Intravenous thrombolysis and three-year ischemic stroke mortality.

BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) in ischemic stroke (IS) does not reduce three-month mortality; however, longer-term survival after IVT has not been clearly established. Thus, we aimed to compare three-year mortality after IS in IVT-treated vs non-treated patients and to indicate predictors of long-term mortality after IVT. METHODS: We have evaluated data of 366 subjects with IS (196 treated with IVT and 170 non-treated with IVT, whose age, sex, and calendar time of IS occurrence matched the control group) collected via the Pomeranian Stroke Register. We estimated the three-year survival and its determinants in both groups. RESULTS: In univariate analysis, IVT was not associated with three-year mortality (OR 0.68; 95% CI 0.44-1.05). Independent predictors for unfavorable long-term outcome in a Cox regression model were older age, parenchymal hemorrhage type 2 (ph2), and modified Rankin scale >2 points at discharge from the hospital. IVT was strongly associated with a lower risk of death in the period 0-36 months from IS (HR 0.44, 95% CI 0.28-0.69, P<.001). CONCLUSIONS: Treatment of IS with intravenous recombinant tissue plasminogen activator was associated with increased survival during the three-year follow-up.

Patient-reported quality of life in multiple sclerosis differs between cultures and countries: a cross-sectional Austrian-German-Polish study.

BACKGROUND: Patient-reported quality of life (QOL) is an outcome measure in clinical trials in multiple sclerosis (MS), but translated QOL instruments may affect the actual comparability of data. OBJECTIVES: We aimed to investigate possible differences in QOL in MS between cultures and countries. We employed the Functional Assessment of Multiple Sclerosis (FAMS) Version 4 questionnaire, which is a state-of-the-art QOL instrument. METHODS: Some 484 MS patients from Austria (145), Germany (144), and Poland (195) aged 20-60 years, and stratified for sex and disease severity as measured by the Expanded Disability Status Scale (EDSS) score completed the respective FAMS translation and a socio-demographic questionnaire. RESULTS: Analysis of variance and post-hoc Scheffé-test showed that 64% of the FAMS items were answered significantly differently (p < 0.001) between the three countries. A multivariate regression analysis including all the available disease-related and socio-demographic variables revealed the factors age, EDSS score, employment, social contacts, MS course, and country to be significant predictors of both the total FAMS score and the score for items answered differently between the three countries. CONCLUSIONS: Differences exist in the QOL of MS patients from Austria, Germany, and Poland which seem to lie beyond the impact of disease severity. They appear to be related to culture or other country-specific factors, as country was an independent predictor of differently answered items of the FAMS and thus also of the whole FAMS. QOL instruments should consider this aspect to faithfully reflect subjective information such as patient-reported benefit of treatment in multinational clinical trials.

Levetiracetam: a long-term follow-up study of efficacy and safety.

OBJECTIVES: To evaluate the efficacy and safety of long-term add-on treatment with levetiracetam 1,000-4,000 mg/day. PATIENTS AND METHODS: In this multicenter, open-label follow-up study, 505 patients, from 10 European countries, who had benefited from previous add-on treatment with levetiracetam in a clinical trial or compassionate-use program were enrolled; 274 (54.3%) stayed to the end. Most then continued levetiracetam by prescription or in a named patient program, where it was not yet commercially available. Mean treatment duration was 1,045 days (range: 24 days to >7 years). Median daily dosage was 3,000 mg/day (range: 250-6,000 mg/day), with 250 (49.5%) patients receiving levetiracetam for >3 years. RESULTS: Median total and partial seizure frequency per week over the evaluation period were 0.8 and 0.7; seizure frequency per week was generally stable over time and remained low. There was a probability of 6.6% of remaining seizure-free for the first 3 years, and of 18.9% of having a seizure-free period of at least 3 years at any time. Most adverse events were mild or moderate and unrelated to study drug. Levetiracetam was well tolerated, and provided stable seizure control during long-term treatment.

A prospective study of the financial costs of multiple sclerosis at different stages of the disease.

The aim of our study was to estimate the costs of multiple sclerosis (MS) in Poland according to severity of disease. Total, direct and indirect costs were compared in 148 patients divided into three groups categorized by disease severity: stage I Expanded Disability Status Scale (EDSS <3.5), stage II (EDSS 4.0-6.0) and stage III (EDSS >6.5). Cost evaluation was performed from the societal perspective and covered the 5-month period. Simple sensitivity analysis was performed by varying the tariffs and valuing caregiving at 40% of the average wage. The mean total cost/patient for 5 months was estimated at 10,955, 15, 603 and 18, 464 PLN for stage I, II and III, respectively [exchange rate: 4 PLN=1 EUR; purchasing power pariety: 1 EUR=2.05 PLN] (P <0.0001). Regardless of EDSS stage indirect costs exceeded direct costs. Both direct and indirect costs increased with MS progression. For indirect cost the main item was productivity loss. This study confirms that MS represents a high economic burden, with indirect costs greatly exceeding direct costs. As costs increase with disease progression, treatment efforts should focus on patients in the early stages of MS.

[Knowledge of stroke problems among adults in Poland]. / Znajomosc problematyki udarowej wsród osób doroslych w Polsce.

An inquiry questionnaire was given to 180 adults without a history of stroke. The questions concerned the problem of stroke. The responders were aged from 15 to 82 years (mean 48 years). They were asked about risk factors for stroke, symptoms preceding stroke, behaviour of stroke witnesses. A correct definition of stroke was given by 86.7% of the responders. Only a small proportion of them knew risk factors for stroke (27.8% knew that one of them was hypertension, 6.1% gave smoking, 4.4% diabetes as risk factors). Although 93.9% knew that in face of stroke physician or ambulance service should be called, 6.1% thought that it would be sufficient to lie down or take paracetamol. The inquiry showed that the knowledge of risk factors for stroke is insufficient in the Polish adult population who not yet had cerebrovascular disturbances. It seems advisable to deliver an education programme in mass media on stroke prevention and its management in case of its development.

[How do general practitioners proceed on initial contact with patients after cerebrovascular ischemia?]. / Jak postepuje lekarz pierwszego kontaktu z chorymi z zaburzeniami krazenia mózgowego?

The reported analysis of an inquiry study of first-contact physicians was carried out for establishing how the manage cases of ischaemic stroke and transient ischaemic accident (TIA). The inquiry questionnaire containing questions related to the management of these patients and outpatient diagnosis of patients after stroke or TIA was sent to general practitioners in 4 regions of the country. The form was returned by 159 out of 300 physicians, mostly those working in towns (90.6%). From 53.5% to 64.8% of physicians referred patients with symptoms suggestive of stroke to hospitals, less often were referred those with vision disturbances. Antiplatelet drugs were prescribed to patients with cerebral circulation disturbances by only 12% to 20.3% of the physicians. Only 46.8% of the physicians used anticoagulants as secondary prevention after cerebral embolism from the heart. In patients treated with anticoagulants INR was checked every 2 weeks by 50.9% physicians. Only 42.8% of the physicians referred the patients for USG examination of neck arteries. The analysis showed that too few first-contact physicians referred stroke cases to hospital and too few prescribed antiplatelet drugs for TIA. Anticoagulants were used insufficiently for secondary prevention after cerebral embolism from the heart. There is much to do in stroke cases for management and prevention.

[A case of binocular blindness in small cell lung cancer]. / Przypadek obuocznej slepoty w przebiegu drobnokomórkowego raka pluca.

A was reported case of binocular blindness associated with small cell lung cancer. Most probably this complication was a clinical manifestation of the paraneoplastic syndrome. No tumor response was induced with chemotherapy and patient died due to tumor progression.

[Class II HLA antigens in patients with multiple sclerosis from Warsaw and Gdansk regions]. / Antygeny HLA II klasy u chorych na stwardnienie rozsiane z regionu Warszawy i Gdanska.

An investigation of class II histocompatibility antigens was carried out in patients with definite diagnosis of multiple sclerosis (MS) according to Poser's criteria. There were 42 patients from Warsaw and 98 patients from Gdansk. Histocompatibility antigens were assayed with microlymphocytotoxicity test. 6 antigens on locus DR and 1 antigen on locus DQ were evaluated. The antigen frequencies were compared in the two groups using the chi-square test. The antigen HLA-DQw1 occurred significantly more frequently in MS patients compared to healthy control group. Antigens HLA-DR2 and DR3 occurred more frequently in patients from Gdansk than Warsaw region.

[Coexistence of multiple sclerosis and myasthenia gravis]. / Wspólistnienie stwardnienia rozsiznego i miastenii.

A young female is reported in whom multiple sclerosis and myasthenia gravis coexisted. The coexistence of multiple sclerosis with other autoimmune diseases and associations with histocompatibility antigens are discussed.