• LAZAR | SEIDEMAN | SMITH

    INTERNATIONAL
    Specialists for rare diseases (Orphan Diseases, Neurology & Dermatology)

    Clinical Teaching Practice of the Jewish University (JUC, United States)

  • Our senior physicians

    Neurology | Psychiatry | Neuroimmunology | Endocrinology

    Professor Dr. David Seideman

    Medical Director

    Neurology, Neuroimmunology, Neuroendocrinology

    Professor Dr. David Seideman is a seasoned neurologist, neuroimmunologist, neuroendocrinologist and senior professor at the Jewish University (JUC). As a rather small Messianic Jewish university, JUC does not operate a university hospital itself. In the case of clinical matters as well as research needs, the LCG Consortium and LCG Research as well as our international practice for rare diseases (Lazar | Seideman | Smith) proudly serve as teaching institutions for well-defined clinical aspects. The director and coordinator of this cooperative effort has been Prof. Dr. David Seideman since summer 2022. He is also still holding his lectures on the scientific study of consciousness. In addition, Professor Dr. Seideman is the Medical Director of the entire Lazar Medical Consortium Group (LCG).

     

    Even at a time when hardly anyone took the term "rare disease" seriously, Professor Seideman was already working on the treatment of precisely such conditions. The fact that he is working in uncharted medical territory every day does not unsettle him, but rather motivates him time and again.

     

    Throughout his career, he has been focussed fully on his work as a clinician, but has never lost touch with science. Being an approachable and compassionate teacher of the next generation of physicians, he is always personally available and concerned about every patient, every young colleague and every student.

     

    Professor Dr. Seideman is working hard on applying the standards and knowledge of evidence-based medicine (as much as possible) to the treatment of rare and under-researched diseases. We apologize that Professor Seideman currently has a waiting list of about eight months for consultations. Thoroughness is his standard, and that takes a lot of time.

     

    Frequently present in:

    Tel Aviv, Athens, Luxembourg, Madrid, Denver

    Dr. Lucas Smith

    Deputy Director

    Internist - Endocrinology

    As director of Hellenic Health™ (part of the Lazar Group) Dr. Smith, neurologist and internist (endocrinology) is Dr. Lazar’s senior assistant in his private practice. Dr. Smith is a highly specialized internist and endocrinologist (orphan/rare/ultra-rare diseases) with a strong focus on the effects of neuropsychiatric syndromes on other organ systems. Appointments with Dr. Smith directly are available through the service center of the Lazar Group.

     

    Frequently present in:

    Athens, Nicosia, Luxembourg, Edinburgh

    Dr. Marius Lazar

    Founder and Owner

    Neurologist, Psychiatrist, Neurodermatologist

     

    Due to the establishment of a steady and excellent medical team and the happy circumstance of a new marital bliss, Dr. Lazar has largely retired from the clinical field and, together with his wife, is devoting most of his energy to the Luzia Healthcare Society, which can enable free treatment for patients with rare diseases, wherever/ whenever possible. Nevertheless, Dr. Lazar continues to lend a hand whenever his expertise is needed at LSS.

     

    For Dr. Marius Lazar, medicine is much more than just a job. As a neurologist, psychiatrist, dermatologist (immunodermatology) and, of course, general practitioner, he compassionately helps patients with rare diseases, worldwide. As native of Transylvanian Saxony, who lived for a long time in Africa as a diplomat's son, he practices in English and German.

     

    You can see him in person or via video consultations worldwide. Dr. Lazar offers the entire spectrum of diagnostic procedures of evidence based medicine in cooperation with local colleagues in the countries where his patients live. At the same time, Dr. Lazar is founder of the Lazar Medical Consortium Group, which provides medical networking worldwide.

     

    Here, in his private practice Dr. Lazar is specialized in rare neurologic diseases (orphan diseases) as well as difficult cases at the crossroads of dermatology and immunology. He takes a multidisciplinary approach to providing excellent, individualized patient-centered care by bringing together a collaborative care team with different perspectives. His patients have access to a team of specialists, the latest diagnostic methods, personalized treatments and the latest research.

     

    All of this on the basis of providing affordable help for everyone and at a strict distance to the pharmaceutical industry or any other lobby group.

     

    For people with orphan diseases, it can be difficult to understand their condition, the medical problems they may encounter, and the options for treating their symptoms. That's why Dr. Lazar relies on a network of specialists in the diagnosis and treatment of such diseases who share his ethical standards.

     

    Frequently present in:

    Athens, Bucharest, Pretoria

    Dr. Jonathan Feldman

    Senior

    Internal Medicine and Dermatology

    • Emergency service for long-term patients with rare diseases.
    • Person to contact when the senior physicians are unavailable.
    • Experience: seasoned staff physician in several countries.

    Frequently present in:

    Tel Aviv, Athens, Nicosia, Bucharest, Dubai

    Dr. Carolina Diamandis

    Senior

    Military Physician (ret.), GP/Internist

    • Care for long-term patients with rare diseases.
    • Person to contact whenever the more specialized experts are unavailable.
    • Experience: Military Doctor, retired. 
    • Grass-root researcher with LCG Greece

    Frequently present in:

    Athens and Nicosia

    Dr. Fabio Rocha

    Director of the team of our assistant doctors

    General Medicine and Neurology

    • Organization of the 24/7 service for our continuance patients.
    • Experience: former resident in several hospitals in South America and the EU.

    Frequently present in:

    Athens, Bucharest, Madrid

    Prof. Dr. Martin Gangnon

    Science Manager (part time with LSS Luxembourg)

    • Reviews new studies, books and other scientific material of relevance, evaluates them, and provides the essence to the clinicians at Lazar, Seideman & Smith (LSS).
    • Teaching professor with the Jewish University (JUC), European section.
    • Clinician with a reputable, external European medical network which is not part of or affiliated with the Lazar Medical Consortium Group (LCG)

    Lazar Medical Consortium Group

    Evidence-based healthcare. Everywhere.

    The Lazar Consortium Group works with 120 doctors worldwide. With 3500+ including our large international cooperation partners.

     

    All we do happens under the constant supervision of the non-profit Supervisory Board of the Lazar Medical Consortium Group.

    Alicia Popescu

    Chief assistant

    Phone +30 21 123447-27

    E-mail: administration@lazar-consortium.com

    Main office: Athens

  • Together. Closer to you than you might think.

    As an international reference practice for rare diseases, we cannot have every patient come to Athens or even fly around the world ourselves. Therefore, we have excellent partners in countless countries. Look at the world map: in the colored nations, we have partner physicians and infrastructure at our disposal. For our patients this means short distances and the comforting feeling of being in safe hands.

     

    Our training facilities in cooperation with JUC: Athens, Luxembourg, Madrid, Bucharest, Pretoria 

  • LCG Greece Research

    We share our experiences as clinicians. Non-profit, of course.

    Working with rare diseases means learning, an ongoing process.

    We share clinical observations as quickly as possible, bypassing lengthy academic discussions.

    Team Dr. Carolina Diamandis | Team Dr. David Seideman

    We are proud Europeans and friends of the Jewish people as well as dear friends of our independent US colleagues.

  • Medical examinations for telemedicine patients

    Possible thanks to our international partners.

    Laboratory tests

    All state of the art laboratory tests are available in more than 30 countries.

    MRI, CT, TCS

    Our partner practices and clinics perform examinations with MRI, CT and TCS (sonography of the brain). Scintigraphy is also still possible but less common than in the past. Due a three-step diagnostic procedure you will get an unusually high level of safety.

    Neurological exams

    All standard neurological tests are being provided by carefully selected partners in over 50 countries.

  • The Doctor will see you now.

    Here you are taken seriously.

    How Lazar | Seideman | Smith works

    Clear rules.

     

    Our top priority is to treat you as individually as your condition requires. Remote treatments (video telemedicine) in the strict sense are performed, but only in well-defined cases. Highly qualified colleagues in over 20 countries perform those physical examinations for us which are not possible via video conference and telemedicine.

    Prudence, vigilance and diligence.

    Remain humble to what you don’t know.

     

    Since no one is omniscient, being well-networked makes a big difference. Dr. Lazar has always made it a point to network with as many colleagues as possible. After all, there's nothing worse than a doctor who thinks he knows everything. Therefore “better safe than sorry” is his credo.

     

    Dr. Lazar puts great emphasis on continuously educating himself and sharing his knowledge. That's why he also contributes pro bono as an editor to DocCheck's medical encyclopedia, among other projects.

     

    Diagnosing and treating rare diseases is more important than ever. Thousands of rare diseases exist, up to about seven thousand rare diseases have already been described scientifically, and more are being identified on an ongoing basis. Yet they remain mostly unknown in day-to-day medical practice. Medical and scientific knowledge about rare diseases is far from sufficient in the medical profession. The subject area of rare diseases has long been neglected by physicians, politicians and scientists, so that neither appropriate health policies nor scientific initiatives existed.

     

    For most rare diseases there is no efficient therapy, nevertheless appropriate interventions can improve the quality of life and also increase life expectancy. Some impressive progress has been made in the treatment of certain diseases, which should motivate us to intensify research efforts.

     

    Patients with rare diseases mostly face similar problems. Difficulties exist mainly in terms of diagnosis, availability of relevant information and referral to appropriate specialists. Equally important is access to qualified specialist facilities, general social and medical support, effective cooperation between hospitals and general practitioners, professional and social integration or maintaining independence.

     

    Those affected often face psychological, social, economic or cultural problems. Many patients do not receive a diagnosis because the lack of sufficient scientific and medical knowledge means that a rare disease is often not recognized. It is precisely this group of patients that is exposed to the greatest pressure of suffering, as they are denied access to adequate support.

    We are first and foremost human beings.

    And care about our patients, more than usual.

     

    Those with a rare disease who are patients of Lazar, Seideman & Smith see their attending specialist every 10 to 14 days. In addition, a team of assistant physicians with a variety of specialties is available 24 hours a day for our long-term patients. Those who receive their treatment under the Luzia Healthcare u.n.a. social program are not billed for treatment by our assistant doctors. Or, to put it briefly: we take good care of our patients.

  • Our social responsibility

    Everyone should have access to the best possible care.

    Social fee system

    The diagnosis and treatment of rare diseases is complex and requires ongoing consultations between all the physicians involved. Therefore, high costs are a consequence of this process. In order to cushion these effects, we have a fee system that is graduated according to the financial strength of the patients. In this solidarity system, wealthy and well-insured patients enable the treatment of less well-off patients in a mixed calculation.

  • Contact us

    In case of an emergency, please call an ambulance immediately!

    LCG Greece
    16 Kifissias Ave, 11526 Athens

    JUC Teaching Office Luxembourg
    luxembourg@lazar-consortium.com
    09:00h until 18:00h, Greek local time
    ATH +30 21 123461-03 / LUX +352 2033424-5
    Submit
  • Information

    Videos (from inspiring colleagues)

    What is neurology?

    Why the world needs neurologists.

    International exchange.

    A key factor for a high quality standard.

    Dr. Josep Dalmau

    Neurology Journal

    PsychScene Hub

    Dr. Sanil Rege

    Treating, learning, teaching.

    That’s what we do.

  • Independence

    and other principles that are important to us.

    Our international practice for rare neurological diseases always strives to incorporate all the latest research findings directly into the diagnostic process and the treatment of our patients. In doing so, we are guided by the following values, without any exception:

     

    Independence:

    We do not use third-party funds, are not part of unnecessary professional associations, and do not maintain relations with representatives of the pharmaceutical industry.

     

    Security:

    We have all our analog and digital infrastructure regularly audited by the relevant specialists.

     

    Reliability:

    All our international partner practitioners are regularly audited in terms of equipment, quality and patient ratings.

  • We are a teaching practice

    for the Jewish University (JUC, United States)

    Teaching Practice of the Jewish University (JUC, United States)

     

    As a the teaching practices of Faculty III (Medical and Health Sciences) of the Jewish University (JUC, CO, United States), we bring together evidence-based and strictly science-oriented medicine with the values of Messianic Judaism. But what is meant by this? Of course, not religious practices, but a worldview on humanity that guides us. Just as is the case with the clinics run by Christian churches in Europe. In terms of the students, there is a focus on teaching internships for students of health sciences. Especially when working with patients suffering from rare diseases, one is at the intersection of established scientific knowledge, medical art ("sophisticated trial and error"), as well as a profound human component. For students of a faith-based university, this field is like a burning glass where various layers of life converge.

    Teaching locations

     

    The Jewish University (JUC, CO, U.S.A.) is not only the world's only higher Messianic Jewish educational institution, but as a now enduring response to the Sars-2 pandemic, it is also a globally active web-based university. As a similarly structured teaching practice for Faculty III (Medical and Health Science) some aspects of education require reliable venues that are readily accessible to all students.

     

    Globally training facilities are currently located in:

    • Athens (Dr. Makris, Dr. Smith, Dr. Diamandis, Dr. Balaskas, Prof. Dr. Seideman)
    • Pretoria (Dr. Lazar)
    • Tel Aviv (Prof. Dr. Seideman, Prof. Dr. Gangnon)
    • Bucharest (Prof. Dr. Gangnon)
    • Madrid  (Prof. Dr. Seideman)
    • Luxembourg (Prof. Dr. Seideman, Prof. Dr. Gangnon, Dr. Smith, et al.)
    • Denver (Prof. Dr. Seideman)
  • IRON DISORDERS

    Would you believe that this young man is seriously ill? Yes, neither does he. That's why one of the focal points of our work is iron metabolism disorders, which are so much more than just classic hereditary hemochromatosis.

  • H63D Syndrome

    Also known as Oslo Syndrome. The “iron brother” of Wilson’s Disease

    A silent epidemic of Wilson’s iron brother.

    Evidence-based medicine (not eminence-based medicine) has shown for many years that homozygous mutations of the HFE gene H63D are by no means negligible. Latest since 1999 (Nielsen et al.) it has been known that this mutation can cause polymorph alterations in the carrier’s iron metabolism. Not the HFE gene H63D itself is a polymorphism as few, but all the louder "scientists" with good connections to the pharmaceutical lobby and their chelation pharmaceuticals fantasized in the early days of these new diagnostic methods two and a half decades ago. It is the clinical picture of a homozygous H63D mutation that is terribly polymorph. This means it makes quite some of its carriers ill but the type of anomaly in the iron metabolism can be very different among the patients. H63D usually causes a mild hereditary hemochromatosis only after a second hit, however, it can also cause numerous other disorders of iron metabolism, such as hypotransferrinemia, changes in binding capacity, etc. which can lead to clinically relevant and even catastrophic symptoms.

     

    In addition, it may lead - among other symptoms - to damages of the heart and the substantia nigra via a causal relationship that remains to be investigated, most likely via a cascade-like dysfunction in iron metabolism. The clinical facts are compelling. Any physician who dismisses mutations of the HFE gene H63D as clinically irrelevant risks the health of his patients and doesn’t work lege artis (=not according to scientific medical practices). Therefore all main researcher working on Oslo Syndrome (synonyme for the research term “H63D syndrome”) have a moral duty to inform the medical community and the public.

     

    Homozygous mutations of the HFE gene H63D have not been taken seriously enough for many decades, despite the fact that a homozygous mutation of gene H63D is a Pandora's box. It has been linked to liver disease, bone and joint disease, diabetes mellitus, heart disease, hormonal disorders, porphyria cutanea tarda (PCT), infertility, stroke, severe neurodegenerative disease, cancer, venous peripheral artery disease, hereditary hemochromatosis (after a second hit), and Oslo syndrome. In the years since the discovery of HFE and its mutations, researchers have focused their studies primarily on the C282Y mutation because it is particularly common in people with elevated iron levels. About 85% of people with abnormally high iron levels have two copies of C282Y, so this mutation has been studied more intensively. Other mutations, such as S65C or H63D, have not attracted the attention of researchers. The S65C mutation can lead to mild to moderate hepatic (liver) iron overload, especially in combination with other mutations. Increased serum iron indices and iron overload have been observed in C282Y/ S65C compound heterozygotes. In scientific evaluation, H63D stands out as a significant modifier of disease onset, disease progression and even response to therapy. H63D is associated with arterial rigidity, pro-oxidation, higher total and low-density lipoprotein cholesterol, acute lymphoblastic leukemia (ALL), decreased sperm production, and higher risk of type II diabetes mellitus, and hereditary hemochromatosis after a second hit.

     

    Being a carrier of the H63D hemochromatosis mutation is also a risk factor for earlier onset and longer duration of kidney disease in type II diabetics. The most striking risk associated with H63D is that for neurodegenerative disease. Connor and colleagues were among the first researchers to examine the role of H63D in brain iron accumulation, oxidative stress, and neurotransmitter performance. Connor reported that the HFE variant H63D contributes to many of the processes associated with various types of dementia. These processes include increased cellular iron, oxidative stress (free radical activity), glutamate dyshomeostasis (abnormal balance), and an increase in tau phosphorylation (abnormal levels of tau proteins can lead to dementias such as Alzheimer's disease). As demonstrated by Jacobs, Papadopoulos Kaufmann, and colleagues (2012, 2015, 2017, 2019, 2020, 2021) using solid patient data, the numerous damages in parenchymal tissues, heart, and brain (substantia nigra and basal ganglia) can be explained by insidious non-transferrin-bound iron (NTBI) intoxication as a consequence of chronic transferrin saturation of >50%. This constellation (Oslo Syndrome) is similar to Wilson's disease, except that NTBI iron, rather than copper, is the culprit here. In addition, the damage caused by Oslo Syndrome is more widespread in the body, affecting not only the liver and brain severely but also the heart, and in men, the testes. Synucleinopathies are a major problem of Oslo Syndrome, but other forms of cognitive decline are also common. Connor states further that HFE H63D cells have been shown to have more oxidative stress, further supporting their role as modifiers of neurodegenerative diseases. He found that patients homozygous for H63D had earlier signs of mild cognitive impairment and earlier onset of dementia disease than patients with normal HFE H63D or H63D heterozygote individuals.

     

    Despite these crystal clear fact, which have been known for over 25 years now, many clinicians still dismiss homozygous HFE-H63D mutations as irrelevant. Even some of the highest authorities in the field of iron metabolism seem to be trapped in the knowledge of the early 1990s. As physicians specialized in rare diseases, we regularly see patients with complex syndromes consistent with those mentioned before. Just as regularly homozygous mutations of HFE gene H63D are found as primum movens (primary cause) of complex metabolic and toxic syndromes. It is also typical for treating colleagues to ignore this finding, as old textbooks (and new ones copy-pasted from old ones) still state that the HFE gene H63D or its homozygous mutation would be clinically irrelevant. This is false, misleading and potentially fatal misinformation. The knowledge about the high clinical relevance is neither new nor a fringe topic. HFE H63D is not a strong hemochromatosis gene, however, with a second hit it can easily cause hereditary hemochromatosis. But even more important than this, a homozygous mutation of the HFE gene H63D is, according to overwhelming evidence, responsible for many cases of complex syndromes associated with heterogeneously altered iron metabolism.

    It is evident from all this that Oslo Syndrome is a not so very distant relative of Wilson's disease, only with NTBI iron instead of copper as the causative agent. But why does every GP/primary care provider have at least some basic knowledge of Wilson's disease and not Oslo Syndrome? It was concluded, after professional discussion in the centers of competence, that the term H63D syndrome is difficult to remember and, moreover, does not do justice to the multifaceted nature of the disease. Therefore H63D syndrome was renamed Oslo Syndrome (for clinical settings) as a result of the 4th H63D Syndrome Conference. Why Oslo? In the Norwegian capital, researchers from around the world agreed for the first time on the leading symptoms of H63D syndrome.

    Only seemingly independent diseases. It’s a one cause syndrome.

     

    As we shall discuss later, narcolepsy with cataplexy is a hallmark symptom of brain damage in Oslo Syndrome. However, there is an anomaly in Oslo Syndrome patients.As Adams et al. (2021) could prove Oslo Syndrome patients who “succeeded” in inhibiting an incipient seizure and did not fall asleep developed other symptoms that appear to the observer as ”sleep-related partial inhibition or reduction of body functions while being awake”. This is a broad area for future research, as it may even help explain comorbidities in primary narcolepsy. There are more symptoms to be found in this very unique phenomenon after attack inhibition. In order to not overwhelm the reader we focussed here on the most important ones: interestingly, the reduced function of gastric motility in particular could be part of the explanation why narcoleptics tend to be overweight. On the one hand, during inhibited attacks there is still food in their stomach from meals taken hours ago and, at the same time, other biosensors send signals to the brain that it is time to eat again. Thus, even during and shortly after a narcoleptic seizure, we see slightly elevated serum glucose levels, even if full seizures have been inhibited and the patient has remained awake. These values suddenly drop again once gastric motility returns to normal.


    IQ decline in H63D syndrome

     

    A significant number of patients with H63D syndrome develops dementia, most likely due to synucleinopathy. Independent of this issue, a significant drop in IQ can be observed in more than 72% of patients compared to corresponding control groups (Fig. 3). Also executive functions might deteriorate to a remarkable extent. To date, we do not have a satisfactory explanation for this aspect, which is probably still substantially underestimated because the effects are less noticeable in everyday life when compared to dementia. Nevertheless, a linear 50% decrease in professionally measured IQ, as shown in the table below, is not only highly significant but also concerning. Considering that most patients have a profession with certain responsibilities, a significant decline in IQ is a matter of public safety. In this case, physicians must not look away simply because IQ loss is a difficult matter to communicate. As the signs are more subtle than those of dementia, families and caregivers must also learn to recognize the signs and symptoms of IQ loss. One very common early sign is a rise in accidental writing errors, may they be misspelling or using associated words like “wood” instead of “tree”. In most cases, the diagnosis is still made too late, which leads to dangerous work errors, failures in the household, problems keeping up intellectually with peers and the danger of overestimating one's own abilities. Since science and medicine have yet to answer the question of which of the brain damages due to NTBI causes this brain symptom in Oslo Syndrome, let alone how to treat this IQ loss, counseling is usually helpful in learning to live with this progressive limitation. Interestingly, the issue of memory impairment does not seem to match in any way with this loss of brain power we see in patients with Oslo Syndrome. Our patients can remember but not use their knowledge as they could in the past. It’s like they know exactly what a puzzle is and how it should work, but they are not able anymore to use this knowledge in a practical way. So, a businessman with an IQ of 65 at age 47 is not as mentally capable as he was with an IQ of 119 when he graduated from college, even without losing his memory. Because he has no memory loss and since he can still remember things quite well, most people around him will not notice his sharp cognitive decline and distorted executive functions until he makes a big mistake. Therefore, depending on the profession, it should not be a taboo to make these patients leave their jobs (retire) even against their will if their IQ has dropped by 25% within 10 years or if their IQ falls below a cut-off range of 75-85, depending on their job.

     

    Heart conditions due to Oslo Syndrome


    Cardiac problems are common in Oslo Syndrome, however, they can be of diverse etiology. Chronically elevated eosinophils, palpitation, calcium channel dysfunction, fibrosis, conduction disturbances (heart blocks) - all of these can occur at high NTBI levels (the basis of the pathomechanism) and cause transient to permanent damage Despite transient symptoms may occur, the prevalence, severity and permanence correlates positively with age. With Oslo Syndrom being sort of a chronic NTBI poisoning this correlation makes sense as well has the fact that younger Oslo Syndrome patients often report palpitations. This leads to the hypotheses that NTBI in lower doses might cause “harmless” functional issues while an accumulation of more NTBI during many years might lead to more severe structural damage. Heart-failure is not common is Oslo Syndrome but it can happen.
     

    Testicular damage in Oslo Syndrome patients


    Since NTBI has a strong affinity for parenchymal tissue, the male gonads are a preferred target for this form of free iron. There, it penetrates the cells, causing oxidative damage and, as a consequence, non-dramatic but significant regressive damage to the testes. On sonography (including Doppler), the tissue appears homogeneous, but a mild form of microlithiasis can be seen with more modern sonography equipment, usually models built after 2015. Older sonography devices may miss microlithiasis because the calcifications are often too small for their resolving power. Patients with microlithiasis should be followed up closely for quite a period of time, especially if under 45 years of age, as microlithiasis can occasionally be a sign of testicular cancer or an early warning sign of this undesirable condition. Usually the damage is bilateral, we have not had a case where only one testicle was affected. The spermiogram usually shows somewhat decreased fertility, but this has not become uncommon in the general male population anyway. So far, we are not aware of any treatment that could stop the regressive process in Oslo Syndrome. However, since the effect is usually rather mild, few patients (or their partners) are likely to consider this a relevant problem. Therefore, this aspect of Oslo Syndrome is still largely unknown to urologists and andrologists.

     

    Fat metabolism

     

    Patients with advanced Oslo Syndrome often have elevated triglyceride levels with quite high postpradnial peaks. In how far this contributes to the development to Steatosis hepatis is still unclear. However, there is a logical connection between both phenomena. A causality still has to be proven.

  • H63D/Oslo Syndrome 

    in TCS Sonography

    In transcranial sonography (TCS), and only in TCS, degeneration of the substantia nigra (brain) is detected in 80-90% of patients with H63D/Oslo syndrome around the age of 40, largely identical to the findings known from Parkinson's disease. The bright foci are iron-rich degenerated brain structures, and in H63D/Oslo syndrome some of the iron has been "carried in". The other part comes from the destroyed brain structures. Note: NTBI iron and these fine-grained lesions are not seen on MRI, CT, or liver biopsy.

  • More about Transcranial Sonography (TCS) in Oslo Syndrome

     

    Trancranial sonography (TCS) is of paramount importance in patients suffering from advanced stages of Oslo-Syndrome. Caused by a homozygous mutation of the HFE gene H63D, H63D/Oslo Syndrome is known for its diverse symptomatology. However, you will hardly find an Oslo Syndrome patient without tics, REM sleep disorders and/or narcolepsy with cataplexy, distorted executive functions, cardiac damage, liver dysfunction and, not infrequently, damage to the male gonads. Transcranial sonography often shows a Parkinson's-like pattern from the 5th decade of life. As was presented in previous studies (Papadopoulos et al. 2021) narcolepsy with cataplexy is a cardinal symptom of advanced Oslo Syndrome that correlates with findings consistent with brain damage on transcranial sonography (hyper-echogenicity in the substantia nigra and abnormal findings in parts of the basal ganglia), as shown in Fig. 1 at the end of this chapter. TCS is the only method with which one can make NTBI visible. MRI, CT, PET and even biopsies will provide a false-negative result. In biopsies it is due to the fact that NTBI cannot be stained with Prussian blue, a fact that even some histopathologists are not aware of.

     

    In another study (Seideman et al. 2021) 200 patients with relevant cataplexy seizures, defined as more than 2 seizures with falls and/or injuries and/or property damage, aged 24 to 49 years, mean age 32 (169 male, 31 female, no significant sex difference in results) were interviewed using structured questionnaires about their symptoms, course of disease, other aspects of their condition; and each of them had at least one transcranial sonography wit modern equipment and physicians very highly trained for this very specific type of ultrasound procedure. The researchers asked the sonography experts to provide, in addition to their normal reports, a severity scale ranging from zero (normal substantia nigra) to ten (very hyper-echogenic substantia nigra). They found found a striking patterns consistent with the anecdotal description of disease progression as reported by the patients themselves (Fig. 2). As can be seen well in this pooled graph, there seems to be a strong inverse correlation between certain motor symptoms (e.g., tics, hyperkinesia) and narcolepsy with cataplexy. The differences between male and female patients are not significant. The results of transcranial sonography are even more striking. Damage to the substantia nigra appears to correlate with a sharp increase in symptom severity of narcolepsy plus cataplexy in Oslo Syndrome patients, with tics decreasing the more substantia nigra damage becomes visible in TCS. To date, no satisfactory explanation exists for this finding.
     
    The fact that the Oslo Syndrome does not fit into any pre-existing box has been obvious since the beginning of research on the subject. However, the finding that narcolepsy (with cataplexy) is a marker for brain damage progression has important consequences for diagnosis and treatment. For some time, there were discussions and attempts to control the motor symptoms of Oslo Syndrome patients with levodopa. One of the side effects of levodopa is actually narcolepsy. However, the levodopa treatment path has been abandoned which is good news for the patients. Thus, levodopa cannot explain the inverse correlation of symptom development. The strikingly similar course of damage to the substantia nigra and parts of the basal ganglia seen on transcranial sonography is a strong indication that the destruction and scarring in this brain region must underlie the answer to this highly interesting and significant phenomenon.


    At the same time, it should caution clinicians to be careful about administering levodopa to patients with Oslo Syndrome. If it cannot be avoided, additional precautions and close follow-up should be mandatory. To an outside observer, tics and symptoms of hyperkinesia may appear drastic, but the heavier burden on the patients is severe narcolepsy with cataplexy.


    Frontline clinicians should be aware of this symptom shift from often very severe tics in H63D syndrome to narcolepsy with cataplexy while all other symptoms of this very serious illness remain progressive:

    • Static or semi-static hypotransferrinemia (non-/semi-reactive after iron ingestion)
    • Chronically elevated transferrin saturation >50-55% (multiple testing is recommended
      due to nutrient-related fluctuations)
    • Deposition of NTBI iron in brain and parenchymal tissue
    • Slow progressive degeneration of substantia nigra and basal ganglia
    • Thought disorders (often severe and usually primarily obsessive in nature,
      compatible with dysfunction of the basal ganglia). Misdiagnosis as a "mental condition" with the consequence of delaying a correct diagnosis is virtually always the case in the early phase
    • Tic disorders (variable, often Tourette-like, partly including danger of self-injury)
    • REM sleep disorders with risk of self-injury
    • Variable motor disorders (in the late course possibly also Parkinson's symptoms
    • Synucleinopathies of various degrees of severity (from mild cognitive impairment to
      dementia)
    • Executive function impairment
    • Drop in IQ measurement results
    • Postural instability (equal to Parkinson's disease)
    • Non-motor Parkinson’s symptoms
    • Loss of the olfactory sense
    • Chronic constipation
    • Narcolepsy, often with cataplexy, often severe. If degenerative brain damage has already manifested the progression of narcolepsy can be used as a marker for brain damage with the same diagnostic value as a positive transcranial sonography (Honda et al. 2021).
    • Cardiac damage and cardiac dysfunction (especially conduction defects and arrhythmias
    • Liver damage (even in the early course often an unexplainable fatty degeneration of the liver
    • Excessive reactions of the non-adaptive immune system with unpredictable autoimmune reactions 
    • Disturbed movements in the digestive system (partial paralysis, similar to the issues that are known from Parkinson's syndrome
    • Low to moderate shrinkage of testicular tissue in male patients with degenerative signs on sonography incl. microlithiasis
    • Variable skin symptoms (including blisters, impetigo, pruritus, hyper-responsiveness, etc.)
    • Mild eosinophilia and/or basophilia
    • Rare: Renal involvement, ocular disease due to NTBI induced oxidative processes, hearing loss, etc.

    Treatment of H63D/Oslo Syndrome

     

    Unlike hemochromatosis the Oslo Syndrome is not curable or profoundly treatable. This is because other than ferritin, NTBI iron cannot be permanently removed from the body. In emergencies, plasma infusions or chelation therapies can remove an acute overload of NTBI iron from the human organism. However, all these methods are risky, only helpful for a short time and thus neither reasonable nor sustainable in the chronically ill. At best, one can try to reduce the transferrin saturation (TFsat) to below 50%, or better below 45%, by means of a low-iron diet. However, since many patients with H63D/Oslo syndrome have low to very low ferritin levels, such a diet should only be undertaken under close medical supervision.

     

    Prognosis

     

    Poor. Especially if organ damage has already manifested. However, we treat in a symptom-relieving manner and improve quality of life quite effectively with a Oslo Syndrome specific medication and diet plan.

  • Hereditary

    Hemochromatosis

    Hemochromatosis must be diagnosed early enough and then treated vigorously. We take care of this with the help of our partner clinics throughout Europe and the rest of the world.

  • Hemochromatosis

    Common, but still detected too late in too many patients.

    Facts and Figures

     

    Hereditary hemochromatosis (HH) is an autosomal recessive storage disorder that can lead to marked iron deposition in various organs, particularly the liver. Almost all primary (hereditary) hemochromatoses are caused by a mutation in the HFE gene. More than 20 mutations of the HFE gene have been described. Particularly clinically relevant is the HFE gene mutation C282Y.

    • C282Y homozygous (C282Y/C282Y): 86% of cases 
    • C282Y and H63D heterozygous (= compound heterozygosity): Rare, mild form (4%).
    • H63D homozygous: Pretty rare, mild form (unless it causes H63D Syndrome instead of Hemochromatosis, also known as Oslo Syndrome. It’s a disease driven by an NTBI iron excess).
    • Other HFE gene mutation constellations do not predispose to increased iron absorption
    • Non-HFE-associated forms of HH exist but are very rare.

    Prevalence: 5/1,000 for the homozygous form, but penetrance is low. Sex-specific manifestation (phenotype) of HH: Males : Females = 5-10 : 1. About 38-50% of patients with C282Y mutation develop iron overload, about 9-35% develop HH-associated disease. However, the data are not very reliable. Advanced age at diagnosis of hemochromatosis is the main factor for the development of hepatocellular carcinoma in the long-term. Alcohol consumption is the main risk factor for the development of hepatopathy in hemochromatosis patients. Other important risk factors include hepatitis B and C.
     

    Pathophysiology 

     

    The cause of HH is the defective expression of HFE protein on hepatocytes. The HFE protein normally binds to the transferrin receptor and results in transferrin and iron being taken up into the liver. In HFE hemochromatosis, this binding is inadequate and results in premature degradation of the HFE-transferrin complex. Accordingly, the liver receives insufficient information about the iron load in the blood and thus cannot activate hepatic iron hormone production (hepcidin), which would lead to a decrease in iron uptake in the intestine and iron release from the reticuloendothelial system. Intestinal iron absorption increased up to 2-4-fold (corresponding to accumulation by up to 1 g/year), depending on its expression, may lead to progressive toxic iron overload in the parenchymal cells of various organs - especially in the liver and joints, less frequently in the pancreas, heart and pituitary gland.
     

    Clinical hallmarks

     

    In most patients, the first symptoms are noticed between the ages of 40-60 years. In women, symptoms are uncommon before menopause because there is some protection via iron loss during menstruation and pregnancies. The symptoms are:Fatigue, upper abdominal pain, arthralgia and osteoarthritis (especially of the metacarpophalangeal joints II and III, OSG, and wrist). Secondary chondrocalcinosis is also possible. Hyperpigmentation especially in sun-exposed areas, hepatomegaly, diabetes mellitus, erectile dysfunction with and without hypogonadism, cardiopathy with cardiac arrhythmias and other heart issues.
     

    Diagnostics


    Laboratory screening for HH should be performed in the following patients: in case of a “collection” of inexplicable diseases or laboratory abnormalities, elevated liver enzymes (transaminase elevation in HH usually < 2 x the norm, elevated ALT and concomitant MCP arthropathy are particularly sensitive and specific HH signs that can guide to the correct diagnosis in the early stages of HH), type 2 diabetes mellitus with concomitant hepatomegaly and/or NAFLD (“non-alcoholic fatty liver disease”) and/or abnormal transaminase levels, atypical arthropathy, especially in young patients, unexplained cardiopathies (especially young patients with heart failure), sexual dysfunction in younger patients. In case of positive family history:
    all first-degree relatives of a patient with HH (homozygous C282Y) between the ages of 18 and 30 yr.

    Differential diagnoses
     

    The most important differential diagnoses are: ethyltoxic hepatopathy (liver disease due to alcohol addiction), drug-induced hepatopathy, Steatosis hepatis (NAFLD) due to other reasons, viral liver inflammations, abnormal serum ferritin (+ CRP, ALT/GPT), elevated fasting transferrin (Tf) saturation, abnormal iver function tests (transaminases, bilirubin, alkaline phosphatase). Screening of individuals with a positive family history includes initial HFE genotyping. Interpretation: Tf saturation > 45 % and ferritin in men > 200 ng/ml, in women > 150 ng/ml confirm the suspicion of HH. Tf saturation > 60 % in men or > 50 % in women is reliably diagnostic. Note: In younger patients, Tf saturation may already be elevated but ferritin still normal. Tf saturation is food-dependent and subject to a strong circadian rhythm. However, iron is usually above normal (> 28 μmol/l) and transferrin below normal (< 25 μmol/l) in patients with hereditary hemochromatosis. Transferrin saturation is calculated from iron and transferrin = iron x 0.5 / transferrin, because 2 iron molecules bind to 1 transferrin molecule. The level of serum ferritin reflects the severity of iron overload. However, ferritin is also an acute phase protein, it can be elevated in inflammation, hepatopathies, hemolysis or rarely in neoplasia (different cancers).


    Consequences


    If laboratory screening confirms the suspicion of HH, HFE genotyping by PCR should be performed. Informed consent from the patient should be obtained for this. “Iron MRI” should be considered in case of ferritin levels > 1,000 μg/l and elevated transaminases to determine the degree of fibrosis, as marked fibrosis and cirrhosis significantly increase the risk of HCC, and close-meshed ultrasound examinations and alpha1-fetoprotein (AFP) determination are recommended. If liver biopsy is too risky or not desirable, fibroscan can be performed, and liver biopsy may be more predictive of the extent of fibrosis than fibroscan.
    Determination of liver iron concentration by MRI is quite reliable for ferritin but completely useless when the task is to detect NTBI iron overload.
     

    Therapy


    Phlebotomy is the treatment of choice. In genetically confirmed hemochromatosis, therapy should be initiated when ferritin levels are elevated (men > 300 μg/l, women > 200 μg (10). The garget is a ferritin at 50-100 μg/l. Deviating from this, target ferriitin values up to 150 μg/l are also accepted in some cases. The initial phlebotomy therapy is scheduled 1 x/week with withdrawal of 450-500 ml whole blood (removing about 250 mg iron), in case of very high ferritin levels every 5 days. Maintenance therapy is normally 3 to 6 phlebotomies per year. Ferritin should be checked after every phlebotomies, also hemoglobin. Increase interval in case of anemia. Phlebotomy therapy relieves symptoms such as fatigue and upper abdominal pain and normalizes laboratory parameters (e.g., transaminases or glucose). Manifest organ damage is only partially reversible; joint pain usually does not respond to phlebotomy therapy.


    Prognosis


    Depends largely on the severity of organ damage, especially to the liver. Life expectancy is shortened in cases of marked liver fibrosis or cirrhosis, but otherwise normal. A specific low-iron diet is not necessary. Veinlet therapy and balanced diet provides the best starting point for health status Red meat, vitamin C supplements and white wine elevate the iron absorption from the intestine and should be used/consumed carefully. Multivitamin supplements containing iron should not be taken.

  • Long Covid (deutsch)

    Wir bieten Beratungen für Menschen mit Long Covid an. Soweit dies derzeit möglich ist, evidenzbasiert, wissenschaftlich fundiert und ohne das Anpreisen nassforscher ‘Wundermittel’. Wir betrachten Long Covid gegenwärtig als eine Orphan Disease - nicht, weil es selten wäre, sondern weil man es gegenwärtig nur wie eine solche patientenschonend behandeln kann.

     

    Das Thema Long Covid wird von einem deutschsprachigen Teammitglied betreut, so dass gute Deutschkenntnisse Voraussetzung für eine Annahme als Patient sind.

     

    The Long Covid issue is taken care of by a German-speaking team member, so a good knowledge of German is a prerequisite for acceptance as a patient.

  • Long Covid Team

    Wir haben keine ultimative Lösung, aber wir helfen mit voller Kraft.

    Post Covid Leidenszustände

    Long-Covid ist ein Begriff, der die Auswirkungen von Covid-19 beschreibt, die noch Wochen oder Monate nach der ersten Erkrankung anhalten. Es wird weiter erforscht, wie man langes Covid am besten definiert, welche Symptome es gibt und wie es behandelt werden kann.

     

    Die britische Gesundheitsbehörde, das National Institute for Health and Care Excellence (NICE), eine der besten medizinischen Institutionen der Welt, definiert eine Person mit "long Covid" wie folgt die Symptome von Covid-19 4 bis 12 Wochen nach der Infektion auftreten oder 12 Wochen oder länger nach der Infektion an den Symptomen von Covid-19 und anderen Symptomen leiden, die nicht durch eine andere Diagnose erklärt werden können.


    Im Juni 2021 veröffentlichte Forschungsergebnisse des Imperial College London, die auf einer halben Million Menschen in England basieren, ergaben zwei Hauptkategorien von anhaltenden Symptomen: eine kleinere Gruppe von Menschen mit Atemwegssymptomen wie Husten oder Atemnot (diese Gruppe hatte anfangs eher eine schwere Covid-19-Erkrankung) und eine größere Gruppe mit einer Reihe von allgemeineren Symptomen, insbesondere Müdigkeit und Erschöpfung.

     

    Eine im Juli 2022 vom King's College London veröffentlichte Studie, die sich auf 1 459 Personen stützt, die über die Zoe Covid Symptom Study App über ihre Symptome bei langem Covid berichtet haben, identifizierte drei verschiedene Typen von langem Covid, die sich nach der Art der Symptome der Teilnehmer richten: Die größte Gruppe der an langem Covid Leidenden berichtete über Symptome wie Müdigkeit, "Brain Fig" (“Gehirnnebel”) und Kopfschmerzen. Eine zweite Gruppe litt unter Atemwegsbeschwerden wie Brustschmerzen und schwerer Kurzatmigkeit. Diese Symptome traten am häufigsten in der Anfangsphase der Pandemie auf, also vor der weit verbreiteten Impfung. Bei einer dritten, kleineren Gruppe traten verschiedene Symptome auf, darunter Herzklopfen, Muskelschmerzen und -beschwerden sowie Veränderungen an Haut und Haaren.

    Merkmale von Long Covid

    Das Britische Office for National Statistics (ONS) schätzt, dass zwischen 3 und 12 Prozent der Personen, die sich mit Covid angesteckt haben, 12 Wochen nach der Erstinfektion noch Symptome haben. Dies basiert auf den Daten von 20 000 Personen, die zwischen dem 26. April und dem 1. August 2021 an der Coronavirus-Infektionserhebung (CIS) teilgenommen haben.

    • Es ist wichtig zu wissen, dass diese Schätzungen gemacht wurden, bevor Omicron die vorherrschende Variante im Vereinigten Königreich wurde. Eine im Juni 2022 veröffentlichte Studie der ZOE Symptom Study App ergab, dass Personen, die Omicron hatten, seltener an long Covid erkrankten als Personen, als jene, welche die Varianten bis Delta hatten.
    • So wurde festgestellt, dass 4,5 Prozent der Personen mit Omicron später Long Covid Symptome entwickelten, verglichen mit 10,8 Prozent der Personen mit Delta. Diese Zahlen beziehen sich auf Erwachsene, die geimpft wurden und sind immer noch erschreckend hoch.
    • Das ONS schätzt, dass 2 Millionen Menschen im Vereinigten Königreich (3,1 % der Bevölkerung) am 1. September 2022 unter lang anhaltenden Covid-Symptomen litten. Dies wurde definiert als Symptome, die länger als vier Wochen nach der Erstinfektion andauerten. Das sind 1,8 Millionen (2,8 Prozent) mehr als am 2. Juli 2022.
    • Mehr als ein Fünftel (ca. 22% bzw. 429.000 Personen) dieser Personen hatten mehr als zwei Jahre nach ihrer ersten vermuteten Infektion noch lange Covid-Symptome. Mehr als zwei Drittel (ca. 73% bzw. 1,5 Millionen) gaben an, dass ihre Symptome ihre Fähigkeit zur Ausübung alltäglicher Aktivitäten eingeschränkt haben, wobei weniger als ein Fünftel (ca. 19%) angab, dass das lange Covid ihre täglichen Aktivitäten stark eingeschränkt hat.
    • Wir alle sind noch dabei zu lernen, wie lange die Krankheit anhält, und dass dies von Mensch zu Mensch sehr unterschiedlich verläuft. Es ist wichtig zu wissen, dass die anhaltenden Auswirkungen nicht nur bei Covid-19 auftreten! Auch andere Viruserkrankungen können anhaltende Auswirkungen haben. Die oben beschriebene Studie unter der Leitung von Forschern aus Leicester deutet darauf hin, dass bei denjenigen, die wegen der anfänglichen Erkrankung im Krankenhaus behandelt werden mussten, die Krankheit in der Regel fünf Monate oder länger andauert, und es gibt einzelne Berichte über eine Dauer von 12 Monaten oder mehr (dies schließt sowohl Personen ein, die anfangs keine Krankenhausbehandlung benötigten, als auch solche, die sie benötigten).
    • Obwohl sich die meisten Menschen, die an Covid-19 erkranken, schnell erholen, können die Auswirkungen des Virus bei einigen noch Wochen oder Monate anhalten. Dies wird als "langes Covid" bezeichnet.
    • Für manche kann es wie ein Kreislauf erscheinen, in dem es eine Zeit lang besser und dann wieder schlechter wird. Diese Langzeitfolgen sind nicht nur bei denjenigen zu beobachten, die ins Krankenhaus mussten oder sich schon bei der ersten Ansteckung mit dem Virus sehr unwohl fühlten.
    • Die im Sommer 2022 im Nature Medicine veröffentlichten Forschungsergebnisse deuten auf ein breites Spektrum möglicher Symptome von Long Covid hin. Für die Studie analysierten Forscher der Universität Birmingham die Gesundheitsakten von mehr zwei Millionen Menschen, deren Daten zwischen Januar 2020 und April 2021 erhoben worden waren, also noch vor dem Gipfel der Delta-Welle und lange vor Omicron. In dieser Studie verglichen die Forscher die Symptome von über 480.000 nicht hospitalisierten Menschen, die mit Covid-19 infiziert waren, mit denen von 1,9 Mio. Menschen, die nicht infiziert waren.
    • Zusammen mit anderen Studien deuten diese Untersuchungen darauf hin, dass zu den Symptomen einer langen Covid-Infektion Folgendes gehören kann:
    • Müdigkeit
    • Atemnot oder Kurzatmigkeit
    • Schlafstörungen
    • Angstzustände, Depressionen oder die Unfähigkeit, Freude zu empfinden und Dinge zu genießen
    • Herzklopfen und Palpitationen
    • Gelenk- oder Muskelschmerzen
    • Unfähigkeit, klar zu denken oder sich zu konzentrieren ("Gehirnnebel")
    • Veränderung des Geruchs- oder Geschmackssinns
    • Anhaltender Husten
    • Veränderungen an Haut und Haaren, einschließlich Haarausfall
    • Übelkeit und Erbrechen
    • Erhöhte Temperatur
    • Stuhlinkontinenz
    • Erektile Dysfunktion
    • Amnesien
    • Schwierigkeiten mit der Motorik oder der Sprache

    Nach Angaben des ONS waren am 2. Juli 2022 die am häufigsten gemeldeten langen Covid-Symptome:

    Müdigkeit (54 %); Kurzatmigkeit (31 %), Verlust des Geruchsinns (23 %), Muskelschmerzen (22 %).

    Behandlung von Long Covid

    Wir behandeln Long Covid wie eine “seltene Erkrankung”. Das bedeutet eingehendere, individuelle Befunderhebungen (Untersuchungen), symptomatische Linderungen, ein auf den Einzelfall ganz und gar maßgeschneidertes Behandlungspaket.

     

    Kurzum, wir nehmen Sie ernst und setzen jene Mittel ein, die Ihrem Long Covid das Leben schwer machen wird und Ihnen so leicht es nur geht.

    Das können Sie nun tun:

    • Kontaktieren Sie und schildern Sie Ihr anliegen. So einfach geht das.
    • Wie behandeln Long Covid wie eine “seltene Erkrankung”. Das bedeutet eingehendere, individuelle Befunderhebungen (Untersuchungen), symptomatische Linderungen, ein auf den Einzelfall ganz und gar maßgeschneidertes Behandlungspaket.

    Kurzum, wir nehmen Sie ernst und setzen jene Mittel ein, die Ihrem Long Covid das Leben schwer machen wird und Ihnen so leicht es nur geht.

  • Get well soon.

    Life. More healthy.

  • Wir helfen auch auf Deutsch.

     

     

    Dr. Lazar, Prof. Dr. Seideman und Dr. Smith haben jeweils eine teils sehr enge Bindung an Deutschland bzw. die deutsche Sprache, so dass das Deutsche eine von mehreren Arbeitssprachen unseres Teams ist. Natürlich pflegen wir auch enge Kontakte zu ärztlichen Kollegen in Deutschland und in Österreich, um eine gute Versorgung dieser Patienten am Wohnort sicherstellen zu können.

     

    Zögern Sie daher nicht, uns auch auf Deutsch anzusprechen. In unserem kleinen Sekretariat in Luxemburg (für Nord- und Westeuropa) ist Deutsch die hauptsächliche Verkehrssprache.

     

    administration@lazar-consortium.com

    +352 2033424-5

     

    THERAPIEKONZEPT

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    • Cross-border (immer dort, wo die passenden Diagnostiker sind) State-of-the-art Diagnostik. Behandlung und Forschung im Bereich der sehr seltenen Orphan Diseases in den Bereichen Neurologie, Neuropsychiatrie, Neuroimmunologie und Psychiatrie.
    • Verbindung von Video-Medizin mit klassischen Arztbesuchen vor Ort bei kooperierenden Kliniken und Praxen.
    • Arzt-Patienten Konsultation mit unseren Spezialisten mindestens alle 14 bis 30 Tage.
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    • Je nach Krankheitsbild bis zu täglichen Online-Visiten unserer Assistenzärzte.
    • Enge Zusammenarbeit mit den lokalen Kollegen am Wohnort des Patienten.
  • Unser “Senior” Team

    International, engagiert und dem Menschen zugewandt.

    Dr. Marius Lazar

    Neurologe & Psychiater

    Dermatoimmunologe

    Dr. David Seideman

    Neuroimmunologe

    Professor (JUC)

    Dr. Lucas Smith

    Internist

    Endokrinologe

     

    Dr. Carolina Diamandis

    Ehem. Militärärztin

    Leiterin der LCG Research

     

  • Wir bleiben an Ihrer Seite.

    Assistenzärzte

    Selbstverständlich kann eine weltweit vernetzte Praxis nicht mit nur drei oder vier Chefärzten alle Patienten versorgen. Wir als Lazar, Seideman & Smith haben daher neben unseren weltweiten Partnerpraxen auch direkt von uns beauftragte Assistenzärzte, die ein unverzichtbarer Teil von Lazar, Seideman & Smith sind. Als pars pro toto seien genannt:

     

    Dr. Sofia Makri

    Dr. Olga Ivanova

    Dr. Evi Papadopoulou

    Ms. Natalia Nikolaidi

    Dr. Benjamin Steinberg

    Bill Watson, M.D.

     

    …und viele mehr

     

    Wir tun alles in uns Mögliche dafür, dass dieses Team möglichst stabil ist und bleibt. Denn wir arbeiten nur mit Kollegen, denen wir voll und ganz vertrauen - fachlich wie auch menschlich. Unsere Patienten haben daher idealerweise stets ein vertrautes Behandlungsteam.

    Hilfsmittelberatung

    • Neurologische Krankheiten führen, sehr viel häufiger als viele Laien es sich vorstellen, zur Notwendigkeit einer Verordnung von Hilfsmitteln. 
    • Krücken, Rollstühle, Gehhilfen, Orthesen und so genannte Schutzhelme machen dabei die Mehrheit der Apparaturen aus, die oft die Lebensqualität und Mobilität verbessern.
    • In den deutschsprachigen Ländern gehört die Verordnung von Hilfsmitteln in die Hände unserer lokalen Partnerpraxen, damit die Kassen die Kosten übernehmen können.
    • Allerdings bieten wir allen Patienten unseres internationalen Praxisnetzwerks zusätzlich die Beratung durch unseren sehr erfahrenen Orthopädietechniker an, um in Ruhe die Notwendigkeit eines Hilfsmittels feststellen zu können und auch dessen Anwendung zu begleiten. 
    • Oft ist die Compliance aufgrund von Scham leider recht niedrig. Auch in diesen Situationen begleitet unter Techniker und das Team der Assistenzärzte die Patienten durch den Weg in die Gewöhnung an ein neues Hilfsmittel.
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