cover image European Journal of Neurology

European Journal of Neurology

2014 - Volume 21
Issue 5 | May 2014
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Short Communication

Background and purpose

Cognitive impairment is common in Parkinson's disease (PD), even in the early stages. We aimed to assess the relationship between insulin‐like growth factor‐1 (IGF‐1) and cognitive functions in early, drug‐naïve patients with PD.

Methods

Serum IGF‐1 was measured in 65 early, drug‐naïve patients with PD that underwent a complete neuropsychological battery at baseline and after 2 years. Linear regression analysis was used to evaluate the relationships between neuropsychological scores and IGF‐1. Repeated‐measures was applied to assess changes in neuropsychological variables over time.

Results

At baseline, IGF‐1 levels were related to phonological fluency. At follow‐up, IGF‐1 levels were associated with the Rey auditory verbal learning test (RAVLT) – immediate and delayed recall, Frontal Assessment Battery, verbal span and Benton judgement of the line orientation test. Patients with low IGF‐1 levels at baseline showed a significantly faster decline of performances than patients with high IGF‐1 levels on immediate and delayed recall of the RAVLT and interference task of the Stroop test.

Conclusions

Low serum IGF‐1 levels are related to poor performance on executive tasks in early, drug‐naïve patients with PD, and may predict poor performance on attention/executive and verbal memory tasks after a 2‐year follow‐up.

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Authors:
M. T. Pellecchia, G. Santangelo, M. Picillo, R. Pivonello, K. Longo, C. Pivonello, C. Vitale, M. Amboni, A. De Rosa, M. Moccia, R. Erro, G. De Michele, L. Santoro, A. Colao and P. Barone
Article first published online:
29 Mar 2013 | DOI: 10.1111/ene.12137

Original Article

Background and purpose

Recent evidence suggests that there may be more than one Gilles de la Tourette syndrome (GTS)/tic disorder phenotype. However, little is known about the common patterns of these GTS/tic disorder‐related comorbidities. In addition, sex‐specific phenomenological data of GTS/tic disorder‐affected adults are rare. Therefore, this community‐based study used latent class analyses (LCA) to investigate sex‐related and non‐sex‐related subtypes of GTS/tic disorders and their most common comorbidities.

Methods

The data were drawn from the PsyCoLaus study (= 3691), a population‐based survey conducted in Lausanne, Switzerland. LCA were performed on the data of 80 subjects manifesting motor/vocal tics during their childhood/adolescence. Comorbid attention‐deficit hyperactivity disorder (ADHD), obsessive‐compulsive disorder, depressive, phobia and panic symptoms/syndromes comprised the selected indicators. The resultant classes were characterized by psychosocial correlates.

Results

In LCA, four latent classes provided the best fit to the data. We identified two male‐related classes. The first class exhibited both ADHD and depression. The second class comprised males with only depression. Class three was a female‐related class depicting obsessive thoughts/compulsive acts, phobias and panic attacks. This class manifested high psychosocial impairment. Class four had a balanced sex proportion and comorbid symptoms/syndromes such as phobias and panic attacks. The complementary occurrence of comorbid obsessive thoughts/compulsive acts and ADHD impulsivity was remarkable.

Conclusions

To the best of our knowledge, this is the first study applying LCA to community data of GTS symptoms/tic disorder‐affected persons. Our findings support the utility of differentiating GTS/tic disorder subphenotypes on the basis of comorbid syndromes.

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Authors:
S. Rodgers, M. Müller, W. Kawohl, D. Knöpfli, W. Rössler, E. Castelao, M. Preisig and V. Ajdacic‐Gross
Article first published online:
07 Oct 2013 | DOI: 10.1111/ene.12274

Editorial

Abstract

Click to view the accompanying paper in this issue.

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Authors:
A. E. Cavanna and D. Martino
Article first published online:
30 Oct 2013 | DOI: 10.1111/ene.12282

Original Article

Background and purpose

Although benign childhood epilepsy with centrotemporal spikes (BECTS) is known to have good prognosis, patients often manifest neuropsychological impairments. This study aimed to investigate cognitive dysfunctions and their relationship with white matter microstructural changes in BECTS patients.

Methods

Nineteen BECTS and 25 normal subjects aged 7–16 years were included. Neuropsychological performances were assessed by the Wechsler Intelligence Scale for Children III, executive function tests, verbal and visuospatial memory tests, the verbal fluency and Boston naming tests. Diffusion tensor imaging (DTI) was performed to measure the fractional anisotropy (FA), axial (AD), radial (RD), and mean diffusivities (MD). The voxel‐wise tract‐based spatial statistics and region of interest methods were used for DTI, and their correlations with cognitive variables were analyzed.

Results

Patients with BECTS had lower intelligence quotient (IQ) scores compared with those of the control group. Higher AD and MD values were found in the left superior longitudinal fasciculus, the retrolenticular part of the internal capsule, posterior thalamic radiation, sagittal stratum and the body of the corpus callosum in BECTS patients compared with controls. Lower performances in verbal IQ, freedom from distractibility and processing speed were correlated with higher AD in the left superior fronto‐occipital fasciculus, and lower verbal IQ scores were correlated with decreased FA values in the splenium of the corpus callosum in these patients.

Conclusions

White matter microstructural changes predominantly in the left hemisphere might contribute to their cognitive abnormalities especially verbal IQ in BECTS patients.

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Authors:
S. E. Kim, J. H. Lee, H. K. Chung, S. M. Lim and H. W. Lee
Article first published online:
16 Dec 2013 | DOI: 10.1111/ene.12301

Original Article

Background and purpose

The association between migraine and transient global amnesia (TGA) is not determined. Only two clinic‐based studies showed that TGA patients had a higher frequency of migraine history. Our population‐based study aimed to investigate whether migraine patients were associated with a higher risk of developing TGA.

Methods

Patients with migraine aged ≥18 years were identified from the Taiwan National Health Insurance Research Database between 2005 and 2009. Each migraine patient was randomly matched to one subject without migraine or other headache disorders based on age, sex and cardiovascular comorbidities. Patients with antecedent stroke, epilepsy or TGA were excluded. Both cohorts were followed up until the end of 2010. The incidence rates of TGA were compared and risk factors were identified.

Results

A total of 158 301 patients in the migraine cohort and 158 301 patients in the matched control cohort were enrolled. During a mean follow‐up of 3.0 years (range 0–6 years), the migraine cohort had a greater risk of developing TGA than the control cohort [7.59 vs. 3.06 per 100 000 person‐years, incidence rate ratio (IRR) = 2.48,  = 0.002]. Compared with the matched cohort, only female migraine patients aged 40–60 years showed a significantly higher risk of TGA [IRR = 3.18 (1.31–8.82),  = 0.005]. Of note, the incidence rates did not differ between migraine patients with and without aura.

Conclusions

This population‐based study demonstrates that migraine is associated with an increased risk of TGA, particularly in female patients aged 40–60 years.

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Authors:
K.‐H. Lin, Y.‐T. Chen, J.‐L. Fuh, S.‐Y. Li, T.‐J. Chen, C.‐H. Tang and S.‐J. Wang
Article first published online:
13 Feb 2014 | DOI: 10.1111/ene.12346

EFNS/ENS GUIDELINES/CME Article

Background and purpose

The symptoms of acquired autoimmune ocular myasthenia are restricted to the extrinsic eye muscles, causing double vision and drooping eyelids. These guidelines are designed to provide advice about best clinical practice based on the current state of clinical and scientific knowledge and the consensus of an expert panel.

Search strategy

Evidence for these guidelines was collected by searches in the MEDLINE and Cochrane databases. The task force working group reviewed evidence from original articles and systematic reviews. The evidence was classified (I, II, III, IV) and consensus recommendation graded (A, B or C) according to the EFNS guidance. Where there was a lack of evidence but clear consensus, good practice points are provided.

Conclusions

The treatment of ocular myasthenia should initially be started with pyridostigmine (good practice point). If this is not successful in relieving symptoms, oral corticosteroids should be used on an alternate‐day regimen (recommendation level C). If steroid treatment does not result in good control of the symptoms or if it is necessary to use high steroid doses, steroid‐sparing treatment with azathioprine should be started (recommendation level C). If ocular myasthenia gravis is associated with thymoma, thymectomy is indicated. Otherwise, the role of thymectomy in ocular myasthenia is controversial. Steroids and thymectomy may modify the course of ocular myasthenia and prevent myasthenia gravis generalization (good practice point).

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Authors:
E. Kerty, A. Elsais, Z. Argov, A. Evoli and N. E. Gilhus
Article first published online:
28 Jan 2014 | DOI: 10.1111/ene.12359

Review Article

Abstract

Levodopa‐induced dyskinesias (LIDs) and graft‐induced dyskinesias (GIDs) are serious and common complications of Parkinson's disease (PD) management following chronic treatment with levodopa or intrastriatal transplantation with dopamine‐rich foetal ventral mesencephalic tissue, respectively. Positron emission tomography (PET) molecular imaging provides a powerful tool that has been employed over the past 20 years for the elucidation of mechanisms underlying the development of LIDs and GIDs in PD patients. PET used together with radioligands tagging molecular targets has allowed the functional investigation of several systems in the brain including the dopaminergic, serotonergic, glutamatergic, opioid, endocannabinoid, noradrenergic and cholinergic systems. In this article the role of PET imaging in unveiling pathophysiological mechanisms underlying the development of LIDs and GIDs in PD patients is reviewed.

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Authors:
F. Niccolini, C. Loane and M. Politis
Article first published online:
28 Jan 2014 | DOI: 10.1111/ene.12362

Original Article

Background and purpose

After aneurysmal subarachnoid hemorrhage (aSAH), cognitive impairment, even mild and relatively isolated, can be devastating, especially in working‐age persons. The Montreal Cognitive Assessment (MoCA) is accepted as a valid screening tool for mild cognitive impairment due to cerebral ischaemia. Whether MoCA is independently associated with excellent outcome [a score of 0 on the modified Rankin Scale (mRS) or 18/18 on the Lawton Instrumental Activities of Daily Living (IADL) scale] 1 year after aSAH was assessed.

Methods

Hong Kong Chinese aSAH patients were assessed prospectively by means of the MoCA, Mini‐Mental State Examination (MMSE), mRS and IADL scale at 1 year. This multicenter prospective observational study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193).

Results

In all, 194 patients completed the assessments at 1 year. After adjustment for age, both excellent IADL and mRS outcomes were associated with MoCA (OR 1.2, 95% CI 1.1–1.3, <0.001, and OR 1.1, 95% CI 1.0–1.2, =0.001, respectively).

Conclusions

MoCA‐assessed cognitive function is an important determinant for excellent outcomes after aSAH.

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Authors:
G. K. C. Wong, S. W. Lam, A. Wong, M. Lai, D. Siu, W. S. Poon and V. Mok
Article first published online:
28 Jan 2014 | DOI: 10.1111/ene.12363

Original Article

Background and purpose

To describe the characteristics of patients presenting a paraneoplastic cerebellar degeneration without classical onconeural antibodies (seronegative PCD).

Methods

Thirty‐nine seronegative PCD patients from the Paraneoplastic Neurological Syndrome Euronetwork were retrospectively analyzed and compared with 180 patients with PCD associated with classical onconeural antibodies (seropositive PCD).

Results

No patient had anti‐CASPR2 or anti‐mGluR1 antibodies. No significant difference between the clinical characteristics of seronegative and seropositive PCD patients was observed. Yet the frequency of associated tumors was different. Lymphoma was more frequent in seronegative than in seropositive women (24% vs. 2%,  = 0.002) whilst gynecological cancer were less frequent (38% vs. 74%,  = 0.002). In comparison with seropositive men, seronegative men more frequently had a non‐small‐cell lung cancer (27% vs. 6%,  = 0.08) or a genitourinary cancer (22% vs. 0%,  = 0.04) but less frequently a small‐cell lung cancer (23% vs. 74%,  = 0.002). Seronegative and seropositive PCD patients with similar tumors had a similar overall survival.

Conclusion

The clinical characteristics of seronegative and seropositive PCD are similar but the spectrum of associated tumors is different. The immunological scenario of seronegative PCD seems to be different from that of limbic encephalitis with only few patients harboring anti‐neuropile antibodies.

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Authors:
F. Ducray, G. Demarquay, F. Graus, E. Decullier, J.‐C. Antoine, B. Giometto, D. Psimaras, J.‐Y. Delattre, A. F. Carpentier and J. Honnorat
Article first published online:
28 Jan 2014 | DOI: 10.1111/ene.12368

Original Article

Background and purpose

To assess the long‐term safety and efficacy of pramipexole as a once‐daily (q.d.) extended‐release oral formulation in early or advanced Parkinson's disease (PD).

Methods

In two double‐blind (DB) studies of early PD and one of advanced PD, active‐treatment arms received pramipexole immediate release (IR) or extended release (ER), with exposure lasting up to 33 weeks. In open‐label (OL) extensions that followed immediately, subjects took ER q.d. for up to 80 weeks, with dosage adjustment permitted (range 0.375–4.5 mg q.d.).

Results

Of 590 subjects completing an early‐PD DB study, 511 entered the early‐PD OL extension; 408 completed it. Reported adverse events (AEs) with incidence ≥10.0% were somnolence (15.1%), peripheral edema (11.7%) and back pain (10.6%). Of 465 subjects completing the advanced‐PD DB study, 391 entered the advanced‐PD OL extension; 329 completed it. Reported AEs with incidence ≥10.0% were dyskinesia (27.4%) and somnolence (13.6%). Impulse control disorders were identified by semi‐structured interview in 13 subjects (1.4% of 902). In exploratory analyses, adjusted mean Unified Parkinson's Disease Rating Scale (UPDRS) Parts II + III scores (excluding ex‐placebo recipients) remained substantially improved from DB baseline scores prior to pramipexole introduction, at −6.6 and −6.3 points amongst ex‐DB‐ER and ex‐DB‐IR recipients after 113 weeks of pramipexole (33 DB plus 80 OL) in early PD, and −11.5 and −9.1 after up to 113 weeks (up to 33 DB plus 80 OL) in advanced PD.

Conclusions

These results support the long‐term safety and efficacy of pramipexole ER in early and advanced PD. AEs were typical for dopaminergic medications, and UPDRS scores suggested sustained symptomatic benefit.

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Authors:
R. A. Hauser, A. H. V. Schapira, P. Barone, Y. Mizuno, O. Rascol, M. Busse, C. Debieuvre, M. Fraessdorf and W. Poewe
Article first published online:
04 Feb 2014 | DOI: 10.1111/ene.12375

Original Article

Background and purpose

The progression pattern of brain structural changes in patients with isolated cerebrovascular disease (CVD) remains unclear. To investigate the role of isolated CVD in cognitive impairment patients, patterns of cortical thinning and hippocampal atrophy in pure subcortical vascular mild cognitive impairment (svMCI) and pure subcortical vascular dementia (SVaD) patients were characterized.

Methods

Forty‐five patients with svMCI and 46 patients with SVaD who were negative on Pittsburgh compound B (PiB) positron emission tomography imaging and 75 individuals with normal cognition (NC) were recruited.

Results

Compared with NC, patients with PiB(−) svMCI exhibited frontal, language and retrieval type memory dysfunctions, which in patients with PiB(−) SVaD were further impaired and accompanied by visuospatial and recognition memory dysfunctions. Compared with NC, patients with PiB(−) svMCI exhibited cortical thinning in the frontal, perisylvian, basal temporal and posterior cingulate regions. This atrophy was more prominent and extended further toward the lateral parietal and medial temporal regions in patients with PiB(−) SVaD. Compared with NC subjects, patients with PiB(−) svMCI exhibited hippocampal shape deformities in the lateral body, whilst patients with PiB(−) SVaD exhibited additional deformities within the lateral head and inferior body.

Conclusions

Our findings suggest that patients with CVD in the absence of Alzheimer's disease pathology can be demented, showing cognitive impairment in multiple domains, which is consistent with the topography of cortical thinning and hippocampal shape deformity.

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Authors:
H. J. Kim, B. S. Ye, C. W. Yoon, Y. Noh, G. H. Kim, H. Cho, S. Jeon, J. M. Lee, J.‐H. Kim, J.‐K. Seong, C.‐H. Kim, Y. S. Choe, K. H. Lee, S. T. Kim, J. S. Kim, S. E. Park, J.‐H. Kim, J. Chin, J. Cho, C. Kim, J. H. Lee, M. W. Weiner, D. L. Na and S. W. Seo
Article first published online:
04 Feb 2014 | DOI: 10.1111/ene.12376

Original Article

Background and purpose

The aim of this study was to explore whether hearing loss is associated with the risk of Parkinson's disease in the elderly in Taiwan.

Methods

Using claims data of the Taiwan National Health Insurance Program, 4976 patients (aged 65 years or older) with newly diagnosed hearing loss from 2000 to 2010 were identified and 19 904 subjects without hearing loss were randomly selected as comparisons, frequency matched by sex, age and index year of diagnosing hearing loss. The incidence of Parkinson's disease by the end of 2010 and the associated risk factors were investigated.

Results

The incidence of Parkinson's disease in the hearing loss group was 1.77‐fold higher than that in the non‐hearing‐loss group (3.11 vs. 1.76 per 1000 person‐years). After controlling for confounding factors, the adjusted hazard ratio (HR) of Parkinson's disease was 1.53 (95% CI 1.17, 1.99) for the hearing loss group compared with the non‐hearing‐loss group. Male sex (HR = 1.33, 95% CI 1.02, 1.74), age (for each year, HR = 1.06, 95% CI 1.04, 1.09), hypertension (HR = 1.70, 95% CI 1.26, 2.30) and cerebrovascular disease (HR = 1.78, 95% CI 1.37, 2.32) were also significantly associated with the risk of Parkinson's disease.

Conclusions

Hearing loss correlates with an increased risk of Parkinson's disease in the elderly. Further studies are needed to confirm whether hearing loss could be a non‐motor feature of Parkinson's disease.

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Authors:
S.‐W. Lai, K.‐F. Liao, C.‐L. Lin, C.‐C. Lin and F.‐C. Sung
Article first published online:
10 Feb 2014 | DOI: 10.1111/ene.12378

Original Article

Background and purpose

The study evaluated headache‐attributed burden and its impact on productivity and quality of life (QoL) in Russia. Its purpose was to support recommendations for change.

Methods

A countrywide population‐based random sample of 2725 biologically unrelated adults (aged 18–65 years) in 35 cities and nine rural areas of Russia were interviewed in a door‐to‐door survey. The structured questionnaire enquired into symptom burden, functional disability, lost productive time and QoL (applying the WHOQoL‐8 question set), as well as willingness to pay (WTP) for adequate headache treatment, if it were available.

Results

Mean lost paid‐work days due to headache in the previous 3 months were 1.9 ± 4.2, and mean lost household work days were 3.4 ± 5.7. The estimated annual indirect cost of primary headache disorders was USD 22.8 billion, accounting for 1.75% of gross domestic product. QoL was reduced by all types of primary headaches. According to WHOQoL‐8, it was significantly lower in those with headache on ≥15 days/month than in those with episodic headache (24.7 ± 4.6 vs. 28.1 ± 5.0;  < 0.05) and lower in those with migraine than in those with tension‐type headache (TTH) (27.1 ± 4.9 vs. 28.8 ± 5.0;  < 0.05). Average WTP for adequate headache treatment was RUB 455 ± 494 per month (median RUB 300), a sum sufficient in most cases, and correlated with illness severity (higher for headache on ≥15 days/month than for migraine, and for migraine than for TTH).

Conclusions

Headache is common, burdensome and costly in Russia and, manifestly, poorly mitigated by existing healthcare. Structured healthcare services for headache need to be urgently put in place.

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Authors:
I. Ayzenberg, Z. Katsarava, A. Sborowski, M. Chernysh, V. Osipova, G. Tabeeva and T. J. Steiner
Article first published online:
13 Feb 2014 | DOI: 10.1111/ene.12380

Original Article

Background and purpose

A number of non‐motor features are known to precede motor manifestations of Parkinson's disease (PD). They are supposed to already represent the prodromal neurodegenerative state in those who later develop PD and are thus called prodromal markers. In this study, three prodromal markers, depression, rapid eye movement behaviour disorder (RBD) and hyposmia, were selected and were related to other prodromal features in elderly individuals without PD.

Methods

From the Tübinger Evaluation of Risk Factors for Early Detection of Neurodegeneration (TREND) study, 698 healthy individuals aged 50–80 years reporting one or more of the selected prodromal markers (SPMs), but without neurodegenerative disorders, were evaluated and classified according to the status of prodromal markers. Other prodromal PD‐related features were assessed with a 23‐item questionnaire and compared between participants with and without the three SPMs.

Results

Individuals with the SPMs for PD endorsed more of the additional possible prodromal features of PD than those without; of 23 possible prodromal features, the median number identified amongst participants with no SPMs was two, compared with four with one marker, five with two and seven with three ( < 0.001). Regarding individual SPMs, participants with depression and RBD endorsed five of 23 markers, compared with three for those with hyposmia ( = 0.001). There was no significant increase in the number of prodromal features amongst those with two SPMs compared with those with only one marker.

Conclusions

Individuals with the SPMs for PD report a higher prevalence of other prodromal PD symptoms. This may indicate that these markers can identify individuals at risk for PD.

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Authors:
A. Gaenslen, I. Wurster, K. Brockmann, H. Huber, J. Godau, B. Faust, S. Lerche, G. W. Eschweiler, W. Maetzler and D. Berg
Article first published online:
24 Feb 2014 | DOI: 10.1111/ene.12382

Original Article

Background and purpose

To evaluate the association between having non‐thymoma myasthenia and the risk of extra‐thymic cancer in a population‐based setting.

Methods

A nationwide case–control study was conducted in Denmark based on medical registries. The study included all cases with a first time diagnosis of cancer during 2000–2009. Each case was matched by birth year and gender with eight population controls using risk set sampling. Subjects with myasthenia were identified through a validated register‐based algorithm. Conditional logistic regression was used to compute crude and adjusted odds ratios (ORs), with 95% confidence intervals (CIs), for cancer associated with a prior diagnosis of myasthenia.

Results

In all, 233 437 cases and 1 867 009 controls were identified. A total of 80 cases and 518 controls had a prior diagnosis of myasthenia. Myasthenia was not associated with an increased risk of overall cancer (OR 1.1; 95% CI 0.9–1.4). Adjusted ORs for major cancer sites were also close to unity, whereas an elevated risk of lymphomas was observed (OR 2.0; 95% CI 0.8–5.5). Early‐onset myasthenia was associated with a slightly increased OR for overall cancer (1.5; 95% CI 1.0–2.3); however, this estimate was based on small numbers.

Conclusions

Non‐thymoma myasthenia was not associated with an increased risk of overall cancer. Larger studies are necessary to evaluate the association between myasthenia and risk of lymphoma and the potential effect modification by age of myasthenia onset in relation to cancer risk.

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Authors:
E. G. Pedersen, A. Pottegård, J. Hallas, S. Friis, K. Hansen, P. E. H. Jensen and D. Gaist
Article first published online:
26 Feb 2014 | DOI: 10.1111/ene.12383

Letter to the Editor

Disruptive nocturnal behavior due to insulinoma revealed by continuous glucose monitoring

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Authors:
A. Kawasaki, K. Suzuki, M. Miyamoto, T. Miyamoto, K. Yanagi, M. Shimizu and K. Hirata
Article first published online:
09 Apr 2014 | DOI: 10.1111/ene.12388

Original Article

Background and purpose

Although the stent retriever (SR) has shown a better reperfusion rate and clinical outcome than the older generation mechanical clot retrieval device, it is uncertain whether the SR is superior to intra‐arterial fibrinolysis (IAF).

Methods

Ischaemic stroke patients who were treated with SR or IAF as initial endovascular treatment modality for unilateral arterial occlusion in the anterior circulation were included. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction grade ≥2b. A favourable clinical outcome was defined as a modified Rankin Score ≤2 at 3 months.

Results

Between January 2009 and May 2012, 55 patients were treated with SR and 50 patients were treated with IAF. The baseline characteristics were similar between the two groups except for the occlusion site and rescue treatment. In binary logistic regression analysis adjusted for the occlusion site and rescue treatment, SR was independently associated with increased successful reperfusion [82.0% vs. 47.3%; odds ratio (OR) 5.21; 95% confidence interval (CI) 1.92–14.14) and a more favourable clinical outcome at 3 months (54.0% vs. 43.6%; OR 3.40; 95% CI 1.31–8.84). The frequency of symptomatic intracranial haemorrhage and mortality at 3 months was not different between the two groups.

Conclusions

Stent retriever was as safe as and more effective than IAF. Our findings suggest that SR may be considered as an initial modality rather than IAF in acute stroke patients who undergo endovascular treatment.

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Authors:
D. Song, B. M. Kim, D. J. Kim, Y. D. Kim, J. Kim, H. S. Lee, H. S. Nam and J. H. Heo
Article first published online:
24 Feb 2014 | DOI: 10.1111/ene.12391

Original Article

Background and purpose

Recent studies found that microembolic signals (MESs) could be detected by transcranial Doppler in patients with moyamoya disease. However, the clinical significance of MESs in moyamoya disease remains unclear. Our aim was to investigate whether the MESs could predict cerebral ischaemic events in patients with moyamoya disease.

Methods

Fifty‐four consecutive patients with moyamoya disease were recruited. MESs were monitored by transcranial Doppler for 30 min in the bilateral middle cerebral arteries of each patient on admission. Patients were followed up for 1 year. The primary end‐point was cerebral ischaemic events including stroke and transient ischaemic attack (TIA).

Results

MESs were detected in 11 (20.4%) patients, with a frequency of 11 (10.2%) in 108 hemispheres. Logistic regression analysis revealed that previous ischaemic events within 3 months were associated with the presence of MESs (odds ratio 4.41, 95% CI 1.11–17.59). During a median follow‐up of 384 days, 14 (13.0%) hemispheres had ischaemic events (seven strokes and seven TIAs). Cox regression showed that the hazard ratio for the risk of new ischaemic stroke and TIA in the hemispheres with MESs was 6.84 (95% CI 1.82–25.66) compared with those without, and 10.61 (95% CI 1.66–67.70) for ischaemic stroke alone, after controlling for age, sex, presence of ischaemic events at baseline, Suzuki stages and revascularization surgery.

Conclusions

In patients with moyamoya disease, the presence of MESs is associated with recent ischaemic symptoms and independently predicts cerebral ischaemic events. MES detection may be of potential clinical value in the management of patients with moyamoya disease.

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Authors:
J. Chen, L. Duan, W.‐H. Xu, Y.‐Q. Han, L.‐Y. Cui and S. Gao
Article first published online:
06 Mar 2014 | DOI: 10.1111/ene.12392

Original Article

Background and purpose

The lack of a wide implementation of stroke units (SU)s in Italy appears to accompany the underuse of the operating units. Community awareness of acute stroke care options may affect stroke resource use. Our aim was to determine the level of knowledge about SUs and tissue‐plasminogen activator (t‐PA) treatment amongst Italian adults and investigate its relationship to local stroke services implementation.

Methods

A nation‐based telephone survey was carried out in a sample of 1000 residents aged >18 years in May–June 2010. The questionnaire included close‐ended questions regarding knowledge of SUs and t‐PA treatment. Number and location of both SUs and t‐PA treatments were provided by a concurrent national hospital‐based survey. The prevalence and distribution of acute stroke care awareness in the community was examined and multivariate analyses were generated.

Results

Amongst the 1000 participants (474 men, mean age 48.8 ± 17.2), only 26.2% reported knowing about the availability of t‐PA treatment and only 15% were aware of the existence of SUs. Awareness of both SUs and t‐PA was significantly associated only with education. These associations remained significant in the multivariate analyses. The degree of stroke services implementation (in terms of SUs/inhabitant rates and number of t‐PA treatments) was not associated with SU and t‐PA awareness.

Conclusions

This is the first European study that explored public knowledge about t‐PA treatment and SUs. Italian adults proved insufficiently educated about SUs and t‐PA; there is no higher awareness in areas with a greater supply of stroke services. This might partially explain the underuse of Italian SUs.

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Authors:
M. Baldereschi, A. Di Carlo, C. Vaccaro, D. Toni, B. Polizzi and D. Inzitari
Article first published online:
06 Mar 2014 | DOI: 10.1111/ene.12395

Letter to the Editor

Post‐stroke sexual dysfunction at a young age: time to act!

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Authors:
R. S. Calabrò
Article first published online:
09 Apr 2014 | DOI: 10.1111/ene.12401

Original Article

Background and purpose

Anosognosia and neglect may coexist in stroke patients. Neglect patients often report poor quality of life (QOL), whereas patients suffering from other cognition disorders with poor insight report better QOL. This study investigates the relationship between anosognosia, neglect and QOL amongst stroke survivors.

Methods

Stroke survivors who met the criteria were used as a sampling pool. Sixty stroke patients were observed in this study, amongst whom 20 patients with anosognosia and neglect (A+N+), 20 patients with neglect but not anosognosia (A−N+) and 20 patients with neither anosognosia nor neglect (A−N−) were selected from the sampling pool based on demographic characteristics matched with the A+N+ group. A questionnaire (SS‐QOL) was used to collect the QOL perceived by the stroke survivors.

Results

The perceived QOL of the A+N+ group was significantly better than those of the other groups, including the subscales of self‐care, mobility, work/productivity, upper extremity, mood, family role and social role. However, the A+N+ group had poor balance level and more fall incidents were reported.

Conclusion

The A+N+ group perceived better QOL but had more falls and poorer balance than the other groups. Health providers should work with caregivers aggressively in preventing accidents.

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Authors:
C.‐Y. Dai, W.‐M. Liu, S.‐W. Chen, C.‐A. Yang, Y.‐C. Tung, L.‐W. Chou and L.‐C. Lin
Article first published online:
15 Mar 2014 | DOI: 10.1111/ene.12413

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Article first published online:
09 Apr 2014 | DOI: 10.1111/ene.12446