have to care about strategies how to prevent headaches in students. In this review, we present published resu...
The German S3 guideline for fetal alcohol syndrome (FAS) contains evidence and consensus based recommendations for the diagnosis of FAS. A "Pocket Guide FAS" was developed which illustrates the key points of the guideline for a quick orientation in clinical practical work.
Zusammenfassung
80% der Schüler berichten über Kopfschmerzen im Laufe von 90 Tagen. Eine frühe Erkrankung an häufigen Kopfschmerzen bedingt eine höhere Wahrscheinlichkeit auch später im Erwachsenenalter an Kopfschmerzen zu leiden. Es ist deshalb sinnvoll, über Möglichkeiten einer Prävention von Kopfschmerzen im Schulalter nachzudenken. In der vorli...
Zusammenfassung
Zur psychologischen Behandlung von Kopfschmerzen bei Kindern und Jugendlichen bieten sich mehrere hocheffektive Therapieverfahren an. Neben Beratung und Entspannung können Biofeedbackverfahren, operante Schmerzbehandlung, Schmerzbewältigung und kognitive Verhaltenstherapie angewendet werden. Dazu kommen multimodale Verfahren, die au...
Hintergrund
Mindestens 14 % der deutschen Frauen trinken Alkohol in der Schwangerschaft. Schätzungsweise 4/1000 Kinder zeigen das Vollbild eines fetalen Alkoholsyndroms (FAS).
Ziel der Arbeit
Mögliche Risikofaktoren für mütterlichen Alkoholkonsum und für die Entwicklung eines FAS sollen bestimmt werden.
Material und Methoden
Eine systematische...
Background: In Europe, up to 30% of all pregnant women consume alcohol. Alcohol related damages of the child are summarized as fetal alcohol spectrum disorders (FASD). The full picture fetal alcohol syndrome (FAS) is estimated to occur in 8 of 1,000 births. The patients with FASD are in large part diagnosed wrongly for a long time and get the right...
Kongressbeitrag/Abstract Cerebral vascular pathology mostly gets manifest in early adulthood. Bleeding, epileptic seizure, and focal neurologic deficits are the most common clinical presentations leading to the diagnosis. We present two children with migraine headache and visual aura as first symptoms.
Background: Up to 30% of all pregnant women drink alcohol. The intrauterine alcohol exposure can lead to fetal alcohol syndrome (FAS). FAS has an estimated prevalence of 8 per 1,000 births. Until now, many professional groups are not informed sufficiently about this syndrome and only a fraction of the affected children are diagnosed early in the li...
Background and purposeHeadache is a common health problem in adolescents. There are a number of risk factors for headache in adolescents that are amenable to intervention. The aim of the study was to assess the effectiveness of a low-level headache prevention programme in the classroom setting to prevent these risk factors.Methods
In all, 1674 stud...
Stable headache diagnosis classification is a prerequisite for identification of headache type specific risk factors. Does the stability of a headache diagnosis over time vary between migraine and tension-type headache (TTH)? Are there differences in diagnosis stability between a probable and a definite headache diagnosis?
In a sample of 783 studen...
The aim of the present analysis is to confirm or refute the association of neck pain to migraine or tension-type headache and to assess whether this association is independent of other risk factors for headache.
Secondary school students were invited to complete a questionnaire on headache and lifestyle factors in a cross-sectional study. Neck pain...
This article illustrates the modular concept for the care of adolescents suffering migraine established in our headache outpatient clinic. The available modules are: diagnosing, education on the diagnosis, acute pharmacotherapy, prophylactic pharmacotherapy, functional therapies, psychological diagnostics and intervention and complementary measures...
Zusammenfassung
Diese Arbeit gibt einen Überblick über das modulare Versorgungskonzept für jugendliche Migräne-Patienten des Pädiatrischen Kopfschmerzzentrums im iSPZ München im Dr. von Haunerschen Kinderspital der Universität München. Es setzt sich aus den Bausteinen Diagnosestellung, ärztliches Diagnosegespräch und Psychoedukation, akute Pharmako...
Die S3-Leitlinie zum Fetalen Alkoholsyndrom (FAS) enthält evidenz- und konsensbasierte Empfehlungen zur Diagnostik des FAS. Für die rasche Orientierung im klinisch-praktischen Alltag wurde ein „Pocket Guide FAS” erarbeitet, der übersichtlich die Kern-Elemente der Leitlinie darstellt.
Summary
The German S3 guideline for fetal alcohol syndrome (FAS)...
