Neurology and Neurorehabilitation Center

Luzern, Switzerland

Neurology and Neurorehabilitation Center

Luzern, Switzerland
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Stegmayer K.,University of Bern | Strik W.,University of Bern | Federspiel A.,University of Bern | Wiest R.,University of Bern | And 2 more authors.
Schizophrenia Research | Year: 2016

Dimensional concepts such as the Research Domain Criteria initiative have been proposed to disentangle the heterogeneity of schizophrenia. One model introduced three neurobiologically informed behavioral dimensions: language, affectivity and motor behavior. To study the brain-behavior associations of these three dimensions, we investigated whether current behavioral alterations were linked to resting state perfusion in distinct brain circuits in schizophrenia.In total, 47 patients with schizophrenia spectrum disorders and 44 healthy controls were included. Psychopathology was assessed with the Positive And Negative Syndrome Scale and the Bern Psychopathology scale (BPS). The BPS provides severity ratings of three behavioral dimensions (language, affectivity and motor). Patients were classified according to the severity of alterations (severe, mild, no) in each dimension. Whole brain resting state cerebral blood flow (CBF) was compared between patient subgroups and controls.Two symptom dimensions were associated with distinct CBF changes. Behavioral alterations in the language dimension were linked to increased CBF in Heschl's gyrus. Altered affectivity was related to increased CBF in amygdala. The ratings of motor behavior instead were not specifically associated with CBF.Investigating behavioral alterations in three schizophrenia symptom dimensions identified distinct regional CBF changes in the language and limbic brain circuits. The results demonstrate a hitherto unknown segregation of pathophysiological pathways underlying a limited number of specific symptom dimensions in schizophrenia. © 2016 The Authors.

Huberle E.,Neurology and Neurorehabilitation Center | Huberle E.,Max Planck Institute for Biological Cybernetics | Lutzenberger W.,University of Tübingen
NeuroImage | Year: 2013

Object recognition is a fundamental mechanism of visual processing and requires the extraction of shape information. Early visual areas have been linked to the analysis of local image features, while higher visual areas of the ventral visual pathway rather mediate the perception and recognition of global shapes. Investigations of the spatiotemporal characteristics of shape analysis in the human visual cortex by rapid event-related fMRI adaptation in combination with a region of interest analysis suggested a transient manner of contour integration and shape processing in early visual areas compared to sustained processing in higher visual areas. fMRI adaptation (or repetition suppression) paradigms offer the possibility to enhance the restricted spatial resolution of conventional fMRI by focusing on decreased responses for repeated stimulus presentation. However, improving our understanding of complex neuronal mechanisms in the human brain requires the investigation not only at high spatial but also temporal resolution. A limitation of fMRI adaptation can be found in its poor temporal resolution which EEG- and MEG-techniques can overcome, though at a lower spatial resolution.The present study aimed to investigate temporal characteristics of shape processing in the human brain by adapting the principles of fMRI adaption in a MEG study. In parallel to an earlier fMRI study, the two stimuli of a trial were presented at varied interstimulus intervals. Additional analyses by means of a dipole analysis and co-registration of MEG and fMRI data were conducted. Adaptation was observed for the short as well as the longer interstimulus interval. Interestingly, the latency of the adaptation effects varied with the interstimulus interval. The findings support a late onset of adaption that possibly underlies global discrimination processes and recognition in higher areas of the ventral visual pathway. Further, the present results indicate a useful extension of adaptation paradigms and 'region of interest'-analyses from fMRI to MEG at a high temporal resolution. © 2012 Elsevier Inc.

Hopfner S.,University of Bern | Cazzoli D.,University of Bern | Cazzoli D.,University of Oxford | Muri R.M.,University of Bern | And 8 more authors.
Neuropsychologia | Year: 2015

Continuous theta burst stimulation (cTBS) represents a promising approach in the treatment of neglect syndrome. However, it is not known whether cTBS in conjunction with another technique may enhance the therapeutic effects. In the present sham-controlled study, we aimed to combine cTBS with smooth pursuit training (SPT), another method known to effectively improve neglect symptoms, and to evaluate whether this combination would result in a stronger effect than SPT alone. Eighteen patients with left spatial neglect after right-hemispheric stroke were included in the study and performed a cancellation task on a large 54.6″ touchscreen monitor. A sequential application of cTBS and SPT induced a significantly greater improvement of neglect than SPT alone. After the combined application of these two methods, patients detected significantly more targets and their cancellation behaviour presented a significantly greater shift towards the contralesional hemispace. We suggest that a combined, sequential application of cTBS and SPT is a promising new approach to treat neglect. © 2014 Elsevier Ltd.

Walther S.,University of Bern | Vanbellingen T.,University of Bern | Vanbellingen T.,Neurology and Neurorehabilitation Center | Muri R.,University of Bern | And 3 more authors.
Neuropsychologia | Year: 2013

Schizophrenia patients frequently present with subtle motor impairments, including higher order motor function such as hand gesture performance. Using cut off scores from a standardized gesture test, we previously reported gesture deficits in 40% of schizophrenia patients irrespective of the gesture content. However, these findings were based on normative data from an older control group. Hence, we now aimed at determining cut-off scores in an age and gender matched control group. Furthermore, we wanted to explore whether gesture categories are differentially affected in Schizophrenia. Gesture performance data of 30 schizophrenia patients and data from 30 matched controls were compared. Categories included meaningless, intransitive (communicative) and transitive (object related) hand gestures, which were either imitated or pantomimed, i.e. produced on verbal command. Cut-off scores of the age matched control group were higher than the previous cut-off scores in an older control group. An ANOVA tested effects of group, domain (imitation or pantomime), and semantic category (meaningless, transitive or intransitive), as well as their interaction. According to the new cut-off scores, 67% of the schizophrenia patients demonstrated gestural deficits. Patients performed worse in all gesture categories, however meaningless gestures on verbal command were particularly impaired (p=0.008). This category correlated with poor frontal lobe function (p<0.001).In conclusion, gestural deficits in schizophrenia are even more frequent than previously reported. Gesture categories that pose higher demands on planning and selection such as pantomime of meaningless gestures are predominantly affected and associated with the well-known frontal lobe dysfunction. © 2013 Elsevier Ltd.

Stegmayer K.,University of Bern | Bohlhalter S.,Neurology and Neurorehabilitation Center | Bohlhalter S.,University of Bern | Vanbellingen T.,Neurology and Neurorehabilitation Center | And 7 more authors.
Cortex | Year: 2016

Introduction: The neural correlates of impaired performance of gestures are currently unclear. Lesion studies showed variable involvement of the ventro-dorsal stream particularly left inferior frontal gyrus (IFG) in gesture performance on command. However, findings cannot be easily generalized as lesions may be biased by the architecture of vascular supply and involve brain areas beyond the critical region. The neuropsychiatric syndrome of schizophrenia shares apraxic-like errors and altered brain structure without macroanatomic lesions. Schizophrenia may therefore qualify as a model disorder to test neural correlates of gesture impairments. Methods: We included 45 schizophrenia patients and 44 healthy controls in the study to investigate the structural brain correlates of defective gesturing in schizophrenia using voxel based morphometry. Gestures were tested in two domains: meaningful gestures (transitive and intransitive) on verbal command and imitation of meaningless gestures. Cut-off scores were used to separate patients with deficits, patients without deficits and controls. Group differences in gray matter (GM) volume were explored in an ANCOVA. Results: Patients performed poorer than controls in each gesture category (p < .001). Patients with deficits in producing meaningful gestures on command had reduced GM predominantly in left IFG, with additional involvement of right insula and anterior cingulate cortex. Patients with deficits differed from patients without deficits in right insula, inferior parietal lobe (IPL) and superior temporal gyrus. Conclusions: Impaired performance of meaningful gestures on command was linked to volume loss predominantly in the praxis network in schizophrenia. Thus, the behavioral similarities between apraxia and schizophrenia are paralleled by structural alterations. However, few associations between behavioral impairment and structural brain alterations appear specific to schizophrenia. © 2016 Elsevier Ltd.

Rennig J.,University of Tübingen | Karnath H.-O.,University of Tübingen | Karnath H.-O.,University of South Carolina | Huberle E.,University of Tübingen | Huberle E.,Neurology and Neurorehabilitation Center
Frontiers in Human Neuroscience | Year: 2013

Visual perception depends on the visual context and is likely to be influenced by size constancy, which predicts a size and distance invariant perception of objects. However, size constancy can also result in optical illusions that allow the manipulation of the perceived size. We thus asked whether the integration of local elements into a global object can be influenced by manipulations of the visual context and size constancy? A set of stimuli was applied in healthy individuals that took advantage of the 'Kanizsa' illusion, in which three circles with open wedges oriented towards a center point are placed to form an illusionary perception of a triangle. In addition, a 3D-perspective view was implemented in which the global target ('Kanizsa' triangle) was placed in combination with several distractor circles either in a close or a distant position. Subjects were engaged in a global recognition task on the location of the 'Kanizsa' triangle. Global recognition of 'Kanizsa' triangles improved with a decreasing length of the illusory contour. Interestingly, recognition of 'Kanizsa' triangles decreased when they were perceived as if they were located further away. We conclude that the integration of local elements into a global object is dependent on the visual context and dominated by size constancy. © 2013 Rennig, Karnath and Huberle.

Rennig J.,University of Tübingen | Bilalic M.,University of Tübingen | Huberle E.,University of Tübingen | Huberle E.,Neurology and Neurorehabilitation Center | And 3 more authors.
Frontiers in Human Neuroscience | Year: 2013

In a recent neuroimaging study the comparison of intact vs. disturbed perception of global gestalt indicated a significant role of the temporo-parietal junction (TPJ) in the intact perception of global gestalt (Huberle and Karnath, 2012). This location corresponded well with the areas known to be damaged or impaired in patients with simultanagnosia after stroke or due to neurodegenerative diseases. It was concluded that the TPJ plays an important role in the integration of individual items to a holistic percept. Thus, increased BOLD signals should be found in this region whenever a task calls for the integration of multiple visual items. Behavioral experiments in chess experts suggested that their superior skills in comparison to chess novices are partly based on fast holistic processing of chess positions with multiple pieces. We thus analyzed BOLD data from four fMRI studies that compared chess experts with chess novices during the presentation of complex chess-related visual stimuli (Bilalić et al., 2010, 2011a,b, 2012). Three regions of interests were defined by significant TPJ clusters in the abovementioned study of global gestalt perception (Huberle and Karnath, 2012) and BOLD signal amplitudes in these regions were compared between chess experts and novices. These cross-paradigm ROI analyses revealed higher signals at the TPJ in chess experts in comparison to novices during presentations of complex chess positions. This difference was consistent across the different tasks in five independent experiments. Our results confirm the assumption that the TPJ region identified in previous work on global gestalt perception plays an important role in the processing of complex visual stimulus configurations. © 2013 Rennig, Bilalić, Huberle, Karnath and Himmelbach.

Ritzinger B.,University of Tübingen | Huberle E.,University of Tübingen | Huberle E.,Neurology and Neurorehabilitation Center | Karnath H.-O.,University of Tübingen | Karnath H.-O.,University of South Carolina
PLoS ONE | Year: 2012

While early and higher visual areas along the ventral visual pathway in the inferotemporal cortex are critical for the recognition of individual objects, the neural representation of human perception of complex global visual scenes remains under debate. Stroke patients with a selective deficit in the perception of a complex global Gestalt with intact recognition of individual objects - a deficit termed simultanagnosia - greatly helped to study this question. Interestingly, simultanagnosia typically results from bilateral lesions of the temporo-parietal junction (TPJ). The present study aimed to verify the relevance of this area for human global Gestalt perception. We applied continuous theta-burst TMS either unilaterally (left or right) or bilateral simultaneously over TPJ. Healthy subjects were presented with hierarchically organized visual stimuli that allowed parametrical degrading of the object at the global level. Identification of the global Gestalt was significantly modulated only for the bilateral TPJ stimulation condition. Our results strengthen the view that global Gestalt perception in the human brain involves TPJ and is co-dependent on both hemispheres. © 2012 Ritzinger et al.

Walther S.,University of Bern | Stegmayer K.,University of Bern | Sulzbacher J.,University of Bern | Vanbellingen T.,University of Bern | And 5 more authors.
Schizophrenia Bulletin | Year: 2015

Schizophrenia patients are severely impaired in nonverbal communication, including social perception and gesture production. However, the impact of nonverbal social perception on gestural behavior remains unknown, as is the contribution of negative symptoms, working memory, and abnormal motor behavior. Thus, the study tested whether poor nonverbal social perception was related to impaired gesture performance, gestural knowledge, or motor abnormalities. Forty-six patients with schizophrenia (80%), schizophreniform (15%), or schizoaffective disorder (5%) and 44 healthy controls matched for age, gender, and education were included. Participants completed 4 tasks on nonverbal communication including nonverbal social perception, gesture performance, gesture recognition, and tool use. In addition, they underwent comprehensive clinical and motor assessments. Patients presented impaired nonverbal communication in all tasks compared with controls. Furthermore, in contrast to controls, performance in patients was highly correlated between tasks, not explained by supramodal cognitive deficits such as working memory. Schizophrenia patients with impaired gesture performance also demonstrated poor nonverbal social perception, gestural knowledge, and tool use. Importantly, motor/frontal abnormalities negatively mediated the strong association between nonverbal social perception and gesture performance. The factors negative symptoms and antipsychotic dosage were unrelated to the nonverbal tasks. The study confirmed a generalized nonverbal communication deficit in schizophrenia. Specifically, the findings suggested that nonverbal social perception in schizophrenia has a relevant impact on gestural impairment beyond the negative influence of motor/frontal abnormalities. © 2015 The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

Vanbellingen T.,Neurology and Neurorehabilitation Center | Vanbellingen T.,University of Bern | Kamm C.P.,University of Bern
Seminars in Neurology | Year: 2016

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system and the most common cause of nontraumatic disability in young adults. It is a heterogeneous disease associated with long-term disability, negatively influencing quality of life. Disease-modifying pharmacological therapies may decrease activity and progression of the disease, and symptomatic pharmacological treatments may reduce complaints to a certain extent; however, MS patients mostly still suffer from several neurologic deficits in the course of their disease. Consequently, specific comprehensive nonpharmacological rehabilitation interventions are needed to reduce disability to obtain better independence in activities of daily living, resulting in an optimal quality of life. Here the authors give an overview of the main sensorimotor symptoms in MS. Some of the most commonly used standardized outcome assessments are presented, and existing evidence-based motor rehabilitation strategies are described. © 2016 by Thieme Medical Publishers, Inc.

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