Muskuläre Dysbalancen sind häufig Ursache für Fehlbelastungen und Haltungsveränderungen, die zu einer Störung der sagittalen Balance führen. Aus chronischer muskulärer Dysbalance, die lange nicht schmerzhaft sein muss, entwickelt sich der chronische Rückenschmerz in der Lendenwirbelsäule und/oder in der Halswirbelsäule. Ein Therapiekonzept mit Infiltrationen und Schmerzmedikation bringt wenig, Sinn macht ein von Ärzt:innen kontrolliertes Trainingsprogramm haltungsrelevanter Muskeln wie dem M. pectoralis minor und dem M. rhomboideus.

Während sich die bisherigen Beiträge im Rahmen dieser Serie mit klar voneinander abgrenzbaren Systemen beschäftigten, widmet sich Teil XIV der Wirbelsäule und deren Störungen als einem zunehmend komplexen biologischen System.

Störungen im Bereich des Kopf-Hals-Übergangs können zu chronischen Nackenschmerzen und zahlreichen weiteren Beschwerden führen. Dieses sogenannte „cervicocephale Syndrom“ ist oft schwer zu diagnostizieren. Der Untersuchungsprozess muss dringend überarbeitet und standardisiert werden.

Im Laufe des Lebens verändert sich unser Stütz- und Haltesystem. Eine aktive Haltungskorrektur und Verlangsamung des Haltungsverfalles sind unabdingbar, um chronische Schmerzen und Erkrankungen wie die Osteoporose zu vermeiden oder zumindest zu reduzieren. Mithilfe von Übungen zum Dehnen, Strecken, Kräftigen und Stabilisieren lernt unser Körper, Bewegungsfähigkeit und Haltungsstabilität zu verbessern. Wie zum Beherrschen eines Instrumentes ist dafür gezieltes tägliches Training erforderlich.

OBJECTIVE The effectiveness and optimal stimulation site of deep brain stimulation (DBS) for central poststroke pain (CPSP) remain elusive. The objective of this retrospective international multicenter study was to assess clinical as well as neuroimaging-based predictors of long-term outcomes after DBS for CPSP. METHODS The authors analyzed patient-based clinical and neuroimaging data of previously published and unpublished cohorts from 6 international DBS centers. DBS leads were reconstructed and normalized. A stimulation map was constructed on the basis of individual stimulation settings and associated outcomes. Furthermore, the authors projected the individual segmented stroke lesions and volumes of tissue activated (VTAs) of the stimulating electrode onto a normalized human connectome to obtain the connectivity profiles of the individual lesions and VTAs. RESULTS The authors analyzed the data of 54 patients, of whom 15 were excluded from the final analysis due to a lack of imaging data. Among the remaining 39 patients from 6 different cohorts, the authors found 14 (35.9%) responders who were defined by pain relief of at least 50% at 12-month follow-up. Stimulation mapping identified areas in the posterior limb of the internal capsule, the sensorimotor thalamus, and the medial and intralaminar thalamus as effective for pain reduction. Baseline characteristics did not differ between responders and nonresponders. The stimulation sites of the responders showed significantly reduced structural connectivity to the sensory areas of the cerebral cortex compared to nonresponders. CONCLUSIONS This comprehensive, multicenter analysis corroborates the efficacy of DBS in treating CPSP for a relevant number of patients. The posterior limb of the internal capsule and the sensorimotor thalamus emerged as potential stimulation sweet spots. The difference in structural connectivity between responders and nonresponders may constitute a biomarker of effective stimulation that can help guide surgical planning in future well-designed prospective trials.

Background: Pallidal neurostimulation is an effective treatment for severe isolated dystonia, but long-term data from clinical trials are lacking. ObjectivesTo evaluate long-term efficacy and safety of pallidal neurostimulation in patients with isolated generalized or segmental dystonia. Methods: Extension study of the prospective multicenter trial (n = 40; July 2002 to May 2004), all patients received effective stimulation and underwent regular follow-up. The 10-year follow-up (n = 31) included Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor and disability score, Beck Depression Inventory, Beck Anxiety Inventory, and Mattis Dementia Rating Scale. Primary and secondary endpoints compared motor symptoms, disability scores, mood, and cognition changes. Results: Thirty-one patients (12 female), aged 23-72 years, completed the 10-year study extension. Per protocol analysis showed sustained significant improvement in BFMDRS motor scores at 10 years compared with baseline, without significant change from the 6-month or 5-year follow-up. On average, motor scores decreased by 25.3 +/- 5.2 points at 10 years (P < 0.0001; 56% improvement). Individual outcomes varied, with 27 responders (>= 25% improvement; mean improvement 65.2 +/- 21.4%) and 13 non-responders compared with baseline. Sustained improvements were seen in disability, mood, and anxiety scores. Cognition remained stable. Conclusions: This study presents the longest prospective, multicenter follow-up of pallidal neurostimulation in generalized and segmental dystonia. Two-thirds of patients showed strong and stable long-term improvements of dystonia, confirming sustained efficacy and safety over 10 years in treatment-refractory dystonic patients. However, one-third experienced primary (3/40) or secondary (10/40) treatment failure. Diagnostic advances, including genetic testing, and technological progress in pallidal neurostimulation may help to reduce the non-responder rates in the future. (c) 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

BACKGROUND:Subthalamic deep brain stimulation (STN-DBS) reduces antiparkinsonian medications in Parkinson's disease (PD) compared with the preoperative state. Longitudinal and comparative studies on this effect are lacking. OBJECTIVE:To compare longitudinal trajectories of antiparkinsonian medication in STN-DBS treated patients to non-surgically treated control patients. METHODS:We collected retrospective information on antiparkinsonian medication from PD patients that underwent subthalamic DBS between 1999 and 2010 and control PD patients similar in age at onset and baseline, sex-distribution, and comorbidities. RESULTS:In 74 DBS patients levodopa-equivalent daily dose (LEDD) were reduced by 33.9-56.0% in relation to the preoperative baseline over the 14-year observational period. In 61 control patients LEDDs increased over approximately 10 years, causing a significant divergence between groups. The largest difference amongst single drug-classes was observed for dopamine agonists. CONCLUSION:In PD patients, chronic STN-DBS was associated with a lower LEDD compared with control patients over 14 years.

Dystonia is a neurological movement disorder characterised by abnormal involuntary movements and postures, particularly affecting the head and neck. However, current clinical assessment methods for dystonia rely on simplified rating scales which lack the ability to capture the intricate spatiotemporal features of dystonic phenomena, hindering clinical management and limiting understanding of the underlying neurobiology. To address this, we developed a visual perceptive deep learning framework that utilizes standard clinical videos to comprehensively evaluate and quantify disease states and the impact of therapeutic interventions, specifically deep brain stimulation. This framework overcomes the limitations of traditional rating scales and offers an efficient and accurate method that is rater-independent for evaluating and monitoring dystonia patients. To evaluate the framework, we leveraged semi-standardized clinical video data collected in three retrospective, longitudinal cohort studies across seven academic centres. We extracted static head angle excursions for clinical validation and derived kinematic variables reflecting naturalistic head dynamics to predict dystonia severity, subtype, and neuromodulation effects. The framework was also applied to a fully independent cohort of generalised dystonia patients for comparison between dystonia sub-types. Computer vision-derived measurements of head angle excursions showed a strong correlation with clinically assigned scores. Across comparisons, we identified consistent kinematic features from full video assessments encoding information critical to disease severity, subtype, and effects of neural circuit interventions, independent of static head angle deviations used in scoring. Our visual perceptive machine learning framework reveals kinematic pathosignatures of dystonia, potentially augmenting clinical management, facilitating scientific translation, and informing personalized precision neurology approaches.

Eisners Wirbelsäulen-Position und Hilfe-Methode, kurz WPH-Methode oder besser WiPiHi-Methode – umfasst verschiedene Testungen zur Diagnosestellung sowie Übungen mit dem Ziel, Fehlhaltungen in eine gute Haltung zurückzuführen, sprich in eine schmerzfreie oder zumindest schmerzreduzierte Haltung inklusive Prophylaxe von Wirbelsäulenschmerzen bzw. von Schmerzen des Haltungs- und Bewegungssystems. Eine zentrale Rolle kommt dabei dem kontinuierlichen Training der Haltemuskulatur zu, um die häufige muskuläre Dysbalance zwischen Halte- und Bewegungsmuskulatur zu reduzieren oder ganz aufzuheben.