Neurological Practice in the Time of War: Perspectives and Experiences from Ukraine.

The full-scale Russian invasion of Ukraine has significantly impacted the country's healthcare system. Insufficient infrastructure, destruction of medical facilities, and barriers to prevention and treatment efforts hinder the provision of timely, high-quality care to our patients. We aim to describe the impact of the war on neurological care across Ukraine. In this article, leading national experts in stroke, epilepsy, multiple sclerosis, and movement disorders describe their personal experience and efforts in organizing and providing care since the war started in February 2022. A neurologist who cared for patients in Mariupol recounts the first weeks of the war when the city was under constant attacks. An international stroke expert describes the role of Task Force for Ukraine, a European Stroke Organization initiative to support the Ukrainian stroke community. We discuss a series of critical challenges facing Ukraine's neurologists, patients, and healthcare delivery system, including shortages of personnel and medical supplies, disrupted logistics, and lack of funding. In addition, we highlight various interventions and strategies aimed at counteracting these challenges, including international support, collaborations within Ukraine, and initiatives enhancing the resilience of the Ukrainian neurology community. As the war is ongoing, this article emphasizes the pressing need for continuous support and investment in the Ukrainian healthcare system to preserve guaranteed access to high-quality healthcare for the Ukrainian people during the war and in its aftermath. Insights from the essays can inform the development and implementation of effective strategies and interventions tailored to such extraordinary circumstances.

ADMISSION VARIABLES ASSOCIATED WITH INDEPENDENT AMBULATION AT TIME OF DISCHARGE FROM A COMPREHENSIVE STROKE UNIT.

OBJECTIVE: The aim: To identify admission variables associated with Functional Ambulation Classif i cation (FAC) 1 to 4 (unable to walk without assistance) at time of discharge (dFAC<5) from a comprehensive stroke unit (CSU). PATIENTS AND METHODS: Materials and methods: Patients admitted to CSU at Oberig Clinic, Kyiv, Ukraine, August 01, 2012 to July 31, 2018, were screened for study selection criteria. Association of qualifying patients' data with FAC score at CSU discharge was retrospectively assessed by univariate and multivariate logistic regression, odds ratios (OR) and 95% conf i dence intervals (95% CI) using MedCalc v. 19.1. RESULTS: Results: The study cohort (442 of 492 admitted patients) had median age: 65.8 years, gender: 43% female, stroke-type: 84% ischemic strokes, median baseline NIHSS total score: 10. Estimated time from stroke onset to CSU admission was from less-than-24-hours to over-180-days. The univariate logistic regression analysis, revealed 28 variables signif i cantly (p<0.05) related to dFAC<5; while in multivariate analysis only 4 admission variables were signif i cantly (p<0.05) associated with dFAC<5: age (OR= 1.07; 95% CI 1.03-1.10, on average, for each additional year, p<0.001), baseline NIHSS score (OR= 1.15; 95% CI 1.08-1.22, on average, with a 1-point increase in the total score, p<0.001), initial FAC score (OR= 0.40; 95% CI 0.31-0.52, on average, with a 1-point decrease in the score, p<0.001), and very late CSU admission (over 180 days; OR= 5.7; 95% CI 1.9-17.1, p=0.002). CONCLUSION: Conclusions: Four admission variables may be independently associated with dFAC<5 and provide opportunity for improving CSU outcomes and mitigating risk for inability to ambulate without assistance after CSU discharge.

Digital health in stroke medicine: what are the opportunities for stroke patients?

PURPOSE OF REVIEW: The European Stroke Organisation published a European Stroke Action Plan (SAP-E) for the years 2018-2030. The SAP-E addresses the entire chain of care from primary prevention through to life after stroke. Within this document digital health tools are suggested for their potential to facilitate greater access to stroke care. In this review, we searched for digital health solutions for every domain of the SAP-E. RECENT FINDINGS: Currently available digital health solutions for the cerebrovascular disease have been designed to support professionals and patients in healthcare settings at all stages. Telemedicine in acute settings has notably increased the access to tissue plasminogen activator and thrombectomy whereas in poststroke settings it has improved access to rehabilitation. Moreover, numerous applications aim to monitor vital signs and prescribed treatment adherence. SUMMARY: SAP-E with its seven domains covers the whole continuum of stroke care, where digital health solutions have been considered to provide utility at a low cost. These technologies are progressively being used in all phases of stroke care, allowing them to overcome geographical and organizational barriers. The commercially available applications may also be used by patients and their careers in various context to facilitate accessibility to health improvement strategies.

Treatment of Vertigo: A Randomized, Double-Blind Trial Comparing Efficacy and Safety of Ginkgo biloba Extract EGb 761 and Betahistine.

A multicenter clinical trial was performed to compare the efficacy and safety of Ginkgo biloba extract EGb 761 and betahistine at recommended doses in patients with vertigo. One hundred and sixty patients (mean age 58 years) were randomly assigned to double-blind treatment with EGb 761 (240 mg per day) or betahistine (32 mg per day) for 12 weeks. An 11-point numeric analogue scale, the Vertigo Symptom Scale-short form, the Clinical Global Impression Scales and the Sheehan Disability Scale were used as outcome measures. Both treatment groups were comparable at baseline and improved in all outcome measures during the course of treatment. There was no significant intergroup difference with regard to changes in any outcome measure. Numerically, improvements of patients receiving EGb 761 were slightly more pronounced on all scales. Clinical global impression was rated "very much improved" or "much improved" in 79% of patients treated with EGb 761 and in 70% receiving betahistine. With 27 adverse events in 19 patients, EGb 761 showed better tolerability than betahistine with 39 adverse events in 31 patients. In conclusion, the two drugs were similarly effective in the treatment of vertigo, but EGb 761 was better tolerated. This trial is registered with controlled-trials.com ISRCTN02262139.

How does fingolimod (gilenya(®)) fit in the treatment algorithm for highly active relapsing-remitting multiple sclerosis?

Multiple sclerosis (MS) is a neurological disorder characterized by inflammatory demyelination and neurodegeneration in the central nervous system. Until recently, disease-modifying treatment was based on agents requiring parenteral delivery, thus limiting long-term compliance. Basic treatments such as beta-interferon provide only moderate efficacy, and although therapies for second-line treatment and highly active MS are more effective, they are associated with potentially severe side effects. Fingolimod (Gilenya(®)) is the first oral treatment of MS and has recently been approved as single disease-modifying therapy in highly active relapsing-remitting multiple sclerosis (RRMS) for adult patients with high disease activity despite basic treatment (beta-interferon) and for treatment-naïve patients with rapidly evolving severe RRMS. At a scientific meeting that took place in Vienna on November 18th, 2011, experts from ten Central and Eastern European countries discussed the clinical benefits and potential risks of fingolimod for MS, suggested how the new therapy fits within the current treatment algorithm and provided expert opinion for the selection and management of patients.