Der Nervenarzt
-
Bacterial infections of the nervous system are often challenging for the treating physician because sensitivity and specificity of clinical signs do not reach 100%. In patients with neuroborreliosis and bacterial meningitis, investigations of the cerebrospinal fluid are necessary to confirm or rule out the diagnosis. In intracranial and spinal abscesses, the alterations of the cerebrospinal fluid are most often non-specific and imaging and neurosurgical aspiration of purulent material are additionally needed to make the diagnosis. Here, the relevant diagnostic and therapeutic aspects of three common bacterial infections of the central nervous system (neuroborreliosis, bacterial meningitis, and brain abscess) are discussed.
-
Multiple sclerosis (MS) is a chronic, immune-mediated disease of the central nervous system in which autoreactive CD4(+) and CD8(+) T lymphocytes, B lymphocytes, macrophages, antibodies, and cytokines attack the myelin sheaths and damage the axons. The basic therapeutic agents and disease-modifying drugs that are currently available for MS require regular and frequent parenteral administration and therefore long-term compliance is unsatisfactory. Among all of the new oral MS agents presently under development, cladribine is the only substance that appears able to achieve long treatment-free intervals after only short-term administration. ⋯ This contribution addresses the need for novel MS treatment approaches to improve compliance and describes the mechanism of action of cladribine, the available data on effectivity and safety, and the clinical development of the oral formulation of cladribine. The results from the recently published 96-week, double-blind, randomized, placebo-controlled, multicenter study CLARITY (CLAdRIbine Tablets Treating MS OrallY) are very promising. They clearly show that oral cladribine reduces relapse rate, disability progression and disease activity and burden as evidenced by MRI.
-
It has been supposed that the introduction of a new inpatient reimbursement system starting in 2004 in Germany using the German diagnosis-related groups (G-DRG) may lead to false incentives with encouragement of premature hospital discharge of patients. Exploring a large database on stroke patients, we addressed the question whether length of stay (LOS) and discharge in more severe condition were associated with the introduction of the G-DRG. We further examined other factors with probable effect on LOS such as variations of patient characteristics and treatment during the observation period. ⋯ This study reveals a significant reduction of LOS during the years after introduction of the G-DRG. However, reduction of LOS was not associated with more severe outcome on discharge, possibly due to changes in stroke treatment implemented during the observational period. Our results do not support the conjecture that changes in the reimbursement system were associated with compromised patient care.
-
To examine the association between apolipoprotein E (ApoE) and a family history of dementia in 1st- and 2nd-degree relatives of patients with frontotemporal dementia (FTD) with a dementia onset by age 70. ⋯ Apo epsilon4 homozygosity is associated with a family history of dementia and FTD in our cohort if the current clinical criteria are employed. It is likely that autopsy might reveal amyloid beta deposits typical for Alzheimer's disease among the Apo epsilon4 homozygous patients with frontotemporal clinical presentation and neuroimaging consistent with FTD. Apo epsilon4 homozygosity has not yet been defined as an exclusion criterion for the diagnosis of FTD. In the future, a revision of the clinical criteria should consider the ApoE genotype.