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Biomedical subjects

H Stolze

Publications and source records attributed to H Stolze.

At least 19 recordsLinked to original sources
PubMed2005

Influence of alcohol on gait in patients with essential tremor.

OBJECTIVE: To study the effect of ethanol on gait in patients with essential tremor (ET). METHODS: Using a three-dimensional opto-electronic gait analysis system, the authors analyzed gait at free-speed walking, at a given velocity, and during tandem gait. Patients with ET with advanced disease were examined before and after a small oral dose of ethanol. The results of the patients with ET were compared with those from age-matched healthy controls (HCs). The primary outcome criteria were the number of missteps and the ataxia score during tandem gait. RESULTS: Before alcohol, patients with ET had more missteps and an abnormal ataxia score compared with HCs. The ingestion of alcohol with a mean blood level of 0.45% led to a significant improvement of the ataxia score and the number of missteps. HCs showed a worsening of the ataxia score and an increase of the number of missteps after alcohol, which failed to reach significance. CONCLUSIONS: Orally administered ethanol improved gait ataxia in patients with essential tremor (ET). This may reflect a reversible effect of ethanol on receptors being involved in the pathology of ET. Ethanol may act via an influence of the inferior olive or directly on alcohol-sensitive gamma-aminobutyric acid receptors within the cerebellum.

Administration, Oral↗
PubMed2004

Gait analysis of sporadic and hereditary spastic paraplegia.

OBJECTIVES: Sporadic (SSP) and hereditary spastic paraplegias (HSP) are clinically and genetically heterogeneous disorders, which are characterised by a slowly progressive spastic paraparesis. Initial symptoms and the rate of progression are variable even among members of the same family. Spastic paraparesis is the major and most disabling clinical symptom and was assessed with gait analysis using a three-dimensional infrared movement analysis system. METHODS AND RESULTS: 22 patients with clinically and/or genetically confirmed SSP/HSP were compared with age-matched control subjects. Significantly lower values were found for gait velocity, stride length, step height and the range of motion of the knee-angle. The gait pattern is characterised by a severe spasticity of both legs with only mild paresis. The balance-related gait parameters show a broad-based gait without inwardly rotated feet. No correlation was found between disease duration and the severity of the gait disorder and the central motor conduction time to the leg muscles and the abnormal gait parameters. The gait pattern did not differ between the 7 SSP cases and the 15 HSP cases. CONCLUSIONS: We conclude that three-dimensional gait analysis can uncover specific features of such rare gait disorders, and may be used as an objective tool to quantify the impairment of gait parameters in patients with SSP/HSP and thus can be used to monitor disease progression and the effect of therapeutic interventions.

Adult↗
PubMed2002

Typical features of cerebellar ataxic gait.

BACKGROUND: Although gait disturbance is one of the most pronounced and disabling symptoms in cerebellar disease (CD), quantitative studies on this topic are rare. OBJECTIVES: To characterise the typical clinical features of cerebellar gait and to analyse ataxia quantitatively. METHODS: Twelve patients with various cerebellar disorders were compared with 12 age matched controls. Gait was analysed on a motor driven treadmill using a three dimensional system. A tandem gait paradigm was used to quantify gait ataxia. RESULTS: For normal locomotion, a significantly reduced step frequency with a prolonged stance and double limb support duration was found in patients with CD. All gait measurements were highly variable in CD. Most importantly, balance related gait variables such as step width and foot rotation angles were increased in CD, indicating the need for stability during locomotion. The tandem gait paradigm showed typical features of cerebellar ataxia such as dysmetria, hypometria, hypermetria, and inappropriate timing of foot placement. CONCLUSIONS: Typical features of gait in CD are reduced cadence with increased balance related variables and an almost normal range of motion (with increased variability) in the joints of the lower extremity. The tandem gait paradigm accentuates all the features of gait ataxia and is the most sensitive clinical test.

Disability Evaluation↗
PubMed2001

Effects of bilateral subthalamic nucleus stimulation on parkinsonian gait.

Gait analysis was carried out to assess the effects of L-dopa and bilateral subthalamic nucleus stimulation on gait velocity, cadence, stride length, and gait kinematics in nine patients with PD. Substantial effects of bilateral subthalamic nucleus stimulation on gait, with an increase in gait velocity and stride length comparable to that of a suprathreshold L-dopa dose, were found. Interestingly, stride length was more improved by L-dopa and cadence more by subthalamic nucleus stimulation. In two patients with freezing during the "on" period, subthalamic nucleus stimulation failed to reduce this symptom effectively.

Antiparkinson Agents↗
PubMed2001

Children's spatial behavior is differentially affected after traumatic brain injury.

Spatial behavior in 20 children with severe traumatic brain injury (TBI) and 20 healthy controls was investigated using the Kiel Locomotor Maze. Children had to remember defined locations in an experimental chamber with completely controlled intra- and extra-maze cues until learning criterion was reached. In a second experiment, spatial orientation strategies were assessed. Children with TBI were shown to be impaired in spatial learning and spatial memory. Spatial orientation was found to be deficient even in cases where spatial learning and memory proved to be unimpaired, especially in tasks that demanded the use of relational place strategies. Children who suffered a TBI at an early age proved to be more severely impaired in spatial learning and orientation than older children.

Brain Injuries↗
PubMed2001

The gait disorder of advanced essential tremor.

Gait disturbances of patients with essential tremor (ET) have been described anecdotally, but have never been investigated quantitatively. Recent studies provided evidence for a cerebellar-like hand tremor in some patients with ET. Therefore, we designed a study to assess cerebellar-like abnormalities of leg function. Twenty-five patients with ET, eight patients with cerebellar diseases (CD) and 21 age-matched healthy subjects were studied for their normal and tandem gait using a three-dimensional gait analysis system. During normal walking, CD and ET patients showed only slight abnormalities. However, ET patients exhibited abnormalities in tandem gait with an increased number of mis-steps and a broad-based, ataxic and dysmetric gait which was indistinguishable from the findings in CD. When ET patients were separated into groups of those with or without intention tremor of the hands, the gait disorder was found to be much more pronounced in the intention tremor group. Patients with this gait disorder were more severely disturbed in their activities of daily living, and suffer from an advanced stage of ET. The present results quantitatively describe a gait disturbance in advanced ET which affects tandem gait, but leaves normal gait almost unaffected. This is strong evidence for a cerebellar-like disturbance in ET.

Adult↗
PubMed2001

Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease.

OBJECTIVES: Comparative gait analyses in neurological diseases interfering with locomotion are of particular interest, as many hypokinetic gait disorders have the same main features. The aim of the present study was (1) to compare the gait disturbance in normal pressure hydrocephalus and Parkinson's disease; (2) to evaluate which variables of the disturbed gait pattern respond to specific treatment in both diseases; and (3) to assess the responsiveness to visual and acoustic cues for gait improvement. METHODS: In study 1 gait analysis was carried out on 11 patients with normal pressure hydrocephalus, 10 patients with Parkinson's disease, and 12 age matched healthy control subjects, on a walkway and on a treadmill. In study 2, patients with normal pressure hydrocephalus were reinvestigated after removal of 30 ml CSF, and patients with Parkinson's disease after administration of 150 mg levodopa. In part 3 visual cues were provided as stripes fixed on the walkway and acoustic cues as beats of a metronome. RESULTS: The gait disorder in both diseases shared the feature of a reduced gait velocity, due to a diminished and highly variable stride length. Specific features of the gait disturbance in normal pressure hydrocephalus were a broad based gait pattern with outward rotated feet and a diminished height of the steps. After treatment in both diseases, the speed increased, due to an enlarged stride length, now presenting a lower variability. All other gait variables remained unaffected. External cues only mildly improved gait in normal pressure hydrocephalus, whereas they were highly effective in raising the stride length and cadence in Parkinson's disease. CONCLUSION: The gait pattern in normal pressure hydrocephalus is clearly distinguishable from the gait of Parkinson's disease. As well as the basal ganglia output connections, other pathways and structures most likely in the frontal lobes are responsible for the gait pattern and especially the disturbed dynamic equilibrium in normal pressure hydrocephalus. Hypokinesia and its responsiveness to external cues in both diseases are assumed to be an expression of a disturbed motor planning.

Aged↗
PubMed2000

Kinetic tremor in a reach-to-grasp movement in Parkinson's disease.

The aim of this study was to quantify the tremor of the hand during a natural movement (kinetic tremor) in tremor-dominant parkinsonian patients (n = 13). We used a three-dimensional camera system to kinematically analyze rest and kinetic tremors in an unrestrained reach-to-grasp movement, and additional tremor recordings were performed under standard postural and rest conditions using electromyography and accelerometry. The standard analysis showed a highly synchronized tremor with similar frequencies at rest and in sustained postural tasks, with and without loading. A kinematic recording was used to compare rest and action conditions. A strong inhibition of the resting tremor was present at the onset of the movement and reached its peak during deceleration. A kinetic tremor of low amplitude was present in most of the parkinsonian patients, but its occurrence was confined mainly to the terminal periods of the movement. The frequency of kinetic tremor was significantly higher than that at rest, before the onset of the movement in Parkinson's disease, as determined by the kinematic analysis (mean, 5.5 Hz vs 6.5 Hz; p <0.01). Our results confirm similarities between the tremor at rest and the oscillations during a sustained postural task in classic parkinsonian tremor. In contrast to this stable tremor, which seems to be generated by basal ganglia oscillators, a different pathophysiology of oscillations during motion must be considered. The kinetic tremor is most likely related to an enhancement of the physiologic tremor in the terminal phase of the reach-to-grasp movement.

Adult↗
PubMed2000

Gait analysis in idiopathic normal pressure hydrocephalus--which parameters respond to the CSF tap test?

OBJECTIVES: Normal pressure hydrocephalus (NPH) is an often underestimated cause of hypokinetic gait disorders in the elderly. Diagnosing NPH is a complex problem, since many symptoms overlap with other neurological diseases. The purpose of the present study was to characterize the gait pattern in NPH quantitatively. Additionally, we analyzed the improvement of gait parameters following tapping of cerebrospinal fluid (CSF). METHODS: Gait analysis was performed in 10 patients and 12 age-matched healthy controls during overground and treadmill locomotion. RESULTS: Compared to healthy controls, patients with NPH walked significantly slower, with shorter and more variable strides and a somewhat lower cadence. The feet were not lifted to a normal height and the dorsal extension of the forefoot prior to heel-strike was insufficient. Balance-related gait parameters such as step width and the foot rotation angles were significantly increased in NPH, while their variability was lower. Only some gait parameters improved after tapping 30 ml CSF. Gait velocity increased by about 23% due to an increased stride length, while the cadence remained unchanged. Balance-related gait parameters and the foot-to-floor clearance during swing were not affected by the treatment. CONCLUSIONS: In conclusion, we found a triad of decreased stride length, decreased foot-to-floor clearance and a broad-based gait to be the typical features of the gait abnormality in NPH. Only the stride length improved following a diagnostic spinal tap. These results may help to more reliably diagnose the condition of NPH in a routine clinical setting.

Aged↗
PubMed2000

Essential tremor and cerebellar dysfunction clinical and kinematic analysis of intention tremor.

The cerebellum is assumed to play a major role in the pathophysiology of essential tremor (ET). As intention tremor is considered one of the classical features of cerebellar disease, we have assessed a large group of patients with ET for the semiology of the tremor and have performed objective quantitative analysis of a grasping movement in patients with ET, cerebellar disease and a normal control group. We found 25% of the patients to have a moderate or severe kinetic tremor with clear-cut features of a classical intention tremor. Another 33% of the patients had a mild intentional component of their kinetic tremor. Patients with intention tremor (ET(IT)) did not differ from those with predominant postural tremor (ET(PT)) with respect to alcohol sensitivity of the tremor and the frequency of a family history. ET(IT) patients were older and more often showed head and trunk involvement. The onset of this intention tremor has been assessed retrospectively. It was found to begin at a randomly distributed time interval after the onset of the postural tremor, but older patients had a shorter time to development of intention tremor. Quantitative accelerometry of postural tremor showed similar tremor frequencies in both patient groups, but ET(IT) patients had a slightly larger tremor amplitude. Quantitative analysis of a grasping movement using an infrared-camera system was performed in two subgroups of the patients with ET(PT) and ET(IT) and control groups with cerebellar disease or normal subjects. The intention tremor could be quantified objectively as an increased amplitude of curvature during the deceleration and target phase of the movement. The amplitude measurements of intention tremor were clearly abnormal and of comparable magnitude for ET(PT) and cerebellar disease. Additionally, the patients with ET(IT) had a significantly slowed grasping movement during the deceleration and target period. Hypermetria was significantly increased for the patients with ET(IT) and cerebellar disease. We conclude that intention tremor is a feature of ET. ET(IT) patients have abnormalities of their upper limb function compatible with cerebellar disease. This suggests that patients with more advanced ET show abnormalities of cerebellar functions.

Adolescent↗
PubMed1999

Prehension movements and motor development in children.

The maturation of manual dexterity and other sensorimotor functions was assessed with various behavioural tests. In healthy children (age 4-5 years) and in adults, the kinematics of reaching and grasping, a bimanual task and fast repetitive tapping movements were analysed. Furthermore a comprehensive motor function score (MOT), probing agility and balance, was evaluated. In the prehension task, the straightness of the reaching trajectories increased with age. Children opened their grip relatively wider than adults, thus grasping with a higher safety margin. The speed of both tapping and bimanual movements increased with age, and higher scores were reached in the MOT. Although the different behavioural tests sensitively indicated maturational changes, their results were generally not correlated, i.e. the outcome of a particular test could not predict the results of other tasks. Hence there is no simple and uniform relationship between different behavioural data describing maturation of sensorimotor functions.

Adult↗
PubMed1999

Analysis of gait in cervical myelopathy.

Gait disorders are a frequent symptom of cervical spondylotic myelopathy (CSM). Twelve patients with CSM underwent gait analysis before and after decompressive surgery. They were assessed on a walkway and a treadmill and compared with a healthy matched control group. The following features were observed in the CSM group before surgery: significantly reduced gait velocity and step length (P<0. 05), prolonged double support, increased step width, and reduced ankle joint extension during treadmill walking. Knee and hip kinematics did not differ from controls. Two months after surgery, spatio-temporal parameters had moved towards normal values, velocity, step length and cadence had increased significantly, and there was reduction of step width during treadmill walking, indicating improved equilibrium. Gait analysis is an objective tool to document functional recovery after decompressive surgery in CSM.

Cervical Vertebrae↗
PubMed1999

Open-labeled long-term study of the efficacy, safety, and tolerability of subcutaneous sumatriptan in acute migraine treatment.

In a multicenter study, a long-term analysis was made of the efficacy, safety, and tolerability of subcutaneous (s.c.) sumatriptan in the acute treatment of migraine attacks over a period of up to 18 months. A total of 2263 patients took part in the study, all able to perform their own acute treatment of migraine attacks at home by s.c. administration of 6 mg of sumatriptan. A headache diary was used by each patient to record the various migraine parameters before the injection and 1 h and 2 h after it. A total of 43,691 attacks were treated and analyzed during the study period from October 1991 to June 1993. Therapy was successful in 89.5% of attacks. Freedom from headache was achieved in 71.0% of cases. In 22.7% of the attacks a second injection was administered on recurrence of the headache; 82.9% of the patients achieved an intraindividual therapy success rate ranging from over 80% to 100%. In the course of treatment there was no change in either the therapy success rate or in the frequency of attacks. Some 4.9% of the patients withdrew from the study because of insufficient efficacy or adverse events. A total of 44.5% of patients reported adverse events, and these were rated serious in the case of 1.7%. S.c. administration of sumatriptan for acute migraine therapy is an effective treatment method, with reliable action, that can be used with good tolerability provided the contraindications are taken into account.

Adolescent↗
PubMed1998

Retest reliability of spatiotemporal gait parameters in children and adults.

The objective of the study was to assess the retest-reliability of ten different gait parameters in healthy children (n=12; age 6-7 years) and adults (n=12; age 21-35 years) during free-speed locomotion on a simple walkway. Further the intra-subject variability of the stride dimensions was checked. On two occasions, spatial gait parameters were measured by footprint analysis, temporal dimensions were recorded using video-analysis. For spatial gait parameters, correlation coefficients (ICC, Pearson's r) between the test and the retest results were found to be high in adults and satisfying in children. The temporal parameters were less consistent. Generally the within-trial variability was higher in children than in adults. Conclusions: (i) The retest reliability for the measurement of the spatial gait parameters can be judged as high. (ii) For gait analysis in children it should be taken into account that gait parameters are more variable from trial to trial than in adults. Copyright 1997 Elsevier Science B.V.

Journal Article↗
PubMed1998

[Acute therapy of episodic and chronic cluster headache with sumatriptan s.c. Results of a one-year long-term study].

The aim of the open prospective study was to investigate the efficacy, safety and tolerability of subcutaneous sumatriptan in the acute treatment of cluster headache. Self-treatment with 6 mg sumatriptan subcutaneously was monitored over a period up to 1 year. Headache parameters were documented by the patients with a headache diary. A total of 2031 attacks in 52 patients were investigated. Treatment with sumatriptan was effective in 88% of the attacks and 57% of the patients were pain-free within 15 min after injection; 42% of the patients became painfree within 15 min after at least 90% of their attacks. During long-time treatment the efficacy remained unchanged. Of the patients 10% withdrew from the study due to lack of efficacy or adverse events. In total, 62% of the patients reported adverse events, which were serious in 3.8% of the cases. Subcutaneous self-treatment of cluster headache is both highly effective and well tolerated.

Acute Disease↗
PubMed1998

Development of prehension movements in children: a kinematic study.

To evaluate the normal development of functional hand motor skill, the kinematics of prehension movements were analyzed in 54 healthy children (age 4-12 years). The subjects repeatedly reached out for cylindrical target objects and grasped them with a precision grip of their dominant hand. The trajectory of the reaching hand and the finger aperture were monitored by optoelectronic motion analysis. To obtain comparable conditions for the different age groups, the experimental setup was scaled according to the individual body proportions of each subject. Within the investigated age range, neither the movement duration nor the normalized (according to body proportions) peak spatial velocity of the reaching hand changed significantly. However, the hand trajectory straightened and the coordination between hand transport and grip formation improved, resulting in smooth and stereotyped kinematic profiles at the age of 12 years. The younger children opened their grip relatively wider than the older ones, thus grasping with a higher safety margin. The dependence on visual control of the movement declined during motor development. Only the oldest children were able to scale the grip aperture adequately, according to various sizes of the target objects, when visual control of the movement was lacking. The results suggest that the development of prehensile skills during childhood lasts until the end of the first decade of life. This functional maturation is discussed in relation to the development of neuronal pathways.

Adaptation, Physiological↗
PubMed1998

Kinematic analysis of prehension movements in children.

The kinematics of the reach-to-grasp movement were analyzed in ten healthy children (age 6-7 years) under different experimental conditions: distance and size of the target objects, and visual feedback during the reach were varied in a within-subjects design. To assess age-related differences, the same experiments were performed in ten healthy adults. The experimental set-up was scaled according to body proportions to obtain equivalent conditions for both age groups. The temporal coupling between the transport and grasp components of prehension was very similar in children and adults. Peak transport velocity increased by the same factor in both age groups when the object distance was doubled. However, the decelerating approach phase was shorter in the children, who opened their hands relatively wider than adults. Unlike the adults, children failed to scale their grip aperture according to object size when visual feedback during the movement was lacking. The grip aperture increased with object distance in adults, but not in the children. The intrasubject variability of kinematic parameters was distinctly higher in the children. The results suggest that grip formation is not yet mature at an age of 6-7 years, depending more on visual feedback than in adult prehension.

Adult↗