Impact of treatment on the short-term prognosis of status epilepticus in two population-based cohorts

Purpose Epidemiological surveys on status epilepticus (SE) in adults in two Italian areas (Bologna and Lugo di Romagna) disclosed a major difference in 30-day case fatality (33% versus 7 %). Since suboptimal management was hypothesised in the first site, we compared the quality of treatment in the two cohorts and examined its contribution to prognosis. Methods The Bologna and Lugo di Romagna cohorts of adults with incident SE were included. Patients with post-anoxic encephalopathy were excluded. Quality of treatment was independently classified by two experts. Clinical and treatment features were compared in the two sites. The contribution of variables collected to the 30-day case fatality was explored through multivariate logistic analysis in the whole group of patients. Results Fifty-seven patients were included. No differences were observed between Bologna and Lugo di Romagna either in clinical features or the time of management. The quality of global drug treatment significantly differed in disfavour of Bologna (p = 0.044). Independent predictors of a worse 30-day case fatality in the whole group of patients were the onset of SE in hospital (OR 9.67, p = 0.0095) and the poor global quality of treatment (partially correct versus correct OR 3.59, p = 0.55, and incorrect versus correct OR 21.09, p = 0.0084). By subgroup analysis, the site of onset factor encompasses the aetiologic background of patients. Conclusion In addition to previously known prognostic factors, epidemiological comparison of mortality rates of SE between different regions must also consider the quality of treatment.     

糖尿病合并脑卒中的研究现状

脑卒中在人类死亡原因中排第3位，是造成严重残疾的首要原因，而且脑卒中的发病率呈明显的上升趋势。大量临床研究发现，糖尿病患者合并脑卒中的风险较非糖尿病患者显著提高，糖尿病是急性脑卒中的独立危险因素之一。并且糖尿病患者在脑卒中后的病死率和残障程度较非糖尿病患者明显升高。本文通过阐述糖尿病患者脑卒中的临床表现、脑损伤机制及预后的特点，以提高糖尿病性脑卒中的诊治效果，改善患者预后。     

肠内营养对急性脑卒中伴吞咽障碍患者短期预后的影响

目的探讨肠内营养对急性脑卒中伴吞咽障碍患者短期预后的影响。方法将86例急性脑卒中伴吞咽障碍患者随机分为肠内营养组(实验组)43例和家庭传统喂养组(对照组)43例。比较21d后2组患者的营养状态、感染发生率、神经功能缺损评分(NIHSS)。结果住院21d时,实验组血清白蛋白、前白蛋白、血红蛋白、上臂肌围等指标均优于对照组,差异均有统计学意义(P0.05);实验组合并感染的发生率为27.9%,对照组为53.5%,2组差异有统计学意义(P0.05);实验组NIHSS评分(11.13±2.03)分低于对照组的(15.35±2.76)分,2组间比较差异有统计学意义(P0.05)。结论对于急性脑卒中伴吞咽障碍患者,早期实施肠内营养能够提升患者营养状态,减少感染发生率,降低神经功能缺损评分,从而改善患者短期预后。     

脑卒中急性期血压与预后的关系

目的分析脑卒中急性期血压与预后的关系，为临床治疗和试验设计提供依据。方法采用前瞻性队列研究方法，连续登记2002年3月至2004年3月人院、发病24h内的脑卒中患者。连续观察人院后10d血压，随访1个月和6个月时死亡、残疾和复发情况。采用Logistic多因素逐步回归分析血压与预后关系。结果共纳入脑卒中患者592例。血压与预后呈U型关系。人院时血压在120／90mmHg左右、第1—7天每天的平均血压在140／90mmHg左右预后较好。独立影响1个月死亡的血压因素是24h内血压下降程度，独立影响6个月死亡／残疾的是第3—7天每天的平均血压。结论脑卒中患者急性期血压独立影响预后，人院7d内血压处理应谨慎。     

Risk factors affecting prognosis in infantile spasm

Aim: To assess risk factors that affect epilepsy prognosis and neurodevelopmental outcome and response to treatment in patients diagnosed with infantile spasm. Methods: In this study, demographics, treatment modalities, etiologies, risk factors affecting neurodevelopmental outcome and epilepsy prognosis were assessed retrospectively at the end of a minimum 24-months follow-up of 104 patients diagnosed with infantile spasm from May 2012 to October 2015. Results: Neonatal seizure during neonatal period, abnormal head circumference, young age at the time of presentation and early gestational age, symptomatic etiology, abnormal initial examination and abnormal development test at the time of diagnosis, consanguinity, the medical center where treatment was started in the second center or beyond and magnetic resonance imaging finding were found to be statistically significant for poor prognosis in terms of neurodevelopment (p < 0.05). Abnormal initial examination and abnormal development test both at the time of diagnosis and at the end of follow-up, consanguineous parents, young age at the time of presentation, symptomatic etiology, a family history of mental retardation and epilepsy were found to be statistically significant for poor prognosis in terms of epilepsy. Administration of adrenocorticotropic hormone (ACTH) for seizure control was statistically significant compared to other antiepileptic drugs (p < 0.05). Conclusion: Infantile spasm is an age-related epileptic encephalopathy, and it was observed that it is still catastrophic, and that the most important factor affecting prognosis of epilepsy is etiology, age at the time of presentation and the medical center where treatment was started in the second center or beyond.     

脑卒中预后的影响因素分析

目的探讨影响脑卒中患者3个月预后的相关危险因素。方法以首发脑卒中住院的急性患者为研究对象，记录其人口特征，脑卒中危险因素，最初脑卒中严重性如眼球运动障碍、失语、吞咽困难、尿失禁(UI)、格拉斯哥昏迷评分(GCS），神经功能缺损评分(NIHSS)，日常生活能力评分(BI）及脑卒中类型；3月后随访其功能康复情况：牛津残障评分(OHS）．并分析影响脑卒中预后的相关危险因素。结果Logistic回归分析发现：GCS，UI和NIHSS独立地与脑卒中后3个月预后不良显著相关。结论脑卒中急性期尿失禁、GCS评分高及神经功能缺损严重是脑卒中后3个月死亡或严重残疾的独立预测指标。     

Course and prognosis of chronic progressive multiple sclerosis: Results of an epidemiological study

In studies on the natural course of multiple sclerosis (MS), several forms of the disease are distinguished. The most important are the relapsing remitting and the chronic progressive forms. The relationship between these remains unclear. In a prospective epidemiological survey we studied the course of MS using the year in which the chronic-progressive phase started as a landmark. The reliability of this "year of progression" was examined in an observer agreement study. Data were acquired from 342 patients. Progression of the handicap was most rapid in case of a secondary progressive course, female sex, high relapse rate in the preceding remitting phase and "year of progression" at a higher age. Survival after the "year of progression" was lowest in the secondary progressive group. Determining the "year of progression" seems to be significant for the prognosis.     

Long-term prognosis of ischemic stroke in young adults

Abstract Background There have been few studies of the long-term prognosis of young adults with ischemic stroke. The present study aimed to evaluate the long-term clinical outcome in a large series of young adults with ischemic stroke admitted to a tertiary medical center over the last 27 years, and to identify possible predictors for mortality, stroke recurrence and poor functional recovery. Methods We retrospectively reviewed 272 young adults (15–45 years) with a first-ever ischemic stroke admitted to the Neurology Department of University Hospital 12 de Octubre between 1974 and 2001. Follow-up assessments were performed by review of medical records and telephone interviews. Results Nine patients (3 %) died as the result of their initial stroke and follow-up information about the status of 23 (8%) patients was not available. The remaining 240 patients (89%) were followed. Two hundred and ten of them (88%) were alive with a mean follow-up of 12.3 years and 30 (12%) died during follow-up. The average annual mortality rate was 1.4%, being notably higher during the first (4.9%) than in the subsequent years (0.9 %) after the initial stroke. Ninety per cent of the followed patients were independent and 53% returned to work, although adjustments were necessary for 23% of them. The annual stroke recurrence rate during the first year was 3.6% dropping to 1.7 % in subsequent years. Age over 35 years, male gender, the presence of cardiovascular risk factors and large-artery atherosclerosis in the carotid territory were predictors of negative long-term outcome after the initial stroke. Conclusions The long-term prognosis for the ischemic stroke in the young is better than in the elderly, but the risk of mortality in young adults with ischemic stroke is much higher than in the general population of the same age. A bad prognosis is associated with an atherosclerotic risk profile, with a higher mortality and recurrent stroke rates and poorer functional recovery. The main functional limitation in the young survivors of their initial ischemic stroke occurs in work activity, since most patients are independent but almost half of them do not return to work.     

缺血型烟雾病手术疗效的多中心研究

目的 通过多中心回顾性研究探讨脑血运重建术及不同手术方式在预防脑卒中再发生及神经功能预后的疗效。方法 研究纳入了中南大学湘雅医院、常德市人民医院和湖南省儿童医院462例缺血型烟雾病患者的临床信息、影像学资料和随访资料,进行倾向性评分匹配后采用Kaplan-Meier曲线比较手术与保守治疗后卒中再发生的差异;多因素Cox回归分析筛选手术治疗的影响因素。结果 462例烟雾病患者平均随访时间为33.6个月,242例手术治疗和220例保守治疗患者中分别有31例（12.8%）和63例（28.6%）新发脑卒中,进行倾向性评分匹配后,185例手术治疗和185例保守治疗患者纳入进一步分析。Kaplan-Meier曲线分析显示两者新发脑卒中发生存在差异（P=0.018）;多因素Cox生存分析提示后循环受累（95% CI：2.343~11.375, P<0.001）和脑白质病变（95% CI：1.083~4.828, P=0.030）是手术后卒中再发的危险因素,两种手术方式（联合和间接血运重建术）在卒中再发生预防方面无统计学差异（P=0.777）。结论 与保守治疗相比,手术能降低缺血型烟雾病卒中再发生的风险和取得良好预后,不同手术方式对防止脑卒中再发生无差异。 [国际神经病学神经外科学杂志, 2024, 51(2): 23-28]     

On the prognosis of outcome after stroke

OBJECTIVES: The study was aimed at improving the accuracy of prognosis for recovery of function in patients suffering a first stroke. MATERIALS AND METHODS: Two-hundred and forty-eight patients were enrolled. The mean interval since the stroke was 23 days. Patients entered a rehabilitation program lasting 60 days. The predictive value of 12 factors were analysed, namely motor, cognitive and sphincter subitems of Functional Independence Measure at admission (FIM-a), age, sex, education, body mass index (BMI), depression, neglect, aphasia, ideomotor and constructive apraxia. FIM score at discharge was the dependent variable. RESULTS: A multiple regression revealed that only age, cognitive and sphincter subitems of FIM-a, neglect and ideomotor apraxia were significantly associated with outcome. Moreover, these factors accounted for only 72% of the variance in outcome scores. A decision of unfavourable prognosis on the basis of a FIM-a value lower than 40 was incorrect in 2.8% of the patients in this study and in 8.2% of those having a FIM score lower than 40. CONCLUSIONS: The use of statistical methods to examine the outcome after stroke is useful for expressing probability on a group basis but is unsuitable for determining the prognosis of individual patients. Such data should not be used for fiscal management. A significant minority of patients presenting with a FIM lower than 40 can regain a useful measure of independence. The errors in prognosis based upon available methods, although small, have unacceptable effects in human terms if they lead to the clinical decisions which deny patients rehabilitation. All of the patients should therefore be admitted for rehabilitation after their first stroke. Severe comorbidity requires special attention.     

Psychological problems affecting the prognosis of stroke patients

BACKGROUND: It is believed that mental disorder influences the morbility and prognosis of cardio-cerebrovascular disease by biological factors. OBJECTIVE: To observe the characteristics of stroke patients complicated by psychological problems and the prognosis of such patients. DESIGN: Observational study. SETTING: Department of Neurology, Beijing Longfu Hospital. PARTICIPANTS: Totally 160 inpatients (46 males and 114 females) with stroke admitted to Department of Neurology, Beijing Longfu Hospital between June 2005 and June 2006 were recruited in this study. The involved patients all corresponded to the diagnosis criteria of cerebrovascular disease formulated in the 1995 National Conference of Cerebrovascular Disease and confirmed by skull CT or MRI examination. The age range was between 43 and 74 years. They all signed the informed consent for the detection and therapeutic regimen, and the application of this technique also gave the approval of the Ethics Committee of the hospital. METHODS: On admission, the patients were investigated on psychological problems using Hopkin symptom checklist. After admission, all the patients received oral administration of aspirin anti-platelet drugs and intravenous infusion of Fufang Danshen. Motor relearning program was used in the rehabilitation treatment for disability rehabilitation. Mental intervention was carried out in the end of observation period. On day 30 after admission, the recovery of two groups of patients was compared using activities of daily living scale, Scandinanvian Stroke Scale (SSS) and disability level. MAIN OUTCOME MEASURES: The activities of daily living were assessed with Barthel index. Higher scores of patients suggested better activities of daily living. For SSS, the higher points, the severer defect degree. The reduction of scores of neurologic impairment suggested that neurological function improved. Disability level was graded according to the method formulated in the Second National Cerebrovascular Conference. RESULTS: All the 160 involved stroke patients participated in the final analysis. ① Hopkin symptom checklist assessment results: Of the 160 stroke patients, 94 (58.7%) were assessed as having any psychological problems. In this study, psychological problems were more likely to be seen in female patients (74.4%) than in male patients (26.1%). Major psychological problems were depression (53.8%), compulsion (52.5%) and anxiety (46.2%). ② Comparison of prognosis of patients: Significant differences in activities of daily living-Barthel index, SSS scores and disability level were found between pre- and post-treatment periods. It indicates that stroke patients complicated by mental disorder had poor prognosis. CONCLUSION: The incidence of complicated psychologic obstacle is high in stroke patients, and its prognosis is inferior to that of patients who have no psychological problems.     

卒中单元对急性脑卒中患者近期预后的影响

目的 探讨卒中单元对急性脑卒中患者近期预后的影响.方法 196例急性脑卒中患者(脑出血59例,脑梗死137例)随机分为卒中单元组(101例)和普通病房组(95例),并进行相应的治疗.比较两组治疗后与治疗前美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)的差值及疗效,以及并发症的发生率.结果 与治疗前比较,卒中单元组治疗后NIHSS评分降低(12.6± 5.5)分,普通病房组降低(8.9 ±4.1)分;卒中单元组BI升高24.3±14.8,普通病房组升高15.1±10.6;两组间差异有统计学意义(均P<0.05).卒中单元组基本痊愈率、总有效率、并发症发生率及病死率(27.7%、97.0%、10.9%及2.0%)与普通病房组(15.8%、88.4%、23.2%及8.4%)比较差异均有统计学意义(均P<0.05).结论 卒中单元能明显改善急性脑卒中患者的近期预后.     

Interest in participating in clinical research: A study of essential tremor patients.

Enrolling essential tremor (ET) patients in clinical research can be challenging. Investigators can maximize recruitment by targeting patient subgroups with greater interest in participation. Nothing has been published on factors that are associated with higher levels of interest in participation. The objective of this study was to identify factors associated with higher levels of interest in participating in clinical research on ET. A total of 149 ET patients were questioned about level of interest in participating in future research. Two questions were used, although one was of primary interest. Interest was rated from 0 to 10 (maximal). Data were collected on demographic factors, family history, and tremor-related disability. Tremor severity was assessed. The mean level of interest was 8.0 +/- 2.3. Level of interest was not related to age of tremor onset, tremor duration, tremor severity, extent of tremor-related disability, or use of tremor medication. Level of interest was related to family history of tremor (P < 0.05), concern that other family members might develop tremor (P < 0.05), >2 versus 0 live births in women (P < 0.05), the view that the tremor worsens with age (P < 0.05), and presence of head tremor (P = 0.05). A variety of factors were identified that were associated with greater interest in participating in clinical research. These observations should be assessed in additional patient samples. Investigators may use our observations to identify and target patients for clinical trials and other research.     

The prognosis of demented patients — one-year follow-up study of a population sample

Functional decline and mortality after 1-year follow-up of 93 demented elderly subjects from a random population sample (N =795) were studied in Helsinki, Finland. Seventeen (18%) of the demented patients died as compared to only 5% of the non-demented subjects. The age-adjusted risk ratio for 1-year mortality of demented patients was 3.2 (95% confidence interval 1.8–5.6). Forty-four per cent (26/59) of the surviving patients who were not bedridden and incontinent at the very beginning of the study suffered further impairment in the following functions: institutionalization (6/21), losing the ability to walk (5/57) or beginning of incontinence (17/30). Sixteen (21%) surviving subjects were already bedbound, incontinent and institutionalized at the beginning of the study. Age, sex or the degree of dementia did not correlate to mortality or functional decline. The number of patients who were institutionalized during the follow-up was small. The appearance of incontinence and other recorded risk factors (age, degree of dementia or motility) did not seem to predispose to institutionalization. Subjective factors, such as caretaker's burden, probably have a great influence on the ending of home care.     

Restless legs syndrome,a predictor of subcortical stroke: a prospective study in 346 stroke patients

ObjectiveThe objective of this study was to assess the prevalence of restless legs syndrome (RLS) among patients with stroke and to examine the anatomical correlation between location of stroke and RLS symptoms.MethodsWe administered a pre-structured sleep questionnaire to consecutive stroke patients seen in our neurology services department over a 3-year period. Unconscious (Glasgow Coma Scale score <15) or aphasic, renally impaired, or neuropathic patients were excluded. Diagnosis of RLS was established according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG), and polysomnography was conducted.ResultsOf 346 stroke patients, 35 (10.11%) fulfilled IRLSSG diagnostic criteria for RLS, which had existed for an average (±standard deviation) of 60 ± 40 months before stroke. The mean age of onset was 52.94 (±10.32) years. Twenty-four patients (68%) had RLS symptoms contralateral to the hemisphere involved in the stroke (eight with unilateral and 16 with grossly asymmetrical RLS). Twenty-nine of 35 patients (82.86%) had imaging evidence of subcortical (16 with hemorrhagic and 13 with ischemic) stroke. Patients with pre-stroke RLS differed from those without it only by subcortical location of the stroke (82.9% vs 31.5% respectively, p < 0.001). The most significant differentiating factor between patients with subcortical stroke and those with cortical stroke was pre-stroke RLS (22.83% vs 2.74%, p < 0.001), the others being history of hypertension and hemorrhagic stroke type.ConclusionRLS, especially unilateral or asymmetrical, might frequently pre-exist in patients presenting with subcortical stroke. The common laterality may suggest an important predictive value for RLS, and may form an important point for future research.     

Epileptic seizures in thrombotic stroke

Summary Epileptic seizures due to thrombotic cerebral infarction were studied in 118 patients. The occurrence of seizures had a bimodal distribution with one peak period within 2 weeks and another peak period from 6 to 12 months after stroke. Four patients had seizures preceding stroke, while 23 patients without a history of previous stroke had silent infarct on the CT scan. Fifteen patients (13%) had status epilepticus. Simple partial seizures occurred in 56% of patients, complex partial seizures in 24% and generalized tonic-clonic seizures in 4%. Epilepsy developed in 35% of patients with early seizures and in 90% of patients with late seizures.     

脑血管病颈动脉粥样硬化14例病理研究

目的探讨颈动脉粥样硬化与脑血管病的关系。方法对１４例脑血管病死亡病例（脑出血及脑梗死各７例）的颈动脉进行病理观察及形态定量分析。结果脑血管病患者颈动脉粥样硬化导致管腔狭窄的程度，轻度占６３％，中、重度狭窄约占３７％。脑梗死患者颈动脉粥样硬化导致管腔狭窄的程度比脑出血患者严重；７例脑梗死患者中２例的病因为颈内动脉栓塞，脑梗死患者颈动脉粥样硬化斑块具备不稳定的组织学特性，常见质地松散、密度不均易脱落的斑块。脑出血组出血灶同侧的颈内动脉较对侧显著狭窄。结论颈内动脉栓塞是大面积脑梗死的常见病因之一；不稳定的颈动脉粥样硬化导致的斑块脱落可能也是脑梗死的病因之一。     

小儿肺炎支原体脑炎近期预后的预警因素分析

目的探讨影响小儿肺炎支原体（MP）脑炎近期预后的预警因素。方法对59例MP脑炎患儿的临床及实验室资料进行回顾性分析．对近期预后进行评估，寻找可能的预警因素。结果与近期预后良好组相比，近期预后不良组的MP脑炎患儿意识障碍、惊厥及发热持续的时间均较长．多伴有肢体运动障碍，而且除脑实质损害外，伴有其他脏器功能损害（OR：11．36，P〈0．01）、脑电图表现为弥漫性慢波或阵发性痫样放电伴低电压（OR：25．81．P〈0．01）及头颅影像学异常（OR：8．75，P〈0．01），其在多因素Logistic回归分析中有显著意义。结论MP脑炎患儿近期预后不良的预警因素是患儿伴有其他脏器功能损害、脑电图表现为弥漫性慢波或阵发性痫样放电伴低电压和头颅影像学异常。     

Serum ferritin levels and early prognosis of stroke

Iron and ferritin are known to have an important role in stroke as well as in other disorders. This prospective study was designed to determine whether administering ferritin levels might help to estimate the severity and prognosis of stroke. Fifty-one patients with a diagnosis of acute stroke were included in the study within 24 h from onset of symptoms. Serum ferritin and cortisol levels were assayed at admission. Clinical status was determined by the Canadian Stroke Scale at admission and on day 21. Serum ferritin level was found to be higher in patients with large lesion size (P < 0.01), deteriorated neurologic status during clinical follow-up (P = 0.03) and deceased patients (P < 0.01). Serum ferritin level was correlated with neurologic deficit (r = 0.50, P < 0.001). No correlation was found between serum cortisol and ferritin levels (r = 0.07, P = 0.7). Serum ferritin level (P = 0.007; OR = 1.02; 95% CI, 1.01-1.03) and large size of lesion (P = 0.021, OR = 11.92; 95% CI; 1.46-197.12) were independently associated with mortality. Increased serum ferritin levels correlate to severity of stroke and the size of the lesion.