Successful Management of Guillain-Barre Syndrome Management through Ayurveda: A Case Report

Acute stroke trials typically use disability scales as their primary end point. Neurologic impairment scales such as the National Institutes of Health Stroke Scale (NIHSS) are possibly more sensitive to change in patient status. We aimed to compare a range of potential NIHSS end points with modified Rankin Scale (mRS) and Barthel Index (BI) end points. We simulated a total of 6000 clinical trials, each with 1400 patients. We estimated statistical power for a range of NIHSS end points, including prognosis-adjusted and fixed dichotomized end points. These end points were compared with the BI and mRS dichotomized at 95 and 1, respectively. The most powerful fixed end point was the NIHSS dichotomized at 1. For prognosis-adjusted outcome, we found greatest power if we defined success as achieving a score of < or =1 or improvement by at least 11 points from baseline. We are more likely to achieve a statistically significant result by using this prognosis-adjusted end point instead of NIHSS < or =1 (odds ratio, 2.8; 95% confidence interval [CI], 2.5 to 3.2). Use of the optimal NIHSS prognosis-adjusted end point rather than BI > or =95 could justify a reduction in sample size of approximately 68% (95% CI, 67% to 69%) without loss of statistical power. The NIHSS neurologic scale appears more sensitive than the BI or mRS, allowing smaller sample sizes or greater statistical power. The use of an NIHSS prognosis-adjusted end point could allow therapeutic effects from drugs to be more easily identified.

BackgroundGuillain‐Barré syndrome is an acute, paralysing, inflammatory peripheral nerve disease. Intravenous immunoglobulin is beneficial in other autoimmune diseases.ObjectivesWe aimed to determine the efficacy of intravenous immunoglobulin for Guillain‐Barré syndrome.Search strategyWe updated the searches of the Cochrane Neuromuscular Disease Group Trials Specialized Register, MEDLINE and EMBASE in June 2009 using the terms 'Guillain‐Barré syndrome' and 'acute polyradiculoneuritis' combined with 'intravenous immunoglobulin'.Selection criteriaWe included randomised and quasi‐randomised trials.Data collection and analysisTwo authors independently selected papers, extracted data and assessed quality.Main resultsAnother Cochrane systematic review has shown that plasma exchange significantly hastens recovery. In this review, five trials compared intravenous immunoglobulin with plasma exchange in 536 severely affected, mostly adult participants. The mean difference of change in a seven‐grade disability scale after four weeks was not significantly different between the two treatments: 0.02 (95% CI 0.25 to ‐0.20) of a grade more improvement in the intravenous immunoglobulin than the plasma exchange group. There were also no statistically significant differences in the other measures considered. Three studies including a total of 75 children suggested that intravenous immunoglobulin significantly hastens recovery compared with supportive care.In one trial involving 249 participants comparing plasma exchange followed by intravenous immunoglobulin with plasma exchange alone, the mean grade improvement was 0.2 (95% CI ‐0.14 to 0.54) more in the combined treatment group than in the plasma exchange alone group, not significantly different but not excluding the possibility of significant extra benefit. Another trial with 37 participants comparing immunoabsorption followed by intravenous immunoglobulin with immunoabsorption alone did not reveal significant extra benefit from the combined treatment.Small trials in children showed a trend towards more improvement with high‐dose compared with low‐dose intravenous immunoglobulin and no significant difference when the standard dose was given over two days rather than five days.Authors' conclusionsA previous Cochrane review has shown that plasma exchange hastens recovery compared with supportive treatment alone. There are no adequate comparisons of intravenous immunoglobulin with placebo in adults but this review provides moderate quality evidence that, in severe disease, intravenous immunoglobulin started within two weeks from onset hastens recovery as much as plasma exchange. Adverse events were not significantly more frequent with either treatment but intravenous immunoglobulin is significantly much more likely to be completed than plasma exchange. Also according to moderate quality evidence, giving intravenous immunoglobulin after plasma exchange did not confer significant extra benefit. In children, according to low quality evidence, intravenous immunoglobulin probably hastens recovery compared with supportive care alone. More research is needed in mild disease and in patients whose treatment starts more than two weeks after onset. Dose‐ranging studies are also needed.Plain Language SummaryIntravenous immunoglobulin for Guillain‐Barré syndromeGuillain‐Barré syndrome is an uncommon disease of the peripheral nerves. It causes weakness, numbness and breathing difficulty. Another Cochrane review has shown that plasma exchange (taking blood from one vein, separating the plasma from the blood cells and then returning the blood cells with a plasma substitute into another vein) is more effective than supportive care alone. In adults, moderate quality evidence shows that receiving intravenous immunoglobulin (antibodies that have been purified from donated blood) speeds recovery from severe Guillain‐Barré syndrome as much as plasma exchange. Intravenous immunoglobulin is slightly safer and much easier to give than plasma exchange. According to moderate quality evidence, intravenous immunoglobulin added to plasma exchange is not significantly more effective than either alone. A small amount of evidence suggests that intravenous immunoglobulin is also beneficial in children. More research is needed to determine the best dose in adults and children.

Objective To investigate the application value of Information-Motivation-Behavioral Skill Model (IMB)-based continuing care on the recovery of nerve function and life quality in patients with stroke after thrombolytic therapy. Methods Stroke patients who underwent thrombolytic therapy were randomly assigned to IMB group(35 cases) and control group(35 cases) according to the method of random number table. The control group recieved routine thrombolysis nursing, IMB group was given IMB-based continuing care. After six months of intervention, nerve function was evaluated by National Institute of Health Stroke Scale(NIHSS) and Modified Rankin Scale(MRS), the active ability was performed by Fugl-Meyer Assessment Scale(FMA) and Barthel Index(BI), the quality of life was assessed by the item short from health survey(SF-36), respectively. Results Before intervention, the scores of NIHSS, MRS, FMA, BI, SF-36 between two groups was no significant difference (P>0.05). After three and six months of nursing, the NIHSS, MRS was (7.84±2.20), (5.00±1.60) points and (3.48±0.84), (3.07±0.69) points in IMB group, and (9.75±1.82), (8.21±1.37) points and (4.06±1.08), (3.91±0.71) points in control group, there was significant difference between two groups (t =2.417-8.647, P<0.01 or 0.05). After one, three and six months of intervention, FMA was (65.86±5.67), (76.41±8.47), (78.79±8.58) points, BI was (46.29±7.29), (58.09±10.20), (67.50±9.44) points, SF-36 was (33.13±4.64), (43.09±6.70), (49.83±8.56) points in IMB group, (58.53±8.92), (64.47±7.56), (71.81±8.90) points, (42.47±5.67), (48.74±5.39), (56.03±6.55) points and (29.63±4.06), (35.91±5.93), (41.02±9.05) points in control group, there was significant difference between two groups (t =2.333-5.972, P< 0.05). Moreover, in the repeated measures ANOVA showed the differences of NIHSS, MRS, FMA, BI, SF-36 were statistically significant for the group by time interaction(F=13.556-133.994, P<0.05). Conclusions IMB-based continuing care can promotes the recovery of nerve function and improves the quality of life in patients with stroke after thrombolytic therapy. Key words: Quality of life; Stroke; Information-Motivation-Behavioral Skill Model; Continuing care; Thrombolysis

P96 Introduction: The National Institutes of Health Stroke Scale (NIHSS) score has been correlated with outcome in ischemic strokes but not intracerebral hemorrhage (ICH). We sought to validate the use of NIHSS in ICH patients by comparing it to outcomes using the Glasgow Coma Scale (GCS) score and volume of ICH. Use of the NIHSS will allow clinicians to follow the outcome of more specific parameters which may be used in clinical trials. Methods: We prospectively followed 61 ICH patients admitted to the Cleveland Clinic within 24 hours of onset. Age, NIHSS, GSC, Barthel index (BI), modified Rankin scale (mRs) were obtained on admission, discharge and at 3 months. An ICH volume was calculated using the AxBxC/2 method from the admission CT scan. Correlation was assessed using the Spearman correlation coefficient (SCC) and 95% CI, with a worst score given to deaths. Patients with a history of ischemic stroke were excluded. The maximum NIHSS for coma was 35. Results: The average age of the patients was 66 years old with 35 females and 26 males. On admission, the average NIHSS was 21 for all patients, 28 for those who died at 3 months and 10 for 3-month survivors. The average NIHSS for 3- month survivors was 3. On admission, the average GCS score was 9 for all patients, 7 for those who died and 12 for 3-month survivors. The average GCS of 3-month survivors was 15. The average BI and mRs were 98 and 0 on admission and 86 and 1 at 3 months for survivors. On admission, the average ICH volume was 49 cc for all patients, 66 cc for those who died at 3 months and 24 cc for 3-month survivors. For admission NIHSS of 18 or greater the 3-month mortality was 82% vs 9% for those with NIHSS Conclusion: The admission NIHSS predicts 3-month survival in ICH patients better than the GCS.

P96 Introduction: The National Institutes of Health Stroke Scale (NIHSS) score has been correlated with outcome in ischemic strokes but not intracerebral hemorrhage (ICH). We sought to validate the use of NIHSS in ICH patients by comparing it to outcomes using the Glasgow Coma Scale (GCS) score and volume of ICH. Use of the NIHSS will allow clinicians to follow the outcome of more specific parameters which may be used in clinical trials. Methods: We prospectively followed 61 ICH patients admitted to the Cleveland Clinic within 24 hours of onset. Age, NIHSS, GSC, Barthel index (BI), modified Rankin scale (mRs) were obtained on admission, discharge and at 3 months. An ICH volume was calculated using the AxBxC/2 method from the admission CT scan. Correlation was assessed using the Spearman correlation coefficient (SCC) and 95% CI, with a worst score given to deaths. Patients with a history of ischemic stroke were excluded. The maximum NIHSS for coma was 35. Results: The average age of the patients was 66 years old with 35 females and 26 males. On admission, the average NIHSS was 21 for all patients, 28 for those who died at 3 months and 10 for 3-month survivors. The average NIHSS for 3- month survivors was 3. On admission, the average GCS score was 9 for all patients, 7 for those who died and 12 for 3-month survivors. The average GCS of 3-month survivors was 15. The average BI and mRs were 98 and 0 on admission and 86 and 1 at 3 months for survivors. On admission, the average ICH volume was 49 cc for all patients, 66 cc for those who died at 3 months and 24 cc for 3-month survivors. For admission NIHSS of 18 or greater the 3-month mortality was 82% vs 9% for those with NIHSS &lt; 18 (P&lt;0.001). Admission NIHSS correlated strongly with admission GCS (SCC=0.82, CI 0.68, 0.97) and the two scores correlated similarly with volume (SCC=0.45, CI 0.22, 0.68; GCS SCC=0.40,CI 0.16, 0.63). Impressively, admission NIHSS correlated with the 3 month NIHSS (SCC=0.72, CI 0.53, 0.91), 3-month BI (SCC=0.74, CI 0.55, 0.92), 3-month mRs (SCC=0.72, CI 0.53, 0.91) significantly better than did the GCS (SCC=0.57,0.57 and 0.59 for the NIHSS, BI, and mRs, respectively). Conclusion: The admission NIHSS predicts 3-month survival in ICH patients better than the GCS.

Background and Purpose- The first of the 2 NINDS (National Institute of Neurological Disorders and Stroke) Study trials did not show a significant increase in early neurological improvement, defined as National Institutes of Health Stroke Scale (NIHSS) improvement by ≥4, with alteplase treatment. We hypothesized that early neurological improvement defined as a percentage change in NIHSS (percent change NIHSS) at 24 hours is superior to other definitions in predicting 3-month functional outcomes and using this definition there would be treatment benefit of alteplase over placebo at 24 hours. Methods- We analyzed the NINDS rt-PA Stroke Study (Parts 1 and 2) trial data. Percent change NIHSS was defined as ([admission NIHSS score-24-hour NIHSS score]×100/admission NIHSS score] and delta NIHSS as (admission NIHSS score-24-hour NIHSS score). We compared early neurological improvement using these definitions between alteplase versus placebo patients. We also used receiver operating characteristic curve to determine the predictive association of early neurological improvement with excellent 3-month functional outcomes (Barthel Index score of 95-100 and modified Rankin Scale score of 0-1), good 3-month functional outcome (modified Rankin Scale score of 0-2), and 3-month infarct volume. Results- There was a significantly greater improvement in the 24-hour median percent change NIHSS among patients treated with alteplase compared with the placebo group (28% versus 15%; P=0.045) but not median delta NIHSS (3 versus 2; P=0.471). Receiver operating characteristic curve comparison showed that percent change NIHSS (ROCpercent) was better than delta NIHSS (ROCdelta) and admission NIHSS (ROCadmission) with regards to excellent 3-month Barthel Index (ROCpercent, 0.83; ROCdelta, 0.76; ROCadmission, 0.75), excellent 3-month modified Rankin Scale (ROCpercent, 0.83; ROCdelta, 0.74; ROCadmission, 0.78), and good 3-month modified Rankin Scale (ROCpercent, 0.83; ROCdelta, 0.76; ROCadmission, 0.78). Conclusions- In the NINDS rt-PA trial, alteplase was associated with a significant percent change improvement in NIHSS at 24 hours. Percent change in NIHSS may be a better surrogate marker of thrombolytic activity and 3-month outcomes.

Quality of life (QoL) is important to stroke survivors yet is often recorded as a secondary measure in acute stroke randomized controlled trials. We examined whether commonly used stroke outcome measures captured aspects of QoL. We examined primary outcomes by National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and modified Rankin Scale (mRS), and QoL by Stroke Impact Scale (SIS) and European Quality of Life Scale (EQ-5D) from the Virtual International Stroke Trials Archive (VISTA). Using Spearman correlations and logistic regression, we described the relationships between QoL mRS, NIHSS, and BI at 3 months, stratified by respondent (patient or proxy). Using χ2 analyses, we examined the mismatch between good primary outcome (mRS ≤1, NIHSS ≤5, or BI ≥95) but poor QoL, and poor primary outcome (mRS ≥3, NIHSS ≥20, or BI ≤60) but good QoL. Patient-assessed QoL had a stronger association with mRS (EQ-5D weighted score n=2987, P<0.0001, r=-0.7, r2=0.53; SIS recovery n=2970, P<0.0001, r=-0.71, r2=0.52). Proxy responses had a stronger association with BI (EQ-5D weighted score n=837, P<0.0001, r=0.78, r2=0.63; SIS recovery n=867, P<0.0001, r=0.68, r2=0.48). mRS explained more of the variation in QoL (EQ-5D weighted score=53%, recovery by SIS v3.0=52%) than NIHSS or BI and resulted in fewer mismatches between good primary outcome and poor QoL (P<0.0001, EQ-5D weighted score=8.5%; SIS recovery=10%; SIS-16=4.4%). The mRS seemed to align closely with stroke survivors' interests, capturing more information on QoL than either NIHSS or BI. This further supports its recommendation as a primary outcome measure in acute stroke randomized controlled trials.

Objective To investigate the effects of early physiotherapy in combination with atorvastatin on the levels of serum brain-derived neurotrophic factor （BDNF） and neurological function in patients with acute ischemic stroke. Methods Fifty patients with acute ischemic stroke were randomly divided into either an atorvastatin group （monotherapy group, n =25） or a early physiotherapy ＋ atorvastatin group （combination treatment group, n = 25 ）. All patients received the prescr~ed drugs according to the diagnosis and treatment guidelines for ischemic stroke. The monotherapy group added atorvastatin calcium （20 rag, 1 tablet every night orally）. On the basis of the monotherapy group, the combination treatment group also conducted early physical therapy. At 2 and 6 weeks before and after treatment, a double-antibody sandwich enzyme-linked immunosorbent assay was used to detect the serum BDNF levels. The National Institutes of Health Stroke Scale （NIHSS） was used to evaluate the degree of neurological deficit. Barthel index （BI） was used to evaluate the activities of daily living. The modified Rankin scale （mRS） was used to assess the degree of disability. Results There was no significant difference in demographics and baseline data between the monotherapy group and the combination treatment group. The scores of NIHSS, BI, and mRS in both groups after treatment were significantly better than those before treatment （all P 〈 0. 001）. There were no difference in the scores of NIHSS, BI and mRS at 2 weeks before and after treatment, but at 6 weeks after treatment, the scores of NIHSS （2.4± 1.38 vs. 3.36±1.73; P =0. 035） and mRS （1.40 ±0.87 vs. 1. 96±0. 94; P =0. 047） of the combination treatment group were significantly lower than those of the monotherapy group, and the BI scores （92.60±7.50 vs. 85.20±11.68; P=0. 011） were significantly higher than those of the monotherapy group. After treatment, the serum BDNF levels were increased significantly in both groups. There were significant differences among all the time points （all P 〈0. 001）. At 2 weeks after treatment, the serum BDNF levels （3.07 ±0.93 ng/ml vs. 2.45±0. 76 ng/ml; t =2. 559, P = 0. 014） and at 6 weeks after treatment, those （2.90±0.93 ng/ml vs. 2.31 ± 0. 77 ng/ml; t =2. 433, P= 0. 019） in the combination treatment group were significantly higher than those in the monotherapy group. Spearman correlation analysis showed that the serum BDNF levels were significantly negatively correlated with the scores of NIHSS （r = -0. 738, P〈 0. 001） and mRS （r = -0. 654, P 〈 0. 001）, but they were significantly positively correlated with the BI scores （r = 0. 716, P 〈 0. 001 ）. No serious adverse reaction occurred in both groups. Conclusions Early physiotherapy in combination with atorvastatin for the treatment of acute ischemic stroke can more effectively promote the recovery of neurological function, and its mechanism may be associated with the increased serum BDNF levels. Key words: Stroke; Brain lschemia; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Atorvastatin; Physical Therapy Modalities; Brain-Derived Neurotrophic Factor

Early platelet activation, inflammation and acute brain injury after a subarachnoid hemorrhage: a pilot study

Immunoglobulin G Fc N-glycosylation in Guillain-Barré syndrome treated with intravenous immunoglobulin.

The aim of the research is the improvement of diagnostic measures in patients with cerebral ischemic hemispheric stroke (CIHS) on the basis of melatonin and serotonin plasma levels study in relation with evidence of neurologic impairment, level of functional independence, level of disability and their dynamics during the early recovery period of the disease. Materials and Methods. The complex clinical and paraclinical study of 77 patients (the average age 57,9±0,9 years) was done in the early recovery period of the CIHS. The study of all patients was complex clinic and paraclinical: test according to National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS) was done on the 10 th , 30 th , 90 th and 180 th day of the disease; computer tomography of cerebrum was made on the first day of the disease; melatonin serum concentration and serotonin plasma level were determined on the 10 th and 30 th day from the onset of the CIHS. The melatonin/serotonin ratio (MSR = melatonin serum concentration / serotonin plasma level) was also calculated. Results and Discussion. Statistical reliable relations between the following indications have been identified: «serotonin plasma level on the10 th day - dynamics mRS score on the 30-90 th day» (R=+0,37, p˂0,05), «melatonin serum concentration on the10 th day - dynamics mRS score on the 30-90 th day» (R=-0,23, p˂0,05),«MSR on the 10 th day - dynamics mRS score on the 30-90 th day» (R=-0,40, p˂0,05),«serotonin plasma level on the 30 th day - BI score on the 90 th day»(R=+0,38, p˂0,05),«serotonin plasma level on the 30 th - BI score on the180 th day»(R=+0,40, p˂0,05), «MSR on the 30 th day - NIHSS score on the 180 th day» (R=+0,29, p˂0,05), «MSR on the 30 th day - mRS score on the 90 th day» (R=+0,29, p˂0,05), «MSR on the 30 th day - mRS score on the 180 th day» (R=+0,32, p˂0,05), «MSR on the 30 th day - BI score on the 90 th day» (R=-0,42, p˂0,05), «MSR on the 30 th day - BI score on the 180 th day» (R=-0,32, p˂0,05). Conclusions. The serum concentration of melatonin on the 10 th day of CIHS correlates with the dynamics of points according to the modified Rankin Scale (mRS) on the 90 th day (R=+0.37, p˂0.05); MSR is associated with BI on the 90 th day (R=-0.42, p˂0.05) and 180 th day of the disease (R=-0,32, p˂0,05); the serotonin plasma level on the 30 th day of CIHS is associated with BI on the 90 th day (R=+0,38, p˂0,05) and 180 th day of the disease (R=+0.40, p˂0.05).

Introduction: Animal studies indicated the protective effect of resveratrol against cerebral ischemic damages, but it has not been researched well in human ischemic stroke. In the present study, the effect of resveratrol on recovery outcomes after acute ischemic stroke was investigated among patients with ischemic stroke who were not eligible for taking recombinant tissue plasminogen activator as an accepted intervention for stroke condition. Materials and Methods: In this double-blind clinical trial, 100 patients with ischemic stroke who suffered from the territory of the middle cerebral artery were randomly allocated to either resveratrol or placebo group. In the intervention group, resveratrol was administered orally at a dose of 500 ± 10 mg daily in three 170 mg divided doses, whereas the placebo group was treated with lactose, both for 30 consequent days. Systolic and diastolic blood pressures and the National Institute of Health Stroke Scale (NIHSS) were measured at the stroke onset and during discharges. Besides, the Barthel index and Modified Rankin Scale (MRS) were performed 3 months after the intervention. Results: Resveratrol had no significant effects on NIHSS (P = 0.97), systolic (P = 0.17), and diastolic blood pressure (P = 0.42) compared with placebo. There were no significant differences in the Barthel index (P = 0.84) and MRS (P = 1.00) between the two groups 3 months after treatment. Conclusion: Resveratrol did not improve functional recovery measured by the NIHSS, MRS, and Barthel index in patients with acute ischemic stroke. In addition, it had no significant effect on blood pressure.

Background and Purpose: The purpose of this study was to examine the relationship between the Modified Rankin Scale (MRS) and poststroke recovery in neurological deficits, activities of daily living (ADL), higher level of physical and social functioning and the patients’ preference for health state. Methods: Four hundred and fifty-nine participants in the Kansas City Stroke Study were prospectively assessed for measures of MRS, NIH Stroke Scale (NIHSS), Barthel ADL, SF-36 physical functioning, SF-36 social functioning, and Time Trade-Off (TTO). ANOVA and Bonferroni multiple comparisons were used to examine any differences in 3-month scores of NIHSS, Barthel ADL, SF-36 physical functioning, SF-36 social functioning and TTO between levels of the MRS. In addition, SF-36 physical functioning, SF-36 social functioning and TTO were characterized in patients who demonstrated improvement in global MRS outcome and also achieved a Barthel Index (BI) ≧95 at 3 months after stroke. Results: Two hundred and eighty patients (62%) shifted at least one grade in MRS from baseline to 3 months after stroke. Only 67 or 194 patients were considered to have a favorable outcome using MRS 0/1 or MRS 0/1/2, respectively, as criteria. Mean 3-month NIHSS and Barthel ADL scores were not significantly different between Rankin 0/1 and 2, but they were significantly different among Rankin 3, 4 and 5 (all p < 0.05). Mean 3-month scores of physical functioning and SF-36 social functioning were significantly different among Rankin 0/1, 2, 3 and 4 (all pairwise p < 0.05). Proportions of patients who achieved NIHSS ≤1 or BI ≧95 decreased as MRS grades worsened. In patients who showed improvement in MRS global outcome and also achieved BI ≧95, mean scores on TTO were similar. Conclusions: Definition of favorable outcomes should include transition in the Modified Rankin score rather than MRS dichotomized as 0/1 or 0/1/2 because patients with transition in MRS scores have improvement in ADL, increased higher level of functioning and higher utility for health state.

The purpose of this study was to assess immunological status and correlations of cytokines of diff erent groups in patients in the acute period of ischemic stroke (IS). Material and methods. 80 patients with IS (treatment group) and 20 patients with cardiovascular diseases (control group) were examined. All patients were assessed for comorbidity, cognitive function and demographic characteristics. The following were assessed in patients with IS: IS subtype, functional status using Barthel Index (BI), Ranking scale (mRS), National Institutes of Health Stroke Scale (NIHSS), neuroimaging parameters. Laboratory diagnosis included assessment of serum concentrations of interleukins, interferons, CXC- and CC-chemokines, MIF, GM-CSF and TNF-α. Statistical analyses were performed using Python and its libraries Pandas and SciPy. Results. Higher levels of IFN-γ, CXCL1, and CCL23 were determined in patients with IS. CXCL1 was found to correlate with BI, NIHSS, MoCA, foci size; IL — 6 — with BI, NIHSS, presence of diabetes, overweight; IFN-γ — with hyperlipidemia, BI, NIHSS. CCL23 levels were associated with mRS at day 14, presence of atherosclerosis, atherothrombotic subtype of IS; CCL2 — with BI, presence of atherosclerosis, leukoaraiosis, and hypertension; CXCL8 — with MoCA, NIHSS, diabetes. Conclusion. The research of the level and differential expression of cytokines in patients in the acute period of IS is an actual direction of clinical medicine. The verifi cation of cytokines CXCL1, CXCL8, CCL23, CCL2, IL-6 and IFN-γ as potential biomarkers of severity, course and outcomes of AI requires clarifi cation through further studies.

Background: In acute stroke trials, the three most commonly used outcome scales are the modified Rankin Scale (mRS) to assess global disability, the Barthel Index (BI) to assess instrumental activities of daily living, and the National Institutes of Health Stroke Scale (NIHSS) to assess neurologic deficit severity. The value of early scale assessments to forecast 3-month disability outcomes has not been formally investigated. Methods: In this cohort study of patients with acute ischemic stroke (AIS) in the NIH Field Administration of Stroke Therapy- Magnesium (FAST-MAG) Phase 3 trial, we assessed the performance of day 2, 4, and 30, BI, and NIHSS to forecast their day 90 counterparts using correlation coefficients and absolute differences. Results: Among 1041 with AIS, mRS on d2 (r=0.67) and d4 (r=0.72) showed strong correlation and mRS on d30 (r=0.89) very strong correlation with d90 mRS. However, value shifts were common. For example, d4 mRS exactly matched d90 mRS in only 35.8%, while 40.2 % had better and 24 % had worse outcomes. D4 BI exactly matched d90 BI in only 41.2%, while 48.5% had better and 11.2% had worse outcomes. For NIHSS, d4 exactly matched d90 value in only 20.5%, while 57.9% had better and 22.6% had worse outcomes. (Figure) Conclusions: mRS, BI, and NIHSS outcomes as early as days 2 and 4 post-stroke correlate strongly with their longterm, 3m outcome rank ordering but only moderately with their absolute values. Delineation of this outcome trajectory provides a foundation for imputing final patient disability, ADL, and deficit outcomes in clinical trials and quality improvement programs.