Abstract WMP103: Epilepsy is Associated With Poorer Neurologic Outcome After Pediatric Arterial Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Christine K Fox ◽  
Lori C Jordan ◽  
Mark T Mackay ◽  
Gabrielle deVeber ◽  
Keyword(s):  
Ischemic Stroke ◽  
Neurologic Outcome ◽  
First Year ◽  
Stroke Outcome ◽  
Arterial Ischemic Stroke ◽  
Post Stroke ◽  
One Year ◽  
Active Epilepsy ◽  
Relationship Of ◽  
The Relationship

Introduction: Post-stroke epilepsy is common in children, but the relationship of childhood epilepsy with stroke outcome is poorly understood. Hypothesis: Children with epilepsy after arterial ischemic stroke have worse outcomes than those without epilepsy. Methods: We prospectively enrolled children (birth-18 years) with arterial ischemic stroke and identified remote seizures (occurring ≥ 7 days post-stroke). At one-year, patients with active epilepsy (≥ 1 remote seizure + maintenance anti-convulsant) were identified and Pediatric Stroke Outcome Measure (PSOM) was scored. Total PSOM scores range from 0-10; higher values reflect more severe neurologic deficits. Ordinal logistic regression was used to evaluate the relationship between clinical factors and PSOM scores. PSOM scores were categorized 0-1, 1.5-3, 3.5-6, 6.5-10 to depict stratified distribution. Results: Among 94 children (54% male; 20% Hispanic; 25% neonatal strokes; median age for childhood strokes 6.1 years, IQR 1.3-12), 12 had ≥ 1 remote seizure during the first year post-stroke. At one-year follow-up, 19 children were taking a maintenance anti-convulsant and 10 children had active epilepsy. Median PSOM score at one-year for the overall cohort was 0.5 (IQR 0-1.5). Median PSOM score among children with active epilepsy was 3.3 (IQR 0.5-6). Figure demonstrates distribution of categorized PSOM scores stratified by the presence of active epilepsy. On univariable regression analyses, older age (OR 1.1, 95% CI 1.0-1.1, P=0.02), maintenance anti-convulsant at one-year (OR 2.7, 95% CI 1.0-7.0, P=0.04) and active epilepsy (OR 6.3, 95% CI 1.7-25, P=0.007) were associated with higher total PSOM scores. After multivariable adjustment for age and maintenance anti-convulsant, active epilepsy remained associated with higher total PSOM score (OR 7.8, 95% CI 1.3-46, P=0.02). Conclusions: Active epilepsy one-year after pediatric arterial ischemic stroke is associated with poorer neurologic outcome.

scholarly journals Children with post-stroke epilepsy have poorer outcomes one year after stroke

2018 ◽  
Vol 13 (8) ◽  
pp. 820-823 ◽  
Author(s):  
Christine K Fox ◽  
Lori C Jordan ◽  
Lauren A Beslow ◽  
Jennifer Armstrong ◽  
Mark T Mackay ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Outcome Measure ◽  
Pediatric Stroke ◽  
Stroke Outcome ◽  
Arterial Ischemic Stroke ◽  
Post Stroke ◽  
Middle Cerebral Artery Stroke ◽  
One Year

Background Epilepsy is a common complication of pediatric stroke. Aim In this study, we aim to measure the association between epilepsy and neurologic outcome after childhood arterial ischemic stroke. Methods Prospective cohort study of children (29 days–19 years) enrolled after an acute arterial ischemic stroke at 21 international pediatric stroke centers and followed to identify epilepsy. One year post-stroke, outcomes were scored using the examination-based Pediatric Stroke Outcome Measure (range = 0–10); higher values reflect greater disability. Ordinal logistic regression was used to measure the association of Pediatric Stroke Outcome Measure scores (categorized as 0–1, 1.5–3, 3.5–6, 6.5–10) with epilepsy. Results Investigators enrolled 86 children (median age = 6.1 years, interquartile range (IQR) = 1.4–12.2 years) with acute stroke. At 1 year, 18/80 (23%) remained on an anticonvulsant including 8/80 (10%) with epilepsy. Among the 70 with Pediatric Stroke Outcome Measure scored, the median was 0.5 (IQR = 0–1.5) for children without epilepsy ( n = 63), and 6 (IQR = 0.5–10) for children with epilepsy ( n = 7). In univariable analyses, poorer 1-year outcome was associated with middle cerebral artery stroke, cortical infarcts, hemorrhagic transformation, hospital disposition not to home, and epilepsy. In multivariable analysis, middle cerebral artery stroke (odds ratio (OR) = 4.9, 95% confidence intervals (CI) = 1.1–21.3) and epilepsy (OR = 24.1, CI = 1.5–380) remained associated with poorer outcome. Conclusions Children who developed epilepsy during the first year post-stroke had poorer neurologic outcomes than those without epilepsy.

scholarly journals The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke

2021 ◽  
pp. 1-13
Author(s):  
Elisabeth Kliem ◽  
Elise Gjestad ◽  
Truls Ryum ◽  
Alexander Olsen ◽  
Bente Thommessen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Executive Function ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
Psychiatric Symptoms ◽  
Post Stroke ◽  
Cognitive Difficulties ◽  
Memory And Attention ◽  
Relationship Of ◽  
The Relationship

Abstract Objective: Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. Method: Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 – Revised (SCL-90-R). Results: In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3–7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). Conclusion: Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment.

Abstract 90: Socioeconomic Status Is Associated With Disability Following Acute Ischemic Stroke: Findings From The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Janet Prvu Bettger ◽  
Xin Zhao ◽  
Cheryl Bushnell ◽  
Louise Zimmer ◽  
Ying Xian ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Ischemic Stroke ◽  
Household Income ◽  
Work Status ◽  
Stroke Patients ◽  
Level Of Education ◽  
Post Stroke ◽  
Relationship Of ◽  
The Relationship ◽  
Education Work

Background: Socioeconomic status (SES) is widely recognized as an area of inequity that affects health outcomes. However, social determinants of health are less frequently measured in longitudinal studies of acute stroke patients. The relationship of SES on disability 3-months post-stroke is unknown. Methods: We analyzed ischemic stroke patients in the AVAIL registry who were enrolled at 98 hospitals participating in Get With The Guidelines-Stroke. Patients who died (n=64) or did not complete a modified Rankin Scale (mRS) at 3-months (n=154) were excluded. Multivariable logistic regression was used to examine the relationship of SES (defined by level of education, work status, and perceived adequacy of household income to meet needs) and disability (mRS scores 3-5). Results: Among the 2092 stroke patients who met eligibility criteria, the mean age was 65.5 ± 13.7, 44.2% were female, and 82.7% were White. Fifty seven percent had a high school or less education, 11.4% were not working post-stroke and were home not by choice, and 25.7% were without an adequate household income. A third of the sample had some level of disability at 3-months (34.6% mRS 3-5). Those with disability were more likely to be older, non-White, female, single, less educated, have inadequate income, and were home not by choice. In the multivariable analysis, lower education, inadequate income, and being home but not by choice (compared with those who returned to work) were independently associated with disability (p<0.01; Table ). Conclusion: In this national cohort of stroke survivors, socioeconomic status as measured by level of education, work status, and income were independently associated with post-stroke disability.

Abstract 147: The Association Between Hematocrit and Mortality among Ischemic Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Laura J Myers ◽  
Dede Ordin ◽  
Linda S Williams ◽  
Dawn M Bravata
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Mortality ◽  
Multivariate Logistic Regression ◽  
P Values ◽  
Time Points ◽  
Post Stroke ◽  
One Year ◽  
The Relationship

Introduction: Anemia is associated with higher mortality among patients with such non-stroke vascular conditions as heart failure and myocardial infarction. Less is known regarding the relationship between anemia and mortality among patients with acute ischemic stroke. Methods: Medical records were abstracted for a sample of 3965 veterans from 131 Veterans Health Administration (VHA) facilities who were admitted for a confirmed diagnosis of ischemic stroke (fiscal year 2007). Hematocrit (Hct) values from 24-hours of admission were categorized into 6-tiers (≤27%, 28-32%, 33-37%, 38-42%, 43-47%, ≥48%). We excluded patients with: female gender (n=95), incomplete Hct data (n=94), thrombolysis (n=32), and inconsistent death dates (n=6). We used multivariate logistic regression to examine the relationship between anemia and in-hospital, 30-day, 60-day and one-year mortality using multivariate logistic regression models for each time point, adjusting for age, NIHSS, comorbidity (including pneumonia), and Acute Physiology and Chronic Health Evaluation (APACHE)-III scores. The discrimination (c-statistics) and calibration (Hosmer-Lemeshow goodness of fit [HLGOF]) statistics were generated to gauge model performance and fit. Results: Approximately 2.1% of the N=3750 patients presented with Hcts ≤27%, 6.2% were 28-32%, 17.9% were 33-37%, 36.4% were 38-42%, 28.2% were 43-47%, and 9.1% were ≥48%. Adjusted mortality odds at all time points were 2.5 to 3.5 times higher for those with ≤Hct 27% (p values < 0.013 for in-hospital and 30-day mortality; p values at 6 months and one year were 0.002 and 0.001, respectively). Mortality risk at 6 months and 1 year showed a significant and dose-response relationship to Hct for all Hct groups <38%. High Hcts were independently associated only with in-hospital mortality and only in those with Hct ≥48 (OR 2.9, p=0.004). Models performed well across time points (C=0.813, HLGOF=0.9684 [in-hospital]; C=0.832, HLGOF=0.8186 [30-day]; C=0.863, HLGOF=0.7307 [60-day]; C=0.880, HLGOF=0.4313 [one-year]). Conclusions: Even a moderate level of anemia is independently associated with an increased risk of death during the first year following acute ischemic stroke. Very low or very high Hct is associated with early post-stroke mortality. Further work is required to evaluate whether interventions that treat anemia, its complications and underlying etiologies may also reduce post-stroke mortality.

scholarly journals Genetic variation at the IGF1 locus shows association with post-stroke outcome and to circulating IGF1

2013 ◽  
Vol 169 (6) ◽  
pp. 759-765 ◽  
Author(s):  
N David Åberg ◽  
Sandra Olsson ◽  
Daniel Åberg ◽  
Katarina Jood ◽  
Tara M Stanne ◽  
...  
Keyword(s):  
Genetic Variation ◽  
Ischemic Stroke ◽  
Stroke Severity ◽  
Stroke Outcome ◽  
Nucleotide Polymorphisms ◽  
Post Stroke ◽  
Index Stroke ◽  
Genetic Impact ◽  
Major Allele ◽  
Community Controls

ObjectiveIn humans, serum IGF1 (s-IGF1) is associated with outcome after ischemic stroke (IS). Therefore variation at the IGF1 locus could also associate with both IS and s-IGF1. We investigated whether genetic variation at the IGF1 locus is associated with i) s-IGF1, ii) IS occurrence, iii) IS severity, and iv) post-stroke outcome.Design/methodsPatients (n=844; 66% males, mean age 56 years) and community controls (n=668) were included from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). Post-stroke outcome was evaluated with the modified Rankin Scale at 3 and 24 months after index stroke, and baseline stroke severity with the Scandinavian Stroke Scale. s-IGF1 was determined in patients and after random selection in 40 of the controls.ResultsEleven single nucleotide polymorphisms (SNPs) were selected in the IGF1 gene. In healthy controls the major allele of rs7136446 was associated with higher s-IGF1, whereas in patients no such association was found. No SNP was associated with IS, nor with stroke severity. After multivariate correction for presence of diabetes, smoking, and hypertension, the major allele of rs7136446 was associated with favorable functional outcome 24-months post-stroke (odds ratio 1.46; 95% CI 1.09–1.96).ConclusionVariation in rs7136446 of the IGF1 gene associates with post-stroke outcome in relatively young IS patients. Also, rs7136446 associates with s-IGF1 in controls but not in IS, which indicates that IS perturbs a normal genetic impact on s-IGF1 levels.

Dresden commemorative meetings: Vladimir Scherbachev — Nikolay Medtner

2020 ◽  
pp. 25-39
Author(s):  
Р.Н. Слонимская
Keyword(s):  
Musical Culture ◽  
Russian Culture ◽  
Opera House ◽  
Boris Godunov ◽  
One Year ◽  
Relationship Of ◽  
The Relationship

В статье рассматриваются взаимоотношения выдающихся музыкальных деятелей русской культуры Владимира Владимировича Щербачёва и Николая Карловича Метнера. Фактический материал анализируется на основе писем Щербачёва к жене, Марии Илларионовне, написанных в период командировки 1922-1923 годов в Пильниц под Дрезденом. В письмах раскрывается атмосфера музыкальной культуры Германии этого периода (в том числе постановка в Дрезденской опере Бориса Годунова Модеста Петровича Мусоргского). Подробно описывается процесс работы Щербачёва над партитурой монументального симфонического полотна Второй симфонии на стихи Александра Блока и приводится мнение Метнера о ней. Раскрываются музыкально-эстетические позиции Щербачёва и Метнера в отношении разных сторон техники сочинения, педагогики, исполнительского искусства. Одна из ключевых проблем сохранение традиции и радикальное новаторство, вызывавшее у Метнера весьма сложную реакцию. В целом, письма музыкантов дают возможность воссоздать живой и органичный облик двух композиторов разных творческих ориентаций, но искренне переживающих за музыкальное искусство. В конце статьи представлена роль Щербачёва в становлении ленинградской школы композиции. The article considers the relationship of outstanding music figures of the Russian culture VladimirV.Scherbachev and NikolayK.Medtner. The analyzed factual material is based on Scherbachevs letters to his wife Maria Illarionovna, written during a one-year trip to Pilnitz on the Elbe near Dresden 19221923. The letters reveal the atmosphere of musical culture of Germany of this period (including the production of Boris Godunov by Mussorgsky in the Dresden opera house). The author gives a detailed description of the process of Scherbachevs work on the score of the monumental symphonic canvas the Second Symphony on the poems by A.Blok, and Medtners opinion about it. In general, the letters of the two musicians give us an opportunity to recreate living and organic image of the two composers possessing different creative bearings, but sincerely worried about the music art.

Factors Associated with Maternal Opinion of Infant Development—Clues to the Vulnerable Child?

PEDIATRICS ◽  
1982 ◽  
Vol 69 (5) ◽  
pp. 537-543
Author(s):  
Marie C. McCormick ◽  
Sam Shapiro ◽  
Barbara Starfield
Keyword(s):  
Birth Weight ◽  
Infant Development ◽  
Infant Health ◽  
Subsequent Development ◽  
First Year ◽  
Factors Associated ◽  
Slow Development ◽  
First Year Of Life ◽  
Relationship Of ◽  
The Relationship

A mother's expectations about the development of her infant have been found to be a strong determinant of child development, but little is known about the factors that may affect maternal assessment of development. In this study, the relationship of the mother's opinion of the development of her infant with several sociodemographic, antenatal, intrapartum, and infant health variables was examined for a large sample of 1-year-old infants for whom gross motor observations were also obtained at the time of the interview. Among those observed to be developing at an appropriate rate, 4.0% were perceived by their mothers as developing more slowly than the mothers considered normal; among infants developing more slowly, 28.6% were considered to be developing slowly by their mothers. In both groups, the major determinants of maternal opinion of slow development concerned the infant's health: low birth weight, congenital anomalies regardless of severity, hospitalization during the first year of life, and high ambulatory care use. These results indicate that maternal perception of infant development may not reflect the infant's level, but past or present illness, and raise questions about the influence of infant health on maternal-infant interactions and the effect of such interactions on subsequent development in the child.

scholarly journals Dynamics of the relationship of emotional intelligence with the results of the state exam during the adaptation of school system to its introduction

2015 ◽  
Vol 8 (2) ◽  
pp. 139-150
Author(s):  
E.S. Dmitrieva ◽  
V.Ya. Gelman
Keyword(s):  
Emotional Intelligence ◽  
School System ◽  
The State ◽  
Russian Language ◽  
Self Report ◽  
First Year ◽  
First Year Students ◽  
Adaptation Processes ◽  
Relationship Of ◽  
The Relationship

Research is devoted to the study of the relationship of emotional intelligence of students with the results of the state exam in the adaptation of the school system for 5 years from the date of introduction. The sample consisted of 156 first-year students. Evaluation of the components of emotional intelligence was measured by self-report (EmIn questionnaire). There was a statistically significant correlation between the severity of different indicators of emotional intelligence of students passing the exam and the results of the three school subjects: Russian language, Mathematics, Social studies. It is shown that since the introduction in 2009 of compulsory exam the level of communication between the indicators of emotional intelligence and the results of the examination has changed. Adaptation processes to the introduction of the state exam lead to changes contingent of successful students: If at the time of the introduction of the exam more successful were students with higher EI, in the process of adaptation more successful became those with lower EI. It was shown that the components of EI, having the most important relationships with the results of the exam, are different for the considered subjects; the dynamics of these relationships has been revealed.

scholarly journals Characteristics of emotional state and cognitive processes in patients with ischemic stroke in acute period

2019 ◽  
Vol 3 (24) ◽  
pp. 40-44
Author(s):  
Yu. V. Kotsyubinskaya ◽  
A. V. Kazakov ◽  
N. Yu. Safonova
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Processes ◽  
Emotional State ◽  
Therapeutic Process ◽  
Anxiety And Depression ◽  
Anterior Cortex ◽  
Acute Period ◽  
Relationship Of ◽  
The Relationship ◽  
Different Levels

Currently, studies aimed at assessing the emotional state and cognitive processes associated with the processing of emotionally determined information in patients with ischemic stroke, as well as finding the relationship between them are particularly relevant, mainly for the subsequent optimization of the therapeutic process. In order to identify the features of the emotional state and cognitive processes, a group of patients with ischemic stroke in the acute period in the amount of 25 people was examined. It was established that in patients with a lesion in the anterior cortex, depressive states in the acute period of stroke are more pronounced. Patients successfully reproduce emotionally significant words in comparison with neutral words; an interrelation between the level of anxiety and depression was found, which indicates that these states are comorbid. But, in turn, the relationship of the severity of anxiety and depression with the cognitive processes of recognition and reproduction, as well as differences in mnestic and gnostic activity in patients with different levels of anxiety and depression were not identified. After the treatment with Semax an improvement was noted.

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