TY - GEN A1 - Spiegel, Rainer A1 - Claassen, Jens A1 - Teufel, Julian A1 - Bardins, Stanislav A1 - Schneider, Erich A1 - Lehrer, Nicole A1 - Jahn, Klaus A1 - Anciaes da Silva, Fábio A1 - Hahn, Ales A1 - Farahmand, Parvis A1 - Brandt, Thomas A1 - Strupp, Michael A1 - Kalla, Roger T1 - Resting in darkness improves downbeat nystagmus: evidence from an observational study T2 - Annals of the New York Academy of Sciences N2 - Resting in an upright position during daytime decreases downbeat nystagmus (DBN). When measured in brightness only, that is, without intermitting exposure to darkness, it does not make a significant difference whether patients have previously rested in brightness or in darkness. In real-world scenarios, people are often exposed to brightness and darkness intermittently. The aim of this study was to analyze whether resting in brightness or resting in darkness was associated with a lower post-resting DBN after intermitting exposures to brightness and darkness. Eight patients were recorded with three-dimensional video-oculography in brightness and darkness conditions, each following two 2-h resting intervals under either brightness or darkness resting conditions. The dependent variable was DBN intensity, measured in mean slow phase velocity. A repeated measures ANOVA with the factors measurement condition (brightness vs. darkness), resting condition (brightness vs. darkness), and time (after first vs. second resting interval) showed a significant effect for the factor resting condition, where previous resting in darkness was associated with a significantly lower DBN relative to previous resting in brightness (P < 0.01). The clinical relevance is to advise patients with DBN to rest in darkness. KW - downbeat nystagmus KW - symptom relief KW - resting KW - oscillopsia KW - video-oculographic measurement (VOG) Y1 - 2016 U6 - https://doi.org/10.1111/nyas.13172 SN - 1749-6632 SN - 0077-8923 VL - 1375 IS - 1 SP - 66 EP - 73 ER - TY - GEN A1 - Striteska, Maja A1 - Chovanec, Martin A1 - Steinmetzer, Tobias A1 - Chrobok, Viktor A1 - Profant, Oliver A1 - Schneider, Erich A1 - Kremlacek, Jan A1 - Valis, Martin T1 - Binocular video head impulse test: Normative data study T2 - Frontiers in Neurology N2 - Introduction The video head impulse test (vHIT) evaluates the vestibulo-ocular reflex (VOR). It’s usually recorded from only one eye. Newer vHIT devices allow a binocular quantification of the VOR. Purpose (Aim) To investigate the advantages of simultaneously recorded binocular vHIT (bvHIT) to detect the differences between the VOR gains of the adducting and the abducting eye, to define the most precise VOR measure, and to assess gaze dys/conjugacy. We aimed to establish normative values for bvHIT adducting/abducting eye VOR gains and to introduce the VOR dysconjugacy ratio (vorDR) between adducting and abducting eyes for bvHIT. Methods We enrolled 44 healthy adult participants in a cross-sectional, prospective study using a repeated-measures design to assess test–retest reliability. A binocular EyeSeeCam Sci 2 device was used to simultaneously record bvHIT from both eyes during impulsive head stimulation in the horizontal plane. Results Pooled bvHIT retest gains of the adducting eye significantly exceeded those of the abducting eye (mean (SD): 1.08 (SD = 0.06), 0.95 (SD = 0.06), respectively). Both adduction and abduction gains showed similar variability, suggesting comparable precision and therefore equal suitability for VOR asymmetry assessment. The pooled vorDR here introduced to bvHIT was 1.13 (SD = 0.05). The test–retest repeatability coefficient was 0.06. Conclusion Our study provides normative values reflecting the conjugacy of eye movement responses to horizontal bvHIT in healthy participants. The results were similar to a previous study using the gold-standard scleral search coil, which also reported greater VOR gains in the adducting than in the abducting eye. In analogy to the analysis of saccade conjugacy, we propose the use of a novel bvHIT dysconjugacy ratio to assess dys/conjugacy of VOR-induced eye movements. In addition, to accurately assess VOR asymmetry, and to avoid directional gain preponderance between adduction and abduction VOR-induced eye movements leading to monocular vHIT bias, we recommend using a binocular ductional VOR asymmetry index that compares the VOR gains of only the abduction or only the adduction movements of both eyes. KW - binocular video head impulse test KW - conjugate gaze KW - adduction KW - abduction KW - ductional VOR asymmetry index KW - dysconjugacy ratio KW - monocular VOR asymmetry index KW - vestibuloocular reflex Y1 - 2023 U6 - https://doi.org/10.3389/fneur.2023.1153102 SN - 1664-2295 VL - 14 ER - TY - GEN A1 - Friedrich, Maximilian U. A1 - Schneider, Erich A1 - Buerklein, Miriam A1 - Taeger, Johannes A1 - Hartig, Johannes A1 - Volkmann, Jens A1 - Peach, Robert A1 - Zeller, Daniel T1 - Smartphone video nystagmography using convolutional neural networks: ConVNG T2 - Journal of Neurology N2 - Eye movement abnormalities are commonplace in neurological disorders. However, unaided eye movement assessments lack granularity. Although videooculography (VOG) improves diagnostic accuracy, resource intensiveness precludes its broad use. To bridge this care gap, we here validate a framework for smartphone video-based nystagmography capitalizing on recent computer vision advances. Methods A convolutional neural network was fine-tuned for pupil tracking using > 550 annotated frames: ConVNG. In a cross-sectional approach, slow-phase velocity of optokinetic nystagmus was calculated in 10 subjects using ConVNG and VOG. Equivalence of accuracy and precision was assessed using the “two one-sample t-test” (TOST) and Bayesian interval-null approaches. ConVNG was systematically compared to OpenFace and MediaPipe as computer vision (CV) benchmarks for gaze estimation. Results ConVNG tracking accuracy reached 9–15% of an average pupil diameter. In a fully independent clinical video dataset, ConVNG robustly detected pupil keypoints (median prediction confidence 0.85). SPV measurement accuracy was equivalent to VOG (TOST p < 0.017; Bayes factors (BF) > 24). ConVNG, but not MediaPipe, achieved equivalence to VOG in all SPV calculations. Median precision was 0.30°/s for ConVNG, 0.7°/s for MediaPipe and 0.12°/s for VOG. ConVNG precision was significantly higher than MediaPipe in vertical planes, but both algorithms’ precision was inferior to VOG. Conclusions ConVNG enables offline smartphone video nystagmography with an accuracy comparable to VOG and significantly higher precision than MediaPipe, a benchmark computer vision application for gaze estimation. This serves as a blueprint for highly accessible tools with potential to accelerate progress toward precise and personalized Medicine. KW - Digital medicine KW - Nystagmus KW - Eye movement disorders KW - Videooculography KW - Computer vision KW - Telemedicine KW - Precision medicine Y1 - 2022 U6 - https://doi.org/10.1007/s00415-022-11493-1 SN - 1432-1459 VL - 270 SP - 2518 EP - 2530 ER - TY - GEN A1 - Ramaioli, Cecilia A1 - Steinmetzer, Tobias A1 - Brietzke, Adrian A1 - Meyer, Paul A1 - Pham Xuan, Rebecca A1 - Schneider, Erich A1 - Gorges, Martin T1 - Assessment of vestibulo-ocular reflex and its adaptation during stop-and-go car rides in motion sickness susceptible passengers T2 - Experimental Brain Research N2 - Motion sickness is a physiological condition that negatively impacts a person's comfort and will be an emerging condition in autonomous vehicles without proper countermeasures. The vestibular system plays a key role in the origin of motion sickness. Understanding the susceptibility and (mal) adaptive mechanisms of the highly integrated vestibular system is a prerequisite for the development of countermeasures. We hypothesize a differential association between motion sickness and vestibular function in healthy individuals with and without susceptibility for motion sickness. We quantified vestibular function by measuring the high-frequency vestibulo-ocular reflex (VOR) using video head impulse testing (vHIT) in 17 healthy volunteers before and after a 11 min motion sickness-inducing naturalistic stop-and-go car ride on a test track (Dekra Test Oval, Klettwitz, Germany). The cohort was classified as motion sickness susceptible (n = 11) and non-susceptible (n = 6). Six (out of 11) susceptible participants developed nausea symptoms, while a total of nine participants were free of these symptoms. The VOR gain (1) did not differ significantly between participant groups with (n = 8) and without motion sickness symptoms (n = 9), (2) did not differ significantly in the factor time before and after the car ride, and showed no interaction between symptom groups and time, as indicated by a repeated measures ANOVA (F(1,15) = 2.19, p = 0.16. Bayesian inference confirmed that there was “anecdotal evidence” for equality of gain rather than difference across groups and time (BF10 < 0.77). Our results suggest that individual differences in VOR measures or adaptation to motion sickness provocative stimuli during naturalistic stop-and-go driving cannot predict motion sickness susceptibility or the likelihood of developing motion sickness. KW - Video head impulse test KW - Vestibulo-ocular reflex KW - Adaptation KW - Motion sickness KW - Stop-and-go car ride Y1 - 2023 U6 - https://doi.org/10.1007/s00221-023-06619-4 SN - 1432-1106 SN - 0014-4819 VL - 241 IS - 6 SP - 1523 EP - 1531 ER - TY - GEN A1 - Dong-Han, Lee A1 - Schneider, Erich A1 - Sang-Yeon, Lee A1 - Kim, Ji-Soo A1 - Koo, Ja-Won T1 - Objective measurement of HINTS (Head Impulse, Nystagmus, Test of Skew) in peripheral vestibulopathy T2 - Auris Nasus Larynx N2 - ABSTRACT Objective To evaluate how often the positive sign of HINTS (Head-Impulse, Gaze Evoked Nystagmus, Test of Skew) appears in patients with acute peripheral vestibular lesion, HINTS findings were quantitatively measured and analyzed in patients with peripheral vestibulopathy accompanying spontaneous nystagmus. Methods HINTS was evaluated in 14 vertigo patients with spontaneous nystagmus. Horizontal vestibulo-ocular reflex (VOR) gain was measured using the video head impulse test (vHIT). To evaluate gaze-evoked nystagmus (GEN), slow-phase velocities at different points of lateral gaze were measured and plotted, then the slope and its inverse value, the neural integrator time constant, were calculated. Skew deviation was tested using anaglyph filters to simulate the alternate cover test, and the degree and latency of vertical eyeball deviation were measured. The ABCD2 score was calculated to evaluate the risk of stroke. Results Among 13 patients of peripheral vestibulopathy, 7 showed positive signs in HINTS (normal vHIT: 5, direction-changing GEN: 0, skew deviation: 3). One patient with a cerebellopontine angle tumor presented with both a peripheral and central pattern and showed positive HINTS findings (presence of direction-changing GEN). The mean VOR gain of patients with abnormal vHIT was 0.58±0.29 and 1.10±0.11 in the affected and contralateral side, respectively, while those in patients with normal vHIT were 1.04±0.21 and 1.13±0.12, respectively. The neural integrator time constant calculated from the mean slope of horizontal slow-phase velocity according to horizontal eye position was 42.9 s. The mean vertical eyeball deviation of patients with positive skew was 2.14±1.18° while uncovering the eye on the affected side, and -1.97±1.59° while uncovering the eye on the unaffected side. The median ABCD2 score of 14 patients was 2 (range, 1-3). Conclusions HINTS findings were objectively measured in vertigo patients with spontaneous nystagmus. Although positive findings of HINTS have been recognized as a central sign, 54% (7/13) of cases with peripheral vestibulopathy showed positive HINTS signs. HINTS results should be interpreted carefully considering that a substantial proportion of peripheral vestibulopathy shows a positive HINTS sign. KW - Dizziness KW - Vertigo KW - Head impulse test KW - Nystagmus KW - Skew deviation Y1 - 2022 U6 - https://doi.org/10.1016/j.anl.2022.03.003 SN - 1879-1476 SN - 0385-8146 VL - 49 IS - 6 SP - 938 EP - 949 ER - TY - GEN A1 - Klug, Marius A1 - Berg, T. A1 - Gramann, K. T1 - Optimizing EEG ICA decomposition with data cleaning in stationary and mobile experiments T2 - Scientific reports N2 - Electroencephalography (EEG) studies increasingly utilize more mobile experimental protocols, leading to more and stronger artifacts in the recorded data. Independent Component Analysis (ICA) is commonly used to remove these artifacts. It is standard practice to remove artifactual samples before ICA to improve the decomposition, for example using automatic tools such as the sample rejection option of the AMICA algorithm. However, the effects of movement intensity and the strength of automatic sample rejection on ICA decomposition have not been systematically evaluated. We conducted AMICA decompositions on eight open-access datasets with varying degrees of motion intensity using varying sample rejection criteria. We evaluated decomposition quality using mutual information of the components, the proportion of brain, muscle, and 'other' components, residual variance, and an exemplary signal-to-noise ratio. Within individual studies, increased movement significantly decreased decomposition quality, though this effect was not found across different studies. Cleaning strength significantly improved the decomposition, but the effect was smaller than expected. Our results suggest that the AMICA algorithm is robust even with limited data cleaning. Moderate cleaning, such as 5 to 10 iterations of the AMICA sample rejection, is likely to improve the decomposition of most datasets, regardless of motion intensity. Y1 - 2024 U6 - https://doi.org/10.1038/s41598-024-64919-3 SN - 2045-2322 VL - 14 IS - 1 SP - 1 EP - 15 PB - Nature Publishing Group UK CY - London ER - TY - GEN A1 - Merseburger, Axel S. A1 - Dornstauder, Eugen A1 - Ohlmann, Carsten-Henning A1 - Aprikian, Armen A1 - Junker, Sophia A1 - Hahn, Philipp A1 - Chilelli, Andrew A1 - Stoelzel, Matthias A1 - Serikoff, Alexis A1 - Spitzer, Stefan G. T1 - Cardiovascular risks and survival with abiraterone vs enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer in Germany : AVENGER study T2 - Advances in therapy N2 - Introduction Recent real-world studies compared effectiveness and safety of enzalutamide (ENZA) and abiraterone acetate (AA) for metastatic castration-resistant prostate cancer (mCRPC). The growing evidence needs further substantiation with long-term data. This study, the first to use German data, investigated cardiovascular (CV) event risk and overall survival (OS) in patients initiating ENZA or AA. AA (2012) and ENZA (2014) are widely used for mCRPC in Germany. Methods This retrospective study used data of chemotherapy-naïve patients with mCRPC on ENZA or AA (2012–2020) from two German claims databases (AOK PLUS and GWQ ServicePlus). The primary endpoint was time to first CV event (CV-related hospitalization) analyzed via a meta-analysis of Cox proportional hazard models of propensity score-matched (PSM) intention-to-treat cohorts. Other endpoints were baseline characteristics, CV event rate, number of CV events per patient, and OS. Results Of 2240 patients in the total study population (ENZA, 828; AA, 1412), 796 PSM patients were included in each group. ENZA patients were older and had a higher prevalence of some comorbidities, but without meaningful differences after PSM. Further, 386 patients had ≥ 1 CV event (ENZA, 172; AA, 214). ENZA was associated with a significantly lower risk of CV events (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.57–0.86, p  = 0.001, I 2  = 0.0%), CV event rate (0.17 vs 0.23 per person-year; event rate ratio 0.75, 95% CI 0.61–0.92, p  = 0.006; I 2  = 38.0%), fewer recurrent CV events (HR 0.77, 95% CI 0.61–0.96, p  = 0.024; I 2  = 0.0%), and prolonged OS (HR 0.79, 95% CI 0.71–0.89, p  < 0.001) than AA. Conclusions The unmatched ENZA cohort had higher average age and more comorbidities than the AA cohort, but no meaningful differences were noted after PSM. ENZA was associated with a significantly lower risk of CV events and improved OS. KW - Abiraterone KW - Cardiovascular events KW - Castration-resistant prostate cancer KW - Enzalutamide KW - Overall survival KW - Propensity score matching Y1 - 2025 U6 - https://doi.org/10.1007/s12325-025-03132-8 SN - 0741-238X SN - 1865-8652 VL - 42 IS - 4 SP - 1919 EP - 1934 PB - Springer Healthcare CY - Cheshire ER - TY - GEN A1 - Urban, Thomas A1 - Reinhardt, Fritjof A1 - Lohse, Peter A1 - Spitzer, Stefan G. A1 - Rasche, Luise A1 - Reichmann, Heinz T1 - Fatigue und sensomotorische Instabilität : neurologisch kontrollierte Konversion von Post-COVID-19- Patienten T1 - Fatigue and sensorimotor instability : neurologically controlled conversion of post-COVID-19 patients T2 - Der Nervenarzt : Organ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde N2 - Hintergrund Für die Behandlung der Symptome des Post-COVID-19-Syndroms wird derzeit keine kausale Therapie nach evidenzbasierten Kriterien breit empfohlen. Die Evaluation der Veränderungen des Leitsymptoms Fatigue und der sensomotorischen Instabilität durch eine individualisierte beanspruchungsgesteuerte Trainingstherapie sowie durch eine intensivierte kognitive Verhaltenstherapie war das übergeordnete Ziel der Interventionsstudie über einen 3‑jährigen Zeitraum (Q1-2021 bis Q4-2023). Methodik Es wurden in den 3 Jahren im Post-COVID-19-Zentrum Lausitz (Senftenberg) 407 geimpfte nukleokapsidpositive Patienten behandelt. Bei 78 (rd. 19 %) von ihnen wurden als Leitsyndrome Fatigue/immunometabolische Depression und sensomotorische Instabilität konstatiert. Die Evaluation der individualisierten beanspruchungsgesteuerten Trainingstherapie erfolgte anhand der konkreten Post-COVID-19-Syndromatik und motorischer Fatigability-Parameter. Die sekundäre psychosomatische Syndromatik wurde mit kognitiven Fatigability-Parametern und mit Instrumenten der kognitiven Verhaltenstherapie bewertet. Die Untersuchung verhaltensbeeinflussender Parameter fand in Q2-2023 bis Q4-2023 mit einem leitfadengestützten qualitativen Interview unter den Therapieteilnehmern statt. Ergebnisse Die Post-COVID-19-Leitsymptomen „Fatigue“, „sensomotorische Instabilität“, „neuropsychiatrische Symptome“, „kardionale/autonome Dysfunktion“ und „Schmerzen“ verbesserten sich signifikant in der Gesamtkohorte sowie bei der geschlechtsspezifischen Analyse. Eine Verschlechterung trat bei „sekundären psychosomatischen Symptomen“ auf. Für alle motorischen Fatigability-Parameter konnte für die Gesamtkohorte mit dem Cohens d-Wert ein therapeutischer Effekt nachgewiesen werden. Positive Wirkungen erzielte eine Intensivierung der kognitiven Verhaltenstherapie durch eine zunehmende Entwicklung der Eigenaktivität der Patienten sowie deren Selbstkontrolle unter Einsatz von Persuasion und Gamification. N2 - Background For the treatment of the symptoms of post-COVID-19 syndrome, no causal therapy is currently widely recommended according to evidence-based criteria. The overarching goal of the intervention study over a 3-year period (Q1-2021–Q4-2023) was to evaluate the changes in the key symptoms of fatigue and sensorimotor instability through individualized stress-controlled training therapy and through intensified cognitive behavioral therapy. Material and methods In the 3‑year period 407 vaccinated nucleocapsid positive patients were treated at the Post-COVID-19 Center Lausitz (Senftenberg). In 78 (around 19%) fatigue/immunometabolic depression and sensorimotor instability were identified as the leading syndromes. The evaluation of the individualized stress-controlled training therapy was based on the specific post-COVID-19 syndrome and motor fatigue parameters. The secondary psychosomatic syndrome was assessed using cognitive fatigue parameters and cognitive behavioral therapy instruments. The investigation of -parameters influencing behavior took place in Q2-2023–Q4-2023 with a guide-supported qualitative interview among the participants. Results The post-COVID-19 key symptoms “fatigue,” “sensorimotor instability,” “neuropsychiatric symptoms,” “cardiac/autonomic dysfunction,” and “pain” improved significantly in the overall cohort and in the gender-specific analysis. A deterioration occurred in “secondary psychosomatic symptoms”. A therapeutic effect was demonstrated for all motor fatigue parameters for the entire cohort using the Cohen’s d value. An intensification of cognitive behavioral therapy achieved positive effects through an increasing development of the patients’ own activity and their self-control using persuasion and gamification. KW - Post-COVID-Syndrom KW - Fatigue KW - Sensomotorische Instabilität KW - Kognitive Verhaltenstherapie KW - Sekundäre psychosomatische Symptome KW - Post-COVID syndrome KW - Fatigue KW - Sensorimotor instability KW - Cognitive behavioral therapy KW - Secondary psychosomatic symptoms Y1 - 2024 U6 - https://doi.org/10.1007/s00115-024-01732-3 SN - 0028-2804 SN - 1433-0407 VL - 95 IS - 12 SP - 1104 EP - 1115 PB - Springer Medizin CY - Heidelberg ER -