[Show abstract][Hide abstract] ABSTRACT: Recent advances in information technology have created opportunities for advances in the management of stroke. The objective of this study was to test the feasibility of using a smartphone software application (app) for the management of vascular risk factors in patients with stroke.
This prospective clinical trial developed a smartphone app, the 'Korea University Health Monitoring System for Stroke: KUHMS₂,' for use by patients with stroke. During a 6-month follow-up period, its feasibility was assessed by measuring the changes in their vascular risk-factor profiles and the number of days per patient with data registration into the app. The effect of the app on the achievement rate of risk-factor targets was assessed by classifying subjects into compliant and noncompliant groups.
At the end of the trial, data on 48 patients were analyzed. The number of days on which data were registered into the app was 60.42±50.17 (mean±standard deviation). Among predefined vascular risk factors, the target achievement rate for blood pressure and glycated hemoglobin (Hb(A1c)) improved significantly from baseline to the final measurement. The serial changes in achievement rates for risk-factor targets did not differ between the compliant and noncompliant groups.
Many challenges must be overcome before mobile apps can be used for patients with stroke. Nevertheless, the app tested in this study induced a shift in the risk profiles in a favorable direction among the included stroke patients.
[Show abstract][Hide abstract] ABSTRACT: Although anxiety and depression have been classified as distinct traits of affective disorders, previous studies have reported their co-occurrence in subjects with migraine. However, few reports are available on the clinical implications of this comorbidity. This study is to assess the comorbidity of anxiety and depression in subjects with migraine and its clinical implications in a population-based sample from Korea.
We selected Korean subjects aged 19–69 years by the stratified random sampling method, and evaluated them using a semi-structured interview, designed to identify headache type, anxiety, and depression. We used Goldberg Anxiety Scale questions and Patient Health Questionnnaire-9 for the diagnosis of anxiety and depression, respectively.
Of the 2,762 participants who completed the interview, 147 subjects (5.4%) were classified as having a migraine during the previous year. Among these 147 subjects, 17 (11.6%) had anxiety and depression, 28 (19.0%) had anxiety alone, 9 (6.1%) had depression alone, and 93 (63.3%) had neither anxiety nor depression. Headache frequency per month was remarkably higher in subjects having migraine with anxiety and depression (median [25–75 percentile values], 8.0 [2.5–21.0]) than in those having migraine with anxiety alone (2.0 [1.0–5.0], p = 0.003), migraine with depression alone (1.0 [0.3–4.0], p = 0.001), and migraine without anxiety or depression (1.0 [0.3–3.0], p < 0.001). The migraine with anxiety alone (7.0 [6.0–8.0], p = 0.011) group and migraine with anxiety and depression (7.0 [5.0–9.0], p = 0.018) group showed higher Visual Analogue Scale scores for pain intensity compare to migraine without anxiety or depression (6.0 [5.0-7.0]) group.
Approximately 1/3 of migraineurs with anxiety had depression and 2/3 of migraineurs with depression had anxiety. Combination of anxiety and depression was associated with an increased headache frequency. Anxiety was associated with exacerbation of headache intensity.
[Show abstract][Hide abstract] ABSTRACT: Background and purpose:
Headache may be a warning sign of subsequent stroke in patients with vertebral artery dissection (VAD). Even though the headache characteristics of VAD have been described predominantly in patients with extracranial VAD and neurological complications, headache semiology is not well known in patients with uncomplicated intracranial vertebral artery dissection (ICVAD). In the present study, we attempt to identify the headache semiology that characterizes ICVAD and validate the revised version of the International Classification of Headache Disorders (ICHD-3 beta) criteria for headache attributed to intracranial artery dissection.
Six patients with neurologically uncomplicated ICVAD presented at a participating medical center, and eight similar patients were reviewed in the literature. Combining these data, we analyzed headache characteristics of patients with uncomplicated ICVAD according to their pain onset and duration, nature, intensity, location, aggravating and relieving factors, associated symptoms, response to medication, and prognosis.
Headache in uncomplicated ICVAD usually has an acute mode of onset (11/14) and persistent (10/14) temporal feature. Pain that has a throbbing quality (nine of 14) and severe intensity (13/14) on the ipsilesional (10/14) and occipitonuchal area (12/14) is a headache prototype in ICVAD. Additionally, headache was intensified by head flexion and rotation (three of six), and relieved by head extension and supine positioning (five of six). Headache of all patients in the present study fulfilled the ICHD-3 beta criteria.
Headache semiology of uncomplicated ICVAD is mostly homogenous in the present study. These characteristics may be helpful in the diagnosis of uncomplicated ICVAD.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to investigate the potential benefits of statin therapy on mortality and stroke recurrence after cardioembolic stroke.
In this retrospective observational study, we analyzed data from 535 patients with first-ever cardioembolic stroke. Patients were classified into nonstatin, low-potency statin, and high-potency statin groups. The primary outcomes were time to mortality and time to recurrent stroke.
The mean duration of follow-up was 22.2 months. The cumulative mortality rate was 7% at the end of the first year and 10% at the end of the third year. Statin therapy was independently associated with reduced mortality (hazard ratio, 0.237; 95% confidence interval, 0.080-0.703 for nonstatin versus low-potency statin; hazard ratio, 0.158; 95% confidence interval, 0.037-0.686 for nonstatin versus high-potency statin). Statin treatment did not affect the incidence of recurrent stroke in patients with cardioembolic stroke.
Statin therapy could be associated with reduced mortality in patients with cardioembolic stroke.
[Show abstract][Hide abstract] ABSTRACT: We aimed to explore cortical thickness abnormalities in a homogeneous group of patients with migraine without aura and to delineate possible relationships between cortical thickness changes and clinical variables.
Fifty-six female migraine patients without aura and T2-visible white matter hyperintensities and 34 female controls were scanned on a 3T magnetic resonance imager. Cortical thickness was estimated and compared between patients and controls using a whole-brain vertex-by-vertex analysis. Correlation analysis was conducted between cortical thickness of significant clusters and clinical variables.
Compared to controls, migraine patients had cortical thickening in left rostral middle frontal gyrus and bilateral post-central gyri. Region-of-interest analysis revealed cortical thickening of bilateral post-central gyri in migraine patients relative to controls. The average thickness of bilateral post-central gyri positively correlated with disease duration as well as estimated lifetime headache frequency.
We have provided evidence for interictal cortical abnormalities of thickened prefrontal cortex and somatosensory cortex in female migraine patients without aura. Our findings of greater thickening of the somatosensory cortex in relation to increasing disease duration and increasing headache frequency suggest that repeated migraine attacks over time may lead to structural changes of the somatosensory cortex through increased noxious afferent input within the trigemino-thalamo-cortical pathway in migraine.
[Show abstract][Hide abstract] ABSTRACT: Background: few studies have addressed the association between the characteristics of ischemic lesions detected by diffusion-weighted imaging (dWi) and the clinical outcome in patients with hyperacute posterior circulation ischemic stroke. this study demonstrates a relationship between the findings assessed by dWi and the outcome in patients with hyperacute posterior circulation ischemic stroke.Methods: We reviewed data from 118 patients who had posterior circulation ischemic stroke within six hours from the onset of their symptoms. the clinical outcome included early neurological deterioration (end) and a favorable outcome at three months after the onset of symptoms. using dWi, the lesion volume and the number and location of injured anatomical regions were analyzed to evaluate whether the results correlated with the clinical outcome measures.Results: the number of injured anatomical regions assessed by dWi was associated with the initial and delayed neurological status. Both the total volume and the number of injured anatomical regions associated with end and a favorable outcome. analysis of the location of the injured regions determined that only a pontine lesion independently associated with end. interestingly, four out of five patients who underwent decompressive craniectomy exhibited a large infarction volume but minor symptoms.Conclusions: in patients with hyperacute posterior circulation ischemic strokes, the lesions assessed by dWi were associated with the clinical outcome, regardless of the initial neurological status. dWi is an effective initial imaging tool for assessing the extent of lesions and clinical outcomes in patients with hyperacute posterior circulation ischemic stroke.
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 03/2014; 41(2):187-92. DOI:10.1017/S0317167100016565 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
Aberrant thalamocortical network has been hypothesized to play a crucial role in the fundamental pathogenesis underlying idiopathic generalized epilepsy (IGE). We aimed to investigate alterations of thalamocortical functional network in patients with IGE using thalamic seed-based functional connectivity (FC) analysis, and their relationships with frontal cognitive functions and clinical characteristics.Methods
Forty-nine IGE patients (31 with juvenile myoclonic epilepsy, 17 with IGE with generalized tonic–clonic seizures only, one with juvenile absence epilepsy) and 42 control subjects were prospectively recruited. Voxel-based morphometry (VBM) was first performed to detect thalamic region of gray matter (GM) reduction in patients compared to controls. Between-group comparison of thalamocortical FC was then carried out using resting-state functional magnetic resonance imaging (MRI) analysis seeding at thalamic region of volume difference. In addition, thalamocortical FC was correlated with frontal cognitive performance and clinical variables.ResultsNeuropsychological assessment revealed that patients with IGE had poorer performance than controls on most of the frontal cognitive functions. VBM detected a reduction in GM in the anteromedial thalamus in patients relative to controls. FC analysis seeding at the anteromedial thalamus revealed a reduction of thalamocortical FC in the bilateral medial prefrontal cortex and precuneus/posterior cingulate cortex in patients with IGE compared to controls. Thalamocortical FC strength of bilateral medial prefrontal cortex correlated negatively with disease duration, but did not correlate with seizure frequency or frontal cognitive functions in patients with IGE.SignificanceOur results indicate that IGE is associated with decreased thalamocortical FC between anteromedial thalamus and medial prefrontal cortex and precuneus/posterior cingulate cortex. Our finding of greater reduction of medial prefrontal FC in relation to increasing disease duration suggests that thalamoprefrontal network abnormality, the proposed pathophysiologic mechanism underlying IGE, may be the consequence of the long-standing burden of the disease.
[Show abstract][Hide abstract] ABSTRACT: To determine whether the plasma level of free fatty acid (FFA) could be associated with recurrent stroke in cardioembolic (CE) stroke patients.
We analyzed data from 669 acute ischemic stroke patients and examined the association between FFA concentration and recurrent stroke in CE stroke patients compared with non-CE stroke patients.
The baseline plasma FFA concentration (mEq/L) was approximately 1.5-fold higher in CE stroke patients (1.01 ± 0.63) than in non-CE stroke patients (0.72 ± 0.51). Multivariate logistic analysis showed that an increased level of FFA was significantly associated with CE stroke (hazard ratio [HR] 2.124, confidence interval [CI] 1.492-3.024). During the mean follow-up period of 25.4 months, a total of 56 (8.4%) patients experienced a stroke recurrence. The recurrence rate did not differ between patients with CE (10.5%) and non-CE (8.0%) stroke (p = 0.396). In CE stroke patients, an elevated baseline FFA concentration was independently associated with stroke recurrence (HR 2.711, CI 1.056-6.959). However, there was no association between FFA and stroke recurrence in non-CE stroke patients.
In this retrospective registry-based observational study, CE stroke seemed to be associated with elevated plasma level of FFA. In addition, the present study suggested that an elevated FFA concentration could be a useful indicator for predicting recurrent stroke in CE stroke patients.
[Show abstract][Hide abstract] ABSTRACT: Post-stroke atrial fibrillation has been frequently reported especially in the patients with right insular infarct as an evidence of cerebrogenic mechanism affecting on cardiac rhythm. However, conversion to normal sinus rhythm after stroke in patients who had atrial fibrillation has not been reported. A 88-year-old men who had untreated atrial fibrillation was admitted to hospital due to left middle cerebral artery territory infarction. During admission, second ischemic attack occurred in right middle cerebral artery territory. At that time, his atrial fibrillation converted spontaneously to normal sinus rhythm. Restored sinus rhythm sustained until he died due to sepsis. This case is evidence supporting a theory that brain is associated with control of cardiac rhythm. If no risk factor is revealed by intensive investigation in patients with acute cerebral infarctions that cardioembolism is strongly suspected as a cause, physicians should concern transformation of atrial fibrillation to normal sinus rhythm after stroke.
Journal of Korean Neurosurgical Society 06/2013; 53(6):368-70. DOI:10.3340/jkns.2013.53.6.368 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neuropsychological and neuroimaging studies both suggest that frontal lobe dysfunction is present in migraineurs. Since P3a abnormalities manifest in other diseases associated with attention problems, such as attention deficit hyperactivity disorder, we hypothesized that migraine patients have P3a abnormalities, particularly in the frontal region.
Event-related potentials were measured using a passive auditory oddball paradigm in 16 female migraineurs (aged 22.9±2.0 years, mean±SD) during the interictal period and in 16 age-matched healthy females (22.6±2.0 years). The amplitudes and latencies were analyzed independently using repeated-measures analysis of variance. Nonparametric statistical testing using a cluster-level randomization method was performed to localize the abnormalities.
The mean P3a amplitude at frontal areas during the third trials was significantly lower in migraineurs (1.06 µV) than in controls (1.69 µV, p=0.026). P3a amplitudes were negatively correlated with the duration of the migraine history (r=-0.618, p=0.014). Cluster-based nonparametric statistical analysis showed that the amplitudes over left frontal areas were significantly lower in migraine patients than in controls.
A reduced P3a amplitude of migraineurs reflects attentional deficits and frontal dysfunction. The negative correlation between P3a amplitude and the duration of the migraine history suggests that attentional deficits and frontal dysfunction are either the cause or the result of headache.
[Show abstract][Hide abstract] ABSTRACT: Background/aims:
Although previous studies showed a high prevalence of abnormal ankle-brachial index (ABI) in patients with ischemic stroke, few data exist regarding ABI in Asian patients with ischemic stroke. The purpose of the present study was to determine the prevalence and factors associated with abnormal ABI (≤0.9) in a cohort of ischemic stroke patients.
In this prospective multicenter study, 1,293 patients diagnosed with acute ischemic stroke or transient ischemic attack underwent ABI measurement to evaluate an association between abnormal ABI and vascular risk factors and clinical characteristics. Differences in ABI by stroke subtypes were also assessed.
Abnormal ABI of ≤0.9 was found in 13.0%. Patients with abnormal ABI were more likely to be older and had higher initial stroke severity. The prevalence of abnormal ABI was 18.4% in large artery atherosclerosis, 7% in small artery disease, and 19.2% in cardioembolism (p < 0.001). Multiple logistic regression analysis showed that age, hyperlipidemia, diabetes, and large artery atherosclerosis subtype were independent factors associated with abnormal ABI.
These data suggest that the prevalence of abnormal ABI in Korean patients with ischemic stroke was lower than that in Caucasian patients, which might be associated with ethnic differences in underlying stroke subtypes.
European Neurology 12/2012; 69(3):179-184. DOI:10.1159/000342892 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Although long-term predictors of mortality and vascular events after ischemic stroke are well defined, the age-dependent differences in predicting outcomes are unknown, particularly for lipid parameters.
We assessed recurrent stroke and other vascular events in patients with first-ever ischemic strokes who were registered in a prospectively collected hospital-based stroke registry. Patients were classified into a middle-age group (40-64 years old) and an old-age group (65 years and older).
A total of 551 patients comprising 235 middle-age and 316 old-age subjects were investigated. At the mean follow-up of 26.4 months, 49 (8.9%) patients had experienced recurrent stroke. Outcome events in the middle-age group (3.8%) were less frequent than in the old-age group (12.7%). The effects of vascular risk factors were different across age groups. In particular, the hazard ratio direction for triglycerides was significantly different between age groups for recurrent stroke or composite outcomes.
Incidence and predictors of stroke and other vascular events following ischemic stroke are age-dependent. Differential effects of triglycerides on long-term outcomes following ischemic stroke were found to be hazardous at middle age but turned out to be non-significant at old age.
European Neurology 12/2012; 69(3):171-178. DOI:10.1159/000345480 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Middle-aged women are frequent visitors in headache clinics. We investigated the differences in headache characteristics of middle-aged women (aged 40-54 years) according to their menopausal status. In total, 229 women were divided into the following three groups: premenopausal (n = 78), perimenopausal (n = 69), and postmenopausal (n = 82). The prevalence of tension-type headaches was higher in the peri- and postmenopausal groups than in the premenopausal group (p < 0.05), whereas the prevalence of migraines was similar across the three groups. The proportion of patients with a short duration of headache history (<6 months) was significantly higher in the perimenopausal group (40.6%) than in the premenopausal (12.8%) or postmenopausal (17.1%) groups (p < 0.01). Analysis of headaches in perimenopausal patients who did not receive exogenous hormone treatment (n = 61) showed that current headaches were reported as new-onset headaches by 47.5% of subjects, as aggravations of prior headaches by 34.4% of subjects, or as unchanged from prior headaches in 18.0% of subjects. This study shows that the prevalence of tension-type headaches is different between menopausal periods, whereas the prevalence of migraines is not changed. Perimenopausal women tended to experience relatively more tension-type headaches and visited the hospital mainly due to new-onset headaches or aggravated headaches.
European Neurology 07/2012; 68(2):79-83. DOI:10.1159/000336838 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Postural instability is one of the most disabling features of Parkinson's disease, usually occurring in late and advanced stages. The aim of this study was to investigate the postural performance of early-stage de novo Parkinson's disease patients with no clinical postural instability using computerized dynamic posturography. We sought to understand the relationship between postural sway and disease severity and the relationship between postural instability quantitatively measured by computerized dynamic posturography and cognitive impairment in early-stage Parkinson's disease patients.
Thirty-one subjects with Parkinson's disease and 20 healthy controls were assessed by the computerized dynamic posturography protocol using the sensory organization test and the motor control test. A neuropsychological assessment was also administered.
The mean equilibrium score for sensory organization test and the vestibular input ratio were significantly correlated with Hoehn-Yahr stage. No associations between motor latency for any motor control test condition and Hoehn-Yahr stage were found. The equilibrium score for sensory organization test correlated with the mini-mental status examination scores. There was a significant correlation between motor latency for large backward translation and mini-mental status examination scores. There were significant correlations between visual perception/construction/ memory of the neuropsychological battery test and the equilibrium score for sensory organization test and between verbal word learning test, controlled word association test and motor latency for large backward translation.
These findings showed the postural instability present in early-stage (Hoehn-Yahr stage 2-2.5) Parkinson's disease. We also found a close relationship between postural instability and cognitive function in Parkinson's disease patients.
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 07/2012; 39(4):473-82. DOI:10.1017/S0317167100013986 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background / Purpose:
Osmophobia (intolerance/fear of smell) is often reported by migraine patients during attack and is included as an item of alternative criteria for migraine in the appendix of International Classification of Headache Disorders 2 (ICHD-2). Most of the previous reports on osmophobia were clinic- or hospital-based studies and osmphobia of migraine sufferers across population samples has yet to be reported.The aim of this study is to assess osmophobia in migraine and probable migraine sufferers across the Korean population and to evaluate the validation of an alternative criteria for migraine.
Approximately half of migraine and probable migraine sufferers across the population sample reported osmophobia. Alternative criteria for migraines that included osmophobia showed good specificity and proper sensitivity.
54th American Headache Society Annual Meeting 2012; 06/2012
[Show abstract][Hide abstract] ABSTRACT: Background / Purpose:
Headache is often disabling and imposes a significant amount of impact on a headache sufferer’s life. However, a considerable proportion of headaches in sufferers are mild enough that they never seek consultation about them. Population-based studies often include headache sufferers whose headaches are of a mild nature and do not reflect the exact picture in a clinical setting. Clinic-based studies do not show the whole picture of headaches and are often issued for proper sampling. Headache Impact Test-6 (HIT-6) is a widely used instrument to assess the impact of headaches on an individual. Individuals with substantial-to-severe impact in HIT-6 were considered to suffer from pain and to miss daily activities due to the onset of their headache. The Korean Headache Survey is a nation-wide, semi-structured interview survey using a questionnaire to determine the status of headache disorders of adults aged 19 or older.
The first year prevalence rating of the headache imposing substantial-to-severe impact (HISSI) was 8.0% in the general population. Probable tension-type headache (PTTH) is the most common headache type and contributes to 44% of the HISSI study. The next frequent headache type is probable migraine (PM) contributing to 29% of the HISSI study. The concurrent diagnosis of PM and PTTH comprise to 22% of the HISSI study.
54th American Headache Society Annual Meeting 2012; 06/2012
[Show abstract][Hide abstract] ABSTRACT: Although the association between elevated C-reactive protein (CRP) level and long-term outcome after ischemic stroke is well known, the association between CRP and early neurologic deterioration (END) has not yet been thoroughly studied. We investigated the impact of CRP on END in patients with acute ischemic stroke. From a prospectively collected, multicenter stroke registry, 428 patients with acute ischemic stroke diagnosed within 24 hours of onset were enrolled in the study. Patients with hemorrhagic stroke, transient ischemic attack, and thrombolysis were excluded. END was defined as a >2-point increase in the National Institutes of Health Stroke Scale score within a 72-hour period. Data considered potentially associated with CRP level and the END were collected. END was observed in 47 patients. CRP level, time before arrival at the hospital, age, female sex, hematocrit, high-density lipoprotein (HDL) cholesterol level, hemoglobin A(1c) level, and internal carotid artery occlusion were significantly associated with END. On logistic regression analysis, CRP level, internal carotid artery occlusion, and HDL cholesterol proved to be independent variables. Our data suggest that CRP level at admission is significantly associated with END in acute ischemic stroke. HDL cholesterol and internal carotid artery occlusion are also associated with END.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 01/2012; 21(3):181-6. DOI:10.1016/j.jstrokecerebrovasdis.2010.06.002 · 1.67 Impact Factor