Psychocorrective effect of application of combined medical rehabilitation methods in patients with ischemic stroke

Background. The annual death rate from stroke in Russia remains the highest in the world. Aims: To study the influence of combined methods of medical rehabilitation on the psychological status and functional independence of patients with post-stroke spasticity. Materials and methods. The article presents data on the effectiveness of the influence on the psychological status and functional independence of the combined methods of medical rehabilitation in 60 patients with ischemic stroke with movement disorders in the form of hemiparesis with increased muscle tone by the type of spasticity in the long-term period. The patients were divided into 2 groups comparable in terms of clinical and functional characteristics: the main group (n=30), who received combined methods of physiotherapy (thermotherapy, oxygen therapy, oxyhyperthermia, vibrotherapy, aromatherapy) from the Alpha LED Oxu Light Spa apparatus in addition to the standard rehabilitation complex , which includes exercise therapy, medical massage, kinesitherapy, and a control group (n=30), who received only a standard rehabilitation complex. To assess the initial psychological status and functional independence of the observed patients undergoing medical rehabilitation in the period from 3 to 6 months after the disease, the SAN method (well-being, activity, mood) and the FIM scale were used. Results. Before the start of rehabilitation in all patients included in the study. Тhere was a moderate degree of deterioration in well-being, a decrease in activity and mood, as well as a decrease in indicators of independence in everyday life. After the course of treatment (on day 14) and in the long-term period (after 8 months) the patients of the main group had a pronounced positive dynamics of the psycho-emotional status, which was manifested in an improvement in the indicators of well-being by 1.93 times (by 28%), activity by 1.95 times (by 29.6%) and mood by 2.01 times (by 29.8%) points. In the control group, after the standard course of treatment, there was less pronounced dynamics of psychometric indicators. When evaluating the results of functional independence on the FIM scale, there was a significant improvement in the indicators of independence in everyday life by 32%. Conclusion. The use of combined methods of medical rehabilitation in patients with post-stroke spasticity contributes to a significant increase in their quality of life and psychological status, which is confirmed by the FIM and SAN tests.

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Excessive White Matter Hyperintensity Increases Susceptibility to Poor Functional Outcomes After Acute Ischemic Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.700616 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sungmin Hong ◽

Anne-Katrin Giese ◽

Markus D. Schirmer ◽

Anna K. Bonkhoff ◽

Martin Bretzner ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Linear Regression Analysis ◽

Functional Independence ◽

White Matter Hyperintensity ◽

Stroke Severity ◽

Post Stroke

Objective: To personalize the prognostication of post-stroke outcome using MRI-detected cerebrovascular pathology, we sought to investigate the association between the excessive white matter hyperintensity (WMH) burden unaccounted for by the traditional stroke risk profile of individual patients and their long-term functional outcomes after a stroke.Methods: We included 890 patients who survived after an acute ischemic stroke from the MRI-Genetics Interface Exploration (MRI-GENIE) study, for whom data on vascular risk factors (VRFs), including age, sex, atrial fibrillation, diabetes mellitus, hypertension, coronary artery disease, smoking, prior stroke history, as well as acute stroke severity, 3- to−6-month modified Rankin Scale score (mRS), WMH, and brain volumes, were available. We defined the unaccounted WMH (uWMH) burden via modeling of expected WMH burden based on the VRF profile of each individual patient. The association of uWMH and mRS score was analyzed by linear regression analysis. The odds ratios of patients who achieved full functional independence (mRS < 2) in between trichotomized uWMH burden groups were calculated by pair-wise comparisons.Results: The expected WMH volume was estimated with respect to known VRFs. The uWMH burden was associated with a long-term functional outcome (β = 0.104, p < 0.01). Excessive uWMH burden significantly reduced the odds of achieving full functional independence after a stroke compared to the low and average uWMH burden [OR = 0.4, 95% CI: (0.25, 0.63), p < 0.01 and OR = 0.61, 95% CI: (0.42, 0.87), p < 0.01, respectively].Conclusion: The excessive amount of uWMH burden unaccounted for by the traditional VRF profile was associated with worse post-stroke functional outcomes. Further studies are needed to evaluate a lifetime brain injury reflected in WMH unrelated to the VRF profile of a patient as an important factor for stroke recovery and a plausible indicator of brain health.

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The peculiarities of cognitive and emotional-volitional spheres of the patients with post-stroke neurological dysfunctions

Психолог ◽

10.25136/2409-8701.2020.1.31680 ◽

2020 ◽

pp. 9-15

Author(s):

Dilara Gamzatovna Nazmetdinova ◽

Viktoriya Borisovna Obukhovskaya

Keyword(s):

Ischemic Stroke ◽

Early Stage ◽

Psychological Status ◽

Long Term Memory ◽

Depression And Anxiety ◽

Post Stroke ◽

Rehabilitation Period ◽

The Subject

The subject of this research is the peculiarities of cognitive (memory, attention) and emotional-volitional (manifestations of anxiety and depression, motivation towards recovery) spheres of the patients with severe dysfunctions of cerebral circulation of ischemic type in the early and late rehabilitation period. The relevance of this topic is defined by commonness of the ischemic stroke, growing number of incapacitating consequences, and mortality rate in Russia. Ischemic stroke leads to the change of physical, social and psychological status of a patient, worsening of quality of life, and unfavorable prognosis for recovery. The scientific novelty consists in assessment of the dynamics of indicators in cognitive and emotional-volitional spheres of the post-stroke patients at various states of rehabilitation treatment. It is determined that the highest positive dynamics in cognitive and emotional-volitional spheres is observed at the early stage of rehabilitation. The resource and deficiency characteristics, which are most important for selecting the target of psychological interventions, are determined for each group of patients. In the cognitive sphere are noted veracious differences in the capacity of auditory-verbal short-term and long-term memory, memory for images, allocation and shifting of attention. In the emotional-volitional sphere – the indicators of depression and anxiety, motivation towards recovery. The presented data underlines the need for simultaneous provision of psychological rehabilitation and medication interventions for fullest readaptation of a patient to life at all stages of rehabilitation.  

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Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan

BMC Neurology ◽

10.1186/s12883-021-02241-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chia-Yu Hsu ◽

Chun-Yu Cheng ◽

Jiann-Der Lee ◽

Meng Lee ◽

Bruce Ovbiagele

Keyword(s):

Valproic Acid ◽

Ischemic Stroke ◽

Cox Regression ◽

Population Based ◽

Primary Diagnosis ◽

Research Database ◽

Post Stroke ◽

Risk Of Death ◽

Index Stroke

Abstract Objective We aim to compare the effect of long-term anti-seizure medication (ASM) monotherapy on the risk of death and new ischemic stroke in patients with post-stroke epilepsy (PSE). Patients and methods We identified all hospitalized patients (≥ 20 years) with a primary diagnosis of ischemic or hemorrhagic stroke from 2001 to 2012 using the National Health Insurance Research Database in Taiwan. The PSE cohort were defined as the stroke patients (1) who had no epilepsy and no ASMs use before the index stroke, and (2) who had epilepsy and ASMs use after 14 days from the stroke onset. The patients with PSE receiving ASM monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new ASM groups. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) of death and new ischemic stroke within 5 years across all groups, using the new ASM group as the reference. Results Of 6962 patients with PSE using ASM monotherapy, 3917 (56 %) were on phenytoin, 1623 (23 %) on valproic acid, 457 (7 %) on carbamazepine, and 965 (14 %) on new ASMs. After adjusting for confounders, compared with new ASM users, phenytoin users had a higher risk of death in 5 years (HR: 1.64; 95 % CI: 1.06–2.55). On the other hand, all ASM groups showed a similar risk of new ischemic stroke in 5 years. Conclusions Among patients with PSE on first-line monotherapy, compared to new ASMs, use of phenytoin was associated with a higher risk of death in 5 years.

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Self-Esteem Evaluation in Children and Adolescents Suffering from ADHD

Clinical Practice and Epidemiology in Mental Health ◽

10.2174/1745017901309010096 ◽

2013 ◽

Vol 9 (1) ◽

pp. 96-102 ◽

Cited By ~ 19

Author(s):

Luigi Mazzone ◽

Valentina Postorino ◽

Laura Reale ◽

Manuela Guarnera ◽

Valeria Mannino ◽

...

Keyword(s):

Children And Adolescents ◽

Treatment Strategies ◽

Well Being ◽

Self Esteem ◽

Control Group ◽

Healthy Controls ◽

Adhd Symptoms ◽

The Relationship ◽

Drug Free

Background: Several recent studies investigated the relationship between self-esteem and ADHD, however, the results are still controversial. In the present study we analyze the characteristics of self-esteem in a sample of children and adolescents suffering from ADHD, with a particular focus on the relationship between ADHD symptoms severity and treatment strategies. Methods: A total of 85 patients with ADHD (44 drug-free and 41 drug-treated, 23 of which atomoxetine-treated and 18 Methylphenidate-treated) and 26 healthy controls were enrolled in the study in order to evaluate self-esteem using the Self-esteem Multidimensional Test (TMA). Results: ADHD subjects revealed lower scores on all self-esteem domains compared to controls. Both ADHD drug-free (47.1%) and ADHD drug-treated (44.1%) groups showed significantly higher rates of subjects in the pathological range as compared to normal control group (8.8%) (p <.001) with a higher percentage of subjects in the pathological range. Among ADHD drug-treated subjects, the methylphenidate group showed higher self-esteem scores as compared to the atomoxetine group. Conclusion: A lower self-esteem profile is more common in subjects suffering from ADHD than in healthy controls, suggesting the importance of an early detection of psychological well-being in these children in order to reduce the ADHD symptoms long-term impacts.

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Effects of self-conditioning techniques in promoting weight loss in patients with severe obesity: a randomized controlled trial protocol

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20170304 ◽

2017 ◽

Vol 4 (1) ◽

pp. 20 ◽

Cited By ~ 1

Author(s):

Simona Bo ◽

Farnaz Rahimi ◽

Bice Properzi ◽

Giuseppe Regaldo ◽

Ilaria Goitre ◽

...

Keyword(s):

Weight Loss ◽

Standard Care ◽

Traditional Approach ◽

Controlled Trial ◽

Well Being ◽

Control Group ◽

Randomized Controlled ◽

Rapid Induction ◽

Conditioning Approach

Background: Obesity is a worldwide epidemic; most obese individuals who lose weight after lifestyle educative treatments, soon regain it. Our aim is to evaluate the effectiveness of a training to teach self-conditioning technique (self-hypnosis) added to standard care in determining weight loss compared with standard care in patients with obesityMethods: This randomized controlled open trial will recruit 120 obese patients (BMI 35-50 Kg/m2), aged 20-70 years. The control group will receive a traditional approach: diet + exercise + behavioral recommendations. The experimental group will receive self-conditioning techniques + traditional approach.Three individual sessions of hypnosis with rapid-induction techniques will be administered by trained personnel. All the participants of both groups will be assessed at three, six, nine and twelve months after randomization. The primary outcome is weight loss difference between groups at 12 months after randomization; secondary outcomes are changes in adherence to dietetic and exercise recommendations, appetite and satisfaction/well-being, waist circumference and body fat, blood pressure and blood metabolic and inflammatory variables.Conclusions: The results of this trial will assess whether a self-conditioning approach, based on self-hypnosis, is able to help participants to modulate unhealthy patterns of eating and sustain weight loss in the long term.

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Cognitive effect of cilostazol in post stroke cognitive impairment: a prospective study

10.21203/rs.2.9552/v1 ◽

2019 ◽

Author(s):

Ling-Chun Huang ◽

Sun-Wung Hsieh ◽

Chun-Hung Chen ◽

Yuan-Han Yang

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Randomized Clinical Trials ◽

Multiple Logistic Regression Analysis ◽

Antiplatelet Agent ◽

Cognitive Change ◽

Control Group ◽

Cognitive Changes ◽

Post Stroke ◽

Significant Difference

Abstract Background Whether antiplatelet agents have a preventive effect on cognitive function after ischemic stroke remains unknown. This study examined the potential effect of cilostazol, an antiplatelet agent and cyclic adenosine monophosphate phosphodiesterase 3 inhibitor, on cognitive impairment after stroke in an Asian population. Methods A total of 45 patients using cilostazol (100 mg) twice per day were enrolled as the study group and 45 patients using aspirin (100 mg) or clopidogrel (75 mg) daily were enrolled as the control group. Mini-mental state examination and Cognitive Assessment Screening Instrument were administered at the start of the study and after 6 months. Multiple logistic regression analysis was used to estimate the association between the cognitive change and cilostazol use. Results Overall, 60-70% of the patients improved their cognition after 6 months follow up. No significant differences were observed in the cognitive change between the cilostazol and control groups. However, the cilostazol group appeared to perform better in the fluency, language and judgment subdomains. Conclusions In the current study, the clinical course of post stroke cognitive changes was described. Although cilostazol did not make a significant difference in cognitive change after ischemic stroke, it may improve fluency, language and judgment subdomains. These findings should be examined further in randomized clinical trials.

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Abstract TP224: Interleukin-37 Level is Elevated in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp224 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Saif Bushnaq ◽

Atif Zafar ◽

Kempuraj Duraisamy ◽

Nudrat Tasneem ◽

Mohammad M Khan ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Inflammatory Responses ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Delayed Presentation ◽

Stroke Patients ◽

Post Stroke ◽

Urine And Serum ◽

Serum And Urine

Background: Interleukin-37 (IL-37) is a new member of IL-1 cytokine family with a defined role as a negative feedback inhibitor of pro-inflammatory responses. IL-37 has yet to be evaluated in non-immune neurological diseases like ischemic or hemorrhagic stroke. This study aimed to measure the urine and serum IL-37 levels in patients with acute ischemic stroke. Method: Twelve patients consented for the study. Two sets of serum and urine samples were obtained and analyzed; one upon admission to the hospital, and the second the next morning after overnight fasting. The trends in serum level of IL-37 in 5 stroke patients, while trends in urine level of 6 patients were available, measured by real-time polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Prior studies with healthy volunteers as control group have consistently showed IL-37 plasma level around or less than 65 pg/ml with maximum normal levels on ELISA approximated at 130 pg/ml. Results: IL-37 level in urine in stroke patients ranged from 297 - 4467. IL-37 levels were in the range of 300s to 1000s in patients with ischemic stroke compared with reported healthy controls in literature where the level was always less than 90. Three of these 10 patients presented within 3 hours of stroke onset with IL-37 serum levels being 2655 pg/ml, 3517 pg/ml and 5235 pg/ml. In all others, it ranged much less than that, with the trend of delayed presentation giving less IL-37 levels, both in urine and serum. There were no clear differences found in patients with or without tPA, diabetes, hyperlipidemia and high blood pressure in our small study. Conclusion: The study shows a rather stable elevation of IL-37 levels post-ischemic stroke, which if compared to available data from other studies, is 3-10 times elevated after acute ischemic stroke with an uptrend in the first few days. IL-37 plays some role in mediating post-stroke inflammation with significant rise in serum and urine IL-37 levels suggesting a key role of this novel cytokine in post-stroke pathology. This is the first ever reported study measuring and trending IL-37 levels in human plasma after an acute ischemic stroke.

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Abstract TP150: Effects of Pre-existing Psychotropic Medication Use on a Cohort of Patients With Ischemic Stroke Outcome

Stroke ◽

10.1161/str.51.suppl_1.tp150 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Dilip Jayaraman ◽

Nils Henninger ◽

Brian Silver ◽

Majaz Moonis ◽

Anthony Rothschild ◽

...

Keyword(s):

Ischemic Stroke ◽

Psychotropic Medication ◽

Medication Use ◽

Female Gender ◽

Control Group ◽

Stroke Outcome ◽

Stroke Registry ◽

Post Stroke ◽

Significant Difference

Background: Although SSRI use for ischemic stroke related motor recovery has been studied with mixed results, the effects of the pre-existing psychotropic medication use (PPMU), such as antidepressants, on a long-term ischemic stroke outcome is unknown. Objective: We sought to determine the prevalence of PPMU, and the clinical outcome in a cohort of patients presenting with acute ischemic strokes. Methods: We retrospectively analyzed 323 consecutive patients who presented with an acute ischemic stroke that were included in an institutional stroke registry between January 2015 and December 2017. Baseline characteristics, functional outcome measured by mRS, cardiovascular complications and death within 90 days and 365 days were recorded. The control was defined as a group of ischemic stroke patients that were not on psychotropic medications pre- and/or post-ischemic stroke. Results: The prevalence of PPMU in the studied cohort was 21.4% (69/323). The prevalence of female gender in PPMU was higher compared to the control and post stroke-psychotropic medication use groups (P<0.001), and the patients with PPMU had similar vascular risk factors compared to the control (NS), except for an increased presence of hyperlipidemia (68.1% vs. 57.5%, p<0.05). Among the patients with an available 90-day follow-up (n=175) and 365-day follow-up (n=246), there was no statistically significant difference in outcome events of MI, stroke, death, and dementia. The mRS was higher on PPMU and poststroke-psychotropic medication use groups compared to the control group within the 365-day follow-up (P=0.013). Conclusion: The prevalence of PPMU is common in ischemic stroke, and it is not associated with worsened post-stroke complications within 1 year.

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Abstract TP319: Risk Factors of Post-stroke Epilepsy

Stroke ◽

10.1161/str.51.suppl_1.tp319 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Tatyana Danilova ◽

Dina Khasanova

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Neuroimaging ◽

Cerebral Arteries ◽

Transcranial Doppler Sonography ◽

Epileptic Seizures ◽

Brain Lesions ◽

Control Group ◽

Ischemic Brain ◽

Post Stroke

Purpose: The aim of the study was to identify the risk factors for seizures in patients with ischemic stroke using clinical, functional, neuroimaging research methods. Materials and methods: The results of the complex survey of 468 patients suffering from ischemic stroke (256 patients experienced epileptic seizures and 203 experienced no epileptic seizures) are presented. The diagnostic procedures included clinical evaluation, magnetic resonance imaging, electroencephalography, extracranial and transcranial Doppler sonography. In addition the assessment of the rate of sodium lithium countertransport (the marker of genetically determined on transport mechanisms of cell membranes) in patients with c ischemic stroke with the development of epileptic seizures and no seizures was carried out. Results: The focal seizures are the most common (92,5%). Cortical ischemic brain lesions prevailed in patients with seizures (81,1%), whereas in the control group cortex was affected in 38,9% patients (χ2=89.2, <0,001). Stenosis of cerebral arteries was more common in patients with epilepsy (82.3%) compared to patients without seizures (74.4%, <0.05). Reduced cerebrovascular reactivity (CVR) in vertebro-basilar basin was more frequently detected in patients with seizures (85.9%, p<0.001) compared to controls (71.6%). CVR < 10% was registered in 33.8% patients with seizures versus 13.4% controls (p<0.001). Patients with epileptic seizures showed cerebral perfusion reduction mostly in vertebro-basilar basin (85.9%) rather than in carotid basin (61.2%, p<0.001). Patients experienced epileptic seizures had high rates of sodium-lithium antitransport (> 346 μmol/liter cells x hour) more often than patients without epileptic seizures (52,6% and 35,5%, respectively, <0,05). Patients experienced epileptic seizures with high rates of sodium-lithium antitransport had a higher seizure frequency than patients with low rates of sodium-lithium antitransport. Conclusion: Thus, cortical ischemic brain lesions, significant stenosis of cerebral arteries, predominant perfusion reserve reduction in the posterior cerebral circulation, as well as a high rate of sodium lithium countertransport may be considered as risk factors for post-stroke epilepsy.

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Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis

The Scientific World JOURNAL ◽

10.1155/2019/7403104 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

David J. McCarthy ◽

Anthony Diaz ◽

Dallas L. Sheinberg ◽

Brian Snelling ◽

Evan M. Luther ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Therapy ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Functional Independence ◽

Long Term Outcomes ◽

Long Term Follow Up ◽

Mr Clean

Mechanical thrombectomy (MT) has become the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS). Few studies have investigated long-term outcomes for AIS treated with MT. Therefore, a pooled meta-analysis using data from randomized clinical trials (RCT) was performed to assess for long-term clinical outcomes. A systematic literature search was conducted on 27 September 2017, by searching the English literature in the Cochrane Library, MEDLINE, and Embase for RCTs investigating long-term outcomes (greater than standard 3-month timepoint) of endovascular intervention versus medical management for patients with AIS. The study was carried out according to PRISMA guidelines and random effects analysis was carried out to account for heterogeneity. Three trials were included: IMS III, MR CLEAN, and REVASCAT, comprising a total of 1,362 patients. Long-term clinical outcomes were available for 1-year follow-up in IMS III and REVASCAT and at 2 years in MR CLEAN. Functional independence at long-term follow-up favored endovascular stroke intervention (OR 1.51; p = 0.02). When stratified by LVO inclusion criteria, greater endovascular functional independence benefits were observed (OR 1.85; p = 0.0005). There was a significant difference between the 2 arms in favor of endovascular therapy for the quality of life at long-term follow-up (mean difference 0.11; p = 0.0002). No difference in mortality at long-term follow-up was observed (OR 0.82; p = 0.12). We conclude that endovascular therapy results in favorable outcomes at long-term follow-up for patients with acute ischemic stroke compared to standard medical treatment alone and that the 90-day timepoint offers a fair representation of the long-term outcomes.

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