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Dr. Gerald Niederwieser


Chlamydia pneumoniae-specific humoral immune responses and clinical disease parameters in multiple sclerosis.
Ann Neurol. 2001; 49(1):135 (ISSN: 0364-5134)
Krametter D; Niederwieser G; Berghold A; Birnbaum G; Strasser-Fuchs S; Hartung HP; Archelos JJ

Chlamydia pneumoniae in multiple sclerosis: humoral immune responses in serum and cerebrospinal fluid and correlation with disease activity marker.
Mult Scler. 2001; 7(1):13-8 (ISSN: 1352-4585)
Krametter D; Niederwieser G; Berghold A; Birnbaum G; Strasser-Fuchs S; Hartung HP; Archelos JJ
Department of Neurology, Karl-Franzens-Universität, Graz, Austria.

Humoral immune responses to Chlamydia pneumoniae (C. pneumoniae) were studied in paired sera and cerebrospinal fluid (CSF) of patients with definite multiple sclerosis (MS) and other inflammatory and non-inflammatory neurological diseases. Seropositivity was not significantly different between these groups. However, C. pneumoniae-specific IgG titers were significantly higher in CSF of MS than in controls. Sixteen out of 52 seropositive MS patients (30.8%) showed intrathecal synthesis of C. pneumoniae-specific IgG but only one of 43 seropositive controls (2.3%). In MS, this was strongly associated with intrathecal synthesis of polyclonal IgG in 13/16 patients. However, these elevated C. pneumoniae antibody titers in CSF did not significantly correlate with disease duration, disease course, clinical or MRI disease activity, disability or presence of oligoclonal IgG in MS.

Diagnostic accuracy of an agarose gel electrophoretic method in multiple sclerosis.
Clin Chem. 2001; 47(1):144 (ISSN: 0009-9147)
Niederwieser G; Bonelli RM; Brunner D; Neubauer M; Buchinger W; Reisecker F; Költringer P

Cerebral vasculitis associated with Reiter's syndrome.
J Neurol. 2001; 248(11):988-9 (ISSN: 0340-5354)
Niederwieser G; Bonelli RM; Pongratz R; Neubauer M; Buchinger W; Kammerhuber F; Reisecker F; Kleinert R; Költringer P

Intracerebral haemorrhage under interferon-beta therapy.
Eur J Neurol. 2001; 8(4):363-4 (ISSN: 1351-5101)
Niederwieser G; Bonelli RM; Kammerhuber F; Reisecker F; Költringer P

Riluzole and olanzapine in Huntington's disease.
Eur J Neurol. 2002; 9(2):183-4 (ISSN: 1351-5101)
Bonelli RM; Niederwieser G; Diez J; Költringer P

Effects of QiGong on brain function
Neurol Res. 2001; 23(5):501-5 (ISSN: 0161-6412)
Litscher G; Wenzel G; Niederwieser G; Schwarz G
Biomedical Engineering Unit, Department of Anesthesiology and Critical Care, University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria.

QiGong is an ancient and widely practiced Chinese meditation exercise. We studied the effects of QiGong on brain function with modern neuromonitoring tools in two subjects. In a male QiGong master (extremely trained practitioner), the technique induced reproducible changes in transcranial Doppler sonography, EEG, stimulus-induced 40 Hz oscillations, and near-infrared spectroscopy findings. Similar effects were seen after the application of multimodal stimuli and when the master concentrated on intense imagined stimuli (e.g. 22.2% increase in mean blood flow velocity (vm) in the posterior cerebral artery, and a simultaneous 23.1% decrease of vm in the middle cerebral artery). Similar effects were seen in the female subject. Neuromonitoring during QiGong appears able to objectify accompanied cerebral modulations surrounding this old Chinese meditation exercise.

Statins as immunomodulators: comparison with interferon-beta 1b in MS.
Neurology. 2002; 59(7):990-7 (ISSN: 0028-3878)
Neuhaus O; Strasser-Fuchs S; Fazekas F; Kieseier BC; Niederwieser G; Hartung HP; Archelos JJ
Department of Neurology, Multiple Sclerosis Research Group, Karl-Franzens-Universität, Graz, Austria.

BACKGROUND: Recent data suggest that statins may be potent immunomodulatory agents. In order to evaluate the potential role of statins as immunomodulators in MS, the authors studied their immunologic effects in vitro and compared them to interferon (IFN)beta-1b. METHODS: Peripheral blood mononuclear cells (PBMC) obtained from untreated or IFN beta-1-treated patients with relapsing-remitting MS or from healthy donors (HD) and T cells were stimulated with concanavalin A, phytohemagglutinin, or antibody to CD3 in the presence of lovastatin, simvastatin, mevastatin, IFN beta-1b, or statins plus IFN beta-1b. The authors analyzed proliferative activity of T cells and B cells, cytokine production and release, activity of matrix metalloproteinases (MMP), and surface expression of activation markers, adhesion molecules, and chemokine receptors on both T and B cells. RESULTS: All three statins inhibited proliferation of stimulated PBMC in a dose-dependent manner, with simvastatin being the most potent, followed by lovastatin and mevastatin. IFN beta-1b showed a similar effect; statins and IFN beta-1b together added their inhibitory potentials. Furthermore, statins reduced the expression of activation-induced adhesion molecules on T cells, modified the T helper 1/T helper 2 cytokine balance, reduced MMP-9, and downregulated chemokine receptors on both B and T cells. Besides strong anti-inflammatory properties, statins also exhibited some proinflammatory effects. CONCLUSIONS: Statins are effective immunomodulators in vitro that merit evaluation as treatment for MS.

High-dose olanzapine in Huntington's disease.
Int Clin Psychopharmacol. 2002; 17(2):91-3 (ISSN: 0268-1315)
Bonelli RM; Niederwieser G; Tribl GG; Költringer P
Department of Neurology and Psychiatry, Hospital BHB Eggenberg, Graz, Austria.

The few reports available on olanzapine in Huntington's disease (HD) are insufficiently documented and/or insufficiently dosed. We describe a 30-year-old woman with genetically confirmed HD who presented with severe chorea. She was not able to eat or dress without help and did not respond to haloperidol; the motor scale of the Unified HD Rating Scale (UHDRS-I) revealed 65 of a possible 124 points. After admission, we treated the patient with a high dose of olanzapine (30 mg daily). The chorea almost ceased in the next 2 days, she was able to eat and walk without assistance (UHDRS-I of 21 points), and fine motor tasks improved, as well as gait and eye movements. This effect lasted for 5 months. We conclude that high-dose olanzapine appears to be useful in grave choreatic attacks.

[Primary high-grade B-cell lymphoma of the CNS. Case report and review of the literature]
Nervenarzt. 2002; 73(8):779-84 (ISSN: 0028-2804)
Melinz K; Bonelli RM; Niederwieser G; Kenner L; Reisecker F
Abteilung für Neurologie und Psychiatrie, Krankenhaus BHB Eggenberg, Bergstrasse 27, A-8021 Graz.

We report the case of a 69-year-old patient referred to our clinic because of mania. When examined by neuroradiological imaging, there were lesions seen appearing and disappearing in different regions of the brain during a period of 2 months. Differential diagnosis of these changing lesions, progressive severe illness, and the role of glucocorticoid therapy concerning these lesions are discussed. The diagnosis of primary CNS lymphoma of the B-cell type could not made sure until autopsy.

Apraxia of eyelid closure in Huntington's disease.
J Neural Transm. 2002; 109(2):197-201 (ISSN: 0300-9564)
Bonelli RM; Niederwieser G
Department of Neurology and Psychiatry, Hospital BHB Eggenberg, Graz, Austria.

We report a patient with genetically confirmed Huntington's disease (HD) presenting apraxia of eyelid closure (AEC). She was unable to close her eyes at command but was able to blink. Chorea and AEC ameliorated significantly during treatment with olanzapine and riluzole, an inhibitor of glutamate release. AEC is reported in progressive supranuclear palsy, Creutzfeldt-Jakob's disease, amyotrophic lateral sclerosis, and as post-stroke AEC. No report on HD is available so far, although oculomotor disturbances are quite common in this disease.

Sexuality in multiple sclerosis.
J Neural Transm. 2005; 112(9):1201-11 (ISSN: 0300-9564)
Schmidt EZ; Hofmann P; Niederwieser G; Kapfhammer HP; Bonelli RM
University Clinic of Psychiatry, Medical University of Graz, Graz, Austria.

Sexuality and partnership have an important influence on the quality of life of every person and also on people with chronic disorders such as multiple sclerosis. The findings in literature show high evidence that people with multiple sclerosis experience high levels of sexual dysfunction, most of them with hypoactive sexual behaviour often associated with dissatisfaction in relationship, and also the partners seem to show lower sexual and partnership satisfaction. The most common problems in women are lack of sexual interest and decreased libido, often with problems in orgasmic capacity, while men report erectile dysfunction and also lack of sexual interest. The impact of the level of disability and duration of the illness remains unclear. Positive familial support can often help the patient in coping with the illness, nonetheless problems with changing roles and multiple-sclerosis-minimizing can improve the need of contacts to outstanding persons.

[Adrenoleukodystrophy mimicking multiple sclerosis]
Nervenarzt. 2001; 72(10):794-7 (ISSN: 0028-2804)
Krenn M; Bonelli RM; Niederwieser G; Reisecker F; Költringer P
Abteilung für Neurologie und Psychiatrie, Krankenhaus BHB Eggenberg, Bergstrasse 27, A-8021 Graz.

The article describes the development of symptoms in a 40-year-old female patient who is a symptomatic carrier of X-linked adrenoleucodystrophy (ALD). ALD is characterized by impaired peroxisomal beta-oxidation of very long chain fatty acids and is associated with mutations of the ALD gene, resulting in a defective peroxisomal membrane-transport protein. Our patient's symptoms are identical to those found in multiple sclerosis, showing spastic paraparesis of the lower limbs with marked sensory deficits, visual disturbances in the right eye, and bladder difficulties. Visual and auditory evoked potentials were pathological, and a cranial MRI revealed multiple periventrical white-matter lesions. We found increased intrathecal immunoglobulin production. Diagnosis was established by high concentrations of very long chain fatty acids in serum and in dermal fibroblasts after the same was found in our patient's son. In familial multiple sclerosis, ALD should be excluded in male and female patients.

Dr. Gerald Niederwieser

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