Long-term effects of prolonged-release fampridine in cognitive function, fatigue, mood and quality of life of MS patients: The IGNITE study.

BACKGROUND: Studies have reported conflicting results regarding the potential benefit of prolonged release (PR) fampridine in other domains besides walking. Moreover, only a small number of studies have explored long- term effects of PR fampridine. The aim of this study was to assess cognitive function, quality of life, mood and fatigue in MS patients treated with fampridine after 6 and 12 months of treatment. METHODS: IGNITE was an observational, open label study. Subjects were examined with the timed 25-ft walk (T25FW) and the BICAMS battery and were asked to complete the Multiple Sclerosis Impact Scale (MSIS-29), Modified Fatigue Impact Scale (MFIS), Beck Depression Inventory-II (BDI-II) and MS International Quality-of-Life questionnaire (MUSIQOL) at baseline and at weeks 24 and 48. Patients were sub-grouped into responders (n:40) and non-responders (n:20) according to T25FW performance after 2 weeks on treatment. RESULTS: After 6 months, statistically significant improvement was observed on T25FW (p < .001), SDMT (p < .001) and MSIS29 (p < .001), for responders. After 1 year on treatment, statistically significant improvement was observed in T25FW (p < .001), MSIS29 (p = .004), SDMT (p < .001) and MUSIQOL (p = .03) for responders. There were no statistically significant improvements for the non-responders. CONCLUSIONS: PR Fampridine may have a beneficial effect on information processing speed though not on memory. Study data provide some evidence that fampridine treatment may reduce the impact of MS on daily activities and improve quality of life but has no effect on subjective fatigue and mood.

Intravenous thrombolysis for patients with in-hospital stroke onset: propensity-matched analysis from the Safe Implementation of Treatments in Stroke-East registry.

BACKGROUND AND PURPOSE: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital stroke (IHS) onset is associated with unfavorable functional outcomes at hospital discharge and in-hospital mortality compared to patients with out-of-hospital stroke (OHS) onset treated with IVT. We sought to compare outcomes between IVT-treated patients with IHS and OHS by analysing propensity-score-matched data from the Safe Implementation of Treatments in Stroke-East registry. METHODS: We compared the following outcomes for all propensity-score-matched patients: (i) symptomatic intracranial hemorrhage defined with the safe implementation of thrombolysis in stroke-monitoring study criteria, (ii) favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0-1 at 3 months, (iii) functional independence defined as an mRS score of 0-2 at 3 months and (iv) 3-month mortality. RESULTS: Out of a total of 19 077 IVT-treated patients with acute ischaemic stroke, 196 patients with IHS were matched to 5124 patients with OHS, with no differences in all baseline characteristics (P > 0.1). Patients with IHS had longer door-to-needle [90 (interquartile range, IQR, 60-140) vs. 65 (IQR, 47-95) min, P < 0.001] and door-to-imaging [40 (IQR, 20-90) vs. 24 (IQR, 15-35) min, P < 0.001] times compared with patients with OHS. No differences were detected in the rates of symptomatic intracranial hemorrhage (1.6% vs. 1.9%, P = 0.756), favorable functional outcome (46.4% vs. 42.3%, P = 0.257), functional independence (60.7% vs. 60.0%, P = 0.447) and mortality (14.3% vs. 15.1%, P = 0.764). The distribution of 3-month mRS scores was similar in the two groups (P = 0.273). CONCLUSIONS: Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tissue plasminogen activator delivery in patients with IHS.

CADASIL presenting with spontaneous intracerebral hemorrhage: report of a case and description of the first family in Northern Greece.

INTRODUCTION: CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), the most common inherited cause of stroke and dementia in adults, has been described in six Greek families. Common presenting manifestations include migraine with aura, brain ischemia, mood disorders and cognitive decline. Spontaneous intracerebral hemorrhage (SICH) rarely occurs in CADASIL and only exceptionally as the first clinical manifestation. CASE DESCRIPTION: We have previously reported the sixth Greek family with CADASIL and in particular, two brothers in whom the genetic testing documented a classic mutation of the NOTCH3 gene (Arg169Cys). In this report, we describe the 30-year-old son of the second brother, who suffered a thalamic SICH as the presenting manifestation of CADASIL, in the absence of arterial hypertension or antiplatelet drug use. CONCLUSION: Patients with acute subcortical infarcts, leukoencephalopathy, a history of migraine, mood disorders, and dementia, should always raise the suspicion of CADASIL. However, a SICH, even in the absence of classical risk factors for hemorrhage, is possible and should not exclude the diagnosis of CADACIL. Hippokratia 2016, 20(1): 76-79.

Intravenous valproate aborts glyceryl trinitrate-induced migraine attacks: a clinical and quantitative EEG study.

We evaluated EEG changes and pain relief in migraineurs with glyceryl trinitrate (GTN)-induced attacks treated with intravenous sodium valproate (iSVP). EEG frequency analysis was performed in 45 migraineurs without aura and in 19 controls at baseline, at the time of maximum GTN-induced headache, and 30 min after 300 mg iSVP. Nineteen migraineurs presented early specific headache (migraine identical to spontaneous attacks; MSp) and 26 presented early non-specific headache (MnSp). During attacks in MSp there was an increase of theta [16.6% (14.8-19.3) to 19.4% (17.4-22.1), P = 0.02] and delta activity [3.6% (3.1-4.4) to 5.4% (3.9-6.5), P = 0.009], whereas there was no decrease in alpha [41.4% (36.2-45.1) to 39.7% (34.7-44.8)] or beta activity [37.6% (34.7-40.3) to 35.1% (33.5-38.8)]. iSVP reduced migraine from severe/moderate to mild/no pain in 17 (90%) MSp patients, and was associated with reversion of the slow rhythmic activity to baseline levels [theta 16.9% (14.6-18.9); delta 3.2% (3-4.1)]. There was no change in EEG frequency activity after administration of GTN or iSVP in controls and in MnSp. iSVP is well tolerated and effective in treating GTN-induced migraine in migraineurs without aura, and appears to restore the disturbances of cortical electrogenesis associated with these attacks.

Are transient increases in blood pressure during the treadmill stress test associated with headache?

We aimed to investigate whether transient increases in blood pressure (BP) are associated with headache, by provoking hypertension in 50 non-hypertensive cephalalgia sufferers (Ce), 50 hypertensive cephalalgia sufferers (HyCe) and 50 healthy subjects (C) with a treadmill stress test. Occurrence of headache among groups did not differ (P = 0.81); however, women developed headache more frequently than men (P < 0.0001). The 35 individuals who developed headache during the test compared with those who did not (regardless of their original group) had higher absolute diastolic BP and higher absolute and relative diastolic BP increase during the test (P < 0.0001). HyCe patients that developed headache had higher diastolic BP than those that did not (P < 0.002). For each group, the absolute/relative mean increases of systolic/diastolic BP did not differ between patients that developed headache and those that did not excepting relative diastolic BP increase in Ce (28% vs. 15%, P = 0.006). The appearance of headache during dynamic exercise is not associated with a history of headache or hypertension. In non-hypertensive cephalalgia sufferers, relative diastolic BP increases of >27% are associated with headache attacks whereas in HyCe sufferers absolute diastolic BP values may be more important.

Gastric emptying after semi-solid food in multiple system atrophy and Parkinson disease.

BACKGROUND: Gastrointestinal symptoms such as nausea, abdominal pain, and bloating are frequent complaints in patients with Parkinson disease (PD) and in patients with multiple system atrophy (MSA), and may be associated with delayed gastric emptying (GE). Although several GE studies in patients with PD have been performed, scant data exist in patients with MSA. METHODS: We assessed GE half-times (T50) in 12 patients with MSA and compared them with those of 12 patients with PD and 12 age-matched healthy controls.GE was estimated scintigraphically using the left anterior oblique method after ingestion of a (99m)Tc colloid-labeled balanced semi-solid meal (yogurt). GE data were obtained every 15 minutes until there was complete emptying of the stomach. Blood pressure, heart rate, plasma glucose and glucosylated hemoglobin were regularly determined. RESULTS: Reproducibility of the GE technique was excellent (Bland-Altman analysis, limits of agreement: -2.3 to 2.8). T50 was longer in MSA (82+/-3.4 min) and in PD (90.6+/-3.9 min) patients compared with controls (46.2+/-0.7) (two-way ANOVA, p<0.0001). T50 did not differ between patients with MSA and those with PD. No correlation existed between T50 and age, duration of the disease, magnitude of postprandial hypotension, levels of plasma glucose and glucosylated hemoglobin (Kendall's tau, p>0.05). CONCLUSIONS: Our results suggest that patients with MSA have GE rates similar to those of patients with PD, but slower than healthy age matched individuals. It remains to be investigated whether gastrointestinal dysfunction in MSA is related to both brain and peripheral pathology, as is presumed for PD.

Prodromal and early epileptic seizures in acute stroke: does higher serum cholesterol protect?

In a case-control study, patients (n = 43/3,628) presenting seizures <1 week before (n = 6), < or =3 hours after (n = 26), and 3 to 24 hours after (n = 11) a first-ever stroke were studied. On multivariate analysis, they were characterized by lower levels of serum cholesterol (5.86 +/- 0.51 vs 6.34 +/- 0.58; p < 0.0001). Mortality and functional outcome at discharge were not influenced. Early poststroke seizures occur mainly during the critical 3-hour window for thrombolysis. Hypercholesterolemia appears to protect against seizures and cerebral ischemia.

Catastrophic reaction in acute stroke: a reflex behavior in aphasic patients.

Twelve patients with a catastrophic reaction (CR) (an outburst of frustration, depression, and anger when confronted with a task) were identified in a prospective cohort population (n = 326) with first-ever stroke admitted within 48 hours from onset. The authors' findings suggest that CR is a rare though not exceptional phenomenon in acute stroke and is associated with nonfluent aphasias and left opercular lesions. CR, poststroke depression, and emotionalism are distinct but related disorders.