M Maschke

Krankenhaus der Barmherzigen Brüder Trier, Trier, Rheinland-Pfalz, Germany

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Publications (172)498.98 Total impact

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    ABSTRACT: With modern antiretroviral drug regimens, HIV-infected people are living longer and HIV has transformed into a chronic illness. The review summarizes pathophysiological as well as clinical aspects of a chronic infection from a neurological point of view including neurocognitive impairment, depression, neuropathies and myopathies. It also draws attention to comorbidities such as syphilis and hepatitis C. They are of particular neurological interest because of the interaction of the pathogens.
    No preview · Article · Dec 2015 · DMW - Deutsche Medizinische Wochenschrift
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    Matthias Maschke

    Preview · Article · Nov 2015
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    G. Arendt · O. Grauer · K. Hahn · M. Maschke · M. Obermann · I. Husstedt

    Full-text · Article · Oct 2015 · Aktuelle Neurologie
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    ABSTRACT: The possibility to survive with amyotrophic lateral sclerosis (ALS) varies considerably and survival extends from a few months to several years. A number of demographic and clinical factors predicting survival have been described; however, existing data are conflicting. We intended to predict patient survival in a population-based prospective cohort of ALS patients from variables known up to the time of diagnosis. Incident ALS patients diagnosed within three consecutive years were enrolled and regularly followed up. Candidate demographic and disease variables were analysed for survival probability using the Kaplan-Meier method. The Cox proportional hazard regression model was used to assess the influence of selected predictor variables on survival prognosis. In the cohort of 193 patients (mean age 65.8, standard deviation 10.2 years), worse prognosis was independently predicted by older age, male gender, bulbar onset, probable or definite ALS according to El Escorial criteria, shorter interval between symptom onset and diagnosis, lower Functional Rating Scale, diagnosis of frontotemporal dementia, and living without a partner. Taking into account these predictor variables, an approximate survival prognosis of individual ALS patients at diagnosis seems feasible. © 2015 S. Karger AG, Basel.
    No preview · Article · Apr 2015 · Neuroepidemiology
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    ABSTRACT: Background Survival in amyotrophic lateral sclerosis varies considerably. About one third of the patients die within 12 months after first diagnosis. The early recognition of fast progression is essential for patients and neurologists to weigh up invasive therapeutic interventions. In a prospective, population-based cohort of ALS patients in Rhineland-Palatinate, Germany, we identified significant prognostic factors at time of diagnosis that allow prediction of early death within first 12 months.Methods Incident cases, diagnosed between October 2009 and September 2012 were enrolled and followed up at regular intervals of 3 to 6 months. Univariate analysis utilized the Log-Rank Test to identify association between candidate demographic and disease variables and one-year mortality. In a second step we investigated a multiple logistic regression model for the optimal prediction of one-year mortality rate.ResultsIn the cohort of 176 ALS patients (mean age 66.2 years; follow-up 100%) one-year mortality rate from diagnosis was 34.1%. Multivariate analysis revealed that age over 75 years, interval between symptom onset and diagnosis below 7 months, decline of body weight before diagnosis exceeding 2 BMI units and Functional Rating Score below 31 points were independent factors predicting early death.Conclusions Probability of early death within 12 months from diagnosis is predicted by advanced age, short interval between symptom onset and first diagnosis, rapid decline of body weight before diagnosis and advanced functional impairment.Trial registrationClinicalTrials.gov (NCT01955369, registered September 28, 2013).
    Full-text · Article · Oct 2014 · BMC Neurology
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    Safer A · wolf j · Wöhrle JC · Palm F · Nix WA · Maschke M · Becher H · Grau AJ
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    ABSTRACT: Hintergrund: Die amyotrophe Lateralsklerose (ALS) ist eine neurodegenerative Systemerkrankung, die zu einem progredienten Untergang peripherer und zentraler Motoneurone führt, mit einer Überlebensdauer von wenigen Monaten bis zu mehreren Jahren. Einige wenige populationsbasierte prospektive Studien haben prädiktive Faktoren für die Überlebensdauer identifiziert, wobei die Bedeutung einiger Faktoren umstritten ist. Fragestellung: Welche Faktoren sind für die Prognose der Überlebensdauer von ALS-Patienten von Bedeutung? Methoden: Das ALS-Register Rheinland-Pfalz hat zwischen 10/2009 und 09/2012 200 Inzidente Patienten mit einer ALS-Erstdiagnose erfasst, und in sechsmonatigen Abständen nachuntersucht. Um eine möglichst vollständige Erfassung zu gewährleisten wurden mehrere überlappende Methoden benutzt. Pseudonymisierte Todesbescheinigungen der Gesundheitsämter dienten zur Erhebung/Kontrolle der Todesfälle. Die Zielgröße war das Patientenüberleben nach Erstdiagnose (ED). Für die multivariate Modellbildung wurde die Überlebensdaueranalyse nach Cox eingesetzt, unter stufenweise Elimination nicht signifikanter Prädiktorvariablen. Ergebnisse: 176 ALS-Patienten (96 Männer, 80 Frauen) wurden in diese Studie eingeschlossen. Das mittlere Erkrankungsalter betrug 66,2 Jahre (SD 10,3; Median 68). Die Dauer der Nachbeobachtung war mindestens 12 Monate (Median: 16.5; Maximum: 48 Monate). Das mittlere Intervall zwischen Symptombeginn und Erstdiagnose (ISE) lag bei 12,5 Monaten (SD 12,8; Median 9). Die Einjahresmortalitätsrate ab Erstdiagnose lag bei 34,1% (60 Patienten) . Die mediane Überlebenszeit dieser 60 Patienten betrug ab Erstdiagnose 19 Monate, ab Erstsymptomatik i 29 Monate. Bei der multivariaten Modellbildung blieben das Alter (Hazard Ratio (HR) von 1,6 66- 75 Jahre; 3,4 bei >75 Jahre), log10(ISE) (HR 0.053), El-Escorial-Kriterien (HR 3,0 bei sicherer ALS), BMI-Veränderung in den letzten 6 Monaten vor ED als signifikant prädiktive Variable übrig. Für Geschlecht, bulbären Symptombeginn, Alkoholkonsum, Rauchen, FRS bei ED und alleine lebend konnte kein signifikanter Einfluss auf die Überlebenswahrscheinlichkeit ab ED festgestellt werden. Schlussfolgerungen: Die Daten unserer Studie weisen darauf hin, dass die Überlebensprognose bei ALS-Patienten bereits zum Zeitpunkt der Erstdiagnose möglich ist, aus Patientenalter, ISE, dem Grad der neurologischen Beeinträchtigung (El-Escorial-Kriterien) und der BMI-Veränderung.
    Full-text · Conference Paper · Sep 2014
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    ABSTRACT: Objectives: The clinical spectrum of amyotrophic lateral sclerosis (ALS) is characterized by a considerable variation. Different phenotypes have been described by previous studies. We assessed clinical variability and prognostic relevance of these phenotypes in a prospective, population-based cohort of ALS patients in Rhineland-Palatinate, Germany. Methods: Incident ALS cases, diagnosed between October 2009 and September 2012, were prospectively enrolled and classified according to established ALS phenotype classification (bulbar, classic, flail arm, flail leg, pyramidal, respiratory). Survival probability was described using Kaplan-Meier method. Moreover, the influence of an additional frontotemporal dementia (FTD) was analysed. Results: Phenotypes of all 200 patients were determined. Bulbar and classic phenotypes accounted for 75% of all cases. Deterioration of functional impairment during disease progression was lowest in flail leg and pyramidal variants, and most pronounced in bulbar and classic phenotypes. A poor survival prognosis was observed for bulbar, classic or respiratory phenotypes. Patients with an additional FTD showed an even worse outcome. Conclusions: Results suggest that ALS is a heterogeneous disease, as ALS phenotypes differ in disease progression and survival time. Patients classified as suffering from bulbar, classic and respiratory ALS, as well as those with an additional FTD, show a marked reduction of survival time.
    No preview · Article · Jul 2014 · Journal of the Neurological Sciences

  • No preview · Article · May 2014 · Mycoses
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    ABSTRACT: There is a lack of prospective and population based epidemiological data on amyotrophic lateral sclerosis in Germany to date. The ALS registry Rhineland-Palatinate was established to investigate the incidence, course and phenotypic variety of ALS in this south-west German state of about 4 million inhabitants. During the period 2010-2011, consecutive incident patients with amyotrophic lateral sclerosis according to the revised El Escorial criteria were included and followed up using multiple overlapping sources of case ascertainment. One hundred and forty-six patients were enrolled. The annual crude incidence for amyotrophic lateral sclerosis in Rhineland-Palatinate was 1.8/100,000 person-years (95% CI 1.6-2.2). Male to female ratio was 1.1:1. Incidence increased with age reaching a peak in the 70-74 years age group and declined thereafter. Late-onset ALS (≥ 75 years) was found in 14.4% of patients. About 32% of patients presented with bulbar onset. In conclusion, incidence rate of amyotrophic lateral sclerosis in Rhineland-Palatinate is within the range of other prospective population based registers in Europe and North America. Gender ratio is nearly balanced.
    Full-text · Article · Feb 2014
  • M. Maschke · K. Schröder
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    ABSTRACT: Physical activity has an increasing evidence base in the primary and secondary prevention of stroke. It prevents the risk of developing hypertension, type 2 diabetes and dyslipidaemia. It helps to improve endothelial function and can reduce systemic inflammatory processes. Recent studies suggest an association between higher intensity and frequency of exercise and higher cerebrovascular risk reduction. In order to maintain the cardiovascular benefits, patients have to continue to participate in regular physical activity. Given that there are no medical contra-indications or severe neurological disabilities the AHA recommends stroke survivors light to moderate regular exercise at least twice or three times per week for twenty to sixty minutes at a time. High-risk or extreme activities should be avoided. At present there is very limited data concerning travelling and stroke. A study published in 2006 showed a significant increased frequency of cardioembolism and patent foramen oval in patients with stroke and a positive travel history. Particularly medium- and long-haul flights should be avoided within the first 30 days after stroke.
    No preview · Article · Jan 2014
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    ABSTRACT: Increases in CSF dopamine in HIV patients are due to the dopamine transporter 10/10-repeat allele which is more frequent in HIV-infected individuals Abstract Dysfunction of dopaminergic neurotransmis-sion has been implicated in HIV infection. We showed previously increased dopamine (DA) levels in CSF of therapy-nave HIV patients and an inverse correlation between CSF DA and CD4 counts in the periphery, sug-gesting adverse effects of high levels of DA on HIV infection. In the current study including a total of 167 HIV-positive and negative donors from Germany and South Africa (SA), we investigated the mechanistic background for the increase of CSF DA in HIV individuals. Interest-ingly, we found that the DAT 10/10-repeat allele is present more frequently within HIV individuals than in uninfected subjects. Logistic regression analysis adjusted for gender and ethnicity showed an odds ratio for HIV infection in DAT 10/10 allele carriers of 3.93 (95 % CI 1.72–8.96; p = 0.001, Fishers exact test). 42.6 % HIV-infected patients harbored the DAT 10/10 allele compared to only 10.5 % uninfected DAT 10/10 carriers in SA (odds ratio 6.31), whereas 68.1 versus 40.9 %, respectively, in Ger-many (odds ratio 3.08). Subjects homozygous for the 10-repeat allele had higher amounts of CSF DA and reduced DAT mRNA expression but similar disease severity compared with those carrying other DAT geno-types. These intriguing and novel findings show the mutual interaction between DA and HIV, suggesting caution in the interpretation of CNS DA alterations in HIV infection solely as a secondary phenomenon to the virus and open the door for larger studies investigating consequences of the DAT functional polymorphism on HIV epidemiology and progression of disease.
    Full-text · Article · Oct 2013 · Journal of Neural Transmission
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    ABSTRACT: Studies about recovery from cerebellar stroke are rare. The present study assessed motor deficits in the acute phase after isolated cerebellar stroke focusing on postural impairment and gait ataxia and outlines the role of lesion site on motor outcome, the course of recovery and the effect of treadmill training. 23 patients with acute and isolated cerebellar infarction participated. Deficits were quantified by ataxia scores and dynamic posturography in the acute phase and in a follow up after 2 weeks and 3 months. MRI data were obtained to correlate lesion site with motor performance. Half of the patients that gave informed consent and walked independently underwent a 2-week treadmill training with increasing velocity. In the acute phase patients showed a mild to severe ataxia with a worse performance in patients with infarction of the superior in comparison to the posterior inferior cerebellar artery. However, after 3 months differences between vascular territories were no longer significant. MRI data showed that patients with larger infarct volumes had a significantly more severe ataxia. In patients with ataxia of stance, gait and lower limbs lesions were more common in cerebellar lobules IV to VI. After 3 months a mild ataxia in lower limbs and gait, especially in gait speed persisted. Because postural impairment had fully recovered, remaining gait ataxia was likely related to incoordination of lower limbs. Treadmill training did not show significant effects. Future studies are needed to investigate whether intensive coordinative training is of benefit in patients with cerebellar stroke.
    No preview · Article · Sep 2013 · Gait & posture
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    ABSTRACT: Objective In Assessment of OraL Laquinimod in PrEventing ProGRession in Multiple SclerOsis (ALLEGRO), a phase III study in relapsing-remitting multiple sclerosis (RRMS), oral laquinimod slowed disability and brain atrophy progression, suggesting laquinimod may reduce tissue damage in MS. MRI techniques sensitive to the most destructive aspects of the disease were used to further investigate laquinimod's potential effects on inflammation and neurodegeneration. Methods 1106 RRMS patients were randomised 1:1 to receive once-daily oral laquinimod (0.6 mg) or placebo for 24 months. White matter (WM), grey matter (GM) and thalamic fractions were derived at months 0, 12 and 24. Also assessed were evolution of gadolinium-enhancing and/or new T2 lesions into permanent black holes (PBH); magnetisation transfer ratio (MTR) of normal-appearing brain tissue (NABT), WM, GM and T2 lesions; and N-acetylaspartate/creatine (NAA/Cr) levels in WM. Results Compared with placebo, laquinimod-treated patients showed lower rates of WM at months 12 and 24 (p=0.004 and p=0.035) and GM (p=0.004) atrophy at month 12 and a trend for less GM atrophy at month 24 (p=0.078). Laquinimod also slowed thalamic atrophy at month 12 (p=0.005) and month 24 (p=0.003) and reduced the number of PBH at 12 and 24 months evolving from active lesions (all p<0.05). By month 24, MTR decreased significantly in NABT (p=0.015), WM (p=0.011) and GM (p=0.034) in placebo-treated patients, but not in laquinimod-treated patients. WM NAA/Cr tended to increase with laquinimod and decrease with placebo at 24 months (p=0.179). Conclusions Oral laquinimod may reduce (at least in the initial phase of treatment) some of the more destructive pathological processes in RRMS patients. Trial registration The ALLEGRO trial identifier number with clinicaltrials.gov is NCT00509145.
    Full-text · Article · Sep 2013 · Journal of neurology, neurosurgery, and psychiatry
  • Matthias Maschke
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    ABSTRACT: Fragestellung: Die vorliegende Studie untersuchte in einem dreiarmigen Design, ob Amphotericin B plus Flucytosin oder Amphotericin B plus Fluconazol der Monotherapie mit Amphotericin B überlegen ist.Hintergrund: Die Kryptokokken-Meningitis ist weltweit mit mehr als einer Million Fälle und 625.000 Toten pro Jahr eine der häufigsten und unangenehmsten Pilzinfektionen des Gehirns [1]. In Deutschland sind dabei am häufigsten Patienten mit HIV-Erkrankung sowie Migranten aus afrikanischen Staaten betroffen. In der Therapie verblieb zum einen unklar, ob die Kombinationstherapie Amphotericin B plus Flucytosin besser wirksam ist als die Monotherapie mit Amphotericin B. Zudem ist Flucytosin nicht in allen Teilen der Welt problemlos erhältlich, sodass Fluconazol eine billigere und besser erhältlichere Therapie bereits in der Induktionstherapie darstellen könnte.Patienten und Methodik: Insgesamt wurden 299 Patienten mit klinisch und serologisch bestätigter akuter Kryptokokken-Meningitis in die Stu ...
    No preview · Article · Sep 2013
  • K. Schröder · C. Klawe · M. Maschke
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    ABSTRACT: Recent trials showed no significant difference in efficacy between IVIG and plasmapheresis in the treatment of severe Myasthenia gravis. Rituximab is efficacious in refractory myasthenia. In case of GBS no significant superiority can be found for treatment with IVIG or plasmapheresis. Corticosteroids might delay recovery of patients with GBS. Due to extensive travel activity "emerging viruses" like West Nile virus, Japanese encephalitis virus or Dengue virus are increasingly frequent causes of viral encephalitis. In patients with TGA focal diffusion lesions can be selectively detected in the CA1 field of the hippocampal cornu ammonis by use of thin slice MRI. Magnetic resonance spectroscopy studies showed corresponding metabolic changes in CA 1 neurons. Recent large trials showed no benefit of Magnesium or Clazosentan in the management of subarachnoidal hemorrhage. In 2012 S3 guidelines for diagnosis and therapy of bipolar affective disorders were published, S3 guidelines for diagnosis and therapy of schizophrenic disorders are expected to be published this year. Trazodon might be effective in the management of neuroleptic-induced acute akathisia.
    No preview · Article · Jan 2013 · Nervenheilkunde
  • Matthias Maschke · Maria Mörsdorf · Dagmar Timmann · Uwe Dietrich
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    ABSTRACT: Traumatic brain injury remains one of the leading causes of residual neurological and neuropsychological deficits in every age group independent from socioeconomic status. Posterior fossa trauma affects structures within the posterior fossa, that is, brainstem and cerebellum. It consists of intra-axial lesions such as contusions, hematoma or diffuse axonal injury, and extra-axial lesions such as epidural and subdural hematoma as well as subarachnoid hemorrhage. Imaging should guide surgical and conservative treatment. CT imaging is the method of choice since it is easier to conduct than MRI and readily available. However, in some cases, MRI is necessary to detect subtle lesions within the brainstem and to visualize long-term complications such as olivary pseudohypertrophy or superficial siderosis of the CNS. In spite of advances in intensive care management, especially control of raised intracranial pressure, and neurosurgical methods, mortality of posterior fossa trauma remains high and a high proportion of surviving patients exhibit substantial neurological deficits.
    No preview · Chapter · Jan 2013
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    Full-text · Chapter · Sep 2012
  • V. Limmroth · M. Maschke · S. Schwab · L. Pageler · H.-C. Diener

    No preview · Article · Sep 2012 · Aktuelle Neurologie
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    ABSTRACT: HIV-associated dementia and its precursors are frequently observed complications of HIV infection, even in the presence of combination antiretroviral treatment (cART). The development, surveillance and treatment of this condition are still not completely understood. Cytokines, as immunological transmitters, may be one key to gaining a deeper understanding of the disease. A total of 33 HIV-positive male patients were evaluated by neuropsychological testing, lumbar and venous puncture, neuroimaging and neurological examination. The cytokine content in the CSF (cerebrospinal fluid) was examined by a solid-phase protein array. The Digit-Symbol Test, contraction time analysis, Rey-Osterrieth Figure and Grooved-Pegboard Test showed inferior results in the presence of an inflammatory CSF environment, whereas neuroprotective or anti-inflammatory conditions were correlated to better results in contraction time analysis. Higher CSF levels of cytokines were independently correlated with the duration of HIV infection. The study showed a correlation of cytokine levels in the CSF of HIV patients with test results of their neuropsychological functioning. The effect was pronounced with regard to the more complex executive tasks. Determining CSF cytokine levels may be a useful supplement to the assessment of HIV patients and contribute helpful information to predict neurocognitive performance. Therapeutic strategies to ameliorate a negative impact of an altered cytokine milieu may aid in slowing the evolution of neurocognitive dysfunction.
    No preview · Article · Apr 2012 · Journal of NeuroVirology
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    David A Morrow · Eugene Braunwald · Marc P Bonaca · Sebastian F Ameriso · Anthony J Dalby · Mary Polly Fish · Keith A A Fox · Leslie J Lipka · Xuan Liu · José Carlos Nicolau · [...] · Frey A · Short L · Stein B · McGee R · Schneider D · Chadwick L · Puleo P · Tarsi D · Singh N · Logwood D. ·
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    ABSTRACT: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.).
    Full-text · Article · Mar 2012 · New England Journal of Medicine

Publication Stats

4k Citations
498.98 Total Impact Points

Institutions

  • 2010-2015
    • Krankenhaus der Barmherzigen Brüder Trier
      Trier, Rheinland-Pfalz, Germany
  • 2000-2013
    • University of Duisburg-Essen
      • Erwin L. Hahn Institute for Magnetic Resonance Imaging
      Essen, North Rhine-Westphalia, Germany
  • 1998-2011
    • University Hospital Essen
      • • Klinik für Neurologie
      • • Institute of Diagnostic and Interventional Radiology and Neuroradiology
      Essen, North Rhine-Westphalia, Germany
  • 2009
    • Krankenhaus Barmherzige Brüder München
      München, Bavaria, Germany
  • 2006-2009
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2007
    • Alfried Krupp Krankenhaus
      Essen, Lower Saxony, Germany