Association between physical activity levels and depressive symptoms in patients with minor ischemic stroke

ObjectivePost-stroke depression is associated with stroke recurrence and it is necessary to identify its influencing factors. The study aims to determine whether physical activity during hospitalization, as measured by accelerometer, was associated with depression after discharge in patients with minor ischemic stroke.Materials and methodsThis prospective observational study assessed 76 patients with minor ischemic stroke (aged 71.2 years) admitted to an acute care hospital. Depressive symptoms 3 months after discharge from the hospital was assessed using a questionnaire sent by mail. Baseline was set during hospitalization, and accelerometers were used to measure sedentary behavior, light and moderate-to-vigorous physical activities during hospitalization.ResultsThree months after hospital discharge, 14 patients (18.4%) were placed in the depressive symptom group, with significantly more sedentary behavior (p = 0.021), less light physical activity (p = 0.016) and more depressive symptoms during hospitalization (p = 0.005) than in the non-depressive symptom group. Logistic regression analysis showed that sedentary behavior (odds ratio = 1.130, 95% confidence interval = 1.013?1.281, p = 0.028) and light-intensity physical activity (odds ratio = 0.853, 95% confidence interval = 0.746?0.976, p = 0.021) were independent factors for depressive symptoms at three months after discharge. Moderate to vigorous physical activity was not an independent factor.ConclusionsSedentary behavior and light-intensity physical activity during hospitalization were associated with depressive symptoms in patients with minor ischemic stroke after discharge. Reducing sedentary behavior and increasing light-intensity physical activity as part of inpatient rehabilitation may help prevent post-stroke depression.     

Effect of Tai Ji Quan training on self-reported sleep quality in elderly Chinese women with knee osteoarthritis: a randomized controlled trail

ObjectiveThe purpose of this study was to explore the effects of a 24-week Tai Ji Quan training program on sleep quality, quality of life, and physical performance among elderly Chinese women with knee osteoarthritis (OA).MethodsA 24-week randomized, controlled trial of 46 elderly women with knee OA. Participants were randomly assigned to either a Tai Ji Quan group (n = 23) or a control group (n = 23). Participants in the Tai Ji Quan group completed training sessions three times per week, while those in the control group had bi-weekly educational classes. The primary outcome was total score of the Pittsburgh Sleep Quality of Index (PSQI). Secondary outcomes were: seven subscales of the PSQI; sleep latency; total sleep time; sleep efficiency; physical component summary (PCS) and mental component summary (MCS) of the 36-item Short Form Health Survey (SF-36); Berg Balance Scale (BBS); and Timed Up and Go (TUG).ResultsCompared with the control group, participants in the Tai Ji Quan group had significantly improved primary outcome (global PSQI score, p = 0.006) and secondary outcomes, including three PSQI sub-scores (sleep latency, p = 0.031; sleep duration, p = 0.043; daytime dysfunction, p = 0.007), total sleep time (p = 0.033), and SF-36 PCS (p = 0.006). The Tai Ji Quan group also had significant improvements compared with baseline in three PSQI sub-scores (sleep latency, p = 0.031; habitual sleep efficiency, p = 0.049; sleep disturbance, p = 0.016), sleep latency (p = 0.003), BBS (p = 0.001), and TUG (p = 0.006).ConclusionTai Ji Quan training is an effective treatment approach to improve sleep quality and quality of life in elderly Chinese women with knee OA.Trial registration: Chinese Clinical Trial Registry (June 16, 2013): ChiCTR-TRC-13003264.     

Seizure Prophylaxis in Unruptured Aneurysm Repair: A Randomized Controlled Trial

BackgroundProphylactic antiepileptic drugs (pAEDs) are often prescribed for seizure prophylaxis in patients undergoing surgical treatment of unruptured intracranial aneurysms (UIAs). We aimed to evaluate the benefit of pAEDs in patients undergoing surgical repair of UIAs.MethodsWe randomly assigned eligible patients undergoing surgical repair of UIAs to receive levetiracetam for seven days post-operatively or standard care alone. The primary outcome was the evaluation of seizures in the perioperative period (within 4 weeks). We also evaluated seizure occurrence throughout follow-up and assessed functional outcomes using the modified Rankin scale score (mRS).Results35 patients were randomized to the “no-levetiracetam” group and 41 patients were randomized to receive levetiracetam. The two study groups had similar overall baseline characteristics and the surgical complication rate was similar for both groups (p = 0.8). One patient in the “no-levetiracetam” group had a seizure in the perioperative period versus 2 patients in the group randomized to receive levetiracetam (2.9% vs 4.9%, respectively, p = 1.00). No patients in the “no-levetiracetam” group had any additional late seizures (mean follow-up of 20.4 months), but three patients in the levetiracetam group had late seizures during follow-up (mean follow-up of 19.1 months) (0% vs 7.3%, p = 0.2). mRS score of 0-2 at 90 days and at the latest follow-up were similar between the two groups (p = 1.00).ConclusionsPerioperative seizure prophylaxis with levetiracetam does not reduce the rate of seizures as compared to controls in patients undergoing surgical repair of UIAs.     

Les facteurs liés aux actes d’homicide chez les patients tunisiens atteints de schizophrénie

IntroductionEvaluation of variables correlated to homicide is a fundamental issue for developing preventive and therapeutic strategies to deal with such criminal behavior.ObjectivesThe objectives of this study were to assess the characteristics of homicide in Tunisian patients suffering from schizophrenia and to determine the correlated socio-demographic, clinical and therapeutic variables.MethodsThe study included two groups of male patients with a DSM-IV diagnosis of schizophrenia who attended the “Razi” university psychiatric hospital of Tunis. The first group was composed of 36 patients hospitalized for homicide in the forensic unit between the first of January 2000 and the 30th of May 2012. The second group included 50 patients without any criminal record. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups.ResultsNo differences were found between the two groups regarding the different socio-demographic variables. Significant differences were found with respect to a duration of untreated psychosis equal to or more than one year (p = 0.048), shorter duration of psychiatric care (p = 0.002), lower number of hospitalizations (p = 0.026), antecedent of forced hospitalization (p < 0.001), low degree of insight (p = 0.001), poor medication compliance (p < 0.001) and higher antipsychotic doses (p = 0.001).DiscussionDemographic variables as suggested by other studies are less valuable predictors of homicide in patients with schizophrenia.ConclusionInterventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease and improvement of insight as well as medication compliance.     

Intra-arterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients in the United States: A case control analysis

BackgroundAlthough observational studies have reported favorable clinical outcomes associated with intra-arterial thrombolysis as adjunct to mechanical thrombectomy, the cost and length of hospitalization associated with this intervention has not been studied.MethodsWe analyzed the nationally representative data of the United States data from Nationwide Inpatient Sample (NIS) to compare hospitalization cost and duration in addition to other outcomes in patients receiving (n = 1990) with those not receiving intra-arterial thrombolysis (n = 1990) in acute ischemic stroke patients undergoing mechanical thrombectomy using a case control design matched for age, gender, and presence of aphasia, hemiplegia, neglect, coma/stupor, hemianopsia and dysphagia.ResultsThere was no difference in the median hospitalization cost in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: $36,992 [28,361 to 54,336] versus $35,440 [24,383 to 50,438], (regression coefficient 2,485 [-1,947 to 6,917], p = 0.27). There was no difference in the median length of hospitalization in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: 6 days [3 to 10] versus 6 days [4 to 10], (regression coefficient -0.34 [-1.47 to 0.80], p = 0.56). There was no difference in odds of home-discharge (OR 1.02 95%CI 0.72-1.43, p = 0.93) or post-procedural intracranial hemorrhage (OR 1.16 95%CI 0.83-1.64, p = 0.39) between the two groups.ConclusionsWe did not observe an increase in the cost or length of hospitalization associated with the use of intra-arterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients. If the ongoing randomized clinical trials demonstrate therapeutic efficacy in reducing death or disability, this intervention has a high likelihood of being beneficial overall.     

Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder

ObjectiveIn this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features.MethodThe life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups.ResultsThe psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p = 0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p = 0.013). Episodes were more severe (p < 0.001) and hospitalization rates were higher (p = 0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p < 0.001).ConclusionThe well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.     

Cluster analysis to predict factors associated with sufficient indirect decompression immediately after single-level lateral lumbar interbody fusion

ObjectiveChanges in indirect decompression using lateral lumbar interbody fusion (LLIF) were classified into three clusters based on cluster analysis. We investigated cage variables and position to assess the effects of single-level LLIF on indirect decompression.MethodsCluster analysis was used to classify patients into three groups based on the change in the axial cross-sectional spinal canal area (ΔCSA): group 1 with slight postoperative indirect decompression (n = 35); group 2 with average indirect decompression (n = 19); and group 3 with marked indirect decompression (n = 13). Preoperative and immediately postoperative imaging data were compared between groups.ResultsPostoperative segmental lordosis, anterior, posterior, and average disc height increased significantly in each group, but the differences between groups were not significant. Cage length (p = 0.251) and cage height (p = 0.709) did not differ, but cage position differed significantly between groups (p < 0.05). ΔCSA correlated significantly with cage position for all 67 levels (r = 0.411, p < 0.01), but this association was not significant in group 2 (r =  − 0.367, p = 0.122) or group 3 (r =  − 0.005, p = 0.986). ΔCSA correlated with cage height in group 2 (r = 0.645, p < 0.01) and with cage width in group 3 (r = 0.644, p < 0.05).ConclusionsThe cluster analysis results suggest that placing the cage in the posterior position might be effective for expanding the CSA, but other factors, such as cage height or width, may also influence the sufficiency of LLIF.     

Care-needs Certification in the National Long-Term Care Insurance is Useful for Assessment of Premorbid Function in Older Japanese Patients with Stroke

ObjectiveTo investigate the effects of premorbid long-term care insurance (LTCI) care-need certification on functional improvement during acute hospitalization in older patients with stroke.MethodsIn this single-center prospective cohort study, we assessed LTCI care-needs certification and the modified Rankin Scale (mRS) at the premorbid stage, on admission, and at hospital discharge in older patients with stroke. We also assessed adverse events during hospitalization. The main outcome was the presence of functional improvement during hospitalization (mRS on admission < mRS at discharge). Multivariate analysis was performed to investigate the relationship between functional improvement and premorbid LTCI care-need certification.ResultsIn total, 246 older patients with stroke were enrolled in this study. There was a significant independent association between premorbid LTCI care-needs certification (care level 1 = odds ratio [OR]: 0.26, 95% CI: 0.10–0.72, p = 0.01; Care level 2 = OR: 0.27, 95% CI: 0.10–0.73, p = 0.01; care level 3–5 = OR: 0.21, 95% CI: 0.08–0.56, p = 0.002; Not applicable = reference) and functional improvement.ConclusionsPremorbid LTCI care-need certification is associated with short-term functional improvement in older patients with stroke. Assessment of premorbid LTCI care-needs certification is valid for predicting functional improvement in older patients with stroke.     

Sleep architecture in patients with Juvenile Myoclonic Epilepsy

AimThe aim is to analyze the sleep architecture using polysomnography (PSG) in patients with Juvenile Myoclonic Epilepsy (JME): (newly diagnosed and those on valproate drug) attending epilepsy clinic at Alexandria University Hospitals.MethodsThis study involved 20 patients with JME on valproate (age: 22.40 ± 5.80 years; M:F = 6:14), 20 newly diagnosed patients (age: 18.55 ± 6.0 years; M:F = 6:14), and 20 matched healthy controls (age: 22.10 ± 5.0 years; M:F = 6:14). Clinical assessment, electroencephalogram (EEG), evaluation with comprehensive sleep questionnaire, and PSG were done for all patients.ResultsPSG showed significant alterations in sleep architecture in the total JME group in the form of reduced mean sleep efficiency (p = 0.001¹), increased mean Rapid eye movement (REM) onset latency (p = 0.046¹), decrease mean REM percentage (p = 0.011¹), increased mean wakefulness after sleep onset (p = 0.018¹), increase the index of total arousal (p = 0.005¹), increased mean periodic limb movement index (P = 0.001¹), and reduced apnea hypopnea index (P = <0.001) in comparison to control group. Valproate treated group showed increased sleep efficiency (p = 0.040¹), decreased REM arousal index (P = 0.012), longer stage 3 (P = 0.038), and prolonged stage 2 (P = 0.049¹) than the newly diagnosed group.ConclusionsSleep architecture was significantly disturbed in JME, with improvement in sleep efficiency in valproate treated patients.     

Enhanced phasic sensory afferents paired with controlled constraint force improve weight shift toward the paretic side in individuals post-stroke

PurposeThe goal of this study was to determine whether enhanced phasic sensory afferent input paired with the application of controlled constraint force during walking would improve weight shift toward the paretic side and enhance use of the paretic leg.MethodsFourteen stroke survivors participated in two experimental conditions, sessions that consisted of 1 min treadmill walking without force and stimulation (baseline), 7 min walking with either “constraint force and sensory stimulation (constraint+stim)” or “constraint force only (constraint)” (adaptation), and then 2 min walking without force and stimulation (post-adaptation). Kinematics of the pelvis and legs, and muscle activity of the paretic leg were recorded.ResultsParticipants showed greater increases in hip abductor (p < 0.001) and adductor (p = 0.04) muscle activities, weight shift toward the paretic side (p = 0.002), and step length symmetry (p < 0.01) during the late post-adaptation period in the “constraint+stim” condition, compared with the effect of the “constraint” condition. In addition, changes in overground walking speed from baseline to 10 min post treadmill walking was significantly greater for the “constraint force and stimulation” condition than for the “constraint force only” condition (p = 0.04).ConclusionEnhanced targeted sensory afferent input during locomotor training may facilitate recruitment of targeted muscles of the paretic leg and facilitate use-dependent motor learning of locomotor tasks, which might retain longer and partially transfer from treadmill to overground walking, in stroke survivors.     

Low threshold to Vestibular and Oral Sensory stimuli might affect quality of sleep among children with autism spectrum disorder

AimsThe current study aimed to validate the relationship between sensory characteristics and sleep dynamics among children with autism spectrum disorder (ASD) using an actigraph, which is an objective assessment device used for sleep monitoring.MethodsA total of 40 children (age range, 3–6 years) participated in this study (n = 20, with ASD and n = 20, age-matched children with typical development [TD]). We examined sleep dynamics using actigraph for 7 consecutive days, and the relationship between sleep parameters and sensory characteristics was analyzed using the Japanese Version of Sensory Profile (SP-J).ResultsSignificant differences were observed in terms of activities per minute during sleep (p = 0.02), sleep efficiency (SE) (p = 0.005), and wake after sleep onset (WASO) (p = 0.02) between the two groups. In the ASD group, significant positive correlations were observed between activities per minute during sleep and low thresholds for Vestibular Sensory stimuli (p = 0.046) and Oral Sensory stimuli (p = 0.006) using the SP-J. Based on a multiple regression analysis, the activities per minute during sleep were associated with low thresholds for Oral Sensory stimuli (β = 0.51, t = 2.29, p = 0.03), but not with other factors, in the ASD group.ConclusionsThe current study showed that atypical Vestibular and Oral Sensory modulation may be a risk indicator for high activities during sleep among preschool children with ASD. Thus, whether the interventions for these sensory characteristics are effective in improving sleep quality, daytime activities, behaviors, and cognitive functions in this group of children must be considered.     

Association of Proinflammatory Cytokine Levels with Stroke Severity,Infarct Size,and Muscle Strength in the Acute Phase of Stroke

ObjectivePatterns of cytokine levels and their association with stroke severity, infarct size, and muscle strength are obscure. We aimed to analyze the immune mediators linked to T helper (Th)1, Th2, Th17, and regulatory T cell patterns and their association with stroke severity, infarct size, and muscle strength.Materials and methodsWe included patients with acute stroke (n = 15) and healthy non-disabled individuals (n = 20) aged > 18 years. The dependent variables were stroke severity according to the National Institute of Health Stroke Scale (NIHSS), infarct size on computed tomography, handgrip strength by dynamometry, and global muscle strength according to the Medical Research Council (MRC) scale. The independent variables were the circulating cytokine levels. The cytokine levels were compared between the groups, and correlations between the clinical data were verified.ResultsThe stroke group had higher interleukin (IL)-6 (p < 0.0001) and IL-10 (p < 0.0001) levels, but lower tumor necrosis factor (TNF)-α (p = 0.036) levels than the control group. IL-10 and soluble tumor necrosis factor receptor (sTNF-RII) levels were correlated with each other (r = 0.533; p = 0.042) and infarct size (r = 0.653; p = 0.033 and r = 0.689; p = 0.018, respectively). MRC scores were positively and negatively correlated with handgrip strength of the affected side (r = 0.78; p = 0.001) and NIHSS scores (r = -0.87; p < 0.0001), respectively.ConclusionsPlasma levels of some cytokines were associated with changes in the acute phase of stroke, and IL-10 and sTNF-RII levels are potential biomarkers of infarct size.     

Shorter sleep duration is associated with lower GABA levels in the anterior cingulate cortex

BackgroundAlterations in the levels of gamma-aminobutyric acid (GABA) and glutamate + glutamine (Glx), which are major inhibitory and excitatory neurotransmitters, respectively, are frequently associated with insomnia. Previous reports also suggested the involvement of the anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) in insomnia and shorter sleep duration. In the current study, we investigated whether the GABA and Glx levels were altered in the ACC/mPFC in subclinical insomnia while focusing on the sleep duration.MethodsWe examined levels of GABA and Glx in the ACC/mPFC of the brain with magnetic resonance spectroscopy in 166 individuals with subjective sleep complaints but without a diagnosis of insomnia. Participants were divided into two groups according to sleep duration (≥6 h/night: n = 79 vs. < 6 h/night: n = 74), which was measured using a wrist-worn actigraphy. Working memory function and overall subjective sleep quality were assessed with a computerized neuropsychological test and self-report questionnaire, respectively.ResultsGABA levels in the ACC/mPFC were lower in the shorter sleep duration group relative to the longer sleep duration group (t = −2.21, p = 0.03). Glx levels did not differ between the two groups (t = −0.20, p = 0.84). Lower GABA levels were associated with lower spatial working memory performance in the shorter sleep duration group (β = −0.21, p = 0.03), but not the longer sleep duration group (β = 0.04, p = 0.72).ConclusionShorter sleep duration was associated with lower GABA levels in the ACC/mPFC. These findings may provide insight into the underlying mechanisms of impaired working memory function related to insomnia and sleep loss.     

Effect of carbamazepine on the sleep microstructure of temporal lobe epilepsy patients: a cyclic alternating pattern-based study

BackgroundStudies looking at the effect of anti-epileptic drugs on the sleep microstructure of patients with epilepsy are scarce. The aim of this study was to compare the sleep microstructural characteristics of drug-naive temporal lobe epilepsy (TLE) patients and those on carbamazepine (CBZ) monotherapy.MethodsThree age-matched (p = 0.286) and sex-matched (p = 0.398) groups were studied: drug-naive TLE (n = 20); TLE on CBZ (n = 20); and healthy controls (n = 40). All groups underwent overnight polysomnography. Scoring and analysis of arousals and cyclic alternating pattern (CAP) parameters were performed. Comparison of arousal parameters and CAP parameters was performed using either one-way analysis of variance or the Kruskal−Wallis test, followed by pairwise comparisons (p ≤ 0.05).ResultsRapid eye movement (REM) arousal indices and overall CAP rates were higher in patients with TLE (group 1, p < 0.001; group 2, p < 0.001) compared to controls. Furthermore, the overall CAP rate was higher in patients on CBZ. The CAP cycle/sequences indices (group 1, p < 0.001; group 2, p < 0.001) were higher, and conversely, the average duration of CAP cycles/sequences (group 1, p = 0.018; group 2, p = 0.003) was lower in patients with TLE. Finally, an increase in A2 percentage was noted in patients with TLE (group 1, p = 0.011; group 2, p = 0.011).ConclusionWe found significant alterations in REM arousal indices and CAP parameters in patients with TLE as compared to controls. Moreover, many of these CAP alterations were greater in patients on CBZ. These findings suggest that anti-epileptic drugs such as CBZ may augment arousal instability in patients with TLE, and hence worsen sleep quality and continuity.     

Freezing of gait subtypes have different cognitive correlates in Parkinson's disease

BackgroundFreezing of gait (FOG) is a major concern for Parkinson's disease (PD) patients because it is a leading cause of falls and is associated with poor quality of life. The pathophysiology is unknown but it is hypothesized that it relates to cognitive abnormalities; particularly executive and visuospatial dysfunction. However, prior results have been discrepant. Pharmacologic subtypes of FOG include those that are responsive and unresponsive to levodopa.ObjectiveTo determine whether executive and visuospatial dysfunction are associated specifically with the levodopa unresponsive subtype of FOG.Methods135 PD subjects completed a single assessment included FOG questionnaire, UPDRS motor scale, comprehensive cognitive battery and measure of hallucinations. Analyses compared unresponsive (n = 16), responsive (n = 20) and no FOG (n = 99) subtypes.ResultsThe unresponsive subtype had a significantly older age of onset of PD than the responsive group (p = .03) and had worse motor scores (p = .003) than the no FOG group. Longer disease duration was associated with the responsive group compared to the no FOG group (p = .002). The unresponsive FOG group had significantly poorer visuospatial ability (p = .001) and executive functioning (p = .02) than both the no and responsive FOG subgroups. These latter groups were not significantly different. The responsive FOG group was associated with the presence of hallucinations.ConclusionAside from pharmacological differences, unresponsive FOG is associated with executive and visuospatial dysfunction implicating frontostriatal pathways while responsive FOG is associated with hallucinations suggesting involvement of posterior cortical regions. Further study and treatment of FOG should include appropriate subtype classification.     

The impact of age and disease duration on the long term outcome of neurostimulation of the subthalamic nucleus

BackgroundSelection of patients with Parkinson's disease for neurostimulation of subthalamic nucleus (STN-DBS) is still poorly studied.AimTo identify the impact of age and disease duration on the outcome of bilateral STN-DBS.Methods110 operated patients in a single center covering a large range of age and disease duration were retrospectively included and followed for up-to 5 years. Standardized UPDRS assessments were obtained at 0.5–1 and 3–5 years. Patients were stratified into three age groups (≤55, 56–64 and ≥65 years) and the middle age group was further stratified into 2 disease duration subgroups (<15years, ≥15 years).ResultsThe age groups had comparable baseline data except for the predefined differences. Compared to baseline early and late intra-group “Med Off-Stim On” motor scores were significantly improved for all groups (p < 0.001). Mood/cognition were significantly improved in younger two groups (p = 0.008, 0.019) at 0.5–1 year. Inter-group comparisons showed significantly worse early and late axial scores for older patients (p < 0.05). All groups had comparable postoperative improvement except for the older group which had significantly less improvement of early UPDRS-II, late UPDRS-I, and early and late PIGD/axial scores. Different disease durations had no effect on the outcome except for worse Schwab and England Off-score in longer duration group (p = 0.02). Side effects of surgery and long-term management were similar.ConclusionSTN-DBS is an efficient treatment of advanced PD for all treated age-groups. Provided strict inclusion criteria are respected, older age and longer disease duration are associated with slightly worse effects mainly on L-dopa-resistant symptoms.     

Polysomnographic phenotype of isolated REM sleep without atonia

ObjectiveIsolated REM sleep without atonia (iRSWA) is regarded as a prodromal phase of REM sleep behavior disorder and synucleinopathies. In iRSWA patients, we investigated the polysomnographic characteristics that are known to be altered in (prodromal) Parkinson’s disease (PD): periodic limb movements of sleep [PLMS] (increased), REM density (reduced), and heart rate variability ([HRV] (reduced).MethodsWe compared video-polysomnographic studies of 49 iRSWA subjects with 41 controls. RSWA and PLMS were scored visually. REM density (REM/hour) and HRV were calculated automatically.ResultsWe found a higher median total (15.90 vs 7.20; p = 0.001), REM (21.80 vs 11.0; p < 0.001) and non-REM (11.75 vs 5.72; p = 0.027) PLMS index, and a higher mean REM density (342.45 vs 275.96; p = 0.010) in the iRSWA group, with a significant positive correlation between RSWA severity and these variables (r = 0.39; p < 0.00, r = 0.48; p < 0.001, r = 0.24; p = 0.021, r = 0.28; p = 0.012). We found no significant difference in HRV between groups.ConclusionsOur results suggest an association between RWSA and REM density and PLMS, but not HRV. The positive correlation between these variabilities may imply overlapping pathophysiological processes.SignificanceThe evidence of higher REM density and normal HRV weakens the hypothesis that iRWSA is a prodromal PD stage. An alternative interpretation is, however, that REM density and HRV change during caudal-rostral neurodegeneration.     

Phenotypes of sleep-disordered breathing symptoms to two years of age based on age of onset and duration of symptoms

ObjectiveChildhood sleep-disordered breathing (SDB) symptoms may comprise multiple phenotypes depending on craniofacial anatomy, tonsil and adenoid growth, body habitus, and rhinitis symptoms. The primary objective of this study is to identify and characterize the different SDB phenotypes to two years of age.MethodsData from 770 infants in the Edmonton sub-cohort of the Canadian Healthy Infant Longitudinal Study (CHILD) were analyzed to identify SDB phenotypes based on age of onset and duration of symptoms. Parents completed the 22-item sleep-related breathing disorder (SRBD) scale. Children with a SRBD ratio greater than 0.33 were considered positive for SDB at each quarterly assessment between three months and two years. The STATA Proc trajectory extension identified SDB phenotypes based on their age of onset and duration of symptoms and attributed the percentage chance of a participant being assigned to each phenotype. Multivariate linear regression identified factors associated with increased risk of being assigned to each SDB phenotype.ResultsTrajectory analysis identified four phenotypes: no SDB (65.7%), early-onset SDB (15.7%) with peak symptoms at nine months, late-onset SDB (14.2%) with peak symptoms at 18 months, and persistent SDB (5.3%) with symptoms from 3 to 24 months. Rhinitis was associated with all three SDB symptom trajectories (p < 0.05). Children with gastroesophageal reflux disease presented with early (p = 0.03) and late SDB (p < 0.001). Maternal obstructive sleep apnea syndrome (OSAS) was associated with persistent (p = 0.01) and late SDB (p < 0.001). Atopy (positive skin prick test at one year) was associated with persistent SDB (p = 0.04). Infants born prior to 36.5 weeks gestational age were more likely to present with late SDB (p = 0.03).ConclusionChildhood SDB symptoms, rather than being a homogenous disorder, may comprise multiple overlapping phenotypes each with unique risk factors.     

Vascular Risk Factor Prevalence and Trends in Native Americans with Ischemic Stroke

IntroductionNative Americans have a higher incidence and prevalence of stroke and the highest stroke-related mortality among race-ethnic groups in the United States. We aimed to analyze trends in the ischemic stroke (IS) vascular risk factor prevalence in Native Americans along with a comparison to the other race-ethnic groups.MethodsNational Inpatient Sample (NIS) database was used to explore the prevalence of risk factors among hospitalized IS patients during 2000 - 2016. Prevalence estimates were calculated for each risk factor within each race-ethnic group in 6 time periods. Linear trends were explored using linear regression models, with differences in trends between the Native American group and the other race-ethnic groups assessed using interaction terms. The analysis accounted for the complex sampling design, including hospital clusters, NIS stratum, and trend weights for analyzing multiple years of NIS data.ResultsNative Americans constituted 5472 of the 1,278,784 IS patients. The age-and-sex-standardized prevalence of hypertension (slope = 2.24, p < 0.001), hyperlipidemia (slope = 6.29, p < 0.001), diabetes (slope = 2.04, p = 0.005), atrial fibrillation/flutter (trend slope = 0.80, p = 0.011), heart failure (trend slope = 0.73, p = 0.036) smoking (trend slope= 3.65, p < 0.001), and alcohol (slope = 0.60, p = 0.019) increased among Native Americans. They showed larger increases in hypertension prevalence compared to Blacks, Hispanics, and Asian/Pacific Islanders and in smoking prevalence compared to Hispanics and Asian/Pacific Islanders. By the year 2015-2016, Native Americans had the highest overall prevalence of diabetes, coronary artery disease, smoking, and alcohol among all race-ethnic groups.ConclusionThe prevalence of most vascular risk factors among ischemic stroke patients has increased in Native Americans over the last two decades. Significantly larger increases in hypertension and smoking prevalence were seen in Native Americans compared to other groups along with them having the highest prevalence in multiple risk factors in recent years.     

Clipping versus coiling for intracranial aneurysms

Background and purposeThe aim of this study was to compare results of clipping and coiling for aneurysms of the anterior circle of Willis. Previous studies have not identified a clear superiority of one method over the other.Material and methodsThe study group included 165 consecutive patients. The assessment took into account the risk of death, neurological status according to the scale of the GOS and mRS, the incidence of early complications and quality of life measured by own surveys and questionnaire EORTC QLQ-C30 v. 3.0.ResultsMean follow-up was more than four years. Early and late results of treatment after embolization and clipping for all patients did not differ. Evaluation of patients with bleeding aneurysms demonstrated better outcomes after embolization, however statistical significance was observed only in terms of symptomatic scale score of QLQ-C30 questionnaire (p = 0.02). For patients with non-bleeding aneurysms better outcomes were obtained after clipping, but statistical significance was found only in the early results: more excellent results in GOS score at discharge (p < 0.03) and fewer complications during hospitalization (p = 0.02).ConclusionsResults of treatment after clipping and coiling do not differ in total for all patients, but differ depending on the presence of bleeding. Patients with bleeding aneurysms achieve better outcomes after coiling, and patients with non-bleeding aneurysms achieve better outcomes after clipping.