Is there a need for long‐term follow‐up in chronic idiopathic polyneuropathy?

Objective – To evaluate the long‐term functional status and well‐being in patients with chronic idiopathic polyneuropathy (CIP) in comparison to Guillain–Barré syndrome (GBS) and healthy controls. Materials and methods – Forty‐two CIP and 42 GBS‐patients were examined at median 5 and 6 years after disease onset and were compared with 50 healthy controls. The Fatigue Severity Scale (FSS), Visual Analogue Scale for pain (VAS), Disability Rating Index (DRI) and Medical Outcome Study 36‐item short‐form health status scale (SF‐36) were used. Variables at onset and symptoms at follow‐up were correlated with outcome measurements in GBS. Results – Patients with CIP and GBS had more pain and disability than healthy controls. Additionally, CIP‐patients were more fatigued than healthy controls. Patients with CIP were more fatigued [FSS 4.9 (SD 1.6) vs 3.8 (SD 1.8); P < 0.01] and disabled [DRI 4.1 (SD 2.3) vs 2.5 (SD 2.1); P = 0.05] than those with GBS. Physical functioning on the SF‐36 was more impaired in CIP than GBS, compared with healthy controls. Conclusions – Patients with CIP and GBS seem to develop persistent impairment on long‐term functional status and well‐being, more clearly in CIP, reflecting the importance of long‐term follow‐up in further disease management.     

European neuroborreliosis: neuropsychological findings 30 months post-treatment

Background: The aim of this study was to compare neuropsychological (NP) functioning in patients with Lyme neuroborreliosis (LNB) 30 months after treatment to matched controls. Methods: We tested 50 patients with LNB and 50 controls with the trail‐making test (TMT), Stroop test, digit symbol test, and California Verbal Learning test (CVLT). A global NP sumscore was calculated to express the number of low scores on 23 NP subtasks. Results: Mean scores were lower amongst LNB‐treated patients than amongst controls on tasks assessing attention/executive functions: (Stroop test 4: 77.6 vs. 67.0, P = 0.015), response/processing speed (TMT 5: 23.4 vs. 19.2, P = 0.004), visual memory (digit symbol recall: 6.6 vs. 7.2, P = 0.038), and verbal memory (CVLT list B: 4.68 vs. 5.50, P = 0.003). The proportion of patients and controls with NP sumscores within one SD from the mean in the control group (defined as normal) and between one and two SD (defined as deficit) were similar, but more LNB‐treated patients than controls had a sumscore more than two SD from the mean (defined as impairment) (8 vs. 1, P = 0.014). Conclusions: As a group, LNB‐treated patients scored lower on four NP subtasks assessing processing speed, visual and verbal memory, and executive/attention functions, as compared to matched controls. The distribution of NP dysfunctions indicates that most LNB‐treated patients perform comparable to controls, whilst a small subgroup have a debilitating long‐term course with cognitive problems.     

Health‐related quality of life in multiple system atrophy

Although multiple system atrophy (MSA) is a neurodegenerative disorder leading to progressive disability and decreased life expectancy, little is known about patients' own evaluation of their illness and factors associated with poor health‐related quality of life (Hr‐QoL). We, therefore, assessed Hr‐QoL and its determinants in MSA. The following scales were applied to 115 patients in the European MSA‐Study Group (EMSA‐SG) Natural History Study: Medical Outcome Study Short Form (SF‐36), EQ‐5D, Beck Depression Inventory (BDI), Mini‐Mental state examination (MMSE), Unified MSA Rating Scale (UMSARS), Hoehn & Yahr (H&Y) Parkinson's disease staging scale, Composite Autonomic Symptom Scale (COMPASS), and Parkinson's Disease Sleep Scale (PDSS). Forty‐six percent of patients had moderate to severe depression (BDI ≥ 17); Hr‐QoL scores on the SF‐36 and EQ‐5D were significantly impaired. Pain, the only domain with similar scores in MSA and published PD patients, was reported more frequently in patients with MSA‐P (predominantly parkinsonian motor subtype) than MSA‐C (predominantly cerebellar motor subtype; 76% vs. 50%; P = 0.005). Hr‐QoL scores correlated most strongly with UMSARS motor, COMPASS, and BDI scores but not with MMSE scores, age at onset, or disease duration. The COMPASS and UMSARS activities of daily living scores were moderate‐to‐strong predictors for the SF‐36 physical summary score and the BDI and UMSARS motor scores for the SF‐36 mental summary score. This report is the first study to show that Hr‐QoL is significantly impaired in MSA. Although not all possible factors related to impaired Hr‐QoL in MSA could be assessed, autonomic dysfunction, motor impairment, and depression were most closely associated with poor Hr‐QoL, and therapeutic management, therefore, should concentrate upon these aspects of the disease. © 2006 Movement Disorder Society     

Activities of daily living and quality of life in persons with newly diagnosed Parkinson’s disease according to subtype of disease,and in comparison to healthy controls

Hariz G‐M, Forsgren L. Activities of daily living and quality of life in persons with newly diagnosed Parkinson’s disease according to subtype of disease, and in comparison to healthy controls.
Acta Neurol Scand: 2011: 123: 20–27.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objective – To describe activity of daily living (ADL) and quality of life (QoL) at first visit to a neurological centre, in patients subsequently diagnosed with Parkinson’s disease (PD), according to subtype of disease and compared to healthy controls. Materials and methods – 99 patients and 31 controls were included. Patients were classified into three groups according to predominant symptoms: 50 Postural instability‐gait difficulties (PIGD), 37 tremor dominant, 12 indeterminate. Evaluations included ADL‐taxonomy, SF‐36, and the Parkinson disease questionnaire (PDQ‐39). Results – Patients experienced early on limitations in ADL and QoL compared to controls. Patients with PIGD subtype had already at first visit a worse status, clinically and in ADL and QoL, than patients with tremor dominant type. Conclusions – Already at first visit to a neurological centre, patients who will eventually receive the diagnosis of PD exhibited restrictions in ADL and QoL. Patients with axial symptoms were affected most.     

Comparison of upright balance in stroke,Parkinson and multiple sclerosis

Background – Myotonic dystrophy type 1 (DM1) is the most common muscular dystrophy in adults. There is a complete lack of studies that assessed quality of life (QoL) trajectory during time in DM1 cohorts. Aim – To analyze changes of QoL in patients with DM1 during a 5‐year follow‐up period and to assess responsiveness of the SF‐36 questionnaire. Patients and Method – At the baseline, this study comprised 84 DM1 patients, of whom 62 were retested after the mean period of 64.2 ± 3.9 months. Severity of muscular weakness was assessed using the Muscular Impairment Rating Scale (MIRS). Patients completed Serbian version of the SF‐36 questionnaire as a measure of health‐related QoL. Results – After 5 years, MIRS score of our DM1 patients showed significant progression of 0.5 grade (P < 0.01). All mental subdomains, role physical, and total SF‐36 scores significantly improved after 5 years (P < 0.01). Unexpectedly, worsening of muscular weakness from mild to severe was in association with improvement of QoL. Conclusion – QoL improved in our cohort of DM1 patients during a 5‐year period despite the progression of the disease. SF‐36 should be used with caution as a patient‐reported outcome measure in DM1 clinical trials.     

Prevalence,correlates and impact of pain and cramps in anti‐MAG neuropathy: a multicentre European study

Background and purpose

The frequency of pain and cramps is uncertain in anti‐myelin associated glycoprotein antibody (anti‐MAG) neuropathy. Whether these symptoms may affect function/quality of life is unknown.

Methods

A cross‐sectional study of the prevalence, correlates and impact of pain, pain subtypes and cramps, their severity, frequency and anatomical distribution was performed for 55 clinically stable patients with anti‐MAG neuropathy.

Results

Pain of any type was reported by 80% of subjects. The most common subtype was paraesthesiae and dysaesthesiae (70%). Cramps were reported by >60% of patients, with lower limb cramps in all and upper limb cramps in about 20%. Cramps affected daily activities in >30% of these subjects, sleep in 60%, ability to exercise in >30%. Total pain score correlated with several Short Form 36 health‐related quality of life (SF‐36 HR‐QoL) measures (P < 0.05), with Inflammatory Rasch‐built Overall Disability Scale (I‐RODS) (P = 0.006) and 10‐m timed walk (P = 0.019). An independent association was ascertained with I‐RODS (P = 0.002). Different pain subtypes showed multiple associations with SF‐36 HR‐QoL measures and/or functional scales. Upper limb cramps had multiple SF‐36 HR‐QoL functional correlates, with an independent association with the Overall Neuropathy Limitation Score (ONLS) (P = 0.004). Cramp severity correlated with ONLS (P = 0.04) and I‐RODS (P = 0.028) and inversely with level of physiotherapy input (P = 0.009). Cramp frequency was associated with tremor score (P = 0.004) and multiple SF‐36 HR‐QoL subsections.

Conclusions

Neuropathic pain and cramps may affect function and quality of life in anti‐MAG neuropathy. Optimizing treatments of these symptoms, including by adequate levels of physiotherapy, may be beneficial in affected patients and requires further research.     

The diagnostic spectrum in patients with suspected chronic Lyme neuroborreliosis – the experience from one year of a university hospital’s Lyme neuroborreliosis outpatients clinic

Background and purpose: Studies addressing the diagnostic relevance of anti‐Borrelia burgdorferi (BB) serum antibodies in patients with non‐specific symptoms and suspected chronic Lyme neuroborreliosis (LNB) are scarce. Methods: In this study, we enrolled within 1 year 122 patients with suspected chronic LNB. One hundred and fourteen patients had previously tested positive for BB. All patients had previously received antibiotic treatment. Each patient received a clinical examination and measurement of BB‐specific antibodies. The diagnosis of neuroborreliosis was made according to the national guidelines of the German Society of Neurology. Nine patients had acute borreliosis. One of the nine met the criteria of acute LNB. Of the remaining 113 patients, 85 patients underwent a lumbar puncture. Ten seronegative subjects without lumbar puncture were also considered. In 61.8% of these 95 patients the quality of life, of sleep, mood, and anxiety were assessed. Results: Of 95 patients, 25.3% had symptoms without a somatic cause or evidence of borreliosis, 38.9% had a well‐defined illness unrelated to BB infection, and 29.5% suffered from symptoms without a detectable somatic cause, displaying antibodies against BB. Six patients were grouped as post‐LNB syndrome. Most common symptoms in all categories were arthralgia, myalgia, dysaesthesia, depressive mood and chronic fatigue. Conclusion: Patients with persistent symptoms with elevated serum antibodies against BB but without signs of cerebrospinal fluid inflammation require further diagnostic examinations to exclude ongoing infection and to avoid co‐infections and other treatable conditions (e.g. autoimmune diseases). One patient with acute LNB, who was treated with ceftriaxone for 3 weeks suffered from LNB with new headaches and persistent symptoms 6 months later. These data should encourage further studies with new experimental parameters.     

Determinants of health‐related quality of life in anti‐MAG neuropathy: a cross‐sectional multicentre European study

Our objective was to assess determinants of quality of life (QoL) in anti‐myelin associated glycoprotein antibody (MAG) neuropathy. The SF‐36 questionnaire was assessed in 55 patients, from Marseille, Angers (France) and Birmingham (UK). Routine clinical evaluations included Medical Research Council (MRC) sum score, inflammatory neuropathy cause and treatment (INCAT) sensory score, inflammatory Rasch‐built overall disability score (I‐RODS), ataxia score, Jamar grip dynamometry, timed 10‐m walk, neuropathic pain symptom inventory (NPSI) score, and fatigue severity score (FSS). Physical component summary (PCS) and mental component summary (MCS) of the SF36 questionnaire were significantly lower than in reported normal subjects of both countries (p < 0.001). All SF‐36 domains correlated with I‐RODS, except MCS for which significance was, however, approached (p = 0.056). PCS correlated with MRC sum score, ataxia score, timed 10‐m walk, tremor, Jamar grip dynamometry, NPSI pain score, FSS and level of social support. MCS correlated exclusively with FSS and level of social support. In multivariate regression, PCS was associated independently with I‐RODS (p < 0.001) and NPSI pain score (p = 0.011), whereas MCS was associated independently with FSS (p = 0.022). QoL is accurately predicted in anti‐MAG neuropathy by the I‐RODS and FSS, lending support to their use in clinical and research settings. Effective measures to improve QoL should include tremor and neuropathic pain treatment, fatigue management, and improved social support.     

CXCL13 chemokine in pediatric and adult neuroborreliosis

Wutte N, Berghold A, Löffler S, Zenz W, Daghofer E, Krainberger I, Kleinert G, Aberer E. CXCL13 chemokine in pediatric and adult neuroborreliosis.
Acta Neurol Scand: 2011: 124: 321–328.
© 2011 John Wiley & Sons A/S. Objectives – Diagnosis of Lyme neuroborreliosis (NB) depends on the proof of intrathecal antibody production against Borrelia burgdorferi. CXCL13 has been seen to be elevated early in NB, before antibody production has started. In this study, we determined the diagnostic role of the CXCL13 chemokine in cerebrospinal fluid (CSF) and serum for the first time in pediatric NB patients as well as in adults, compared to controls and blood donors (BD). Material and methods – CXCL13 levels were measured in CSF and serum of 33 children and 42 adult patients. Serum CXCL13 was measured in 300 BD. Results – CSF CXCL13 levels were significantly elevated in definite and probable acute NB in children and adults compared to seropositive and seronegative neurological controls (P < 0.001). Serum CXCL13 levels showed great fluctuations and were not significantly elevated in NB patients. Conclusions – Our study suggests that CSF CXCL13 can be used as a diagnostic marker for NB in children as well. In contrast, CXCL13 serum levels show great variance even in the healthy population and are not indicative of active NB.     

Escitalopram in the treatment of major depressive disorder in primary‐care settings: an open‐label trial

Background: The present trial was designed to assess the efficacy and safety of escitalopram prescribed to patients seeking treatment of major depressive disorder (MDD) in a Canadian primary‐care setting. Methods: Investigators (mainly primary‐care physicians) enrolled patients with MDD from their daily practice. Patients were treated with escitalopram (flexible dose 10–20 mg/day) for up to 24 weeks. Efficacy assessments included the Montgomery–Åsberg Depression Rating Scale (MADRS), the Clinical Global Impression‐Improvement and ‐Severity scales (CGI‐I, CGI‐S), the Patient Global Evaluation (PGE), and the Medical Outcome Study 36‐item Short Form (SF‐36). Results: Out of the 647 patients enrolled, 461 (71%) completed 24 weeks of treatment. The most common reason for discontinuation was adverse events (10%). The mean MADRS score decreased from 30.7 at baseline to 10.9 at the end of 24 weeks (last observation carried forward, LOCF). Remission (MADRS≤12) was achieved by 65.5% of patients (LOCF). Symptom improvements were confirmed by global ratings of improvement made by physicians (CGI‐I) as well as patients PGE. There was improvement on all dimensions of the SF‐36, suggesting an overall improvement in quality of life. Conclusions: Escitalopram was well tolerated, safe, and efficacious. Escitalopram can be used with confidence to treat patients with MDD in Canadian primary‐care settings. Depression and Anxiety, 2008. © 2008 Wiley‐Liss, Inc.     

Long-term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well-being

Santos‐García D, Sanjurjo LF, Macías M, Llaneza M, Carpintero P, de la Fuente‐Fernández R. Long‐term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well‐being.
Acta Neurol Scand: 2012: 125: 187–191.
© 2011 John Wiley & Sons A/S. Background – Continuous duodenal levodopa infusion (DLI) is an effective therapy that improves quality of life (QoL) in advanced Parkinson′s disease (PD). However, in which aspects improve the patients their QoL has been poorly documented. Methods – We evaluated 39‐item Parkinson′s disease Quality of Life Questionnaire Summary Index score (PDQ‐39SI) changes analyzing its different domains in nine patients with advanced PD treated with DLI. Results – All the patients (64.7 ± 11.1 years, 55.5% men) improved PDQ‐39SI 6 months after beginning with DLI (29.7 ± 8.6, P = 0.008) and after median duration infusion of 25.3 ± 8.8 months (34.8 ± 11.2, P = 0.008) compared with baseline (55.6 ± 11.5). All domains except social support improved significantly at 6 months. Mobility (P = 0.012), activities of daily living (P = 0.015), and emotional well‐being (P = 0.008) improved significantly at the end of the follow‐up. Conclusions– DLI improves QoL in patients with advanced PD after short‐ and long‐term exposure. Whereas all domains except social support improve after 6 months under DLI, only mobility, activities of daily living and emotional well‐being improve significantly after long‐term exposure to DLI.     

Family recurrence and oligo-anuria predict uremic restless legs syndrome

Pizza F, Persici E, La Manna G, Campieri C, Plazzi G, Carretta E, Cappuccilli ML, Ferri B, Stefoni S, Montagna P. Family recurrence and oligo‐anuria predict uremic restless legs syndrome.
Acta Neurol Scand: 2012: 125: 403–409.
© 2011 John Wiley & Sons A/S. Objectives – To determine clinical and laboratory predictors of restless legs syndrome (RLS) in patients with end‐stage kidney disease (ESKD) undergoing long‐term hemodialysis (HD). Materials and Methods – One hundred and sixty‐two consecutive patients were assessed. History of sleep disturbances, neurological examination, clinical, and laboratory data were collected. Patients with and without RLS were compared, and a logistic regression model described the relations between independent predictors and RLS. Results – Fifty‐one patients (32%) currently had RLS (RLS+). RLS+ vs RLS? patients were more frequently women (49% vs 29%, P = 0.012), had first‐degree relative with RLS (22% vs 6%, P = 0.004), insomnia (59% vs 36%, P = 0.007), peripheral neuropathy (41% vs 21%, P = 0.006), and low residual diuresis (92% vs 68% with below 500 ml/24 h, P = 0.001). Low (OR = 8.71, CI = 2.27–33.41; P = 0.002) and absent (OR = 4.96, CI = 1.52–16.20; P = 0.008) residual diuresis, peripheral neuropathy (OR = 4.00, CI = 1.44–11.14; P = 0.008), and first‐degree relative with RLS (OR = 3.82, CI = 1.21–12.13; P = 0.023) significantly predicted RLS in ESKD patients undergoing HD. Conclusion – Positive family history for RLS together with reduced/absent residual renal function and peripheral neuropathy predicts the risk for RLS in ESKD patients undergoing HD. Longitudinal studies are warranted to correlate RLS occurrence with genetic and environmental factors.     

Plasma neurofilament light significantly decreases following treatment in Lyme neuroborreliosis and is not associated with persistent symptoms

Background and purpose

Currently there is an unmet need for a highly standardized blood biomarker test to monitor treatment response in Lyme neuroborreliosis (LNB). Differentiating between active or past infection is challenged by the relatively high frequency of persistent symptoms after the end of antibiotic treatment (estimated 15%–20%), the variable clinical course and the long-lasting Borrelia burgdorferi antibodies. The aim was therefore to evaluate plasma neurofilament light chain (pNfL) as a marker for disease activity in LNB.

Methods

This was a prospective cohort of definite LNB (N = 36) with blood samples and clinical evaluation including Glasgow Outcome Score at treatment initiation and 3 and 6 months’ follow-up. Consecutive plasma was retrospectively analysed for the content of neurofilament light chain by Quanterix® kits (Simoa® NF-light Kit).

Results

Plasma neurofilament light chain significantly decreased between treatment initiation and the 3-month follow-up (median 83 pg/ml vs. median 14 pg/ml (25 pairs), p < 0.0001). No significant change was observed between 3 and 6 months’ follow-up (median 14 pg/ml vs. median 12 pg/ml (21 pairs), p = 0.33). At treatment initiation 90% had pNfL above the age-defined reference compared to only 23% and 7% respectively at 3 and 6 months’ follow-up. Decreases in pNfL were mirrored by increasing Glasgow Outcome Score. Reporting persistent symptoms at the 6-month follow-up was not associated with pNfL (relative change from reference or actual values) at baseline or at 6 months’ follow-up.

Conclusion

Plasma neurofilament light chain decreases following antibiotic treatment in LNB and is not associated with reporting persistent symptoms. It was therefore speculated that it may prove useful as a treatment response biomarker in LNB.     

Interleukin-2 gene expression in different phases of episodic cluster headache--a pilot study

Kummer A, Scalzo P, Cardoso F, Teixeira AL. Evaluation of fatigue in Parkinson’s disease using the Brazilian version of Parkinson’s Fatigue Scale.
Acta Neurol Scand: 2011: 123: 130–136.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objective – Fatigue is common in Parkinson’s disease (PD). However, factors associated with fatigue in PD are still controversial. This study aimed to translate the Parkinson’s Fatigue Scale (PFS) into Brazilian‐Portuguese, to test its psychometric properties, and to assess the severity of fatigue in PD as well as its relation to demographic and clinical features, depression, anxiety, excessive daytime sleepiness and cognitive performance. Methods – We translated and assessed the internal consistency of the Brazilian version of the PFS. After, we assessed 87 PD patients with several neurological and psychopathological instruments. Results – The Brazilian version of PFS had good internal consistency (Cronbach’s alpha = 0.939). Clinical significant fatigue was present in 36 patients (41.4%). A logistic regression analysis showed that fatigue was better explained by dysthymia (P = 0.006), more severe symptoms of depression as assessed by the Hamilton Depression Rating Scale (P = 0.027), daytime sleepiness (P = 0.022) and female gender (P = 0.031). Conclusions – Fatigue is a common non‐motor symptom in PD and seems to be associated with female gender, dysthymia, severity of depression and daily somnolence.     

Chronic Acquired Polyneuropathy Patient Reported Index (CAPPRI) in chronic inflammatory demyelinating polyradiculoneuropathy

To date there are only two validations on the Chronic Acquired Polyneuropathy Patient‐Reported Index (CAPPRI) questionnaire, both originated from the North America. We sought to translate and validate CAPPRI for use in Serbian patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We included 109 CIDP patients. CAPPRI, short form (36) health survey (SF‐36), Medical Research Council Sum Score (MRC‐SS), Inflammatory Neuropathy Cause and Treatment (INCAT) sensory and disability scores, Beck Depression Inventory (BDI), and Krupp's Fatigue Severity Scale (FSS) were used. Serbian CAPPRI questionnaire was understandable and the language was appropriate and simple. Calculation demonstrated good person (0.9) and item (0.9) reliability with adequate item (4.1), and person (2.9) separation indices. There was a minor floor effect (13.8%), and no ceiling effect. All items had good fit, except items 2 (pain), 5 (sleeping), and 14 (eating) to some degree. Category responses were well ordered and organized, except item 14 (eating). The CAPPRI score did not vary regarding gender, age, or education. Patients with worse scores on MRC‐SS, INCAT sensory score, INCAT disability score, FSS, and BDI had worse scores on CAPPRI (P < .01). The CAPPRI score showed strong correlation with the SF‐36 score (rho = ?0.76, P < .01). The Serbian version of the CAPPRI is reliable and valid patient‐reported index for patients with CIDP, able to differentiate between levels of impairment and disability in this disease.     

Italian validation of INQoL,a quality of life questionnaire for adults with muscle diseases

Background and purpose: A quality of life (QoL) questionnaire for neuromuscular diseases was recently constructed and validated in the United Kingdom in a sample of adult patients with a variety of muscle disorders. Preliminary results suggested it could be a more relevant and practical measure of QoL in muscle diseases than generic health measures of QoL. The purpose of our work was: (i) To validate INQoL in Italy on a larger sample of adult patients with muscle diseases (ii) to compare INQoL to SF‐36. Methods: We have translated into Italian and applied language adaptations to the original UK INQoL version. We studied 1092 patients with different muscle disorders and performed (i) test–retest reliability (n = 80); (ii) psychometric (n = 345), known‐group (n = 1092), external criterion (n = 70), and concurrent validity with SF‐36 (n = 183). Results: We have translated and formally validated the Italian version of INQoL confirming and extending results obtained in the United Kingdom. In addition to good results in terms of reliability, known‐group and criterion validity, a comparison with the SF‐36 scales showed a stronger association between INQoL total index and SF‐36 physical (r = ?0.72) than mental (r = ?0.38) summary health indexes. When considering comparable domains of INQoL and SF‐36 with respect to an objective measure of muscle strength assessment (MMRC), regression analysis showed a stronger correlation using INQoL rather than SF‐36 scores. Conclusions: INQoL is recommended to assess QoL in muscle diseases because of its ability to capture physical limitations that are specifically relevant to the muscle condition.     

Intraventricular thrombolysis with rt-PA in patients with intraventricular hemorrhage

Dunatov S, Antoncic I, Bralic M, Jurjevic A. Intraventricular thrombolysis with rt‐PA in patients with intraventricular hemorrhage.
Acta Neurol Scand: 2011: 124: 343–348.
© 2011 John Wiley & Sons A/S. Objectives – To evaluate safety, clinical feasibility, and outcome of intraventricular (IVen) administration of recombinant tissue plasminogen activator (rt‐PA) in patients with intraventricular hemorrhage (IVH). Materials and methods – Forty‐eight patients with IVH who received IVen rt‐PA were compared with 49 age‐, sex‐, Glasgow Coma Scale score‐, and Intracerebral Hemorrhage score‐matched control patients. Patients with IVH of aneurysmal or arteriovenous malformation origin were excluded. External ventricular drainage was inserted as soon as baseline CT was performed and rt‐PA was administered within 12 ± 1 h after the ictal onset. Results – The outcome after 3 months was evaluated using the modified Rankin Scale (mRS). In addition, Glasgow Outcome Scale (GOS) and mortality were assessed. A good outcome, defined as mRS 0–3, was detected in 27% of patients from the control group vs 58% of patients in the IVen group; P = 0.003. GOS as other outcome scale yielded a significant difference between groups: 20% in the control group, vs 54% in the IVen group; P = 0.001. A statistically significant decrease in mortality was observed in the IVen group: 30% in the control vs 10% in IVen group; P = 0.003. No one patient died because of a complication which could be directly attributed to the IVen thrombolytic therapy. Conclusions – IVen administration of rt‐PA seems to be safe in cases of IVH. This pilot study shows that it may be associated with better outcomes. Further studies and clinical randomized trials are needed to establish indications and IVen administration protocols.     

D‐dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

Krarup L‐H, Sandset EC, Sandset PM, Berge E. D‐dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation.
Acta Neurol Scand: 2011: 124: 40–44.
© 2010 John Wiley & Sons A/S. Background – Patients with acute ischemic stroke and atrial fibrillation are at increased risk of stroke progression and recurrence. We sought to assess whether D‐dimer and other markers of hemostatic activation could predict these adverse events in such patients. Method – Blood samples were obtained from patients included in the Heparin in Acute Embolic Stroke Trial. Stroke progression was defined as a ≥3‐point worsening on the Scandinavian Stroke Scale during the first 48 h after randomization. Blood samples were analyzed for D‐dimer, prothrombin fragment 1 + 2, soluble fibrin monomer, and C‐reactive protein. Results – A total of 382 patients were included in the analyses. Levels of D‐dimer and other markers of hemostatic activation were not significantly higher in patients with stroke progression than in other patients (D‐dimer median values: 1025 ng/ml vs 970 ng/ml, P = 0.73). The same was true for recurrent stroke (D‐dimer: 720 ng/ml vs 973 ng/ml, P = 0.96), and the combined endpoint of stroke progression, recurrent stroke, and death (D‐dimer: 991 ng/ml vs 970 ng/ml, P = 0.91). Multivariable analyses did not alter the results. Conclusion – D‐dimer and other markers of hemostatic activation were not associated with stroke progression, recurrent stroke, or death in patients with acute ischemic stroke and atrial fibrillation.     

Validation of the multiple sclerosis international quality of life (MusiQoL) questionnaire in Norwegian patients

Beiske AG, Baumstarck K, Nilsen RM, Simeoni M‐C. Validation of the multiple sclerosis international quality of life (MusiQoL) questionnaire in Norwegian patients.
Acta Neurol Scand: 2012: 125: 171–179.
© 2011 John Wiley & Sons A/S. Objectives – To assess the validity and reliability of the multidimensional, self‐administered Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire, previously validated in a large international sample, in Norwegian patients. Patients and methods – Patients with different types and severities of multiple sclerosis (MS) were recruited from a single MS centre in Norway. All patients completed the MusiQoL and Short Form‐36 (SF‐36) QoL questionnaires at baseline and a mean of 21 (SD 7) days later. A neurologist collected sociodemographic, MS history and outcome data. Construct validity, internal consistency, reproducibility and external consistency were tested. Results – One hundred and four patients were evaluated. Construct validity was confirmed in terms of satisfactory item internal consistency correlations in eight of nine MusiQoL dimensions (Spearman’s correlation: 0.34–0.79) and scaling success of item discriminant validity (75.0–100%). All dimensions of the MusiQoL questionnaire exhibited satisfactory internal consistency (Cronbach’s alpha: 0.44–0.87) and reproducibility (intraclass correlation coefficients: 0.36–0.86). External validity testing showed that the global MusiQoL score correlated significantly with all but one individual SF‐36 dimension score (Spearman’s correlation: 0.29–0.56). Conclusions – These results demonstrate that the Norwegian‐language version of the MusiQoL questionnaire is a valid and reliable instrument for assessing health‐related QoL in Norwegian patients with MS.     

The long‐term functional status in patients with Guillain‐Barré syndrome

Background and purpose: The purpose of this study was to analyse the long‐term impact of Guillain‐Barré syndrome (GBS) on quality of life, and the relationship between clinical variables at disease onset and symptoms at follow‐up to general health status. Methods: Forty‐two GBS patients were examined at median 6 years after disease onset and were compared with 50 healthy controls. The fatigue severity scale (FSS), visual analogue scale (VAS) for pain, disability rating index (DRI) and medical outcome study 36‐item short‐form health status scale (SF‐36) were applied. Variables at onset and symptoms at follow‐up were correlated with outcome measurements in GBS. Results: VAS [2.9 (SD 3.3) vs. 1.5 (SD 1.9); P = 0.01] and DRI [2.5 (SD 2.1) vs. 1.0 (SD 1.5); P < 0.001] were significantly higher in patients with GBS, compared with healthy controls. Decreased physical functioning and general health were found on SF‐36. Differences between GBS patients with shorter (<6 years) and longer (≥6 years) follow‐up after onset were not found. Conclusions: Relatively independent from various variables at onset, patients with GBS seem to have a reduced quality of life and functioning, and the distress seems to have become persistent after the first few years with improvement following the acute disease.