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Tai Hwan Park,
Keun-Sik Hong,
Jay Chol Choi,
Pamela Song,
Ji Sung Lee,
Juneyoung Lee,
Jong-Moo Park,
Kyusik Kang,
Kyung Bok Lee, Yong-Jin Cho,
Gustavo Saposnik,
Moon-Ku Han,
Hee-Joon Bae
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ABSTRACT: BACKGROUND: Patients with low National Institutes of Health Stroke Scale (NIHSS) scores are frequently excluded from thrombolysis, but more than 25% of them remain disabled. We sought to define a validated minor stroke definition to reduce the inappropriate treatment exclusion. METHODS: From an outcome database, untreated patients with an NIHSS score of 5 or less presenting within a 4.5-hour window were identified and 3-month modified Rankin Scale (mRS) outcomes were analyzed according to individual isolated symptoms and total NIHSS scores. The validity of the following minor stroke definitions were assessed: (1) the National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator (NINDS-TPA) trials' definition, (2) the total NIHSS score, varying a cutoff point from 0 to 4, and (3) our proposed definition that included an NIHSS score = 0 or an NIHSS score = 1 on the items of level of consciousness (LOC), gaze, facial palsy, sensory, or dysarthria. RESULTS: Of 647 patients, 172 patients (26.6%) had a 3-month unfavorable outcome (mRS score 2-6). Favorable outcome was achieved in more than 80% of patients with an NIHSS score of 1 or less or with an isolated symptom on the LOC, gaze, facial palsy, sensory, or dysarthria item. In contrast, unfavorable outcome proportion was more than 25% in patients with an NIHSS score of 2 or more. When the NINDS-TPA trials' definition, our definition, or the definition of an NIHSS score of 1 or less were applied, more than 75% of patients with an unfavorable outcome were defined as a non-minor stroke and less than 15% of patients with an unfavorable outcome were defined as a minor stroke. CONCLUSION: Implementation of an optimal definition of minor stroke into thrombolysis decision-making process would decrease the unfavorable outcomes in patients with low NIHSS scores.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 03/2013; 22(4):482-490.
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Tai Hwan Park,
Gustavo Saposnik,
Hee-Joon Bae,
Soo Joo Lee,
Kyung Bok Lee,
Jun Lee,
Jong-Moo Park,
Jay Chol Choi,
Dong-Eog Kim, Yong-Jin Cho,
Joon-Tae Kim,
Jae-Kwan Cha,
Juneyoung Lee,
Kyung-Ho Yu,
Byung-Chul Lee,
Byung-Woo Yoon
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ABSTRACT: BACKGROUND AND PURPOSE: Several stroke risk scores for prediction of functional outcome have been developed, but rarely validated in Asian populations. We assessed the validity of the iScore, recently developed from Canadian stroke population, in an Asian stroke population from Korea. METHODS: We applied the iScore to 4061 eligible participants with acute ischemic stroke in the nationwide multicenter stroke registry in Korea. The main outcome was poor functional outcome defined as having a modified Rankin Scale 3 to 6 at 3 months after stroke onset. The secondary outcome was death at 3 months. C-statistics were calculated to assess performance of the iScore. RESULTS: Poor functional outcome was found in 1496 patients (36.8%), whereas death at 3 months occurred in 294 patients (7.2%). C-statistics were 0.819 (95% confidence interval, 0.805-0.833) for poor functional outcome and 0.861 (95% confidence interval, 0.840-0.883) for death. Overall, there was a high correlation between observed and expected outcomes for poor functional outcome (Pearson correlation coefficient, r=0.990) and for death (r=0.969) according to risk score. CONCLUSIONS: The iScore reliably predicts poor functional outcome or death at 3 months after stroke in Korean patients.
Stroke 03/2013; · 5.73 Impact Factor
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Sang-Chul Kim,
Keun-Sik Hong,
Seon-Il Hwang,
Ji-Eun Kim,
Ah-Ro Kim,
Joong-Yang Cho,
Hee Kyung Park,
Ji-Hyun Park,
Ja-Seong Koo,
Jong-Moo Park,
Hee-Joon Bae,
Moon-Ku Han,
Dong-Wha Kang,
Mi-Sun Oh,
Kyung-Ho Yu,
Byung-Chul Lee,
Ji-Sung Lee, Yong-Jin Cho
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ABSTRACT: Stroke requires consistent care, but there is concern over the "weekend effect", whereby a weekend admission results in a poor outcome. Our aim was to determine the impact of weekend admission on clinical outcomes in patients with acute ischemic stroke in Korea.
The outcomes of patients admitted on weekdays and weekends were compared by analyzing data from a prospective outcome registry enrolling 1247 consecutive patients with acute ischemic stroke admitted to four neurology training hospitals in South Korea between September 2004 and August 2005. The primary outcome was a poor functional outcome at 3 months, defined as modified Rankin Scale (mRS) of 3-6. Secondary outcomes were 3-month mortality, use of thrombolysis, complication rate, and length of hospitalization. Shift analysis was also performed to compare overall mRS distributions.
On weekends, 334 (26.8%) patients were admitted. Baseline characteristics were comparable between the weekday and weekend groups except for more history of heart disease and shorter admission time in weekend group. Univariate analysis revealed poor functional outcome at 3 months, 3-month mortality, complication rate, and length of hospitalization did not differ between the two groups. In addition, overall mRS distributions were comparable (p=0.865). After adjusting for baseline factors and stroke severity, weekend admission was not associated with poor functional outcome at 3 months (adjusted odds ratio, 1.05; 95% CI, 0.74-1.50). Furthermore, none of secondary endpoints differed between the two groups in multivariate analysis.
Weekend admission was not associated with poor functional outcome than weekday admission in patients with acute ischemic stroke in this study. The putative weekend effect should be explored further by considering a wider range of hospital settings and hemorrhagic stroke.
Journal of Clinical Neurology 12/2012; 8(4):265-70. · 1.69 Impact Factor
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Dong-Wha Kang,
Sung-Il Sohn,
Keun-Sik Hong,
Kyung-Ho Yu,
Yang-Ha Hwang,
Moon-Ku Han,
Jun Lee,
Jong-Moo Park,
A-Hyun Cho,
Hye-Jin Kim,
Dong-Eog Kim, Yong-Jin Cho,
Jaseong Koo,
Sung-Cheol Yun,
Sun U Kwon,
Hee-Joon Bae,
Jong S Kim
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ABSTRACT: BACKGROUND AND PURPOSE: Unclear-onset strokes are generally excluded from time-based thrombolytic therapy. We examined the safety and feasibility of magnetic resonance imaging-based reperfusion therapy in unclear-onset stroke. METHODS: This prospective, multicenter, single-arm study screened consecutive unclear-onset stroke patients within 6 hours of symptom detection. Patients with perfusion-diffusion mismatch >20% and negative or subtle fluid-attenuated inversion recovery changes were treated with intravenous tissue plasminogen activator, intra-arterial therapy, or a combination. The safety outcome was symptomatic intracranial hemorrhage within 48 hours after treatment. The primary efficacy outcome was a 3-month modified Rankin Scale score of 0 to 2. Controls were untreated unclear-onset stroke patients prospectively captured in stroke registries. RESULTS: Of 430 unclear-onset stroke patients, 83 (19.3%) received reperfusion therapy (mean age, 67.5 ± 10.4 years; males, 66.3%; median baseline National Institutes of Health Stroke Scale, 14). Symptomatic intracranial hemorrhage with any neurological decline developed in 5 patients (6.0%). Symptomatic intracranial hemorrhage with National Institutes of Health Stroke Scale worsening ≥4 developed in 3 patients (3.6%). Thirty-seven patients (44.6%) achieved modified Rankin Scale score of 0 to 2, and 24 (28.9%) had modified Rankin Scale score of 0 to 1. Female, baseline National Institutes of Health Stroke Scale score, no immediate or early recanalization, and more white blood cells were independent predictors of poor outcome. Compared with untreated controls, the treated group was significantly associated with good outcomes of modified Rankin Scale score of 0 to 2 after adjusting for age, sex, and baseline National Institutes of Health Stroke Scale in logistic regression analysis (odds ratio, 2.25; 95% CI, 1.14-4.49). CONCLUSIONS: In unclear-onset stroke patients, magnetic resonance imaging-based reperfusion therapy was feasible and safe. Randomized controlled trials are warranted to confirm the benefit of reperfusion therapy for unclear-onset stroke.
Stroke 10/2012; · 5.73 Impact Factor
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ABSTRACT: Thromboembolism is a rare complication in patients with myotonic dystrophy. While immobilization of patients with advanced disease predisposes to high risk for venous thromboembolism, hypercoagulability could account for venous thromboembolism in patients without impaired mobilization. We report a patient with myotonic dystrophy type 1 who developed pulmonary thromboembolism unrelated to immobilization.
Annals of Indian Academy of Neurology 10/2012; 15(4):317-9. · 0.93 Impact Factor
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ABSTRACT: BACKGROUND AND PURPOSE: Our goal was to investigate whether initial ischemic lesion pattern can predict stroke recurrence in patients with symptomatic intracranial arterial stenosis. METHODS: Of the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS)-2 trial participants, we included patients who underwent diffusion-weighted imaging and fluid attenuation inversion recovery imaging at baseline with a follow-up fluid attenuation inversion recovery imaging at 7 months. Based on the diffusion-weighted imaging findings, we classified the initial ischemic lesion patterns according to location (subcortical versus cortical versus subcorticocortical) and multiplicity (single versus multiple). We also evaluated the occurrence of new ischemic lesions on follow-up fluid attenuation inversion recovery as well as clinical stroke in the symptomatic intracranial arterial stenosis territory. RESULTS: Of 353 patients included in this study, 44 (12.5%) and 13 (3.7%) patients had new ischemic lesions and clinical recurrent stroke in the initial symptomatic intracranial arterial stenosis territory, respectively. On multivariable analysis, the initial lesion patterns of subcorticocortical and multiple lesions were independent predictors of new ischemic lesions in the symptomatic intracranial arterial stenosis territory (OR, 3.01; 95% CI, 1.33-7.01; P=0.03; OR, 2.81; 95% CI, 1.34-5.9; P=0.006). These patterns also predicted clinical recurrent stroke. CONCLUSIONS: Subcorticocortical lesions and multiple lesions are radiological predictors of recurrent ischemic stroke in symptomatic patients with intracranial arterial stenosis. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT00130039.
Stroke 08/2012; 43(10):2785-2787. · 5.73 Impact Factor
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Dong-Eog Kim,
Jeong-Yeon Kim,
Sang-Wuk Jeong, Yong-Jin Cho,
Jong-Moo Park,
Ju-Hun Lee,
Dong-Wha Kang,
Kyung-Ho Yu,
Hee-Joon Bae,
Keun-Sik Hong,
Ja-Seong Koo,
Seung-Hoon Lee,
Byung-Chul Lee,
Moon-Ku Han,
Joung-Ho Rha,
Yong-Seok Lee,
Gyeong-Moon Kim,
Seok-Lae Chae,
Jong S Kim,
Sun U Kwon
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ABSTRACT: Predictors of progression of intracranial atherosclerotic stenosis have not been clearly identified. We investigated whether poststroke changes in lipid profiles would affect the prognosis of symptomatic intracranial atherosclerotic stenosis.
This is a substudy of Trial of cilOstazol in Symptomatic intracranial Stenosis 2 (TOSS-2). From 10 centers we enrolled 230 subjects with acute symptomatic stenosis in the M1 segment of the middle cerebral artery or basilar artery. At baseline and 7 months after stroke, subjects underwent MR angiogram and assessment of cardiovascular risk factors including lipoprotein levels. Progression of intracranial atherosclerotic stenosis was determined by comparing stenosis on the baseline and follow-up MR angiograms.
Cilostazol treatment was more frequently seen in the nonprogression group (109 of 198 [55.1%]) than in the progression group (11 of 32 [34.4%]). At 7 months after stroke when compared with baseline, low-density lipoprotein cholesterol and total cholesterol levels decreased in both groups. However, only nonprogressors showed increase in high-density lipoprotein cholesterol levels between baseline and follow-up. Changes in apolipoprotein B/apolipoprotein A-I levels were not different between the groups, although apolipoprotein B/A-I at 7 months was higher in progressors than in nonprogressors. Remnant lipoprotein cholesterol levels decreased in nonprogressors, whereas they did not change in progressors. In multivariable analyses, after adjusting for cilostazol treatment and remnant lipoprotein cholesterol reduction or apolipoprotein B/A-I at 7 months, high-density lipoprotein cholesterol elevation remained as a significant predictor for the nonprogression.
This is the first prospective multicenter study to demonstrate that high-density lipoprotein cholesterol elevation, along with remnant lipoprotein cholesterol reduction and low apolipoprotein B/A-I, is associated with prevention of angiographic progression of symptomatic intracranial atherosclerotic stenosis.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00130039.
Stroke 04/2012; 43(7):1824-30. · 5.73 Impact Factor
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Sun U Kwon,
Keun-Sik Hong,
Dong-Wha Kang,
Jong-Moo Park,
Ju-Hun Lee, Yong-Jin Cho,
Kyung-Ho Yu,
Ja-Seong Koo,
K S Lawrence Wong,
Seung-Hoon Lee, [......],
Moon-Ku Han,
Joung-Ho Rha,
Hahn Young Kim,
Vincent C Mok,
Yong-Seok Lee,
Gyeong-Moon Kim,
Nijasri Charnnarong Suwanwela,
Sung-Cheol Yun,
Hyun-Wook Nah,
Jong S Kim
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ABSTRACT: An optimal strategy for management of symptomatic intracranial atherosclerotic stenosis (ICAS) has not yet been established. We compared the efficacy of 2 combinations of antiplatelets, aspirin plus cilostazol (cilostazol group) verus aspirin plus clopidogrel (clopidogrel group), on the progression of ICAS, which is known to be associated with clinical stroke recurrence.
In this investigator-initiated double-blind trial, 457 patients with acute symptomatic stenosis in the M1 segment of the middle cerebral artery or the basilar artery were randomly allocated into either a cilostazol group or a clopidogrel group. After 7 months of treatment, follow-up MR angiogram and MRI were performed. The primary end point was the progression of ICAS in comparison with stenosis on the baseline MR angiogram. Secondary end points included the occurrence of new ischemic lesions on MRI, composite of cardiovascular events, and major bleeding complications.
Cardiovascular events occurred in 15 of 232 patients (6.4%) in the cilostazol group and 10 of 225 (4.4%) in the clopidogrel group (P=0.312). Cilostazol did not reduce the progression of symptomatic ICAS (20 of 202) compared to clopidogrel (32 of 207) (odds ratio, 0.61; P=0.092), although favorable changes in serum lipoproteins were observed in the cilostazol group. There were no significant differences between the 2 groups with respect to new ischemic lesions (18.7% versus 12.0%; P=0.078) and major hemorrhagic complications (0.9% versus 2.6%; P=0.163).
This trial failed to show significant difference in preventing progression of ICAS and new ischemic lesions between the 2 combination antiplatelet therapies in the patients with symptomatic ICAS.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00130039.
Stroke 07/2011; 42(10):2883-90. · 5.73 Impact Factor
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Keun-Sik Hong,
Jaiyong Kim, Yong-Jin Cho,
So-Young Seo,
Seon-Il Hwang,
Sang-Chul Kim,
Ji Eun Kim,
Ahro Kim,
Joong-Yang Cho,
Hee Kyung Park, [......],
Mi Hwa Yang,
Myung Suk Jang,
Moon-Ku Han,
Juneyoung Lee,
Dong-Wha Kang,
Jong-Moo Park,
Jaseong Koo,
Kyung-Ho Yu,
Mi-Sun Oh,
Byung-Chul Lee
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ABSTRACT: Disability-adjusted life years (DALY), incorporating both disability and mortality, has been widely employed to measure regional and global burdens of stroke. Thus far, the DALY lost to stroke in a population has been estimated using only the crude population-level data; no previous study has incorporated refined data from stroke registries. The aim of this study was to integrate the stroke registry data and the population-level incidence data to project the nationwide DALY lost to ischemic stroke.
from the data of two large ischemic stroke registries, we derived an average daly lost due to ischemic stroke for each of the following age groups: <45, 45-54, 55-64, 65-74, 75-84, and ≥85 years. The nationwide ischemic stroke incidence for each age group was extracted from a cardiovascular and cerebrovascular surveillance study that analyzed the 2004 Korean Health Insurance database.
The average DALY lost due to ischemic stroke for the age groups <45, 45-54, 55-64, 65-74, 75-84, and ≥85 years was 5.07, 4.63, 4.35, 3.88, 2.88, and 1.73, respectively. By multiplying the incidence and the average DALY lost, the nationwide DALY lost was determined to be 9,952 for those <45 years, 24,608 for 45-54 years, 50,682 for 55-64 years, 88,875 for 65-74 years, 52,089 for 75-84 years, and 8,192 for ≥85 years, respectively. The projected nationwide DALY lost due to 64,688 ischemic strokes in 2004 was 234,399 (121,482 for men and 113,244 for women), and the DALY lost per 100,000 person-years was 483 (500 for men and 469 for women).
Incidence data from a population study and DALY values derived from stroke registries can be integrated to provide a more refined projection of the nationwide burden of ischemic stroke. In Korea, more than 230,000 years of healthy life are being lost annually due to ischemic stroke, and hence prompt action is imperative.
Journal of Clinical Neurology 06/2011; 7(2):77-84. · 1.69 Impact Factor
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Yong-Seok Lee,
Hee-Joon Bae,
Dong-Wha Kang,
Seung-Hoon Lee,
Kyungho Yu,
Jong-Moo Park, Yong-Jin Cho,
Keun-Sik Hong,
Dong-Eog Kim,
Sun Uck Kwon,
Kyung Bok Lee,
Joung-Ho Rha,
Jaseong Koo,
Moon-Gu Han,
Soo Joo Lee,
Ju-Hun Lee,
Sang Wook Jung,
Byung-Chul Lee,
Jong S Kim
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ABSTRACT: Aspirin is a proven antiplatelet agent in acute ischemic stroke, and there are no current guidelines for other antiplatelet treatments. We aimed to compare the efficacy and safety of cilostazol with aspirin in acute stroke.
Patients with measurable neurological deficits (NIHSS score ≤15) within 48 h of onset were randomly assigned to cilostazol (200 mg/day) or aspirin (300 mg/day) for 90 days. The primary endpoint was a modified Rankin Scale (mRS) score of 0-2 at 90 days. Cardiovascular events, bleeding complications, and other functional outcomes were also assessed. Statistical analysis was carried out by intention-to-treat and per-protocol bases. This trial is registered with ClinicalTrials.gov (NCT00272454).
In total, 458 patients were enrolled (mean age of 63 years, median NIHSS of 3), and mRS at 90 days was obtained in 447 patients. The primary endpoint was achieved in 76% (173/228) of those randomized to cilostazol and in 75% (165/219) assigned to aspirin, which supported the pre-specified non-inferiority of cilostazol to aspirin (95% CI of proportion difference: -6.15 to 7.22%, p = 0.0004). These results were also supported by per-protocol analysis (p = 0.045). Cardiovascular events occurred in 6 patients (3%) treated with cilostazol, and in 9 patients (4%) treated with aspirin (p = 0.41). Adverse events were more common in cilostazol-treated patients during the trial (91 vs. 85%, p = 0.055), while the frequencies of bleeding complications (cilostazol 11%, aspirin 13%, p = 0.43) or drug discontinuation (cilostazol 10%, aspirin 7%, p = 0.32) were not different.
Cilostazol is feasible in acute ischemic stroke, and comparable to aspirin in its efficacy and safety.
Cerebrovascular Diseases 05/2011; 32(1):65-71. · 2.72 Impact Factor
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Young Seo Kim,
Sang-Soon Park,
Hee-Joon Bae,
A-Hyun Cho, Yong-Jin Cho,
Moon-Ku Han,
Ji Hoe Heo,
Kyusik Kang,
Dong-Eog Kim,
Hahn Young Kim, [......],
Kyung Bok Lee,
Seung-Hoon Lee,
Su-Ho Lee,
Yong-Seok Lee,
Hyo Suk Nam,
Mi-Sun Oh,
Jong-Moo Park,
Joung-Ho Rha,
Kyung-Ho Yu,
Byung-Woo Yoon
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ABSTRACT: Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea.
A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay.
Among the 500 patients (median 67 years, 62% men), the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313). Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS) score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381), knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633) and use of ambulance (OR 1.961, 95% CI 1.176-3.270) were significantly associated with early arrival.
In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.
BMC Neurology 01/2011; 11:2. · 2.17 Impact Factor
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Young Kim,
Sang-Soon Park,
Hee-Joon Bae,
A-Hyun Cho, Yong-Jin Cho,
Moon-Ku Han,
Ji Heo,
Kyusik Kang,
Dong-Eog Kim,
Hahn Kim, [......],
Kyung Lee,
Seung-Hoon Lee,
Su-Ho Lee,
Yong-Seok Lee,
Hyo Nam,
Mi-Sun Oh,
Jong-Moo Park,
Joung-Ho Rha,
Kyung-Ho Yu,
Byung-Woo Yoon
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ABSTRACT: Abstract Background Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Methods A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay. Results Among the 500 patients (median 67 years, 62% men), the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313). Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS) score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381), knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633) and use of ambulance (OR 1.961, 95% CI 1.176-3.270) were significantly associated with early arrival. Conclusions In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.
BMC Neurology. 01/2011;
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ABSTRACT: Despite the important role of taste function in nutrition and health, little is known about changes in taste function caused by Parkinson disease (PD). The taste function of 31 PD patients and 29 healthy controls was assessed quantitatively using filter paper taste strip tests (TSTs) impregnated with four basic taste qualities at four different concentrations. The mean TST score was significantly lower in PD patients, as a consequence of taste impairment in the female PD patients (it did not differ significantly in males), which was likely to be attributable to the lower Mini-Mental State Examination score in patients with PD than in controls in women. TST scores in PD patients were not correlated with patient age, duration, or severity of their PD, or olfactory function. The findings of our study suggest that taste dysfunction should be included in the list of nonmotor symptoms of PD.
Journal of Neurology 12/2010; 258(6):1076-9. · 3.47 Impact Factor
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ABSTRACT: Complications after stroke increase disability or death. The disability-adjusted life-year (DALY) metric, developed by the World Health Organization to measure the global burden of disease, integrates both mortality and disability. Widely used in population-level data analyses, it has not been applied to individual patient-level data captured in outcome registries.
We analyzed patient-level data from the outcome registry of 1254 consecutive patients with acute ischemic stroke enrolled between September 1, 2004, and August 31, 2005, in South Korea. For each subject, we calculated DALY lost due to the qualifying stroke and then analyzed additional DALY lost due to complications after stroke.
For 1233 patients with available 3-month outcomes, the average DALY lost due to the index stroke was 3.82 (95% CI, 3.68 to 3.96). Any complications, neurological complications, and medical complications occurred in 34.0%, 20.8%, and 24.0%, respectively. The additional DALYs lost associated with any, neurological, and medical complications were 2.11 (95% CI, 1.78 to 2.44), 2.15 (95% CI, 1.72 to 2.59), and 1.99 (95% CI, 1.59 to 2.40), respectively. Patients with 1 complication had 1.52 (95% CI, 1.15 to 1.89) additional DALY lost, and those with >or=2 complications had 2.69 (95% CI, 2.18 to 3.20) additional DALY lost.
Early poststroke complications deprive patients of approximately 2 years of optimum health. Greater numbers of complications are associated with greater loss of healthy life-years. DALY analysis quantifies the burden of poststroke complications with a uniform metric potentially useful for health system planners.
Stroke 08/2010; 41(8):1758-65. · 5.73 Impact Factor
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ABSTRACT: In the cerebellopontine angle cistern, the nervus intermedius (NI) runs close to the motor division of the facial nerve (FN). A vascular loop compressing the FN in patients with hemifacial spasm (HFS) can thus also affect the NI. However, to our knowledge, taste has not been investigated in patients with HFS. In this pilot study, we assessed the sense of taste quantitatively in 10 female patients with HFS using filter paper strips impregnated with four taste qualities (sweet, sour, salty, and bitter) at four concentrations. The taste score did not differ between the ipsilateral and contralateral sides. The taste score for salty on the ipsilateral side increased with disease duration. Our findings suggest that a vascular loop compressing the FN does not affect the function of the NI. Further studies with greater numbers of patients are needed to confirm our results.
Journal of Clinical Neuroscience 07/2010; 17(7):950-1. · 1.25 Impact Factor
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ABSTRACT: Frovatriptan is a selective 5-HT(1B/1D) agonist with a long duration of action and a low incidence of side effects. Although several placebo-controlled trials have documented the clinical efficacy and safety of frovatriptan in adults with migraine, this drug has not previously been studied in Asian including Korean patients.
In this double-blind multicenter trial, 229 patients with migraine were randomized to receive frovatriptan 2.5 mg or placebo upon the occurrence of a moderate-to-severe migraine. The primary outcome was the 2-hour headache response rate.
Frovatriptan significantly increased the 2-hour headache response rate compared with placebo (52.9% vs. 34.0%, p=0.004). The headache response rates at 4, 6, and 12 hours were significantly higher in the frovatriptan group than in the placebo group, as was the pain-free rate at 2 hours (19.0% vs. 5.7%, p=0.004), 4 hours (40.7% vs. 23.0%, p=0.006), and 6 hours (56.1% vs. 34.0%, p=0.002). The median time to a headache response was significantly shorter in the frovatriptan group than in the placebo group (2.00 hours vs. 3.50 hours, p<0.001). The use of rescue medications was more common in the placebo group (p=0.005). Chest tightness associated with triptan was infrequent (2.5%), mild, and transient.
These results demonstrate that 2.5-mg frovatriptan is effective and well tolerated in Korean migraineurs for acute treatment of migraine attacks.
Journal of Clinical Neurology 03/2010; 6(1):27-32. · 1.69 Impact Factor
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ABSTRACT: Nonmotor symptoms (NMSs) are common in patients with Parkinson disease (PD), but little is known about the burden of the full range of NMSs in de novo PD patients.
NMSs in untreated de novo PD patients were evaluated both quantitatively and qualitatively using the Non-Motor Symptoms Assessment Scale (NMSS); the findings were compared to those of control subjects. The effects of dopaminergic treatment on NMSs were also determined.
NMSs were evaluated in 23 patients with untreated de novo PD and 23 healthy controls. The motor section of the Unified Parkinson Disease Rating Scale (mUPDRS) and the Hoehn and Yahr (HY) stage were also checked in the PD patients. The number of NMSs and the NMSS scores of the PD patients were compared with those of the controls. Three months after the start of dopaminergic medication, 16 PD patients were reevaluated with respect to the NMSS and mUPDRS, and the HY stage.
The number of NMSs and the NMSS scores were significantly higher in the PD patients than in the controls. The three most prevalent NMSs among the PD patients were 'nocturia,' 'forget things or events,' and 'restless legs.' In the PD group, the number of NMSs was correlated with the HY stage but not with age, disease duration, or mUPDRS score. Follow-up of 16 patients at 3months after commencing PD medication revealed no changes in either the number of NMSs or the NMSS score, despite improvement in motor symptoms.
Untreated de novo PD patients have more nonmotor problems than controls, and these NMSs are not ameliorated by dopaminergic medication.
Journal of the neurological sciences 09/2009; 287(1-2):200-4. · 2.32 Impact Factor
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ABSTRACT: Headache is a common complication of lumbar puncture (LP). Although in most cases post-LP headaches are not severe and have a benign course, they can also be a manifestation of a potentially life-threatening complication such as subdural hematoma (SDH).
We describe a patient in whom a massive SDH developed after LP and cerebrospinal fluid (CSF) drainage, which were performed during the diagnostic evaluation of freezing of gait.
SDH should not be excluded from the differential diagnosis of headache following LP, especially when there is a loss of CSF.
Journal of Clinical Neurology 07/2009; 5(2):95-6. · 1.69 Impact Factor
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Movement Disorders 06/2009; 24(11):1700-1. · 4.51 Impact Factor
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ABSTRACT: Acute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications.
A 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed. Repeated history-taking, physical examination, and imaging studies led to the timely diagnosis and surgical treatment of AoD, which produced a successful outcome.
Clinical suspicion is invaluable for the diagnosis of this rare cause of stroke. Considering the stroke mechanism and complications, the risks of thrombolysis might outweigh its benefits.
Journal of Clinical Neurology 04/2009; 5(1):49-52. · 1.69 Impact Factor
