ABSTRACT
INTRODUCTION: Acetylsalicylic acid (ASA) cessation, is suggestive of a rebound phenomenon laying the ground for ischemic stroke (IS) re-occurrence but nothing is known about its implication for IS severity (ISS). Thus, the aim of our study is to examine whether or not aspirin withdrawal is a risk factor for ISS. PATIENTS AND METHODS: This study, recruited patients having presented an IS in the following 2 weeks of ASA withdrawal, matched with treatment free cases. ISS was evaluated in all patients at admission using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) at 3 months' follow-up. FINDINGS: Fifty cases were included in this study and fifty, manually matched, controls. ISS analysis found that the case group had a more severe stroke at admission (mean NIHSS: 12.76 (±7.319) in cases vs 10.04 (±5.562) in controls, P=0.039), with ASA discontinuation judged as a risk factor directly related to ISS regardless of the underlying cardiovascular risk factors (using the multivariate analysis). CONCLUSION: Our study's findings suggest that aspirin interruption over a 15-days period could result in a more severe IS in the acute phase. To our knowledge, no study has ever discussed this outcome, shedding the light on the pressing need for larger studies with various withdrawal periods to support these data.
Subject(s)
Brain Ischemia , Ischemic Stroke , Stroke , Aspirin/adverse effects , Humans , Risk Factors , Stroke/etiologySubject(s)
Arteritis/etiology , Behcet Syndrome/complications , Cerebral Arterial Diseases/etiology , Posterior Cerebral Artery , Adolescent , Arteritis/diagnostic imaging , Behcet Syndrome/diagnosis , Behcet Syndrome/drug therapy , Cerebral Arterial Diseases/diagnostic imaging , Humans , Immunosuppressive Agents/therapeutic use , Male , Posterior Cerebral Artery/diagnostic imaging , Steroids/therapeutic use , Treatment OutcomeABSTRACT
Impulse control disorders (ICDs) in Parkinson's disease (PD) comprise a class of psycho-behavioral disorders often associated with dopamine agonist treatment. The aim of our study was to determine the prevalence of ICDs in a group of Moroccan PD patients and to bring forward some specific aspects in our population. One hundred twenty-five PD patients, without memory impairment and treated for at least six months, were studied. They were questioned about ICDs using the QUIP-RS, and simultaneously evaluated on the motor symptoms and their treatment. Our sample was then divided into two groups: ICDs (+) and ICDs (-) groups. ICDs were identified in 28% of patients: pathological gambling in 3.2%, compulsive sexual behavior in 7.2%, pathological buying in 9.6%, eating behavior disorder in 7.2%, punding-hobbyism in 11.1%. At least two ICDs were found in 14% of patients and dopamine dysregulation syndrome in 10.4%. We also noticed another kind of "ICDs-mimics" specific to our own social context such as "excessive charity" in 18.4%, or excessive reading of the Qur'an in 9.6%. These aspects were not included in the calculation of ICDs prevalence. The ICDs (+) group was younger than the ICDs (-) group (P=0.042) and ICDs were more frequent in men (P=0.031). Dopamine agonist equivalent daily dose (DAED) was significantly higher (P=0.01) in the ICDs (+) group. There are no differences between classes of dopamine agonist used. Young age, male gender and DAED are risk factors for the occurrence of ICDs in Moroccan PD patients, as already described in the DOMINION cohort, but the prevalence found in our study was higher. We highlighted some specific ICDs-mimics in our Arab-Muslim population.
