Walter Paulus

Bio: Walter Paulus is an academic researcher from University of Göttingen. The author has contributed to research in topics: Transcranial magnetic stimulation & Transcranial direct-current stimulation. The author has an hindex of 149, co-authored 809 publications receiving 86252 citations. Previous affiliations of Walter Paulus include Maastricht University & VU University Amsterdam.

Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.

Abstract: The approach taken in this study to produce localised changes of cerebral excitability in the intact human was modulation of neuronal excitability by weak electric currents applied transcranially. So far, this technique has mainly been used in animal research, primarily through modulation of the resting membrane potential (Terzuolo & Bullock, 1956; Creutzfeld et al. 1962; Eccles et al. 1962; Bindman et al. 1964; Purpura & McMurtry, 1965; Artola et al. 1990; Malenka & Nicoll, 1999). In general, cerebral excitability was diminished by cathodal stimulation, which hyperpolarises neurones. Anodal stimulation caused neuronal depolarisation, leading to an increase in excitability (Bindman et al. 1962; Purpura & McMurtry, 1965), as was shown by spontaneous neuronal discharges and the amplitudes of evoked potentials (Landau et al. 1964; Purpura & McMurtry, 1965; Gorman, 1966). However, in single cortical layers opposite effects were seen (Purpura & McMurtry, 1965), underlining the fact that the effects of DC stimulation depend on the interaction of electric flow direction and neuronal geometry. Enduring effects of 5 h and longer have been described if the stimulation itself lasts sufficiently long, about 10–30 min. These prolonged effects are not simply due to prolonged membrane potential shifts or recurrent excitation, because intermittent complete cancellation of electrical brain activity by hypothermia does not abolish them (Gartside, 1968a,b). Long-term potentiation (LTP) and long-term depression (LTD) have been proposed as the likely candidates for this phenomenon (Hattori et al. 1990; Moriwaki, 1991; Islam et al. 1995; Malenka & Nicoll, 1999). The concept described here was an attempt to induce neuronal excitability changes in man by application of weak DC stimulation through the intact skull. It has already been demonstrated within invasive presurgical epilepsy diagnostics that intracranial currents of sufficient strength can be achieved in humans by stimulation with surface electrodes at intensities of up to 1.5 mA (Dymond et al. 1975). A suitable candidate for evaluating cortical excitability changes is transcranial magnetic stimulation (TMS), because it allows the quantification of motor-cortical neurone responses in a painless and non-invasive manner. The amplitude of the resulting motor-evoked potential (MEP) represents the excitability of the motor system. In the following, we confirm the principal possibility of altering cortical excitability by applying weak DC. Furthermore we show that systematic DC stimulation with minimum stimulation duration and intensity is necessary for an effective application of weak current in humans. This is of particular importance for inducing effects which outlast the duration of stimulation.

How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology

Abstract: Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of heart failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF > 50% and an LV end-diastolic volume index (LVEDVI) 16 mmHg or mean pulmonary capillary wedge pressure >12 mmHg) or non-invasively by tissue Doppler (TD) (E/E' > 15). If TD yields an E/E' ratio suggestive of diastolic LV dysfunction (15 > E/E' > 8), additional non-invasive investigations are required for diagnostic evidence of diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion. The updated strategies for the diagnosis and exclusion of HFNEF are useful not only for individual patient management but also for patient recruitment in future clinical trials exploring therapies for HFNEF.

Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans

Abstract: The authors show that in the human transcranial direct current stimulation is able to induce sustained cortical excitability elevations. As revealed by transcranial magnetic stimulation, motor cortical excitability increased approximately 150% above baseline for up to 90 minutes after the end of stimulation. The feasibility of inducing long-lasting excitability modulations in a noninvasive, painless, and reversible way makes this technique a potentially valuable tool in neuroplasticity modulation.

Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Abstract: The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Principles of Neural Science

Abstract: I have developed "tennis elbow" from lugging this book around the past four weeks, but it is worth the pain, the effort, and the aspirin. It is also worth the (relatively speaking) bargain price. Including appendixes, this book contains 894 pages of text. The entire panorama of the neural sciences is surveyed and examined, and it is comprehensive in its scope, from genomes to social behaviors. The editors explicitly state that the book is designed as "an introductory text for students of biology, behavior, and medicine," but it is hard to imagine any audience, interested in any fragment of neuroscience at any level of sophistication, that would not enjoy this book. The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or