Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson

BackgroundStroke is the leading cause of disability worldwide. Upper extremity paresis is the most common functional consequence, affecting more than half of all stroke survivors. Research has shown that an adequate therapy should begin in the sub-acute stage, but also that an enhanced intensity and frequency of therapy can positively affect patients’ recovery curve. Therefore, here we assessed whether an additional VR-based training can be beneficial for recovery of stroke patients, with particular emphasis on upper extremity functions.MethodsThe study was organized as prospective and single-blinded (analysis). Two groups of pairwise-matched subacute stroke patients with arm paresis were recruited at our rehabilitation clinic while controlling for gender, age, sidedness and modified Rankin scale (mRS). Both groups – conventional therapy (CT) and conventional therapy plus virtual reality (CT + VR) – received 30–45 min of conventional therapy on 3 to 4 days/week over 4 weeks; in addition to that, the CT + VR group received 3 times per week a specially designed VR-based training for upper extremity. Data acquisition was performed within 24 h before the baseline and after the training has ended. Main outcomes were patients’ performance on Fugl-Meyer test for upper extremity (FME), Box-and-Block test, hand dynamometry and Functional independence test (FIM).ResultsTwenty-two subjects aged 57–85 were pairwise-matched and assigned to the conventional therapy (CT) group (n = 11, 67.82 ± 8.69 years; three females) and the conventional therapy plus virtual reality (CT + VR) group (n = 11, 70.45 ± 6.79 years; three females). No difference in gender, age, sidedness, mRS and mini-mental status examination (MMSE) existed between the two groups. The CT + VR group showed significantly better improvements over time on FME (44.3 ± 7.8 to 58.7 ± 11.2 vs. 42.1 ± 6.2 to 49.5 ± 10.9; p = 0.009) and FIM (90.1 ± 18.0 to 118.1 ± 6.9 vs. 105.0 ± 12.4 to 110.6 ± 12.6; p < 0.001), compared to the CT group. Other tests revealed no significant differences.DiscussionAs hypothesized, an additional immersive VR-based training can be beneficial for stroke patients suffering from upper extremity deficiency. Nevertheless, the principle of specificity could be observed, with only trained functions being associated with improvements on FME and FIM. Future studies with larger sample of participants are required to confirm these findings.

Post-stroke spasticity (PSS) affects up to 48% of stroke survivors, with disabling forms in about 18%. In the upper limb, 95% of cases show a flexor-dominant pattern. Botulinum toxin A (BoNT-A) is the treatment of choice, but adjunctive strategies such as serial casting may be used to enhance outcomes. To evaluate whether serial casting prior to abobotulinumtoxinA (AboBoNT-A) injections improves the reduction of wrist and finger flexor spasticity in subacute stroke survivors. In this prospective, randomized, two-center trial, 27 stroke patients with moderate wrist and finger flexor spasticity were allocated to one of two groups: SC + BoNT-A group (Group 1): serial casting for two weeks prior to AboBoNT-A injection (n = 14). BoNT-A group (Group 2): standard treatment with AboBoNT-A alone (n = 13). Both groups participated in an eight-week inpatient neurorehabilitation program. Spasticity and joint stiffness were assessed using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale (MTS). Additional validated outcome measures for stroke rehabilitation were also employed, including the passive Range of Motion (PROM), Wolf Motor Function Test (WMFT), Grip Strength, Barthel Index, Visual Analogue Scale for pain (VAS), and Stroke Impact Scale (SIS). Both groups showed improvements after BoNT-A. In the SC + BoNT-A group, MAS scores decreased and remained stable during follow-up. In the BoNT-A group, a recurrence of muscle stiffness was observed at week 6. Serial casting prior to BoNT-A was associated with a trend toward more sustained reduction of spasticity, but superiority over BoNT-A alone was not statistically confirmed.

IntroductionWe evaluated continuous subcutaneously administered foslevodopa/foscarbidopa (LDp/CDp) in younger patients earlier within advanced Parkinson’s disease (aPD).MethodsThis phase 3 trial included patients aged ≥ 30 years with levodopa-responsive PD, Mini-Mental State Examination score ≥ 24, and levodopa equivalent dose ≥ 400 mg/day. Patients were considered by the investigator as inadequately controlled on current oral/transdermal therapy and experienced ≥ 2.5 h/day “Off” time, with recognizable “On”/“Off” states. Patients were randomized (1:1) to LDp/CDp plus placebo capsules or orally administered immediate-release levodopa/carbidopa plus placebo infusion. This post hoc exploratory analysis focused on younger patients (≤ 65 years) earlier within aPD (Hoehn and Yahr stage ≤ 2 [“On” state], ≤ 5 years since motor fluctuations started). Outcomes included change from baseline (CFB) to week 12 in “Off” and “On” time, Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) II, 39-item PD Questionnaire (PDQ-39), and PD Sleep Scale-2 (PDSS-2).ResultsTwenty-six patients met subgroup criteria (LDp/CDp, n = 13; orally administered levodopa/carbidopa, n = 13). Despite small sample sizes, at week 12, LDp/CDp was associated with significantly greater improvements in “Off” time (mean [SD] CFB − 3.7 [3.1] vs − 1.6 [2.9] h; P = 0.0011), “On” time without troublesome dyskinesia (+ 3.9 [3.3] vs + 1.4 [3.8] h; P = 0.0011), and PDSS-2 (− 6.4 [4.6] vs − 1.8 [3.1]; P = 0.0220) vs orally administered levodopa/carbidopa. Mean (SD) CFB to week 12 (LDp/CDp vs orally administered levodopa/carbidopa) was + 4.2 (2.8) vs + 1.9 (4.6) h for “On” time without dyskinesia (P = 0.0878), − 3.0 (6.4) vs − 0.9 (3.5) for MDS-UPDRS II (P = 0.3539), and − 9.9 (7.4) vs − 1.9 (9.4) for PDQ-39 (P = 0.0534). For most assessments, treatment differences were numerically larger in the subgroup vs the overall population. Safety findings were consistent with the overall population.ConclusionsLDp/CDp was associated with significantly greater improvements in motor function and sleep vs orally administered levodopa/carbidopa in younger patients earlier within aPD whose symptoms were inadequately controlled by oral/transdermal therapies. Larger real-world studies are needed to confirm findings.Trial RegistrationClinicalTrials.gov identifier, NCT04380142.

IntroductionEarly gait training plays a critical role in stroke rehabilitation, as reflected in relevant guidelines. However, patients with visuospatial neglect—a factor that negatively impacts gait recovery—have traditionally been excluded from robot-assisted gait training studies. To address this issue, our study examined the effects of end-effector-based gait training on subacute stroke patients with visuospatial neglect.MethodsA total of 43 patients were randomized in a controlled, assessor-blinded study and assigned either to end-effector-based gait training plus standard physical therapy or early verticalization with a standing frame plus standard physical therapy. All patients underwent nine training sessions over 2 weeks. We analyzed the primary outcome measure, the Functional Ambulation Category, using an ordinal regression model, reporting results for both the intention-to-treat population and the per-protocol sample, and also assessed trunk stability and balance as secondary outcomes.ResultsNeither the intention-to-treat analysis (odds ratio [95% confidence interval]: 1.20 [0.30–4.78]) nor the per-protocol analysis (odds ratio: 4.08 [0.80–20.87]) revealed any significant overall superiority of gait training compared to standing training. However, the per-protocol analysis showed a promising pattern: Severely affected patients were more likely to improve their walking ability after gait training depending on their baseline Functional Ambulation Category score. Gait training also led to greater improvements in trunk stability and balance than standing training did.ConclusionThese results suggest that early adjunctive end-effector-based gait training could benefit a subgroup of severely affected, non-ambulatory, subacute stroke patients with visuospatial neglect.Clinical trial registrationDRKS00021654, www.drks.de/search/de/trial/DRKS00021654.

Introduction. ADHD is one of the most common neurodevelopmental disorders, affecting millions of children and adults worldwide. The significance of ADHD extends far beyond its prevalence. It impacts multiple areas of life, including academic achievement, job performance, relationships, and mental health. Significant challenges remain in terms of diagnosis and treatment. Methods. A search for information was conducted from January to June 2025 in the databases SciELO, Scopus, PubMed/MedLine, Google Scholar, Cochrane Library, as well as Clinical Keys services. From the resulting documents, those written in the last 10 years were selected; this time range was prioritized; some systematic reviews covered broader periods, such as the last 5 years, the last 10 years, or even did not apply a specific date limit. Conclusions. Attention-Deficit Hyperactivity Disorder (ADHD) represents a multifactorial challenge that transcends the clinical context to involve neurobiological, psychosocial, and cultural dimensions. Empowering patients and their families through psychoeducation strengthens understanding of the disorder, especially in vulnerable populations such as children, adolescents, and young adults. Investing in research, therapeutic innovation, and equitable public policies will be key to transforming ADHD care into a real opportunity to improve the quality of life for those who suffer from it.

BackgroundMotor fluctuations are routinely documented using the Parkinson's disease (PD) home diary. However, the validity of this diary when compared to clinical observers is limited.ObjectiveThis study disassembled the effects of nonmotor symptoms (NMS) on inter‐method agreement between the PD home motor diary and clinical observers (outside validity criterion).MethodsA prospective observational VALIDATE‐PD cohort study in advanced PD assessing symptom severity by simultaneous hourly ratings using the home diary (Off, On, dyskinetic state) and a nonmotor diary (11 key NMSs) was performed. Test validity measures (accuracy and Cohen's κ) were compared between hours with and without co‐occurring NMS.ResultsFour hundred eighty‐seven hourly time periods from 47 participants were analyzed. Inter‐method agreement (accuracy, Cohen's κ) of the motor diary was independent of co‐occurring NMSs, but simultaneous NMSs inversely influence false ratings of motor Off and On states.ConclusionsSimultaneously occurring NMSs do not affect general validity but the interpretation of the PD home motor diary.

Introduction: More than 140 million people in the world live at high altitudes, above 2,500 meters (m) above sea level. Oxygen is vital for cellular metabolism; therefore, hypoxic conditions found at high altitude affect all physiological functions. Metods: A search for information was carried out in the SciELO, Scopus, PubMed/MedLine databases, the Google Scholar search engine, as well as in the ClinicalKeys services. Advanced search strategies were used to retrieve the information, by structuring search formulas using the terms "Cardiovascular Physiology", "Cardiovascular Physiology at Altitude", as well as their translations into Spanish " Fisiología Cardiovascular " and " Fisiología Cardiovascular en la altitud ". Results discussion: The heart is composed of three main types of cardiac muscle: atrial muscle, ventricular muscle, and specialized excitatory and conductive muscle fibers. The efficiency and work of the heart as a pump is often measured in terms of cardiac output, or the amount of blood the heart pumps per minute. Cardiac output is the product of stroke volume and heart rate Cardiovascular Changes at Altitude It is possible to think of the goal of acclimatization as maintaining oxygen delivery to the tissues as close to normal as possible. The cardiovascular system is central to this. Acute exposure to high altitude produces an increase in heart rate and cardiac output both at rest and for a given amount of work compared with sea level. In general, the normal heart tolerates even severe hypoxia very well. The heart, as a hemodynamic pump, has two mechanisms at its disposal to enhance its performance: heart rate and stroke volume, which together constitute cardiac output. The altitude electrocardiogram shows a variably increased amplitude of the P wave, deviation of the QRS axis to the right, and signs of right ventricular overload and hypertrophy. Conclusions: Advances in high-altitude research have shown that the cardiovascular system deploys some efficient mechanisms of acclimatization to oxygen deprivation, and the healthy heart adapts to hypoxia, even when severe, with preservation of systolic function and only minor impairment of LV and RV diastolic function. With acclimatization, desensitization of the adrenergic system, together with increased parasympathetic influence, leads to a decrease in maximum heart rate and protection of the myocardium against potentially damaging energy imbalances. Acute exposure to high altitude stimulates the adrenergic system, increasing heart rate and cardiac output; although arterial pressure remains stable, pulmonary artery pressure increases due to hypoxic pulmonary vasoconstriction. Our improved understanding of the effect of altitude hypoxia on the cardiovascular system will allow better-informed, evidence-based advice for patients with pre-existing cardiovascular disease

Background and objectiveThere are multiple pharmacological treatment options for motor symptoms of Parkinson’s disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details.MethodsThe recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson’s Guideline Group, and publicly released in November 2023.ResultsIn the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise “Parkinson medication”, “Initial monotherapy”, “Early combination therapy”, “Fluctuations and dyskinesia”, and “Parkinsonian tremor”. Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding.ConclusionThe recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations.