Josef Georg Heckmann

Background and purpose: Facial nerve palsy is the most common cranial nerve disorder, and over 60% are idiopathic (Bell’s palsy, BP). An inflammatory process is discussed as a causative factor. The aim of this study was to search for changes in various cytokine concentrations in serum and cerebrospinal fluid (CSF) in patients with facial nerve palsy. Methods: In this prospective study, 47 patients with peripheral facial nerve palsy were included. Of these, 40 patients were diagnosed as BP and seven patients as non-idiopathic peripheral facial palsy (nipFP). Seventeen cytokines, including IL-1A, IL-5, IL-9, granulocyte colony-stimulating factor (G-CSF), CXCL-13, granulocyte–macrophage-colony-stimulating factor (GM-CSF), tumor necrosis factor-SF13 (TNFSF13), IL-8, IL-1ß, CXCL-10, fractalkine (Fract), monocyte chemotactic protein (MCP-1), IFN-y, IL-4, IL-17A, tumor necrosis factor (TNF), and Granzyme, were measured in the serum and CSF. For comparison, sera from 10 healthy individuals were used. Results: In serum, the levels of cytokines G-CSF, CXCL13, TNFSF13, and Granzyme were statistically significantly higher in patients with BP and nipFP compared to healthy individuals ( p < 0.05). Cytokine IL-1ß was significantly higher in nipFP patients compared to healthy individuals and patients with BP ( p < 0.05). Cytokine IL-8 was significantly lower in both patient groups than in healthy individuals ( p < 0.05). In CSF, G-CSF, CXCL13, TNFSF13, IL-8, IL-1ß, and IL-17A were statistically significantly higher in patients with nipFP compared to patients with BP ( p < 0.05). In addition, patients with BP also showed a clustering of cytokine elevation. For differentiating nipFP from BP, serum G-CSF and IL1ß indicated a certain discrimination (AUC 0.643; 0.614). Patients with severe facial palsy revealed higher CSF TNFSF13 ( p = 0.02), and clinical outcome after 3 months was less favorable at higher CSF Fractalkine ( p = 0.025). Elevated CSF cell count was associated with elevated CXCL13, IL-8, IL-1ß, IP-10, IFNa and granzyme in the CSF ( r = 0.32–0.57; p < 0.05). Conclusion: Compared to healthy individuals, our study revealed an altered cytokine profile in patients with BP that resembles patients with nipFP. In CSF, a subset of cytokines was identified in patients with BP, but higher levels were found in patients with nipFP, suggesting a graduated inflammatory process. Study registration: The study "Serum and CSF cytokine profile in patients with facial palsy (Bell´s palsy)" has been officially registered at the German Clinical Trials Register (DRKS00037815).

Background: Due to demographic changes, the task of dental treatment for older patients is increasing. The aim of this study was to record polypharmacotherapy in elderly patients undergoing dental-prosthetic treatment. In addition, it was hypothesized that patients with removable dentures have a higher polypharmacy rate than patients with fixed dentures. Methods: In a prospective and observational study, 103 patients aged 70 years and over were included. Age, gender, and the type of denture were recorded. Daily medication was charted using a questionnaire and patients’ medication plan. The medication was recorded according to the anatomical-therapeutic-chemical classification system of the World Health Organization. In addition, a patient-related medication analysis was carried out. Results: Of the 103 study participants, 59 were female and 44 were male. The average age was 80.7 years. Twenty-six patients were fitted with fixed restorations (PFR) and 77 patients with removable dentures (PRD). Polypharmacy (more than 5 medications taken) was equally common in both patient groups (62% in PFR and 61% in PRD; P = 0.964). The number of medicaments (4.8 ± 2.8 in PFR and 6 ± 4.3 in PRD; P = 0.318) and the number of medication groups (1.6 ± 0.9 in PFR and 2 ± 1 in PRD; P = 0.053) did not differ significantly. Considering the medication groups PRD group took anti-diabetic drugs significantly more frequent (4% in PFR and 25% in PRD; P = 0.021). Of the medications taken, 24% belonged to the group of anticoagulants/platelet inhibitors, 12% to the group of psychotropic/neurological drugs, 11% to antidiabetics, 1% to bisphosphonates/monoclonal antibodies, 1% to cytostatics, and 51% other medications. The patient-related analysis showed that 47% of the study participants took anticoagulants/platelet inhibitors, 25% psychotropic/neurological drugs, 19% anti-diabetics, 3% cytostatics/angiogenesis inhibitors, and 2% bisphosphonates/monoclonal antibodies. In addition, 93% of the patients took other medications, while only 6% of the study participants received no drug therapy. Conclusion: On average, the majority of patients requiring prosthetic treatment were on polypharmacy. However, there was no difference between PFR and PRD patients regarding the number of medication groups and the number of medicaments. The dental treatment of elderly patients requires beside expertise in gerostomatology profound knowledge of pharmacotherapy in old age.

A 61-year-old man had epilepsy related to chronic alcoholism and occipito-temporal porencephaly. Over a span of 19 years, he had been admitted to our institution 227 times, undergoing 55 CT scans of the head and 11 CT scans of the cervical spine. His blood alcohol concentrations varied between 1.9 g/L and 5.1 g/L. We discuss the challenges of emergency management of patients with alcoholism and seizures and the overuse of radiological examinations.

Background: Forest therapy demonstrates positive effects on mood, immune system, stress levels, and general well-being. Studies on depression, stress-related illnesses, sleep disorders, and arterial hypertension have provided evidence-based proof of this. Summary: The aim of this review was to examine the possible effects of forest therapy with regard to its evidence in the treatment of chronic neurological diseases such as stroke in the rehabilitation phase, Parkinson’s disease, dementia, and multiple sclerosis. Therefore, the electronic databases Medline, Scopus, and Cochrane were searched for such clinical trials for the years 1970 to mid-2023 without language restriction. The literature search revealed only few studies with positive indications but too few cases to be able to make generalizable evidence-based statements. In terms of improvement in the Hamilton Depression Scale analysis of two studies in stroke patients showed slight benefits in the forest therapy group (standard mean difference −0.43; 95% CI: −0.76 to −0.10; p < 0.01). One observational study revealed a higher rate of stroke survival in patients living in marked greenness. Few nature-based interventions in dementia patients showed certain benefits in particular details. Key Messages: There are no evidence-based results on the benefit of forest therapy for chronic neurological diseases. However, there are hints that forest therapy could have a positive benefit. Therefore, a proposal for forest therapy as a component of multimodal neurological rehabilitation is presented.

A 44-year-old man presented with generalised weakness, shakiness, loss of appetite, fatigue, flank pain and vertigo for several days. He had vomited several times. On examination, he was somnolent, with psychomotor slowing and disorientation, but with no additional focal neurological deficit. Laboratory findings identified acute kidney injury (creatinine 1389 µmol/L, normal<115). Blood gas analysis showed acidosis with pH 7.29 (normal 7.35–7.45), reduced bicarbonate (15 mmol/L; normal 22–26), a negative base excess (−10 mmol/L; normal −2 to 2) and elevated anion gap (28 mmol; normal 3–11). Ultrasound scan of abdomen showed enlarged kidneys. MR scan of brain showed extensive signal changes bilaterally in the basal ganglia and brainstem as well as in temporomesial areas (figure 1A,B). The cerebrospinal fluid (CSF) showed a granulocytic pleocytosis (164 cells/µL; normal <4) with elevated CSF protein (2.3 g/L; normal <0.45). No bacterial or viral pathogen was detected in the PCR multiplex, nor any oxalate crystals or etylene glycol in a later assay. A broad autoimmune …

Vestibular neuritis is a common neuro-otological entity. Therapeutically, corticosteroids are advised, although the evidence is limited. The objective of this review is to update meta-analyses of clinical trials that address the question of whether patients with vestibular neuritis treated with corticosteroids show better recovery than control patients. The electronic databases Medline, Scopus and Cochrane were searched for clinical trials for the years 1970-2020 without language restriction. Data were extracted, and outcome parameters were subjected to conventional and cumulative meta-analysis using a commercially available software program (www.meta-analysis.com). Finally, 15 trials with 363 participants in the treatment and 489 in the control groups were identified and could be included. Eight studies were judged to be at high risk of bias. The odds ratio (OR) for good outcome in the acute phase was 3.1 (95% CI 1.2-7.8; p = .015) in favour of steroid treatment leading to the number needed to treat (NNT) = 6 (95% CI 4-23). The odds ratio (OR) for restoration of vestibular function in the follow-up was 2.4 (95% CI 1.3-4.4; p = .004) for the benefit of steroid treatment resulting in a NNT = 7 (95% CI 5-18). The results of the cumulative statistics did not differ. The risk of adverse effects was higher in patients treated with steroids with an OR of 10.9 (95% CI 1.3-93.8; p = .015) and an estimated number needed to harm (NNH) = 4 (95% CI 3-19). The advantage for corticosteroids remained when differentiating between patients who participated in randomized or non-randomized clinical trials. Steroid treatment in vestibular neuritis resulted in a statistically significant benefit compared to control therapies. However, broad heterogeneity of the studies, mostly low-grade quality of studies, high risk of bias and broad confidence intervals put the findings into perspective allowing only a careful judgement of some benefit of corticosteroids. The findings, however, support the call for an adequately powered and well-designed randomized controlled trial to re-evaluate the effectiveness of corticosteroids.