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Neurol. Int., Volume 7, Issue 1 (March 2015) – 6 articles

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3 pages, 572 KiB

Open AccessArticle

A Real Life Clinical Practice of Neurologists in the Ambulatory Setting in Thailand: A Pragmatic Study

by Kannikar Kongbunkiat, Somsak Tiamkao, Verajit Chotmongkol, Piyawan Chieawthanakul, Sarawut Kitcharoen, Suthipun Jitpimolmard and Kittisak Sawanyawisuth

Neurol. Int. 2015, 7(1), 5840; https://doi.org/10.4081/ni.2015.5840 - 22 Jun 2015

Cited by 2 | Viewed by 498

Abstract

The burden of neurological disorders is high in developing countries. Real life data from neurologists as to how they practice in Thailand are limited in literature. Practices of neurologists in a university hospital clinical setting in Thailand were studied. A prospective study was performed at the ambulatory neurology clinic, Khon Kaen University Hospital, between 1 February and 31 October 2009. The following data were recorded: numbers of patients, characteristics of patients, consultation notes, and time spent for each patient. There were three neurologists, each of whom ran one afternoon clinic, once a week. There were 6137 visits during the 9 months, with an average of 681 visits per month. The total number of patients was 2834. The three most common diseases were cerebrovascular diseases (33%), epilepsy (16%), and movement disorders (non-Parkinson’s disease, 12%). Neurologists spent an average of 6.34 minutes per patient. In conclusion, neurologists in medical schools have limited time to take care of each patient. Several strategies are needed in medical education and neurology training to improve the quality of care. Full article

4 pages, 571 KiB

Open AccessArticle

Estimation of the Presence of Small Dense Lipoprotein Cholesterol in Acute Ischemic Stroke

by Yasuhiro Manabe, Ryuta Morihara, Kosuke Matsuzono, Yumiko Nakano, Yoshiaki Takahashi, Hisashi Narai, Nobuhiko Omori and Koji Abe

Neurol. Int. 2015, 7(1), 5973; https://doi.org/10.4081/ni.2015.5973 - 3 Jun 2015

Cited by 12 | Viewed by 591

Abstract

Small dense low-density lipoprotein (sdLDL) is an established risk factor in ischemic heart disease. However, its clinical significance in acute ischemic stroke (AIS) is uncertain. This study evaluates the prognostic value of the presence of sdLDL in patients with AIS by determining whether it contributes to clinical outcome or not. We studied 530 consecutive patients admitted within the first 48 hours after onset of ischemic stroke and 50 corresponding controls. Serum lipid parameters were measured on admission by standard laboratory methods. The percentage of AIS patients with sdLDL was significantly higher than the one of matched controls with sdLDL. Concerning comparisons between AIS patients with or without sdLDL, the percentages of males and patients with histories of smoking, hypertension, and cardiovascular disease were significantly higher in AIS patients with sdLDL. Concerning the grade of severity, modified Rankin Scale (mRS) on discharge was significantly higher in AIS patients with sdLDL. On logistic regression analysis, age (OR=2.29, P<0.001), male gender (OR=0.49, P<0.01), history of atrial fibrillation (OR=3.46, P<0.001), and the presence of sdLDL (OR=1.59, P<0.05) were significantly associated with poor prognosis (mRS on discharge >3). Our study showed that the presence of sdLDL might be independently associated with a poor prognosis after AIS. Full article

4 pages, 601 KiB

Open AccessArticle

Omega-3 Fatty Acid Ethyl Esters Do Not Improve Clopidogrel Associated P2Y12 Inhibition in Stroke Patients

by Ping Li, Haris Kamal, Melissa Baxter and Bijal K. Mehta

Neurol. Int. 2015, 7(1), 5809; https://doi.org/10.4081/ni.2015.5809 - 3 Jun 2015

Viewed by 572

Abstract

The specific action of omega-3 fatty acid ethyl esters (OFA) in preventing cerebrovascular disease remains unknown, but research has demonstrated multiple possible mechanisms. In addition to altering lipid profiles, OFA may inhibit platelet aggregation. Clopidogrel inhibits platelets via the P2Y12 receptor. OFA may alter clopidogrel-associated platelet-inhibition via a possible combined effect on P2Y12 inhibition. To determine if OFA affects clopidogrel associated P2Y12 platelet receptor inhibition by comparing the percentage of responders in patients with cerebrovascular disease who were taking clopidogrel with or without OFA. We retrospectively reviewed data from adult patients with cerebrovascular disease or cerebral aneurysms and taking clopidogrel, who were seen at a single hospital between March 2010 to September 2011. We included 438 subjects in the study. For the 67 subjects who received loading doses of both clopidogrel and OFA, 71.6% had a P2Y12 inhibition response more than 20%, which is considered a positive response. For the 55 subjects who received just clopidogrel load, 67.2% of subjects were responders. There were 70.4% responders in the 274 subjects who were taking 75 mg of clopidogrel alone at home, and 73.8% responders in the 42 subjects who were taking both clopidogrel and OFA at home. However, these percentage differences were not statistically significant. This study did not find additional P2Y12 platelet inhibition when patients were given OFA, either given as a loading dose or taking it daily. Full article

3 pages, 600 KiB

Open AccessCase Report

Posterior Reversible Encephalopathy Syndrome and Acute Post-Streptococcal Glomerulonephritis Mimicking Breakthrough Seizures

by Kamille Abdool, Kanterpersad Ramcharan, Neal Bhagwandass, Navindra Persad, Vasant Temull, Karan Seegobin and Cassie Mike

Neurol. Int. 2015, 7(1), 5971; https://doi.org/10.4081/ni.2015.5971 - 29 May 2015

Cited by 2 | Viewed by 600

Abstract

We report the case of a 14-year-old boy with a past history of primary generalized seizures, who had been seizure-free for 2 years on sodium valproate and presented with generalized tonic clonic seizures suggestive of breakthrough seizures. Examination revealed hypertension, impetiginous lesions of the lower limbs, microscopic hematuria, elevated antistreptolysin O titre and low complement levels consistent with acute post-streptococcal glomerulonephritis. Cranial magnetic resonance imaging (MRI) demonstrated changes consistent with posterior reversible encephalopathy syndrome. Hypertension was controlled with intravenous nitroglycerin followed by oral captopril and amlodipine. Brain MRI changes returned normal within 2 weeks. The nephritis went in to remission within 2 months and after 8 months the patient has been seizure free again. Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient. The relationship between posterior reversible encephalopathy syndrome and seizures is reviewed. Full article

6 pages, 701 KiB

Open AccessArticle

by Wilma Costa Souza, Adriana B. Conforto, Marco Orsini, Annette Stern and Charles André

Neurol. Int. 2015, 7(1), 5430; https://doi.org/10.4081/ni.2015.5430 - 26 Mar 2015

Cited by 17 | Viewed by 911

Abstract

Modified constraint-induced movement therapy (CIMT) protocols show motor function and real-world arm use improvement. Meanwhile it usually requires constant supervision by physiotherapists and is therefore more expensive than customary care. This study compared the preliminary efficacy of two modified CIMT protocols. A two-group randomized controlled trial with pre and post treatment measures and six months follow-up was conducted. Nineteen patients with chronic stroke received 10 treatment sessions distributed three to four times a week over 22 days. CIMT3h_direct group received 3 hours of CIMT supervised by a therapist (n=10) while CIMT1.5h_direct group had 1.5 hours of supervised CIMT+1.5 hours home exercises supervised by a caregiver (n=9). Outcome measures were the Fugl-Meyer Assessment, the Motor Activity Log, and the Stroke Specific Quality of Life Scale. The modified CIMT protocols were feasible and well tolerated. Improvements in motor function, real-world arm use and quality of life did not differ significantly between treated groups receiving either 3 or 1.5 hours mCIMT supervised by a therapist. Full article

1 pages, 994 KiB

Open AccessEditorial

Previous Acute Polio and Post-Polio Syndrome: Recognizing the Pathophysiology for the Establishment of Rehabilitation Programs

by Marco Orsini, Jano Alves de Souza, Marco Antonio Araújo Leite, Silmar Teixeira, Arthur de Sá Ferreira, Victor Hugo Bastos, Marcos R.G. de Freitas and Acary Bulle Oliveira

Neurol. Int. 2015, 7(1), 5452; https://doi.org/10.4081/ni.2015.5452 - 9 Mar 2015

Cited by 5 | Viewed by 497

Abstract

Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world[...] Full article

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Neurol. Int., Volume 7, Issue 1 (March 2015) – 6 articles

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