ABSTRACT
Objective: To compare the prevalence and characteristics of migraine and tension-type headache (TTH) among patients with Parkinson's disease (PD), progressive supranuclear palsy/corticobasal syndrome (PSP/CBS), and healthy controls (HCs). Methods: This cross-sectional study involved the collection of data from consecutive PD (n = 81) and PSP/CBS (n = 21) patients along with 104 HCs. Migraine and TTH were diagnosed using the International Classification of Headache Disorders 3rd edition criteria. Demographic data, PD or PSP/CBS details, and the presence and characteristics of migraine and TTH were collected. Montreal Cognitive Assessment Scale, Patient Health Questionnaire-9, and Pittsburgh Sleep-Quality Index were used to assess cognition, depression, and sleep quality, respectively. Results: A comparable proportion of PD and PSP/CBS patients reported lifetime headache (46.9% vs 23.8%; P = 0.06). TTH was more common, observed in 84.3%, 100%, and 93.5% of PD, PSP/CBS, and HCs with lifetime headache, respectively. A comparable proportion of participants in all three groups had bilateral (P = 0.10), dull-aching headache (P = 0.09), and occurring <5/month (P > 0.99). The mean severity score of headache among three groups was comparable (P = 0.39). Although the demographic and clinical characteristics of PSP/CBS patients with and without headache were comparable, PD patients with headache had a higher MDS-UPDRS-III score than those without. More than two-third PD and all PSP/CBS patients with lifetime headache reported headache improvement following parkinsonism onset. Conclusion: The prevalence and characteristics of migraine and TTH were comparable in PD, PSP/CBS, and HCs. Headache was associated with greater motor severity in PD. Following parkinsonism onset, headache improved in the majority of PD and PSP/CBS patients with lifetime headache.
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PURPOSE: This study compared the clinical and electrodiagnostic (EDX) features and long-term outcomes of patients with very early Guillain-Barré syndrome (VEGBS, duration of illness ≤4 days) and those with early/late (>4 days)-presenting GBS. METHODS: One hundred patients with GBS were clinically evaluated and categorized into VEGBS and early/late GBS groups. Electrodiagnostic studies were performed on the bilateral median, ulnar, and fibular motor nerves and the bilateral median, ulnar, and sural sensory nerves. Admission and peak disability were assessed using the 0 to 6 Guillain-Barré Syndrome Disability Scale (GBSDS). The primary outcome was disability at 6 months, which was categorized as complete (GBSDS ≤1) or poor (GBSDS ≥2). The secondary outcomes were frequencies of abnormal electrodiagnostic findings, in-hospital progression, and mechanical ventilation (MV). RESULTS: Patients with VEGBS had higher peak disability (median 5 vs. 4; P = 0.02), frequent in-hospital disease progression (42.9% vs. 19.0%, P < 0.01), needed MV (50% vs. 22.4%; P < 0.01), and less frequent albuminocytologic dissociation (52.4% vs. 74.1%; P = 0.02) than those with early/late GBS. Thirteen patients were lost to follow-up at 6 months (nine patients with VEGBS and four patients with early/late GBS). The proportion of patients with complete recovery at 6 months was comparable (60.6% vs. 77.8%; P = ns). Reduced d-CMAP was the most common abnormality, noted in 64.7% and 71.6% of patients with VEGBS and early/late GBS, respectively (P = ns). Prolonged distal motor latency (≥130%) was more common in early/late GBS than in VEGBS (36.2% vs. 25.4%; P = 0.02), whereas absent F-waves were more frequent in VEGBS (37.7% vs. 28.7%; P = 0.03). CONCLUSIONS: Patients with VEGBS were more disabled at admission than those with early/late GBS. However, 6 month's outcomes were similar between the groups. F-wave abnormalities were frequent in VEGBS, and distal motor latency prolongation was common in early/late GBS.
ABSTRACT
Objective This study assesses the impact of coronavirus disease 2019 (COVID-19) on the pattern of neurological emergencies reaching a tertiary care center. Materials and Methods This is a retrospective and single center study involving 295 patients with neurological emergencies mainly including acute stroke, status epilepticus (SE), and tubercular meningitis visiting emergency department (ED) from January 1 to April 30, 2020 and divided into pre- and during lockdown, the latter starting from March 25 onward. The primary outcome was number of neurological emergencies visiting ED per week in both periods. Secondary outcomes included disease severity at admission, need for mechanical ventilation (MV), delay in hospitalization, in-hospital mortality, and reasons for poor compliance to ongoing treatment multivariate binary logistic regression was used to find independent predictors of in-hospital mortality which included variables with p <0.1 on univariate analysis. Structural break in the time series analysis was done by using Chow test. Results There was 53.8% reduction in number of neurological emergencies visiting ED during lockdown (22.1 visits vs. 10.2 visits per week, p = 0.001), significantly affecting rural population ( p = 0.004). Presenting patients had comparatively severe illness with increased requirement of MV ( p < 0.001) and significant delay in hospitalization during lockdown ( p < 0.001). Poor compliance to ongoing therapy increased from 34.4% in pre-lockdown to 64.7% patients during lockdown ( p < 0.001), mostly due to nonavailability of drugs ( p < 0.001). Overall, 35 deaths were recorded, with 20 (8.2%) in pre-lockdown and 15 (29.4%) during lockdown ( p = 0.001). Lockdown, nonavailability of local health care, delay in hospitalization, severity at admission, and need for MV emerged as independent predictors of poor outcome in stroke and delay in hospitalization in SE. Conclusion COVID-19 pandemic and associated lockdown resulted in marked decline in non-COVID neurological emergencies reporting to ED, with more severe presentations and significant delay from onset of symptoms to hospitalization.
