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Latest & greatest articles for stroke
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Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. BACKGROUND: Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. METHODS: FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 (...) years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked
Overview of stroke Overview of stroke - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of stroke Last reviewed: October 2018 Last updated: November 2018 Introduction Stroke is defined as an acute neurological deficit lasting more than 24 hours and caused by cerebrovascular aetiology. It is subdivided into ischaemic stroke (caused by vascular occlusion or stenosis) and haemorrhagic stroke (caused by vascular (...) rupture, resulting in intra-parenchymal and/or subarachnoid haemorrhage). Ischaemic stroke accounts for 87% of all stroke cases, haemorrhagic stroke for 10%, and subarachnoid haemorrhage for 3%. Benjamin EJ, Virani SS, Callaway CW, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics - 2018 update: a report from the American Heart Association. Circulation. 2018 Mar 20;137(12):e67-492
Omega-3 supplements do not prevent heart disease, stroke or death Omega-3 supplements do not prevent heart disease, stroke or death Dissemination Centre Discover Portal NIHR DC Discover Omega-3 supplements do not prevent heart disease, stroke or death Published on 6 November 2018 doi: Omega-3 fatty acid supplements from fish oils or plants have little or no effect on the risk of heart disease, stroke or overall death rates. This finding contradicts a widespread belief that omega-3 supplements (...) health, and it is possible that the intake of foods rich in omega-3 may have a place in a healthy balanced diet. Share your views on the research. Why was this study needed? Heart disease, stroke and arterial disease, all affect blood vessels. They account for one-third of deaths and, in 2010, cost NHS England £8 billion. There is a widespread belief that omega-3 can protect against heart disease and stroke, and capsules containing purified omega-3 are widely used. Three different types of omega
Return to work after ischemic stroke in young adults: A registry-based follow-up study 30315074 2018 11 13 1526-632X 91 20 2018 Nov 13 Neurology Neurology Return to work after ischemic stroke in young adults: A registry-based follow-up study. e1909-e1917 10.1212/WNL.0000000000006510 We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW. Patients from the Helsinki (...) Young Stroke Registry with an IS occurring in the years 1994-2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were included. Data on periods of payment came from the Finnish Centre for Pensions, and death data from Statistics Finland. Multivariate logistic regression analyses assessed factors associated with NRTW 1 year after IS, and lasagna plots visualized the proportion of patients returning to work over time. We included
Effects of robot-(Morning Walk((R))) assisted gait training for patients after stroke: a randomized controlled trial 30326747 2018 10 17 1477-0873 2018 Oct 16 Clinical rehabilitation Clin Rehabil Effects of robot-(Morning Walk ® ) assisted gait training for patients after stroke: a randomized controlled trial. 269215518806563 10.1177/0269215518806563 To investigate the effects of Morning Walk ® -assisted gait training for patients with stroke. Prospective randomized controlled trial. Three (...) hospital rehabilitation departments (two tertiary and one secondary). We enrolled 58 patients with hemiparesis following a first-time stroke within the preceding year and with Functional Ambulation Category scores ⩾2. The patients were randomly assigned to one of two treatment groups: 30 minutes of training with Morning Walk ® , a lower limb rehabilitation robot, plus 1 hour of conventional physiotherapy (Morning Walk ® group; n = 28); or 1.5 hour of conventional physiotherapy (control group; n = 30
Ordinal vs dichotomous analyses of modified Rankin Scale, 5-year outcome, and cost of stroke 30341155 2018 10 20 1526-632X 2018 Oct 19 Neurology Neurology Ordinal vs dichotomous analyses of modified Rankin Scale, 5-year outcome, and cost of stroke. 10.1212/WNL.0000000000006554 10.1212/WNL.0000000000006554 To compare how 3 common representations (ordinal vs dichotomized as 0-1/2-6 or 0-2/3-6) of the modified Rankin Scale (mRS)-a commonly used trial outcome measure-relate to long-term outcomes (...) , and quantify trial ineligibility rates based on premorbid mRS. In consecutive patients with ischemic stroke in a population-based, prospective, cohort study (Oxford Vascular Study; 2002-2014), we related 3-month mRS to 1-year and 5-year disability and death (logistic regressions), and health/social care costs (generalized linear model), adjusted for age/sex, and compared goodness-of-fit values (C statistic, mean absolute error). We also calculated the proportion of patients in whom premorbid mRS score >1
Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke 30354990 2018 10 25 1524-4628 49 9 2018 Sep StrokeStroke Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke. 2138-2146 10.1161/STROKEAHA.117.020607 Background and Purpose- We aimed to determine whether low-frequency electric field navigated repetitive transcranial magnetic stimulation to noninjured motor (...) cortex versus sham repetitive transcranial magnetic stimulation avoiding motor cortex could improve arm motor function in hemiplegic stroke patients when combined with motor training. Methods- Twelve outpatient US rehabilitation centers enrolled participants between May 2014 and December 2015. We delivered 1 Hz active or sham repetitive transcranial magnetic stimulation to noninjured motor cortex before each of eighteen 60-minute therapy sessions over a 6-week period, with outcomes measured at 1 week
Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial 30274772 2018 10 27 1474-4465 2018 Sep 28 The Lancet. Neurology Lancet Neurol Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial. S1474-4422(18)30319-3 10.1016/S1474-4422(18)30319-3 Patent foramen ovale (PFO) is a contributor to embolic stroke (...) of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial. NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries
NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemic stroke 30266885 2018 10 30 1526-632X 91 18 2018 Oct 30 Neurology Neurology NIHSS cut point for predicting outcome in supra- vs infratentorial acute ischemic stroke. e1695-e1701 10.1212/WNL.0000000000006437 To determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemic stroke (AIS). Data are from (...) participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics of clinically defined supratentorial and infratentorial AIS patients and poor functional outcome, defined by scores 3-6 on the modified Rankin Scale, were evaluated in logistic regression models, with area under the curve (AUC) receiver operating characteristics defining the optimal NIHSS predictor cut point
Preadmission use of glucocorticoids and risk of cardiovascular events in patients with ischemic stroke 30179297 2018 11 02 1538-7836 16 11 2018 Nov Journal of thrombosis and haemostasis : JTH J. Thromb. Haemost. Preadmission use of glucocorticoids and risk of cardiovascular events in patients with ischemic stroke. 2175-2183 10.1111/jth.14283 Essentials The risk of thrombosis among ischemic stroke patients using glucocorticoids is unknown. We examined the risk of thrombosis in 98 487 ischemic (...) stroke patients, by glucocorticoid use. Myocardial infarction and venous thromboembolism risk was increased in glucocorticoid users. Hemorrhagic stroke risk was lower and recurrent ischemic stroke the same in glucocorticoid users. SUMMARY: Background Glucocorticoid users have a high mortality rate following stroke, but the underlying clinical pathways are poorly understood. Objectives To examine the risk of cardiovascular events among ischemic stroke patients using glucocorticoids. Methods We
Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke 30333158 2018 11 13 1526-632X 91 20 2018 Nov 13 Neurology Neurology Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke. e1838-e1850 10.1212/WNL.0000000000006506 To examine whether the Montreal Cognitive Assessment (MoCA) administered within 7 days after stroke predicts long-term cognitive impairment, functional impairment, and mortality. MoCA was administered to 274 (...) patients from 2 prospective hospital-based cohort studies in Germany (n = 125) and France (n = 149). Cognitive and functional outcomes were assessed at 6, 12, and 36 months after stroke by comprehensive neuropsychological testing, the Clinical Dementia Rating (CDR) scale, the modified Rankin Scale (mRS), and Instrumental Activities of Daily Living (IADL) and analyzed with generalized estimating equations. All-cause mortality was investigated by Cox proportional hazard models. Analyses were adjusted
Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemic stroke by promoting anterograde reperfusion and retrograde collateral flow 30295338 2018 11 02 1531-8249 2018 Oct 08 Annals of neurology Ann. Neurol. Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemic stroke by promoting anterograde reperfusion and retrograde collateral flow. 10.1002/ana.25352 The present study was undertaken to determine the efficacy of coadministration (...) of fingolimod with alteplase in acute ischemic stroke patients in a delayed time window. This was a prospective, randomized, open-label, blinded endpoint clinical trial, enrolling patients with internal carotid artery or middle cerebral artery proximal occlusion within 4.5 to 6 hours from symptom onset. Patients were randomly assigned to receive alteplase alone or alteplase with fingolimod. All patients underwent pretreatment and 24-hour noncontrast computed tomography (CT)/perfusion CT/CT angiography
Evolocumab (Repatha) - In adults with established atherosclerotic cardiovascular disease (myocardial infarction, stroke or peripheral arterial disease) Published 12 November 2018 Statement of advice SMC2133 evolocumab 140mg solution for injection in pre-filled syringe / 140mg solution for injection in pre-filled pen / 420mg solution of injection in cartridge (Repatha®) Amgen Ltd 5 October 2018 ADVICE: in the absence of a submission from the holder of the marketing authorisation evolocumab (...) (Repatha®) is not recommended for use within NHSScotland. Indication under review: In adults with established atherosclerotic cardiovascular disease (myocardial infarction, stroke or peripheral arterial disease) to reduce cardiovascular risk by lowering LDL-C levels, as an adjunct to correction of other risk factors: ? in combination with the maximum tolerated dose of a statin with or without other lipid- lowering therapies or, ? alone or in combination with other lipid-lowering therapies in patients
Action observation for upper limb rehabilitation after stroke. BACKGROUND: Action observation (AO) is a physical rehabilitation approach that facilitates the occurrence of neural plasticity through the activation of the mirror-neural system, promoting motor recovery in people with stroke. OBJECTIVES: To assess whether action observation enhances motor function and upper limb motor performance and cortical activation in people with stroke. SEARCH METHODS: We searched the Cochrane Stroke Group (...) Trials Register (last searched 4 September 2017), the Central Register of Controlled Trials (24 October 2017), MEDLINE (1946 to 24 October 2017), Embase (1974 to 24 October 2017) and five additional databases. We also searched trial registries and reference lists. SELECTION CRITERIA: Randomized controlled trials (RCTs) of AO, alone or associated with physical practice in adults after stroke. The primary outcome was upper limb motor function. Secondary outcomes included dependence on activities
Gamma aminobutyric acid (GABA) receptor agonists for acute stroke. BACKGROUND: Gamma aminobutyric acid (GABA) receptor agonists have been shown to have a neuroprotectant effect in reducing infarct size and improving functional outcome in animal models of cerebrovascular disease. However, the sedative effects of GABA receptor agonists have limited their wider application in people with acute stroke, due to the potential risk of stupor. This is an update of a Cochrane Review first published (...) in 2013, and previously updated in 2014 and 2016. OBJECTIVES: To determine the efficacy and safety of GABA receptor agonists in the treatment of acute stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (accessed May 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) 2018, Issue 4 (accessed May 2018), MEDLINE (from 1949 to May 2018), Embase (from 1980 to May 2018), CINAHL (from 1982 to May 2018), AMED (from 1985 to May 2018), and 11 Chinese databases
Swallowing therapy for dysphagia in acute and subacute stroke. BACKGROUND: Dysphagia (swallowing problems), which is common after stroke, is associated with increased risk of death or dependency, occurrence of pneumonia, poor quality of life, and longer hospital stay. Treatments provided to improve dysphagia are aimed at accelerating recovery of swallowing function and reducing these risks. This is an update of the review first published in 1999 and updated in 2012. OBJECTIVES: To assess (...) the effects of swallowing therapy on death or dependency among stroke survivors with dysphagia within six months of stroke onset. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (26 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 26 June 2018), MEDLINE (26 June 2018), Embase (26 June 2018), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (26 June 2018), Web of Science Core Collection (26