scholarly journals Quality of Life in Physical, Social, and Cognitive Domains Improves With Endovascular Therapy in the DEFUSE 3 Trial

Stroke ◽  
2021 ◽  
Author(s):  
Laura C. Polding ◽  
William J. Tate ◽  
Michael Mlynash ◽  
Michael P. Marks ◽  
Jeremy J. Heit ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Medical Therapy ◽  
Social Participation ◽  
Endovascular Therapy ◽  
Neurological Disorders ◽  
Measurement Tool ◽  
Modified Rankin Scale ◽  
Standard Medical Therapy

Background and Purpose: The DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) randomized clinical trial demonstrated the efficacy of endovascular therapy in treating ischemic stroke 6 to 16 hours after onset, resulting in better functional outcomes than standard medical therapy alone. The objective of this secondary analysis is to analyze the effect of late-window endovascular treatment of ischemic stroke on quality of life (QoL) outcomes. Methods: Patients (n=182) who presented between 6 and 16 hours after they were last known to be well with acute anterior circulation ischemic stroke were randomized to endovascular thrombectomy plus standard medical therapy or standard medical therapy alone and followed-up through 90 days poststroke. QoL at day 90 was assessed with the QoL in Neurological Disorders measurement tool. Results: Of the 146 subjects alive at day 90, 136 (95%) filled out QoL in Neurological Disorders short forms. Patients treated with endovascular therapy had better QoL scores in each domain: mobility, social participation, cognitive function, and depression ( P <0.01 for all). Variables other than endovascular therapy that were independently associated with better QoL included lower baseline National Institutes of Health Stroke Scale, younger age, and male sex. The degree to which the modified Rankin Scale captures differences in QoL between patients varied by domain; the modified Rankin Scale score accounted for a high proportion of the variability in mobility (Rs 2 =0.82), a moderate proportion in social participation (Rs 2 =0.62), and a low proportion in cognition (Rs 2 =0.31) and depression (Rs 2 =0.19). Conclusions: Patients treated with endovascular therapy 6 to 16 hours after stroke have better QoL than patients treated with medical therapy alone, including better mobility, more social participation, superior cognition, and less depression. The modified Rankin Scale fails to capture patients’ outcomes in cognition and depression, which should therefore be assessed with dedicated QoL tools. REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02586415.

scholarly journals Impaired Emotion Recognition after Left Hemispheric Stroke: A Case Report and Brief Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Hugo P. Aben ◽  
Yael D. Reijmer ◽  
Johanna M. A. Visser-Meily ◽  
Jacoba M. Spikman ◽  
Geert Jan Biessels ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Case Report ◽  
Emotion Recognition ◽  
Social Participation ◽  
Neural Correlates ◽  
Brain Regions ◽  
Social Competency ◽  
Review Of The Literature

Impaired recognition of emotion after stroke can have important implications for social competency, social participation, and consequently quality of life. We describe a case of left hemispheric ischemic stroke with impaired recognition of specifically faces expressing fear. Three months later, the patient’s spouse reports that the patient was irritable and slow in communication, which may be caused by the impaired emotion recognition. The case is discussed in relation to the literature concerning emotion recognition and its neural correlates. Our case supports the notion that emotion recognition, including fear recognition, is regulated by a network of interconnected brain regions located in both hemispheres. We conclude that impaired emotion recognition is not uncommon after stroke and can be caused by dysfunction of this emotion-network.

Abstract 137: Endovascular Intervention versus Standard Medical Therapy for Patients Presenting with Large Acute Ischemic Strokes - A Large Single Center Experience

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Maxim Mokin ◽  
Peter Kan ◽  
Adib Abla ◽  
Travis Dumont ◽  
Shady Jahshan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Medical Therapy ◽  
Endovascular Therapy ◽  
Intervention Group ◽  
Medical Group ◽  
Standard Medical Therapy ◽  
Best Medical Therapy

Objective. Endovascular interventions for acute ischemic stroke have been widely adopted on the basis of single-arm registries that reported high recanalization rates with limited complications. We conducted a retrospective cohort study to compare the clinical outcomes in acute ischemic stroke patients who underwent endovascular treatment with patients who were treated with standard medical therapy alone at our institution. Methods. The study group consisted of two cohorts of patients with acute ischemic stroke over a 4-year period: 260 patients underwent endovascular treatment and 597 patients were treated with best medical therapy alone. All patients from the medical group presented with a NIHSS score of >8 and were ineligible for IV tPA. Clinical outcomes at discharge and at 3 months were compared. Results. Compared with the medical group, the endovascular group had a significantly greater proportion of patients who were discharged home (21.2% vs 8.7%, p<0.001) and who could ambulate independently at discharge (32.1% vs 16.8%, p<0.001). Of the patients with follow-up, the proportion of patients with a good outcome (mRS score of <=2) at 3 months was also significantly higher in the endovascular group (51.9% vs 35.7%, p<0.05). Conversely, the endovascular group had a significantly smaller proportion of patients who was discharged to nursing home (11.9% vs 24.1%, p<0.01) and hospice (6.9% vs 14.1%, p=0.003). Mortality rate at discharge was not different (21.2% vs 18.9%, p=0.451). The rate of symptomatic ICH was 9.2% in the intervention group. Conclusion. In our study, endovascular therapy provides a better functional outcome compared with standard medical therapy in select patients. Ultimately, determination of efficacy of endovascular therapy for acute ischemic stroke compared with best medical therapy will depend on results of randomized trials.

scholarly journals Comparison of 3-Month Stroke Disability and Quality of Life across Modified Rankin Scale Categories

2016 ◽  
Vol 6 (1-2) ◽  
pp. 36-41 ◽  
Author(s):  
Srikant Rangaraju ◽  
Diogo Haussen ◽  
Raul G. Nogueira ◽  
Fadi Nahab ◽  
Michael Frankel
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Functional Disability ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Good Outcome ◽  
Health Related Qol ◽  
Health Related ◽  
Sparse Methods

Background and Purpose: Modified Rankin Scale (mRS) score 0-2 has been used to define “good outcome” while stroke patients with mRS 3 are grouped with mRS 4-6 as having “poor outcome.” Long-term data comparing quality of life (QoL), particularly across the mRS 2, 3, and 4 subgroups, are sparse. Methods: Participants in the Interventional Management of Stroke 3 (IMS3) trial with documented 3-month mRS, functional disability (Barthel index [BI]), and self-reported EQ5D-3L QoL questionnaires at 3 months after stroke were included. EQ5D-3L summary indices were calculated using published utility weights for the US population. BI and EQ5D-3L indices were compared across mRS categories using multiple pairwise comparisons with appropriate alpha error corrections. Results: Four hundred twenty-three patients were included (mean age 64 ± 13 years, median baseline NIHSS 16 [IQR 12-19], mean BI 84.1 ± 25.3, and mean EQ5D-3L index 0.73 ± 0.24). While significant differences in BI were observed across mRS categories, QoL in the mRS 2 and 3 categories was similar. Based on BI and EQ5D-3L index, mRS 3 status was more similar to mRS 2 than to mRS 4 status, and large heterogeneity in the mRS 3 group was observed. Conclusions: Ischemic stroke patients who achieve mRS 2 and 3 functional outcomes seem to have similar health-related QoL scores. mRS 0-3, rather than 0-2, should be considered a good outcome category in moderate to severe ischemic stroke.

Musical Anhedonia

2020 ◽  
Vol 31 (2) ◽  
pp. 62-68
Author(s):  
Sara E. Holm ◽  
Alexander Schmidt ◽  
Christoph J. Ploner
Keyword(s):  
Quality Of Life ◽  
Nucleus Accumbens ◽  
Brain Damage ◽  
Parietal Cortex ◽  
Neurological Disorders ◽  
Brain Regions ◽  
Precise Information ◽  
Exact Localization ◽  
High Prevalence

Abstract. Some people, although they are perfectly healthy and happy, cannot enjoy music. These individuals have musical anhedonia, a condition which can be congenital or may occur after focal brain damage. To date, only a few cases of acquired musical anhedonia have been reported in the literature with lesions of the temporo-parietal cortex being particularly important. Even less literature exists on congenital musical anhedonia, in which impaired connectivity of temporal brain regions with the Nucleus accumbens is implicated. Nonetheless, there is no precise information on the prevalence, causes or exact localization of both congenital and acquired musical anhedonia. However, the frequent involvement of temporo-parietal brain regions in neurological disorders such as stroke suggest the possibility of a high prevalence of this disorder, which leads to a considerable reduction in the quality of life.

Assessment of quality of life in patients with the effects of transient ischemic stroke

2016 ◽  
pp. 37-39
Author(s):  
A. Babirad
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Large Scale ◽  
Cerebrovascular Diseases ◽  
Control Measures ◽  
Sociological Research ◽  
Cerebrovascular Events ◽  
Sf 36 ◽  
Angioplasty And Stenting

Cerebrovascular diseases are a problem of the world today, and according to the forecast, the problem of the near future arises. The main risk factors for the development of ischemic disorders of the cerebral circulation include oblique and aging, arterial hypertension, smoking, diabetes mellitus and heart disease. An effective strategy for the prevention of cerebrovascular events is based on the implementation of large-scale risk control measures, including the use of antiagregant and anticoagulant therapy, invasive interventions such as atheromectomy, angioplasty and stenting. In this connection, the efforts of neurologists, cardiologists, angiosurgery, endocrinologists and other specialists are the basis for achieving an acceptable clinical outcome. A review of the SF-36 method for assessing the quality of life in patients with the effects of transient ischemic stroke is presented. The assessment of quality of life is recognized in world medical practice and research, an indicator that is also used to assess the quality of the health system and in general sociological research.

scholarly journals A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3)

2017 ◽  
Vol 12 (8) ◽  
pp. 896-905 ◽  
Author(s):  
Gregory W Albers ◽  
Maarten G Lansberg ◽  
Stephanie Kemp ◽  
Jenny P Tsai ◽  
Phil Lavori ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Primary Endpoint ◽  
Endovascular Therapy ◽  
Symptom Onset ◽  
Medical Management ◽  
Controlled Trial ◽  
Modified Rankin Scale ◽  
Computed Tomography Perfusion

Rationale Early reperfusion in patients experiencing acute ischemic stroke is effective in patients with large vessel occlusion. No randomized data are available regarding the safety and efficacy of endovascular therapy beyond 6 h from symptom onset. Aim The aim of the study is to demonstrate that, among patients with large vessel anterior circulation occlusion who have a favorable imaging profile on computed tomography perfusion or magnetic resonance imaging, endovascular therapy with a Food and Drug Administration 510 K-cleared mechanical thrombectomy device reduces the degree of disability three months post stroke. Design The study is a prospective, randomized, multicenter, phase III, adaptive, blinded endpoint, controlled trial. A maximum of 476 patients will be randomized and treated between 6 and 16 h of symptom onset. Procedures Patients undergo imaging with computed tomography perfusion or magnetic resonance diffusion/perfusion, and automated software (RAPID) determines if the Target Mismatch Profile is present. Patients who meet both clinical and imaging selection criteria are randomized 1:1 to endovascular therapy plus medical management or medical management alone. The individual endovascular therapist chooses the specific device (or devices) employed. Study outcomes The primary endpoint is the distribution of scores on the modified Rankin Scale at day 90. The secondary endpoint is the proportion of patients with modified Rankin Scale 0–2 at day 90 (indicating functional independence). Analysis Statistical analysis for the primary endpoint will be conducted using a normal approximation of the Wilcoxon–Mann–Whitney test (the generalized likelihood ratio test).

Intake of Anti-Epileptic Drugs and their Influences on Sexual Dysfunctions

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Roheela Yasmeen ◽  
Nida Mobeen ◽  
Muhammad Amjad Khan ◽  
Irfan Aslam ◽  
Samia Chaudhry
Keyword(s):  
Quality Of Life ◽  
Sexual Dysfunction ◽  
Neurological Disorders ◽  
Penile Erection ◽  
The Central Nervous System ◽  
Relationship Of ◽  
The Relationship ◽  
The Brain ◽  
Psychiatric Problems

Epilepsy which is also called seizures disorder is an uncontrolled action of the central nervous system. Itis not a single disease but a set of neurological disorders. Actually in this situation, the brain does notreceive a precise signal and as a result an abnormal condition is produced that is usually involuntary inaction. In this review, we aimed to focus on the relationship of anti-epileptic drugs with sexual dysfunctionand adaptation of better remedies that improve a patient’s family life. Sexual dysfunction is a commoncomorbidity in people with epilepsy which badly affects their quality of life. Sexual dysfunction is causedby different factors like psychiatric problems, anti-epileptic drugs (AEDs) and social factors etc. Sexualdysfunctions include ejaculatory failure, lessen libido, penile erection in men and irregular menstrual cyclein women. Common drugs such as Topiramate, Gabapentin (GBP), Valproate (VA), Carbamazepine (CBZ),Olanzapine (OL) and Risperidone (RTG) that are in practice to treat epilepsy usually produced adverseeffect on sexual dysfunction. Even though a lot of studies have been carried out to control sexualdysfunction in epilepsy’s patient, but still research is going on. Medicine such as Cyproheptadine,Mianserin, Buspirone, Yohimbine were found better to treat epilepsy with minimum side effects of sexualdysfunction. Moreover, it is also seen that certain vasodilators, folate , and vitamin supplements areeffective in improving the quality of life.

scholarly journals An Alternative Approach to the Terminal Management of Ogilvie Syndrome

2017 ◽  
Vol 11 (2) ◽  
pp. 352-358
Author(s):  
Daniel Galban ◽  
Joshua J. Baiel
Keyword(s):  
Quality Of Life ◽  
Surgical Resection ◽  
Medical Therapy ◽  
Subtotal Colectomy ◽  
Abdominal Discomfort ◽  
Conservative Approach ◽  
Replacement Surgery ◽  
Alternative Approach ◽  
Ogilvie Syndrome

Ogilvie syndrome is defined as colonic pseudo-obstruction due to nonmechanical causes. Mortality of nearly 50% is associated with perforation of the distended, pseudo-obstructed colon. While conservative medical therapy has proven to be beneficial in a majority of cases, >3% of patients have significant distention or perforation of the colon that warrants surgical resection. The case of a 48-year-old male with progressive abdominal discomfort and distention 12 days following knee replacement surgery is presented. He was subsequently diagnosed with colonic pseudo-obstruction and definitively treated with subtotal colectomy and colostomy. We propose that a more conservative approach to treatment of colonic pseudo-obstruction may prevent the need for colostomy, significantly improving quality of life.

How Social Participation Benefits the Chronically Ill: Self-Management as a Mediating Pathway

2018 ◽  
Vol 31 (7) ◽  
pp. 1134-1154 ◽  
Author(s):  
Shannon Ang
Keyword(s):  
Quality Of Life ◽  
Social Participation ◽  
Low Income ◽  
Chronically Ill ◽  
Self Management ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Causal Mediation Analysis

Objective: Few studies have tested the purported causal mechanisms between social participation and health, especially among those in poor health. This study aimed to determine whether self-management of chronic disease operates as a pathway through which social participation affects health-related quality of life. Method: I utilized causal mediation analysis among 600 low-income older Singaporeans living with chronic conditions, to test whether self-management mediates the association between social participation and health-related quality of life. Results: Results show that self-management fully mediated the positive effect of informal social participation on health-related quality of life. Formal social participation was found to have a negative direct effect on health-related quality of life. Discussion: These findings reiterate the primacy of family and friends for older adults, but highlight that a better understanding of formal engagement with the low-income population is still needed.

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