Dr. Ingrid Wagner
Specialist in neurology
Certified user of botulinum toxin
Born 1978 in Steyr/Upper Austria
Doctorate in medicine (Dr. med. univ.) at the Medical Faculty of the University of Vienna (2001)
Training as a general practitioner at the LKH Steyr/Upper Austria
Training as a specialist in neurology at the Neurological (Prof. Dr. med. Dr. h.c. Stefan Schwab) and Psychiatric (Prof. Dr. med. Johannes Kornhuber) University Hospital in Erlangen with a focus on moderate training and scientific activity in
- neurological intensive care under the direction of Prof. Dr. J. Bardutzky (intracerebral hemorrhage, intraventricular fibrinolysis, lumbar drainage, hypothermia treatment and hemicraniectomy for hemorrhagic and ischemic stroke).
- Stroke medicine and neurological emergency medicine (stroke unit and emergency outpatient clinic headed by Prof. Dr. med. P. Schellinger)
- Neurophysiology and Outpatient Clinic for Movement Disorders and Botulinum Toxin Therapy (Head PD Dr. med. Axel Schramm) with acquisition of the partial certificate for BoNT therapy for blepharospasm, hemifacial spasm and cervical dystonia of the German Working Group for Botulinum Toxin Therapy
- Peripheral neurology (Prof. Dr. med. Dieter Heuss - lead in the preparation of the DGN guideline for polyneuropathies)
- General Neurology (General Neurological Outpatient Clinic, Prof. Christoph Lang, MD)
2011 Doctorate Dr. med.
Work at the Psychiatric University Hospital Zurich (Prof. E. Seifritz)
Since 07/2015 senior physician with participation in the development of the Neurological Department of the Barmherzige Brüder Eisenstadt (Head of Department Prim. PD Dr. med. Dimitre Staykov)
Certified user of botulinum toxin for neurological indications (ÖDBAG certified)
Electroneuro- and myography certificate (EMG certificate)
Publications and areas of interest
- 1: Wagner I, Volbers B, Kloska S, Doerfler A, Schwab S, Staykov D. Sex differences in perihemorrhagic edema evolution after spontaneous intracerebral hemorrhage. Eur J Neurol. 2012 Nov;19(11):1477-81. doi: 10.1111/j.1468-1331.2011.03628.x. Epub 2012 Jan 4. PMID: 22221591.
- 2: Staykov D, Wagner I, Volbers B, Doerfler A, Schwab S, Kollmar R. Mild prolonged hypothermia for large intracerebral hemorrhage. Neurocrit Care. 2013 Apr;18(2):178-83. doi: 10.1007/s12028-012-9762-5. PMID: 22864858.
- 3: Wagner I, Volbers B, Hilz MJ, Schwab S, Doerfler A, Staykov D. Radiopacity of intracerebral hemorrhage correlates with perihemorrhagic edema. Eur J Neurol. 2012 Mar;19(3):525-8. doi: 10.1111/j.1468-1331.2011.03526.x. Epub 2011 Sep 26. PMID: 21951394.
- 4: Staykov D, Wagner I, Volbers B, Hauer EM, Doerfler A, Schwab S, Bardutzky J. Natural course of perihemorrhagic edema after intracerebral hemorrhage. Stroke. 2011 Sep;42(9):2625-9. doi: 10.1161/STROKEAHA.111.618611. Epub 2011 Jul 7. PMID: 21737803.
- 5: Staykov D, Wagner I, Volbers B, Huttner HB, Doerfler A, Schwab S, Bardutzky J. Dose effect of intraventricular fibrinolysis in ventricular hemorrhage. Stroke. 2011 Jul;42(7):2061-4. doi: 10.1161/STROKEAHA.110.608190. Epub 2011 May 5. PMID: 21546475.
- 6: Volbers B, Wagner I, Willfarth W, Doerfler A, Schwab S, Staykov D. Intraventricular fibrinolysis does not increase perihemorrhagic edema after intracerebral hemorrhage. Stroke. 2013 Feb;44(2):362-6. doi: 10.1161/STROKEAHA.112.673228. Epub 2013 Jan 10. PMID: 23306318.
- 7: Volbers B, Staykov D, Wagner I, Dörfler A, Saake M, Schwab S, Bardutzky J. Semi-automatic volumetric assessment of perihemorrhagic edema with computed tomography. Eur J Neurol. 2011 Nov;18(11):1323-8. doi: 10.1111/j.1468-1331.2011.03395.x. Epub 2011 Apr 4. PMID: 21457176.
- 8: Wagner I, Hauer EM, Staykov D, Volbers B, Dörfler A, Schwab S, Bardutzky J. Effects of continuous hypertonic saline infusion on perihemorrhagic edema evolution. Stroke. 2011 Jun;42(6):1540-5. doi: 10.1161/STROKEAHA.110.609479. Epub 2011 Apr 21. PMID: 21512173.
- 9: Wagner I, Staykov D, Volbers B, Kloska S, Dörfler A, Schwab S, Bardutzky J. Therapeutic hypothermia for space-occupying Herpes simplex virus encephalitis. Minerva Anestesiol. 2011 Mar;77(3):371-4. Epub 2011 Mar 1. PMID: 21364501.
- 10: Staykov D, Volbers B, Wagner I, Huttner HB, Doerfler A, Schwab S, Bardutzky J. Prognostic significance of third ventricle blood volume in intracerebral haemorrhage with severe ventricular involvement. J Neurol Neurosurg Psychiatry. 2011 Nov;82(11):1260-3. doi: 10.1136/jnnp.2010.234542. Epub 2011 Apr 21. PMID: 21515556.
- 11: Staykov D, Speck V, Volbers B, Wagner I, Saake M, Doerfler A, Schwab S, Bardutzky J. Early recognition of lumbar overdrainage by lumboventricular pressure gradient. Neurosurgery. 2011 May;68(5):1187-91; discussion 1191. doi: 10.1227/NEU.0b013e31820c0274. PMID: 21273925.
- 12: Volbers B, Staykov D, Wagner I, Doerfler A, Schwab S, Bardutzky J. Teaching neuroimages: a look beneath the surface in a "typical" thalamic hemorrhage. Neurology. 2010 Aug 24;75(8):e40. doi: 10.1212/WNL.0b013e3181eee4c2. PMID: 20733139.
- Neural networks - fMRI
- Clinical neurophysiology
- Movement disorders and dystonia in musicians - as a flutist, I know about the specific forms of disruptive and sometimes professionally disabling functional disorders in musicians.
- Neurology in Filmography in the European Area following Eelco Widjick's "Neurocinema - when Film meets Neurology".
Botulinum toxin therapy (BoNT) for neurological indications (blepharospasm, hemifacial spasm, oromandibular dystonia, cervical dystonia, segmental, focal and generalized dystonia, tasks specific dystonia - e.g., writing cramps, dystonia in musicians (e.g., embouchure dystonia), chronic spasticity after strokes, craniocerebral trauma, paraplegic syndromes. e.g., writer's cramps, dystonias in musicians (e.g., embouchure dystonias), spasticity following strokes, traumatic brain injury, paraplegic syndromes, chronic migraine, trigeminal neuralgia, and axillary hyperhidrosis and hypersalivation).
Pre- and post-stroke care
Dizziness syndromes (e.g.: benign paroxysmal peripheral positional vertigo (BPPLS), neuritis vestibularis, Meniere's disease, central forms of vertigo).
Headache syndromes (episodic and chronic tension headache, episodic and chronic migraine, cluster headache and other trigeminal autonomic headaches, idiopathic intracranial hypertension/pseudotumor cerebri, symptomatic headache (in intracerebral lesions/space), atypical facial pain.
Clinical, neurophysiological, laboratory/liquor-chemical and sonographic clarification of polyneuropathic complaints (sensory disturbances in feet/hands with/without signs of paralysis)
Clinical, neurophysiological and sonographic evaluation of peripheral nerve constriction syndromes (e.g. carpal tunnel syndrome, sulcus nervi ulnaris syndrome, Loge de Guyon syndrome, supinatorlogen syndrome, pronator teres syndrome, interosseus anterior syndrome, anterior and posterior tarsal tunnel syndrome, meralgia paresthetica, thoracic outlet syndrome)
Neuromuscular transmission disorders (myasthenia gravis, Lambert Eaton myasthenic syndrome, botulism, ...).
Clinical, neurophysiological, laboratory-chemical, genetic-histological clarification of myopathies, myositides and myalgic complaints
Clarification of back pain
Differential diagnostic classification of neurodegenerative diseases (dementia syndromes, Parkinson's syndromes, MND (Motor Neuron Disease), Huntington's disease, Wilson's disease, neuroferritinopathies, ...)
Initial evaluation of chronic inflammatory CNS disorders (multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), autoimmune/paraneoplastic/pathogen-induced encephalitides) with referral to specialized centers/outpatient clinics.
Differential diagnosis of dementia syndromes and states of confusion
Initial assessment of symptoms suspicious of epilepsy with referral to specialized centers/outpatient clinics
Clarification of peripheral facial paralysis
Differential diagnosis of tremor forms (tremor) of the hands, head, chin, legs, voice, ... (e.g. essential tremors, Parkinson's tremor, dystonic tremor, increased physiological tremor, orthostatic tremor, ...)
Concerning neurological clinical pictures
(Explanations based on the DGN guideline for dystonia) - The term dystonia refers to a movement disorder characterized by involuntary, sustained, or intermittent muscle contractions of various body parts, with resulting abnormal, often repetitive movements and/or malpositions. These may be accompanied by twisting movements or be tremor-like (Albanese et al.). Dystonic movement patterns are often triggered or amplified in affected individuals by voluntary muscle activity of affected or distant muscle groups (so-called overflow effect).
The term dystonia is synonymous with an independent disease entity or a clinical syndrome in the context of other underlying diseases (complex dystonia) or a disease symptom (e.g.: "off-dystonia" in Parkinson's disease).
The causes can be very different and are divided into genetic and acquired (strokes, traumatic brain injury, inflammation/infection of the central nervous system, metabolic, toxic, ..) causes depending on the age of onset of the first symptoms. In addition, however, there are also so-called task-specific forms of dystonia such as writing cramps and dystonia in musicians (e.g., embouchure dystonia, ..).
The therapy of choice, especially for focal dystonia, is selective denervation of the affected muscle groups by local injection of botulinum neurotoxin (BoNT).
BoNT is the exotoxin of Clostridium botulinum, a gram-positive anaerobic spore former. Immunologically, 7 serotypes (A, B, C, D, E, F, G) can be distinguished.
BoNT binds highly selectively to nerve endings and inhibits so-called synaptic transmission via complex intermediate steps - a consecutive disturbance of neuromuscular impulse transmission that becomes clinically apparent as paralysis (paresis) of certain body regions/parts.
Depending on the dose of BoNT applied, paralysis of the musculature occurs to varying degrees. The effect occurs after about 2 to 3 days, reaches the maximum effect after 2 to 3 weeks and then remains stable at an unchanged level for 6 to 8 weeks, depending on the clinical picture and the injected dose. After this period, there is a so-called collateral sprouting of nerve endings and finally restitution of the neuromuscular synapse, whereby the muscle gradually regains its function.
A total of 3 BoNT type A preparations are approved in Germany and Austria:
- BOTOX (Onabotuliunumtoxin)
- DYSPORT (Abobotulinumtoxin) and
- XEOMIN (Incobotulinumtoxin)
A BoNT type B preparation (Neurobloc - rimabotulinumtoxin) is approved for the treatment of cervical dystonia in Germany.
BoNT injection is anatomically oriented, EMG and/or sonography supported, or EMG stimulator assisted, depending on the body region and type of dystonia/spasticity.
Axillary hyperhidrosis is not only a cosmetic problem, but also a symptom limiting the quality of life. In most cases, various conservative dermatological treatments are applied in advance, which, however, often do not lead to satisfactory results in the long term.
BoNT is applied intracutaneously in the treatment of axillary hyperhidrosis - if necessary also after light superficial anesthesia with an anesthetic ointment/plaster - according to a specific injection regimen. This results in an inhibition of the innervation of the sweat glands.
Hypersalivation (excessive salivation) as an accompanying symptom of some neurodegenerative diseases (e.g..: Parkinson's disease, amyotrophic lateral sclerosis, infantile cerebral palsy, ...) can be applied by means of sonography-assisted injection BoNT into the salivary glands (parotid gland and submandibular gland). The result lasts for several weeks to months.
(Explanations based on the DGN guideline Prophylaxis of Migraine) - Migraine is a common disorder with a prevalence of 20% in women and 8% in men. Attacks are severe, often unilateral pulsating-pounding headaches that increase in intensity with physical activity. The individual attacks are accompanied by loss of appetite, nausea (80%), vomiting (40 to 50%), photophobia (60%), sensitivity to noise (50%), and hypersensitivity to certain odors (10%). As a sign of activation of the parasympathetic nervous system, mild eye tearing is most commonly found in up to 82% of patients.
Depending on the number of headache days per month, a distinction is made between episodic and chronic migraine.
While numerous drugs of different substance classes are available for the prophylaxis of episodic migraine, only 2 substances showed significant efficacy for the treatment of chronic migraine - besides the increasing use of subcutaneous antibody therapy - namely topiramate and onabotulinumtoxin A (BOTOX). The latter is ONLY approved for the treatment of CHRONIC migraine and the cost is usually covered by health care providers.
BoNT injections in the treatment of chronic migraine are anatomically oriented according to the PREEMPT scheme and, if necessary, an additional "follow the pain" principle.
Cluster headache or other trigeminal autonomic headache syndromes (SUNCT, SUNA, hemicrania continua partialis, ...)
BoNT can be used as an off-label preparation when conservative treatment options fail.
BoNT can be used as an off-label treatment for essential tremor after failure of conventional treatment options.
In the treatment of hemifacial spasm, BoNT is the therapy of choice and is approved for this indication. With regard to trigeminal neuralgia, there is an off-label application option in case of unsatisfactory results of conservative therapy measures.
(Explanations based on the DGN guideline for polyneuropathies) - Polyneuropathies are generalized diseases of the peripheral nervous system (PNS). The PNS includes all parts of the motor, sensory and autonomic nerves lying outside the central nervous system with their Schwann cells and ganglionic satellite cells, their connective tissue sheath structures (peri- and epineurium) and the blood and lymph vessels supplying them.
The complaints include sensory irritation and failure symptoms such as tingling, formication, heat and cold sensations, stinging, electrifying, sensations of furiness and numbness, burning pain, itching, feeling of being constricted, swelling sensations, feeling of uncomfortable pressure, Feeling of walking on absorbent cotton, unsteadiness of gait especially in the dark, painless sores, and motor and autonomic deficits such as muscle twitching, muscle cramps, muscle weakness, muscle atrophy, muscle pain, decreased or increased sweating, dry skin, atrophic skin, burning-attack-like sensitive sensations.
The causes are manifold and range from metabolic (diabetes associated, alcohol toxic PNP, uremic PNP, ....) to infectious (Borrelia, neurotropic viruses...), toxic, drug toxic, genetic, immune mediated (e.g.: AIDP, CIDP, MMN, MADSAM, ...) and oncological (paraneoplastic sydromes) triggers.
The therapies depend on the triggering cause and are thus very different.
Application of botulinum toxin (BoNT) in various neurological indications (eyelid spasms, hemifacial spasm, oromandibular dystonia, cervical dystonia, focal dystonia, post-stroke spasticity, axillary hyperhidrosis, hypersalivation, chronic migraine, trigeminal neuralgia, ...). - anatomically oriented, EMG and/or sonography supported.
In case of questionable ineffectiveness of botulinum toxin, test for neutralizing antibodies or perform EDB test.
Detailed electroneurographic workup for polyneuropathies and peripheral nerve lesions.
Facialis neurography for prognosis assessment due to peripheral facial paralysis
Detailed electromyographic studies for differential diagnostic classification of various myopathic, polyneuropathic and neurogenerative diseases.
CTS diagnostics incl. Inching method
SNUS (Sulcus n. Ulnaris Syndrome) - and LDG (Loge de Guyon) - diagnostics
Dr. Ingrid Wagner
Ordination by appointment by phone and online
As an elective doctor, I do not have a contract with the public health insurance companies. After the appointment you will receive an invoice, which you can pay by ATM or payment slip. If you submit this to your health insurance company, you will be refunded part of the costs (up to 80%). The amount of reimbursement varies from health insurance company to health insurance company. However, some services are billed purely to private physicians (e.g.: Botox treatment for axillary hyperhidrosis and certain neurophysiological examination methods, which are not yet uniformly included in the tariff catalog of the regional offices of the ÖGK). Please do not hesitate to contact me for further information.
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Dr. Ingrid Wagner
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