Stroke Horizon Scanning Bulletin Volume 10 Issue 5

Sauna bathing reduces the risk of stroke in Finnish men and women A prospective cohort study

Source: Neurology

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Date of Publication: 2 May 2018

Publication Type: Research Article

In a Nutshell:

Objective To assess the association between frequency of sauna bathing and risk of future stroke.

Methods Baseline habits of sauna bathing were assessed in 1,628 adult men and women aged 53–74 years (mean age, 62.7 years) without a known history of stroke in the Finnish Kuopio Ischemic Heart Disease prospective cohort study. Three sauna bathing frequency groups were defined: 1, 2–3, and 4–7 sessions per week. Hazard ratios (HRs) (95% confidence intervals [CIs]) were estimated for incident stroke.
Results During a median follow-up of 14.9 years, 155 incident stroke events were recorded. Compared with participants who had one sauna bathing session per week, the age- and sex-adjusted HR (95% CI) for stroke was 0.39 (0.18–0.83) for participants who had 4–7 sauna sessions per week. After further adjustment for established cardiovascular risk factors and other potential confounders, the corresponding HR (95% CI) was 0.39 (0.18–0.84) and this remained persistent on additional adjustment for physical activity and socioeconomic status at 0.38 (0.18–0.81). The association between frequency of sauna bathing and risk of stroke was not modified by age, sex, or other clinical characteristics (p for interaction > 0.10 for all subgroups). The association was similar for ischemic stroke but modest for hemorrhagic stroke, which could be attributed to the low event rate (n = 34).
Conclusions This long-term follow-up study shows that middle-aged to elderly men and women who take frequent sauna baths have a substantially reduced risk of new-onset stroke.

 

Length of publication: online article

Some important notes: Please contact your local NHS library for the full text of this article. Follow this link to find your local NHS library.

Non-Invasive Brain Stimulation Leads to Fine Motor Improvement After Stroke: a meta-analysis

Source: European Journal of Neurology

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Date of publication: 10 May 2018

Publication type: Review

In a nutshell:

The aim of this study was to determine whether non‐invasive brain stimulation (NIBS) techniques improve fine motor performance in stroke. We searched PubMed, EMBASE, Web of Science, SciELO and OpenGrey for randomized clinical trials on NIBS for fine motor performance in stroke patients and healthy participants. We computed Hedges’ g for active and sham groups, pooled data as random‐effects models and performed sensitivity analysis on chronicity, montage, frequency of stimulation and risk of bias. Twenty‐nine studies (351 patients and 152 healthy subjects) were reviewed. Effect sizes in stroke populations for transcranial direct current stimulation and repeated transcranial magnetic stimulation were 0.31 [95% confidence interval (CI), 0.08–0.55; P=0.010; Tau2, 0.09; I2, 34%; Q, 18.23; P=0.110] and 0.46 (95% CI, 0.00–0.92; P=0.05; Tau2, 0.38; I2, 67%; Q, 30.45; P=0.007). The effect size of non‐dominant healthy hemisphere transcranial direct current stimulation on non‐dominant hand function was 1.25 (95% CI, 0.09–2.41; P=0.04; Tau2, 1.26; I2, 93%; Q, 40.27; P<0.001). Our results show that NIBS is associated with gains in fine motor performance in chronic stroke patients and healthy subjects. This supports the effects of NIBS on motor learning and encourages investigation to optimize their effects in clinical and research settings.

 

 

Length of publication: online article

Cell Therapy for Chronic Stroke

Source: Stroke

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Date of publication: 18 April 2018

Publication type: Research

In a nutshell:

Recent advances in stroke treatment have targeted acute and subacute stroke with therapies administered in the first 48 hours after onset. Current treatment options focus on dissolution of thrombus via the use of a tissue-type plasminogen activator within 4.5 hours (eg, alteplase), or mechanical thrombectomy within 6 hours of stroke onset. However, both of these approaches are applicable to limited numbers of stroke patients and not all patients achieve good outcomes.

Although the pathology of acute stroke is well described, the time course for recovery is not. Most return of function after stroke occurs early and evidence suggests that recovery plateaus 3 to 6 months after stroke onset. For the purposes of this article, chronic stroke will be defined as 6 months to years after onset. At this point, liquefaction of damaged tissue should be complete resulting in a fluid-filled cyst. Behavioral recovery tends to plateau during this period revealing the likely scale of permanent disability.

 

Length of publication: online article

The Dose of Direct Oral Anticoagulants and Stroke Severity in Patients with Acute Ischemic Stroke and Nonvalvular Atrial Fibrillation

Source: Journal of Stroke and Cerebrovascular Diseases

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Date of publication: June 2018

Publication type: Research

In a nutshell:

Background
The severity and the functional outcome of patients with stroke occurring during off-label underdosing of direct-acting oral anticoagulants (DOACs) remain uncertain.

Methods
We studied 53 consecutive patients with acute ischemic stroke and nonvalvular atrial fibrillation who were treated with DOACs before the onset of stroke. Thirty patients were treated for primary prevention of stroke and 23 patients were treated for secondary prevention. DOAC treatments were categorized into 3 groups based on the following doses: (1) standard-dose group (n = 17), (2) low-dose group (n = 23), and (3) off-label underdose group (n = 13).
Results
Age was significantly older in the low-dose group than in the standard-dose group (P = .026). The standard-dose group and the low-dose group showed higher CHA2DS2–VASc scores (median, 4) compared with the off-label underdose group (median, 3). More than half of the patients had a National Institutes of Health Stroke Scale score of less than 8, and many patients had a good outcome (modified Rankin Scale score ≤1). There were no differences in stroke severity and outcome among the 3 groups. The ratio of being discharged home was the highest in the standard-dose group.

Conclusions

This study shows that patients who have off-label underdosing of DOACs do not develop more severe stroke and a poorer outcome than those with the recommended dose. Careful attention to recommended doses is required for the full benefits from DOACs.

 

Length of publication: online article

Some important notes: Please contact your local NHS library for the full text of this article. Follow this link to find your local NHS library.

Quicksteel Ltd staff take on huge challenge for charity

Source: Warrington Guardian

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Date of publication: 9 May 2018

Publication type: News

In a nutshell:

Staff from Quicksteel Ltd in Middlewich will take on a gruelling 230-mile cycle for the Stroke Association, after they lost their friend and colleague just this year.

Quicksteel managing director, Jon Higgin has arranged the cycle challenge from Bridlington to Lytham (East Coast to West Coast) from Thursday, May 24, when he’ll be joined by four other members of the team, James Higgin, Mel Jones, Phil Moss and Gord Whitney.

They were inspired to take on the challenge during Make May Purple for Stroke, after Gord’s wife Sue passed away after a severe stroke just five months ago, aged 59. Sue’s son Phil Moss is also taking part in the cycle.

 

Length of publication: online article

 

 

 

 

 

 

£8.6k of revolutionary equipment will benefit recovery of stroke patients

Source: Cumbria Crack

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Date of publication: 3 May 2018

Publication type: News

In a nutshell:

Thanks to the generosity of local people, stroke patients in the Furness area now have access to an innovative piece of equipment that aims to improve upper limb function in patients who have suffered a neurological event, such as a stroke.

Therapists at University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) are trialling the SaeboGlove at Furness General Hospital, after the successful use of the equipment at the Royal Lancaster Infirmary.

When a stroke occurs (a serious life-threatening medical condition when the blood supply to part of the brain is cut off), an individual can experience a range of disabilities, which often includes the upper limbs. Reduced movement, strength, and tone are common in the arm, as is reduced grip and dexterity in the hand. This is caused by the disruption in the connections between the brain and body.

Phil Woodford, Associate Director of Corporate Affairs, UHMBT, said: “As a Stroke Survivor myself who suffered from left sided Hemi-paresis, the SaeboGlove which was provided as part of my rehabilitation has I believe been a large reason for why my progress in using my left hand has been successful. I’m really pleased and proud that the Trust through the generosity of the public have been able to invest in this equipment to assist the rehabilitation of not just Stroke Survivors but also for other neurological patients and some orthopaedic injuries.

 

Length of publication: online article

 

Healthcare interventions for reducing the risk of future stroke in people with previous stroke or transient ischaemic attack (TIA)

Source: Cochrane

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Date of publication: May 2018

Publication type: Research article

In a nutshell:

How effective are healthcare interventions for preventing a recurrent stroke or other events in people who have had a stroke or a ischaemic attack (TIA: also known as a mini-stroke)?

Background

Stroke and TIA are diseases caused by interruptions in the blood supply to the brain. People who experience a stroke or TIA are at of future stroke. Several medications and lifestyle changes can be used to lower stroke by improving the of modifiable factors such as blood pressure, blood fats, being overweight, raised blood sugar, and the use of preventive medications. These factors are often not managed effectively following a stroke or TIA. It is important to identify healthcare interventions that can help prevent stroke by improving these factors. Interventions in this targeted patients or clinicians, or both (aimed at or changing behaviour, or both); and organisations (e.g. changing the way services were provided).

This is an update of our review published in 2014.

 

Length of publication: online article

Some important notes: Please contact your local NHS library for the full text of this article. Follow this link to find your local NHS library.

We collaborate to ensure research results are shared openly

Source: Stroke Association

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Date of publication: 1 May 2018

Publication type: News

In a nutshell:

AMRC Open Research is a new online platform for publishing medical research findings.

The Stroke Association is one of 23 members of the Association of Medical Research Charities (AMRC) that are collaborating on the development and launch of this important new initiative.

We hope it will help charities maximise the value of the donations we receive by making it possible for all the findings from the research we fund to be rapidly and openly shared with the scientific community and public.

By removing traditional barriers and delays to publication, and making articles available in a matter of days, rather than the typical months or years that traditional publishing can take, AMRC Open Research could help accelerate our understanding of conditions and diseases that affect so many lives, including stroke.

Dr Richard Francis, Head of Research Awards at the Stroke Association said:

“We want to ensure that all the findings from our funded research, no matter how big or small, are available for all to see. This new platform will enable researchers to disseminate their findings efficiently and transparently”.

 

Length of publication: online article

Artificial Intelligence improves stroke and dementia diagnosis in brain scans

Source: Imperial College

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Date of publication: 14 May 2018

Publication type: News

In a nutshell:

Machine learning has detected one of the commonest causes of dementia and stroke, in brain scans (CT), more accurately than current methods.

New software, created by scientists at Imperial College London and the University of Edinburgh, has been able to identify and measure the severity of small vessel disease, one of the commonest causes of stroke and dementia. The study, published in Radiology, took place at Charing Cross Hospital, part of Imperial College Healthcare NHS Trust.

 

Length of publication: online article

Prediction of Outcome in Patients With Acute Ischemic Stroke Based on Initial Severity and Improvement in the First 24 hours

Source: Frontiers in Neurology

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Date of publication: 8 May 2018

Publication type: Research Article

In a nutshell:

Introduction: Stroke severity measured by the baseline National Institutes of Health Stroke Scale (NIHSS) is a strong predictor of stroke outcome. Early change of baseline severity may be a better predictor of outcome. Here, we hypothesized that the change in NIHSS in the first 24 h after stroke improved stroke outcome prediction.

Materials and methods: Patients from the Leuven Stroke Genetics Study were included when the baseline NIHSS (B-NIHSS) was determined on admission in the hospital and NIHSS after 24 h could be obtained from patient files. The delta NIHSS, relative reduction NIHSS, and major neurological improvement (NIHSS of 0–1 or ≥8-point improvement at 24 h) were calculated. Good functional outcome (GFO) at 90 days was defined as a modified Rankin Scale of 0–2. Independent predictors of outcome were identified by multivariate logistic regression. We performed a secondary analysis after excluding patients presenting with a minor stroke (NIHSS 0–5) since the assessment of change in NIHSS might be more reliable in patients presenting with a moderate to severe deficit.

Results: We analyzed the outcome in 369 patients. B-NIHSS was associated with GFO (odds ratio: 0.82; 95% CI 0.77–0.86). In a multivariate model with B-NIHSS and age as predictors, the accuracy [area under the curve (AUC): 0.82] improved by including the delta NIHSS (AUC: 0.86; p < 0.01). In 131 patients with moderate to severe stroke, the predictive multivariate model was more accurate when including the RR NIHSS (AUC: 0.83) to the model which included B-NIHSS, age and ischemic heart disease (AUC: 0.77; p = 0.03).

Conclusion: B-NIHSS is a predictor of stroke outcome. In this cohort, the prediction of GFO was improved by adding change in stroke severity after 24 h to the model.

Length of publication: online article

 

 

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