Diazepam to improve acute stroke outcome: results of the early GABA-Ergic activation study in stroke trial. a randomized double-blind placebo-controlled trial

BACKGROUND: We tested whether diazepam, a GABA-ergic drug that also inhibits brain nitric monoxide formation, improves acute stroke prognosis. METHODS: 880 patients, randomized within 12 h of acute stroke, received diazepam 10 mg or placebo by rectiole, as soon as possible, followed by 10-mg tablets twice daily for 3 days. Primary outcome was independence (Rankin score <3) at 3 months; secondary outcome was complete recovery (Barthel index >or=95 or Rankin score 相似文献   

The long-term outcome of delinquent children: a 30-year follow-up study

This study reports the results of a longitudinal study of unselected samples of German delinquent children, stratified by frequency of offences recorded before and after the age of criminal responsibility (14 years). A total of 256 young adults (mean age, 22 years), juvenile offenders and control non-offenders, were assessed using the following: a standardized interview regarding family, child development and life history; a multidimensional personality inventory (the Freiburg Personality Inventory, FPI); a version of the Wechsler Adult Intelligence Scale; a self-report questionnaire on the delinquency for which the subject was not apprehended during childhood; and a questionnaire concerning parental child-rearing style. The subsequent criminal records of subjects were followed over the next 20 years. It was possible to define three outcome groups (non-offenders, persisters and desisters), which differed in many respects. The outcome was significantly predicted by several variables. Psychosocial risk variables were the most effective predictors, followed by personality variables and childhood delinquency for which the subject had not been apprehended. The distinction between early-onset and late-onset delinquency as a predictor of adult criminality proved valid only if non-apprehended childhood offending was taken into account. The implications of the study for preventive intervention are discussed.     

Recovery of aphasia after stroke: a 1-year follow-up study

Semantics, phonology, and syntax are essential elements of aphasia diagnosis and treatment. Until now, these linguistic components have not been specifically addressed in follow-up studies of aphasia recovery after stroke. The aim of this observational prospective follow-up study was to investigate semantic, phonological, and syntactic recovery in aphasic stroke patients. In addition, we investigated the recovery of verbal communication and of aphasia severity. We assessed 147 aphasic patients at 1, 2, and 6 weeks, 3 and 6 months, and 1 year after stroke with the ScreeLing, a screening test for detecting deficits on the three main linguistic components, the aphasia severity rating scale (ASRS), a measure of verbal communication, and the Token test, a measure of aphasia severity. We investigated the differences in scores between the six time points with mixed models. Semantics and syntax improved up to 6 weeks (p < 0.001) after stroke, and phonology up to 3 months (p ≤ 0.001). ASRS improved up to 6 months (p < 0.05) and the Token test up to 3 months (p < 0.001). We conclude that in aphasia after stroke, various linguistic components have a different recovery pattern, with phonology showing the longest period of recovery that paralleled aphasia severity, as measured with the Token test. The improvement of verbal communication continues after the stabilization of the recovery of the linguistic components.     

Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke

Repetitive transcranial magnetic stimulation (rTMS) or sham stimulation was given over the motor cortex daily for 10 days to two randomly assigned groups of 26 patients with acute ischemic stroke. Patients otherwise continued their normal treatment. Disability scales measured before rTMS, at the end of the last rTMS session, and 10 days later showed that real rTMS improved patients' scores more than sham.     

Suicidal ideation among the long-term unemployed: a 5-year follow-up

Suicidal ideation was monitored in a 5-year follow-up of a representative sample of long-term unemployed Norwegians. Four items from the General Health Questionnaire-28 were used as a Suicidal Ideation Index, which showed a prevalence of 17% in the present sample of unemployed subjects, higher than the value of 11% in a sample of Australian students used to construct the Index. Five years later, suicidal ideation was found in 6% of those who had been re-employed and 22% of those still unemployed, indicating that the high prevalence of suicidal ideation may be due to unemployment. Routine clinical examination was also tried for preventive purposes. In total, 8% of the unemployed subjects showed clinically significant suicidal ideation. They were referred to a psychologist or their GP, and were given the standard advice about suicide prevention. A Resource Centre, which many employees at the Labour Office have missed, has now been set up in the area under the National Plan for Suicide Prevention.     

Magnetoencephalography in stroke: a 1-year follow-up study

Recovery after stroke is closely linked to cerebral plasticity. Magnetoencephalography (MEG) is a non-invasive technique, which allows location of cerebral cells activities. In the present work, a cohort of patients has been studied with MEG. Twelve patients with a recent ischemic or hemorragic stroke were included as soon as possible after onset of stroke. Neurologic assessment, including standard neurologic examination, functional independence measure (FIM) and Orgogozo's scale was performed for 1 year in addition to a study of the somatosensory evoked field (SEF) using a 37-channel Biomagnetometer system. No response could be recorded in five patients at the first SEF exploration. In three cases, no response was ever recorded during the study. All these patients had a bad recovery. The location of the SEF sources was always in the normal non-infarcted cortex of the postcentral gyrus. Sensory recovery seemed to be linked to the reorganization of the persistent functional cortex, which was a limiting factor for recovery. These observations confirm the experimental results obtained in animal models. After stroke it can be assumed that in the case of incomplete lesion, an intensive sensory peripheral stimulation could maximize the use of residual sensory function and then contribute to improve the sensory deficit. In case of total sensory loss other techniques have to be used, such as visual monitoring of hand activity in order to improve hand function.     

Long-term outcome is unchanged by antiepileptic drug treatment after a first seizure: a 15-year follow-up from a randomized trial in childhood

PURPOSE: In 1989 we reported that 1 year of daily treatment with carbamazepine (CBZ) significantly reduced the recurrence rate after a first afebrile seizure in children compared with no treatment in a randomized open trial. We sought to determine if the long-term clinical course and rate of remission were changed by treatment starting after the first seizure. METHODS: Participants of the original trial (14 CBZ, 17 no medication) were contacted in 2001. RESULTS: Sixteen controls and 10 CBZ (84%) cases were followed up for 15 years. After randomization and follow-up, 12 controls and five treated patients had at least one more seizure (p = NS). For those with recurrences, the number of recurrences appeared to be the same in both groups. Number of medications used was also the same. Terminal remission (>2 years seizure free with or without medication) was achieved by eight (80%) of 10 CBZ and 14 (88%) of 16 controls, and terminal remission off medication in six (60%) of 10 CBZ (p = NS). CONCLUSIONS: Based on this small study with long follow-up, it appears that for children treated with CBZ after a first seizure, the subsequent clinical course and remission rates are not improved in comparison with a no-treatment strategy. Delaying treatment after a first seizure appears defensible.     

The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

Objective

Epileptic seizures are a common complication after stroke. The relation between occurrence of seizures after stroke and long-term mortality remains elusive. We aimed to assess whether seizures in an early or late phase after ischemic stroke are an independent determinant of long-term mortality.

Methods

We prospectively included and followed 444 ischemic stroke patients with a first-ever supratentorial brain infarct for at least 2 years after their stroke regarding the occurrence of seizures. The final follow-up for mortality is from April 2015 (follow-up duration 24.5–27.8 years, mean 26.0 years, SD 0.9 years). We compared patients with early-onset seizures with all seizure-free patients, whereas the patients with late-onset seizures were compared with the 1-week survivors without any seizures. We used Cox-regression analyses to correct for possible confounding factors.

Results

Kaplan–Meier analysis showed significantly higher mortality for the patients with early-onset seizures (p?=?0.002) but after correction for known risk factors for (long term) mortality early-onset seizures had no independent influence on long-term mortality (HR 1.09; 95% CI 0.64–1.85). In patients with late-onset seizures, no significant influence from late-onset seizures on long-term mortality was found (univariate p?=?0.717; multivariate HR 0.81; 95% CI 0.54–1.20).

Conclusion

Both early-onset and late-onset seizures do not influence long-term mortality after ischemic stroke.

     

Metabolic syndrome increases the risk of stroke: a 5-year follow-up study in a Chinese population

Limited information is available on the relationship between metabolic syndrome and stroke in the Chinese population. The aim of this study was to establish the prevalence of metabolic syndrome in the Chinese population and the relationship between stroke and metabolic syndrome in that population. 2,173 subjects aged 45 years and above without a history of stroke were recruited from six communities in Chongqing city, China. The participants were followed for incident stroke events (ischemic stroke and hemorrhagic stroke) for 5 years. Incidence rates and hazard ratios (HRs) for both subtypes of stroke were stratified by the presence or absence of metabolic syndrome and by each component. Among the subjects, women had a higher prevalence rate of metabolic syndrome than men (26 vs. 19%). As the number of metabolic syndrome components increased, HRs increased significantly, up to 5.1 (95% CI, 1.9–7.4) for ischemic stroke and 3.3 (95% CI, 1.7–5.7) for hemorrhagic stroke. We found that abdominal obesity had the highest HR (2.12, P < 0.001) for ischemic stroke, followed by metabolic syndrome (HR 1.65, P < 0.001). For hemorrhagic stroke, high blood pressure had the highest HR (2.17, P < 0.001), followed by abdominal obesity (HR 1.83, P < 0.001). After 5-year follow-up, the survival rates of stroke events were 94.2% among those with metabolic syndrome and 96.9% among those without. As the number of metabolic syndrome components increased, survival rates decreased progressively, from 99.6% for individuals with none of the components to 90.1% for those with four to five components. The results showed that metabolic syndrome is highly prevalent among the Chinese adult population and is associated with an increased risk for both ischemic stroke and hemorrhagic stroke.     

Correction to: The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

Journal of Neurology - The original article can be found online at     

Lifestyle intervention can prevent weight gain during menopause: Results from a 5-year randomized clinical trial

Context: Menopausal-related weight gain and increased waist circumference have major cardiovascular health implications for older women. The efficacy of a dietary and physical activity lifestyle intervention to prevent weight gain and elevations in cardiovascular disease (CVD) risk factors from the peri- to postmenopause is unknown.Objective: To report the 54-month results of a lifestyle dietary and physical activity program on weight, body composition, physical activity, diet, and other CVD risk factors.Design: Data are from a 5-year randomized clinical trial known as the Women’s Healthy Lifestyle Project, conducted from 1992 to 1999.Participants: 535 healthy, premenopausal women ages 44 to 50 at study entry enrolled into the trial.Intervention: Participants were randomly assigned to either a lifestyle intervention group receiving a 5-year behavioral dietary and physical activity program or to an assessment-only control group. The lifestyle intervention group was given modest weight loss goals (5–15 lb, or approximately 2.3–6.8 kg) to prevent subsequent gain above baseline weight by the end of the trial. To achieve weight loss and lower low-density lipoprotein cholesterol levels, intervention participants followed an eating pattern consisting of 1,300 kcal/day (25% total fat, 7% saturated fat, 100 mg of dietary cholesterol) and increased their physical activity expenditure (1,000–1,500 kcal/week).Main Outcome Measures: Regarding weight gain prevention, 55% (136/246) of intervention participants were at or below baseline weight compared with 26% (68/261) of controls after 4.5 years, χ(2, N = 507) = 45.0, p < .001. The mean weight change in the intervention group was 0.1 kg below baseline (SD = 5.2 kg) compared with an average gain of 2.4 kg (SD = 4.9 kg) observed in the control group. Waist circumference also significantly decreased more in the intervention group compared with controls (M = −2.9 cm, SD = 5.3 vs. M = −0.5 cm, SD = 5.6, p < .001). Moreover, participants in the lifestyle intervention group were consistently more physically active and reported eating fewer calories and less fat than controls. Long-term adherence to physical activity and a low-fat eating pattern was associated with better weight maintenance.Conclusions: In healthy women, weight gain and increased waist circumference during the peri- to postmenopause can be prevented with a long-term lifestyle dietary and physical activity intervention. This research was supported through a grant from the National Heart, Lung, and Blood Institute, National Institutes of Health awarded to Lewis H. Kuller, M.D., Dr. PH. (HL 45167-03). We thank the participants of Women’s Healthy Lifestyle Project for their enduring dedication and the investigators and staff for their valuable contributions to the study (listed in alphabetical order): Michelle Berry, Alhaji Buhari, Michele Burnette, Jane Cauley, Yuefang Chang, David Chernew, DJ Conner-Beatty, Debbi Cusick, Aileen Faulkner, Shannon FitzGerald, Rich Foran, Sara Friel, Ed Gregg, Donna Hansen, Beth Hauth, Diane Ives, Ja Kielty, Mary Lou Klem, Andrea Kriska, Jean Lennon, Araxi Macaulay, Mehran Massoudi, Nancy Mazzei, Eileen McMahon, Elaine Meilahn, Marguerite Meyer, N. Carole Milas, Joann Naujelus, Pam Carter-Nolan, Mary Parker, Annette Rexroad, Loran Salamone, Danit Shahar, Siao Mei Shick, Maria Smith, Pam Vincent, Michelle Volansky, Charlene Walter, Marie Wilkerson, and Randi Wolf.