Safe implementation of thrombolysis in stroke-monitoring study in Italy

Background and purpose:  The safe implementation of thrombolysis in stroke-monitoring (SITS-MOST) study was an unique opportunity to test in Italy, where only few centres were expert in thrombolytic treatment before, safety and efficacy of i.v. alteplase within 3 h of ischaemic stroke outside the setting of clinical trials.
Methods:  In Italy to participate in the study the clinical centres had to possess organizational and structural characteristics certified by Regional Health Authorities.
Results:  Seventy-one centres were activated, 56 (79%) treated patients of which 41 (73%) had never used thrombolysis before the study. Globally, 586 patients were included. Baseline median National Institute of Health Stroke Scale of Italian patients was 13 vs. 12 in other European centres ( P  = 0.0001). Symptomatic intracerebral haemorrhage as per the NINDS/Cochrane definition, mortality and independence (modified Rankin Scale 0–2) rates at 3 months occurred respectively in 6.7% (95% CI: 4.8–9.1), 11.7% (9.2–14.6) and 51.6% (47.4–55.7) of Italian patients compared with 7.3% (6.7–8.0) ( P  = 0.56), 11.2% (10.4–12.1) ( P  = 0.75) and 55.1% (53.8–56.4) ( P  = 0.09) in the European patients and in 8.6% (40/65; 6.3–11.6), 17.3% (14.1–21.1) and 50.1% (44.5–54.7) of the patients treated in the pooled randomized controlled trials.
Conclusions:  The SITS-MOST study showed that in Italy i.v. alteplase is safe and effective in routine clinical use also in non-expert centres.     

Cardiac autonomic dysfunction and functional outcome after ischaemic stroke

ischaemic stroke has been associated with an impairment of cardiac autonomic balance. The aim of this study was to assess the impact of cardiac autonomic derangement on functional outcome after a rehabilitation program in patients with recent ischaemic stroke. The study population included 85 consecutive first-ever stroke survivors (46 men and 39 women; mean age 60.0 ± 12.4 years), who underwent 24-h Holter monitoring before the beginning of a 60-day rehabilitation program. Time-domain measures of heart-rate variability (HRV) were considered in all cases. By the end of the rehabilitation program an unfavorable functional outcome with dependency (Barthel Index score of <75) was found in 44.7% of patients. Multivariate analysis demonstrated that age [odds ratio (OR) 1.09, 95% CI 1.04–1.19, P  = 0.002], stroke severity (OR 1.12, 95% CI 1.01–1.34, P  = 0.004), Barthel Index score (OR 0.92, 95% CI 0.87–0.98, P  = 0.01) and Rankin Scale score (OR 3.88, 95% CI 2.13–7.56, P  = 0.02) on admission, as well as lower values of the standard deviation of normal-to-normal R wave to R wave (RR) intervals (OR 9.67, 95% CI 2.58–18.67, P  = 0.006) were independent predictors of an unfavorable functional outcome. Assessment of HRV before a rehabilitation program may provide additional information on the probability of a functional recovery in stroke survivors.     

Metabolic syndrome and three of its components as risk factors for recurrent ischaemic stroke presenting as large-vessel infarction

Background and purpose:  Although a clear protocol for reduction of recurrent ischaemic stroke (RIS) has been established, few studies have compared the stroke subtype distribution and risk factors between RIS and first-ever stroke (FES).
Methods:  This one-year hospital-based study enrolled 587 FES and 475 RIS patients. Patients were categorized into four stroke subtypes according to a modified TOAST stroke subtype classification system. Risk factor profiles were compared between the two major stroke groups and between the corresponding four subtypes to discriminate the significant risk factors for RIS.
Results:  A multivariate regression analysis identified hypertension (OR, 1.87; 95% CI, 1.34–2.62), diabetes mellitus (DM) (OR, 1.57; 95% CI, 1.22–2.02), low high-density lipoprotein (LHDL) (OR, 1.43; 95% CI, 1.08–1.88) and older age as significant RIS risk factors. The significance of the former three RIS factors was further recognized in its large-vessel subtype. Moreover, metabolic syndrome was significantly more common in the recurrent stroke group ( P  = 0.01), including its large-vessel subtype ( P  = 0.04). Progressively increasing odds ratios from 1.49 to 2.02, in accordance with increased number of diagnostic components of metabolic syndrome for recurrent large-vessel ischaemic stroke, were noted.
Conclusions:  Metabolic syndrome likely plays a crucial role in the development of RIS, including large-vessel infarction in modern-day Taiwan.     

Constipation: a potential cause of pelvic floor damage?

Background Pelvic floor damage is a major clinical problem usually attributed to obstetric injury. We speculated that constipation may also be an aetiological and preventable factor resulting from repeated stress on the perineum over many years, and this study aimed to test this hypothesis. Methods A total of 600 women attending a gynaecological clinic were assessed using a structured questionnaire gathering data on pelvic floor damage, constipation and obstetric trauma. Complete data were available on 596 subjects. Key Results The prevalence of pelvic floor damage was 10% (61/596). In this group, constipation was identified in 31% (19/61) of women and obstetric trauma in 31% (19/61). In the group without pelvic floor damage, constipation was present in 16% (86/535) and obstetric trauma in 16% (83/535). In univariate analysis, pelvic floor damage was associated with age (OR: 1.05; 95% CI: 1.03–1.08; P < 0.0001), constipation (OR: 2.36; 95% CI: 1.31–4.26; P < 0.0001) and obstetric trauma (OR: 2.46; 95% CI: 1.37–4.45; P < 0.0028). In multivariate analysis, the OR for age was 1.05 (95% CI: 1.03–1.08; P < 0.0001), for constipation 2.35 (95% CI: 1.27–4.34; P < 0.0001) and for obstetric trauma 1.37 (95% CI: 0.72–2.62; P = 0.3398). Conclusions & Inferences Constipation appears to be as important as obstetric trauma in the development of pelvic floor damage. Thus, a more proactive approach to recognizing and treating constipation might significantly reduce the prevalence of this distressing problem.     

Cytotoxic T lymphocyte associated antigen-4 exon 1 A/G polymorphism in Iranian patients with multiple sclerosis

Background:  Cytotoxic T lymphocyte antigen-4 (CTLA-4) is a T-cell surface receptor of activated T cells.
Material and methods:  We studied 100 Iranian patients with clinically definite multiple sclerosis (MS) and 100 ethnic, sex- and age-matched controls. CTLA-4 exon 1 A/G polymorphism was compared amongst patients and controls.
Results:  There was no statistically significant difference in the allelic [odds ratio (OR): 1.19, confidence interval (CI) 95%: 0.76–1.85, P  = 0.4] and genotypes (OR: 1.60, CI 95%: 0.911–2.824, P  = 0.102) distribution amongst patients and controls. Also gender, course and progression index did not reveal any statistically significant differences in allele and genotype distribution of A/G polymorphism.
Conclusion:  As a non-European patient population, our results are consistent with the major previous studies showing no significant associations between CTLA4 exon 1 polymorphism and neither MS nor any of its subtypes.     

Adjunctive dexamethasone therapy for bacterial meningitis in adults: a meta-analysis of randomized controlled trials

The objective of this review was to study the effectiveness of dexamethasone for the treatment of adult patients with bacterial meningitis. Data was extracted from randomized controlled trials (RCTs) comparing dexamethasone with placebo or no treatment and pooled using meta-analysis techniques. Treatment with dexamethasone was associated with a non-significant lower mortality than placebo or no treatment [odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.45–1.04]. If a RCT conducted in Malawi was excluded from the analysis, dexamethasone was associated with lower mortality than placebo or no treatment (OR = 0.58, 95% CI 0.40–0.83). Dexamethasone was associated with lower mortality in patients with definite meningitis (OR = 0.55, 95% CI 0.31–0.96), short duration of symptoms (OR = 0.61, 95% CI 0.38–1.00), Streptococcus pneumoniae meningitis (OR = 0.26, 95% CI 0.08–0.78), patients in countries with high (OR = 0.45, 95% CI 0.23–0.87) and medium Human Development Index (OR = 0.65, 95% CI 0.42–1.00). No benefit was seen in patients with longer duration of symptoms (OR = 0.80, 95% CI 0.47–1.36) or no antibiotic use (OR = 0.68, 95% CI 0.36–1.28). Dexamethasone was associated with fewer episodes of hearing impairment in high quality RCTs (OR = 0.64, 95% CI 0.43–0.94). The currently available evidence suggests that dexamethasone should be administered to all adult patients with bacterial meningitis. Large studies are needed to clarify the role of the duration of symptoms, disease severity, and antibiotic administration before the initiation of treatment with dexamethasone on modifying the outcomes.     

Self-reported depression and anti-depressant medication use in essential tremor: cross-sectional and prospective analyses in a population-based study

There are few data on the co-morbidity of essential tremor (ET) with depression. To assess the associations of ET with self-reported depression and antidepressant medication use. In a population-based study in central Spain, participants were evaluated at baseline (1994–1995) and 3 years later. Self-reported depression and use of antidepressant medications were evaluated at each assessment. In cross-sectional analyses, prevalent ET cases were twice more probably than controls to report depression [103 (43.8%) of 235 cases versus 1137 (26.0%) of 4379 controls; adjusted odds ratio (OR) 2.20, 95% confidence interval (CI) 1.66–2.93, P  < 0.001] and three times more probably to be taking antidepressant medications [16 (6.8%) cases versus 113 (2.6%) controls; adjusted OR 3.33, 95% CI 1.91–5.82, P  = 0.001]. In prospective analyses, baseline self-reported depression (adjusted RR 1.78, 95% CI 1.11–2.89, P  = 0.018) and, perhaps, baseline use of antidepressant medication (adjusted RR 1.90, 95% CI 0.59–6.05, P  = 0.28) were associated with incident ET. Rather than being totally benign, ET seems to be associated with a mood disorder. Furthermore, as well as being a secondary response to disease manifestations, this mood disorder may be a primary feature of the underlying disease.     

Timing of stenting of symptomatic carotid stenosis is predictive of 30-day outcome

For patients with symptomatic carotid stenosis, benefit from carotid artery stenting (CAS) highly depends on the 30-day stroke and death rates. Identification of predictors of unfavourable outcome would help guide the patient selection. We analysed the influence of clinical and angiographic factors on the 30-day outcomes of 77 consecutive patients who underwent CAS for ≥60% symptomatic carotid stenosis within 180 days of transient ischaemic attack or moderate stroke (modified Rankin Scale score ≤3). The 30-day composite end-point for stroke (7.8%) and death of any cause (1.3%) was 9.1%. Patients with complicated CAS were older than patients with uncomplicated CAS (mean age 75.1 ± 8.2 vs. 65.9 ± 9.5 years, P  = 0.015) and underwent stenting significantly earlier after the qualifying event: median delay 1.5 weeks (range: 0.2–3.0) vs. 3.2 weeks (range: 0.5–26), P  = 0.004. In multivariate logistic regression analyses, age [odds ratio (OR) = 1.148; 95% confidence interval (CI): 1.011–1.304 and P  = 0.033] and delay of treatment <2 weeks (OR = 22.399; 95% CI: 2.245–223.445 and P  = 0.008) remained the only variables significantly associated with 30-day outcome. CAS carries a considerable risk in old patients and when performed early (<2 weeks) after the qualifying event. Future reports should address the timing of CAS.     

Prevalence of disabling spasticity 1 year after first-ever stroke

Objective:  To estimate the prevalence of disabling spasticity (DS) 1 year after first-ever stroke.
Design:  Cross-sectional survey 1 year after first-ever stroke.
Methods:  Patients above 18 years from one county with first-ever stroke were identified by use of the national stroke registry. A representative sample of 163 patients was created and 140 of these were followed up. Assessments of motor function and ability with the modified Ashworth Scale, the modified Rankin Scale (mRS), the Barthel Index (BI) and clinical evaluation were performed in order to identify patients with spasticity-related disability.
Results:  The observed prevalence of any spasticity was 17% and of DS 4%. Patients with DS scored significantly worse than those with no DS on the mRS ( P  = 0.009) and the BI ( P  = 0.005). DS was more frequent in the upper extremity, correlated positively with other indices of motor impairment and inversely with age. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9–125) and age below 65 years (OR 9.5, CI 1.5–60).
Conclusions:  The prevalence of DS after first-ever stroke is low but corresponds to a large number of patients and deserves further attention with regards to prevention and treatment .     

Psychotic boys performing well in school are at increased risk of suicidal ideation

Aim:  This study investigated how the level of school performance is associated with suicidal behavior and psychiatric disorders among adolescent psychiatric inpatients aged 12–17 years.
Methods:  Data were collected from 508 adolescents (300 girls, 208 boys; age 12–17 years) admitted to inpatient psychiatric hospitalization between April 2001 and March 2006. Information on the adolescents' school performance, suicidal ideation, suicide attempts and self-mutilation as well as psychiatric DSM-IV diagnoses was obtained using the Schedule for Affective Disorder and Schizophrenia for School-Age Children.
Results:  An elevated risk of suicidal ideation (OR = 3.6, 95% CI 1.3–10.2, P  = 0.017) and of psychotic disorders (OR = 3.2, 95% CI 1.0–10.0, P  = 0.048) was observed among male adolescents performing well in school. In addition, adolescents with poor school performance had an increased likelihood of substance-related disorder both in boys (OR = 2.6, 95% CI 1.1–6.1, P  = 0.027) and girls (OR = 2.5, 95% CI 1.2–5.1, P  = 0.011).
Conclusions:  Our findings indicate that psychotic inpatient male adolescents performing well in school are at an elevated risk of suicidal ideation. Although good school performance is often considered a marker of high intelligence and good general ability, symptoms of major psychiatric disorders and suicidality need to be taken very seriously among adolescents performing well in school.     

Meta-analysis of genetic variability in the beta-amyloid production, aggregation and degradation metabolic pathways and the risk of Alzheimer's disease

Background –  Variants in genes encoding enzymes involved in production, aggregation or degradation of β-amyloid are potential risk factors for sporadic Alzheimer's disease (AD).
Methods –  Meta-analyses on AD association with BACE1 exon 5, BACE1 intron 5, FE65 intron 13, CYP46 intron 2, α₁-antichymotrypsine Ala17Thr, bleomycin hydrolase I443V, lectin-like oxidized low-density lipoprotein receptor (OLR1) 3'-UTR (+1071) and (+1073), and very-low-density lipoprotein receptor (VLDLR) 5'-UTR (CGG-repeat) polymorphisms.
Results –  In BACE1 exon 5, genotype CC+CT acts as a protective factor in Apolipoprotein E (ApoE) ε4 carriers [odds ratio (OR) = 0.57; 95% confidence interval (CI): 0.38–0.88], and as a risk factor in ApoE ε4 non-carriers (OR = 1.33; 95% CI: 1.00–1.78). OLR1 3'-UTR (+1073) allele C is associated with increased risk (OR = 1.23; 95% CI: 1.01–1.50). VLDLR 5'-UTR genotype 2 is associated with increased risk (OR = 1.70; 95% CI: 1.09–2.63) in the Asian population and is protective (OR = 0.48; 95% CI: 0.26–0.86) in the non-Asian population. Other studied polymorphisms are not associated with AD.
Conclusions –  The overall impact on AD risk of the genes for which meta-analyses are now available is rather limited. Additional meta-analyses of other different genes encoding for Aβ production, aggregation and degradation mediators might help in determining the risk profile for AD.     

Optical platelet aggregometry does not appear useful as a means of assessing the risk of recurrent vascular events in aspirin-treated patients

Objectives –  To investigate whether the results of optical platelet aggregometry indicate the risk of recurrent ischemic events.
Materials and methods –  Cerebro- and cardiovascular patients taking aspirin for at least 30 days were studied retrospectively. Ischemic vascular events occurring prior to testing and the presence of vascular risk factors were recorded.
Results –  241 subjects were included. Among the 78 patients (32.4%) who displayed recurrent vascular episodes, the age (62.5 ± 10.6 vs. 58.4 ± 11.6, P  = 0.009) and the proportion of hypertensives (80.8% vs. 68.1%, P  = 0.040) were significantly higher when compared with the participants who exhibited single events. The degree of platelet aggregation did not differ significantly between the patients with and those without recurrent episodes. Logistic regression analysis identified only age (OR 1.033, 95% CI 1.008–1.058, P  = 0.010), and not aggregation values, as a risk condition for recurrent vascular episodes.
Conclusions –  Results of optical platelet aggregometry were not indicative of the risk of recurrent vascular events. The role of conventional risk factors appeared to be more important.     

Clinical features of convulsive status epilepticus: a study of 220 cases in western China

Background and purpose:  Convulsive status epilepticus (CSE) is the most common and life-threatening form of status epilepticus (SE). The aim of this study was to describe the clinical features of CSE in western China.
Methods:  Convulsive status epilepticus patients hospitalized from January 1996 to October 2007 were prospectively observed. Logistic regression was used to identify predictors of prognosis.
Results:  The average age of CSE patients ( n  = 220) was 37.5 years (SD 20.31), 50% of the patients had a history of epilepsy. The primary cause of CSE was central nervous system infection (32.7%), followed by discontinuation or reduction of antiepileptic drugs (AEDs; 15.5%). The median duration of CSE was 5 h and median duration of seizures before treatment was 2 h; both were longer in rural patients than in urban patients ( P  < 0.05). The fatality rate on discharge was 15.9%. Logistic regression analysis showed the duration of CSE [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03–1.07], a history of epilepsy (OR 0.35, 95% CI 0.14–0.89), and respiratory depression (OR 5.96, 95% CI 2.49–14.24) were independent predictors of CSE prognosis.
Discussion:  Central nervous system infection and AEDs withdrawal in epilepsy patients were the most important causes of CSE. There is a large gap between antiepileptic therapy in China and European Status Epilepticus guidelines.     

A population-based study of irritable bowel syndrome in a non-Western population

Abstract  Previous studies have found no female predominance in irritable bowel syndrome (IBS) in non-Western countries. The aim of the study was to assess the prevalence and correlates of Rome II (IBS) in both sexes in Pakistan. A Population-based survey in a low-income inner city area using questionnaires to diagnose Rome II IBS and assess distress, disability and stressful life events. Data were collected from 880/938 (93%) randomly selected residents. 13.4% of women and 13.1% men met criteria for Rome II IBS; 34 (3.9%) had diarrhoea-predominant, 59 (6.7%) had constipation-predominant IBS and 24 (2.7%) had 'mixed IBS'. In logistic regression analysis, IBS was associated in men with high income (OR = 1.56; 95% CI: 1.05–2.3) and few years of education (OR = 2.17; 95% CI: 1.2–3.9) and in women with being married (OR = 3.6; 95% CI: 1.1–11.9) and stressful life events score (OR = 1.14; 95% CI: 1.01–1.3). Disability was associated with constipation-predominant IBS (OR = 1.99; 95% CI: 1.1–3.6), distress (OR = 1.19; 95% CI: 1.14–1.23) and stressful life events (OR = 1.19; 95% CI: 1.1–1.3). Investigations were more likely in men (54%) than in women (27%) ( P  = 0.003). These findings suggest that the equal sex ratio of IBS in urban Pakistan could result from a close association between marked distress and IBS in men similar to that found in women in western studies.     

Unnoticed post-void residual urine volume in people with moderate to severe intellectual disabilities: prevalence and risk factors

Background   Increased post-void residual urine volume (PVR) is often seen in geriatric populations. People with intellectual disabilities (ID) have risk factors in common with these populations.
Aims   To investigate in adults with ID:

• • 

  Feasibility of portable ultrasound bladder scanning;
• • 

  Prevalence of PVR; and
• • 

  Relations with proposed risk factors for PVR.

Methods   In a cross-sectional design, PVR was measured using ultrasound scanning in 346 adults with moderate to severe ID aged 18–82 years. Relationship between increased PVR and the following risk factors was assessed: age, level of ID, gender, ambulancy, medication, chronic illnesses, incontinence and profound multiple disabilities (PMD). Acceptation of scanning and manageability were noted.
Results   Feasibility: All participants were cooperatively undergoing the ultrasound scan and all outcomes were sufficiently interpretable. Prevalence: PVR ≥ 150 mL was newly identified in 30/346 persons (8.7%, 95% confidence interval 5.92–12.14). Associations: Higher age ( P  = 0.001), laxative use ( P  = 0.001), chronic illnesses other than epilepsy ( P  = 0.005), profound ID ( P  = 0.008), incontinence ( P  = 0.048) and immobility ( P  = 0.005) are determinants that were associated with urinary retention.
Conclusions   The bladder ultrasound scan is a feasible method to identify increased PVR in adults with more severe levels of ID. The prevalence of PVR in adults is similar to prevalences found in the geriatric general population.     

Risk and predictors of early epileptic seizures in acute cerebral venous and sinus thrombosis

We assessed the risk and determined predictors of early epileptic seizures (ES) in patients with acute cerebral venous and sinus thrombosis (CVST). A prospective series of 194 consecutive patients with acute CVST admitted to neurological wards in two German university hospitals was analysed for frequency of ES and in-hospital mortality. Demographic, clinical and radiological characteristics during the acute stage were retrospectively analysed for significant association with ES in univariate and multivariate analyses. During the acute stage, 19 patients (9.8%) died. Early symptomatic seizures were found in 86 patients (44.3%). Status epilepticus occurred in 11 patients (12.8%) of whom four died. Amongst patients with epileptic seizures, mortality was three times higher in those with status than in those without (36.4% and 12%, respectively). In multivariate logistic regression analysis, motor deficit [odds ratio (OR) 5.8; 95% CI 2.98–11.42; P  < 0.001], intracranial haemorrhage (OR 2.8; 95% CI 1.46–5.56; P  = 0.002) and cortical vein thrombosis (OR 2.9; 95% CI 1.43–5.96; P  = 0.003) were independent predictors of early epileptic seizures. Status epilepticus was an important source of morbidity and early mortality in patients with CVST in this study. Patients with focal motor deficits, cortical vein thrombosis and intracranial haemorrhage carried the highest risk for ES. Prophylactic antiepileptic treatment may be an option for these patients.     

Polymorphism in the sorbin and SH3-domain-containing-1 (SORBS1) gene and the risk of brain infarction in the Japanese population: the Fukuoka Stroke Registry and the Hisayama study

Background and purpose:  Sorbin and SH3-domain-containing-1 (SORBS1) is an important adaptor protein in insulin-signalling pathway, and its genetic polymorphism may regulate the activity of insulin resistance. We investigated the association between the SORBS1 T228A polymorphism and ischaemic stroke.
Methods:  Genotyping was achieved by a rapid-cycle PCR and melting curve analysis using fluorescent probes in 1049 incident cases of ischaemic stroke and 1049 age- and sex-matched control subjects recruited from the Hisayama study.
Results:  The allele distributions of the SORBS1 T228A polymorphism were similar amongst cases and controls. The multivariate-adjusted odds ratio (OR) of the AA genotype for ischaemic stroke was 2.897 (95% CI, 0.907–8.018) compared with the TT genotype. In terms of stroke subtype, there was a trend toward a difference in the AA genotypes for lacunar infarction, compared with the TT genotype (OR = 8.740, P  = 0.0510), and combined TT and TA genotypes (OR = 8.768, P  = 0.0505). The other polymorphisms genotyped were not associated with any subtypes of ischaemic stroke. T228A polymorphism of SORBS1 was not associated with the prevalence of diabetes.
Conclusions:  The AA genotype of SORBS1 T228A polymorphism may play a role in lacunar infarction in the Japanese population.     

DCUN1D1 is a risk factor for frontotemporal lobar degeneration

Background and purpose:  Frontotemporal lobar degeneration (FTLD) is considered as a proteinopathy; therefore, it is conceivable that genes encoding for factors involved in protein misfolding and/or degradation could play a role in its pathogenesis.
Methods:  An association study of defective in cullin neddylation 1 ( DCN-1 )-domain containing 1 ( DCUN1D1 ), which is involved in protein degradation, was carried out in a population of 220 patients with FTLD as compared with 229 age-matched controls.
Results:  A statistically significant increased frequency of the GG genotype of the DCUN1D1 rs4859146 single nucleotide polymorphism (SNP) was observed in patients compared with controls (6.9 vs. 1.7%, P  =   0.011, adjusted OR: 4.39, 95% CI: 1.40–13.78). Stratifying according to the clinical syndrome, significant differences were observed between the behavioral variant of frontotemporal dementia and controls ( GG frequency: 6.3 vs. 1.7%, P  =   0.02, OR:4.0, 95%, CI = 1.24–12.92), as well as between patients with progressive aphasia compared with controls (15.4 vs. 1.7%, P  =   0.014, OR = 11.30, 95%, CI = 1.63–78.45), but not in patients with SD versus controls (8.3 vs. 1.7%, P  =   0.18, OR = 5.24, 95% C.I. = 0.45–60.63). No significant differences in allelic and genotypic frequencies of the DCUN1D1 rs4859147 SNP were found.
Conclusions:  The GG genotype of the DCUN1D1 rs4859147 SNP represents a risk factor for the development of FTLD, increasing the risk of about fourfold.     

Clinical aspects of bowel symptoms in Parkinson's disease

Background –  The clinical importance of bowel symptoms in Parkinson's disease (PD) remains to be described in detail.
Methods –  A 33-item questionnaire including background parameters, the Cleveland Constipation Score (CCS), and items from the Neurogenic Bowel Dysfunction score was sent to 468 PD patients. Results were compared to a control group (CG) ( n =  45). A CCS of at least 15 was used to define severe constipation.
Results –  Four hundred and sixteen subjects (89%) responded. Median CSS was only 4 (range 0–21) in PD and 2 (range 0–13) in the CG ( P  < 0.05). Severe constipation was found in 7% with PD and 0% in the CG ( P  < 0.05). Incomplete emptying at defecation, need for assisted defecation and use of oral laxatives was reported more frequently by PD patients than by the CG (all P  < 0.05). The severity of PD was associated with assisted defecation ( P  < 0.001), unsuccessful attempts at defecation ( P  < 0.001), incomplete emptying at defecation ( P  < 0.05), and the CCS ( P  < 0.01). Time since diagnosis was associated with infrequent defecation ( P  < 0.0001) and the CCS ( P  < 0.05). The use of levodopa was associated with less unsuccessful attempts at defecation ( P  < 0.05).
Conclusion –  Most patients with PD only have minor constipation-related symptoms. However, severe constipation is associated with time since diagnosis and severity of disease.     

The response to IV rt-PA in very old stroke patients

The use of rtPA in stroke patients aged >80 years remains controversial and it is debated whether there are sex-based differences in the response to rtPA. We assessed the clinical value of thrombolytic therapy in patients aged >80 years (elderly group) in comparison with a non-elderly group, and evaluated the existence of sex differences in the response to rtPA. All consecutive patients ( n  = 157) treated with rtPA were prospectively assessed since July 2001, including 49 elderly patients who fulfilled the National Institute of Neurological Disorders and Stroke (NINDS) criteria. Changes of the National Institute of Health Stroke Scale (NIHSS) score at 1 h, 24 h, and 7 days after rtPA administration, favourable outcome at day 90 [(modified Rankin Scale) mRS 0–1, or 2 if mRS = 2 before the stroke], symptomatic bleedings, and death rates were compared between elderly and non-elderly patients. Using logistic regression, baseline NIHSS score [odds ratio (OR) 0.59, 95% confidence interval (CI) 0.41–0.84] was an independent predictor of favourable outcome, but not sex (OR 0.72, 95% CI 0.33–1.56), or age >80 years (OR 0.74, 95% CI 0.32–1.70). The rates of clinical improvement, mortality, or symptomatic CNS bleeding were also unrelated to age and sex. In conclusion, the response to IV rtPA is not impaired in elderly stroke patients and male and female are equally responsive.