Objective: This study was conducted to demonstrate whether nurse trainees are adequately prepared in terms of professionalism to provide quality care to patients with epilepsy. Method: The descriptive and cross-sectional study was conducted among first-year (n=104) and fourth-year (n=96) nursing students in a public university in eastern Turkey. Data were collected using the “Student Introduction Form”, “Attitude Scale for Nursing Profession (ASNP)”, “Epilepsy Knowledge Scale (EKS)”, and “Epilepsy Attitude Scale (EAS)”. Number, percentage, mean, standard deviation, minimum, maximum, Chi-square test, Whitney-U test, Kruskal-Wallis test, and Kruskal-Wallis Bonferroni test were used to evaluate the data. Results: There was no statistically significant difference between the mean scores of ASNP, EKS, and EAS total scores according to the years of the students (p>0.05). In fourth year students, female gender, knowing someone with epilepsy, having a mother/father/sister/sibling with epilepsy or self, and being involved in the treatment and care of a patient with epilepsy were associated with better attitudes towards the nursing profession, their level of knowledge about epilepsy and their attitudes towards individuals with epilepsy. In addition, ASNP total scores of the first-year and fourth- year students had positive and significant effects on the total scores of the EKS (r=0.379, p=0.000; r=0.311, p=0.004, respectively). Conclusion: It was found that first and fourth-year nursing students in Southeastern Turkey had positive attitudes towards the nursing profession, moderate knowledge about epilepsy, and moderate attitudes towards people with epilepsy. In this context, students should be supported more in theoretical education and clinical practice.

Fibromyalgia syndrome is a musculoskeletal condition and presents with fatigue, sleep disturbances, cognitive symptoms, and heightened sensitivity to touch. Autonomic dysfunction is an associated symptom observed in fibromyalgia. The present study examines the association between autonomic dysfunction and fibromyalgia severity. The study enrolled 144 individuals based on the American College of Rheumatology diagnostic criteria (2010) for fibromyalgia. Autonomic functions were assessed using heart rate variability and Ewing’s battery of tests. Fibromyalgia Impact Questionnaire-Revised was used to explore fibromyalgiya severity. A varying degree of fibromyalgia severity was observed in the enrolled individuals with associated increases in pain sensitivity and intensity. Autonomic dysfunction was present in 45.8% (66) of individuals and 8.3% (12) individuals had definite autonomic dysfunction. No correlation was found between fibromyalgia severity and level of autonomic dysfunction. Additionally, no difference was observed in the levels of pain or daily functioning among the three categories of cardiac autonomic dysfunction. Different levels of autonomic dysfunction may be associated with varying levels of fibromyalgia severity, but no definite grade of autonomic dysfunction is associated with a particular grade of severity of fibromyalgia. Conclusion: Autonomic interaction with chronic pain requires further exploration, considering potential confounders that may impact both factors.

Background and Purpose: Stroke has a particularly high incidence and mortality in the Association of Southeast Asian Nations (ASEAN) region. Complementary and alternative medicine (CAM) usage is widespread in this region, including Traditional Chinese Medicine (TCM) and Ayurvedic medicine, but also other forms of traditional medicine. This study aims to systematically review the prevalence, type and effectiveness of non-TCM non-Ayurvedic CAM in post-stroke patients in the ASEAN region. Methods: PubMed, Embase and Scopus databases were searched from inception to 27 July 2024. Studies with patients from the ASEAN region who were diagnosed with stroke and used any CAM that was not TCM or Ayurvedic medicine were included. Two independent authors screened through relevant articles, extracted data and assessed risk of bias. Results: Sixteen studies from four countries were included. The use of massages, herbs, spiritual and energy healing methods were widely adopted for post-stroke patients in the ASEAN region. Evidence for CAM improving neurological and physical stroke outcomes were limited. Despite this, studies have been largely unanimous in reporting improved psychological and quality of life outcomes following CAM use. Conclusions: There is a severe paucity of published literature on non-TCM and non-Ayurvedic CAM use in stroke patients in the ASEAN region despite likely widespread use. There is some evidence of potential benefit but these are limited to subjective patient-reported outcomes. More research is needed to understand its impact and how best to complement conventional stroke care without compromising outcomes.

With every increment of glomerular filtration rate (GFR) by 10%, there is an elevated risk of stroke by 7%. Stroke death is also 9 times higher in end stage renal failure (ESRF) patients as compared to the general population. Certain studies have described that intravenous thrombolysis in ESRF patients with acute ischaemic stroke has no added benefit with increased risk of bleeding while some still recommend intravenous thrombolysis (IVT) as it improves neurological outcome. We describe two cases of acute ischaemic stroke at 0 hours post haemodialysis (HD) and 3.5 hours post HD. A 62-year- old gentleman with underlying hypertension and ESRF, presented 3.5 hours after haemodialysis with National Institute of Health Stroke Scale (NIHSS) of 7. Computed Tomography Angiography (CTA) showed a right distal M1 non occlusive thrombus and IV Alteplase 40mg was given. NIHSS post IVT at 6hours showed improvement to 3 and 0 upon discharge. Current mRS is 0. Upon undergoing 3hours of haemodialysis, a 66-year-old gentleman with underlying Hepatitis C and ESRF had an acute stroke with NIHSS of 10. CTA showed left M2 occlusion and IV Alteplase 50mg was given. NIHSS 6hours post IVT is 7 and 4 upon discharge. Complications include, oozing over his left BCF and minimal sulcal subarachnoid haemorhage. Current mRS is 1. In conclusion, post dialysis patients who suffer from an acute stroke, may be given intravenous thrombolysis as to improve their clinical outcome. In this study, both patients were given a lower dose of Alteplase (0.6mg/kg) and had favourable outcomes.

Objective: To investigate the impacts of environmental and lifestyle factors on progression and survival in a large Chinese amyotrophic lateral sclerosis (ALS) cohort. Methods: We investigated a cohort of 1,312 sALS patients prospectively. A questionnaire was designed to collect information on environmental exposure and lifestyle at baseline. Uni- and multivariate analysis were performed to analyze the influence of environmental and lifestyle factors on the onset age, bulbar onset, progression rate and survival time of ALS. Results: A total of 1,050 questionnaires were finally received from the patients, among which 407 questionnaires were fully filled out. Low educational level and ever smoked were significantly related to late onset in both univariate and multivariate analysis with backward section (p<0.05). Exposure to organophosphorus pesticide was significantly related to bulbar onset (p=0.027) and rapid progression (p=0.007). Ever drinking alcohol was related to longer survival time in Cox regression model (p=0.040) and the mean survival time of non-drinkers was significantly higher than patients with history of drinking alcohol (p=0.023). Conclusion: In Chinese ALS population, low educational level was an independent indicator of late onset. Exposure to organophosphorus pesticide was the risk factor for bulbar onset and rapid progression. Smoking and drinking alcohol were less common among ALS patients with late onset and long survival time.

Background & Objective: Nocturnal pain and paresthesias are common in carpal tunnel syndrome (CTS). However, there is limited literature on the impact of CTS on sleep profile. The aim of this study was to systematically analyse sleep profile in CTS and to correlate with clinical and electrophysiological features. Methods: Prospective evaluation of 44 patients diagnosed to have CTS was carried out using Visual Analog Scale (VAS), Functional Severity Scale (FSS) and Symptom Severity Scale (SSS) components of Boston Carpal Tunnel Questionnaire (BCTQ), Historic and objective scale (HiOb), and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). Sleep was assessed using Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and overnight polysomnography (PSG). Results: Cases had significantly higher mean PSQI, ESS, ISI and STOP-BANG scores as compared to controls. PSQI, ESS, and ISI correlated significantly with FSS, SSS and QuickDASH. PSQI and ISI correlated with VAS. No significant correlation was found between sleep questionnaires and electrophysiological severity. PSG, carried out in 16 cases, showed reduced total sleep time and sleep efficacy, reduced duration of N2 and rapid eye movement (REM) sleep, and higher wake after sleep onset (WASO), wake index, and stage shift index (p<0.05). Sleep efficacy, sleep onset latency, WASO and wake percentage were better in those with clinical and electrophysiological severe grades of CTS. Conclusion: CTS causes poor sleep quality, and fragmented and reduced sleep, which is under- recognised, but causes significant distress to the patients. Longitudinal alterations in sleep profile including the impact of medical/surgical intervention need to be delineated.

Background & Objective: The purpose of the present study was to evaluate the association between erythrocyte and platelet related parameters with the initial severity of acute ischemic stroke (AIS). Methods: This observational study included 113 patients with AIS in the 4th Department of Internal Medicine, Xiong’an New District Rongcheng People’s Hospital. Erythrocyte and platelet related parameters including red blood cell distribution width (RDW), hematocrit value (HCT), platelet volume distribution width (PDW), and plateletcrit (PCT) were measured for all patients. In addition, modified Rankin Scale (mRS) was performed to assess the initial severity of AIS for all patients. Ordinal logistic regression analysis was used to investigate the association between the erythrocyte and platelet related parameters with mRS. Results: RDW was positively and significantly associated with mRS (Estimate = 0.532, P = 0.025, 95% CI: 0.067, 0.997) in patients with AIS. Conclusion: RDW is associated with the initial severity of AIS.

Background & Objective: Nursing students will play an important role in providing care to epilepsy patients in the future. Epilepsy education is an important tool in improving knowledge, attitude and seizure first aid approaches. The purpose of this research was to assess the efficacy of the epilepsy training program. Method: This one-group pretest-posttest quasi-experimental study was conducted with 95 students studying at the Nursing Department of the Faculty of Health Sciences in Turkey between November 2022 and February 2023. The data of the study were collected with the first aid management form, The Epilepsy Knowledge Scale and The Epilepsy Attitude Scale. In this study, which included pretest and posttests, a three-session face-to-face epilepsy education programme based on epilepsy was applied. Results: In this research, it was shown that the results before and after education were statistically significantly different (p<0.05). The epilepsy knowledge scale score increased from 8.33±3.56 to 13.27±2.19, and the epilepsy attitude scale score increased from 59.70±7.67 to 62.96±6.02 after the training. The attitudes and knowledge of students about epilepsy were significantly correlated positively (r=0.399, p<0.05 before education, r=0.403, p<0.05 after education). The number of students who felt capable of seizure intervention increased significantly after the education (p<0.05). Conclusion: The research revealed the beneficial effects of epilepsy education intervention applied to nursing students. In the future, awareness should continue to be promoted through epilepsy education programs, and accessibility to such programs should be increased.

Spastic trismus (ST) is a rare manifestation of stroke-induced spasticity, characterised by sustained contraction of the masticatory muscles, resulting in restricted jaw opening. It can severely impact oral hygiene, feeding, speech, and access to dental procedures, and may complicate emergency airway management. ST is more commonly observed in bilateral cerebral cortical lesions, while isolated unilateral ST following a brainstem stroke is exceedingly rare. We report a case of unilateral ST in a 57-year-old man with a history of diabetes mellitus and dyslipidaemia who suffered a brainstem stroke affecting the pontomedullary junction and medulla. He developed severe limb incoordination, dysphagia, and dependence on nasogastric tube feeding but remained cognitively intact. He was referred to us two years post-stroke, presenting with severe trismus (interincisal distance of 11 mm) and right jaw hypertrophy. Conservative treatments, including warm compresses and stretching exercises, failed. Botulinum toxin injection was offered, but declined. He was started on oral baclofen (10 mg twice daily), which was later reduced due to drowsiness. After two weeks, his interincisal distance improved to 22 mm, facilitating oral hygiene and speech articulation. Baclofen was discontinued after four weeks as no further improvement was observed, but gains were maintained at three, six, and 12 months post-discharge. This case highlights the challenges in managing post-stroke ST, particularly in a unilateral brainstem lesion. While botulinum toxin remains the treatment of choice, oral antispasmodics may serve as viable alternatives when injections are contraindicated or declined. Further research is needed to establish evidence-based rehabilitation strategies to improve long-term outcomes for ST.

Objective: This study investigates the implications of combining blood biochemical indicators with imaging for Cerebral venous sinus thrombosis (CVST) diagnosis, aiming to enhance diagnostic precision and speed. Methods: We retrospectivity analyzed data from 120 CVST patients between August 1, 2016, and July 31, 2023, examining clinical, laboratory, and cranial MRI and MRV imaging data. Statistical methods assessed the diagnostic significance of various blood indicators and their correlation with CVST. Results: Headache was the most common symptom, followed by changes in vision, epileptic seizures, and neurological deficits. D-dimer levels, fibrinogen, plateletcrit, mean corpuscular volume (MCV) and platelet distribution width were higher in CVST patients compared to controls. Subgroup analysis revealed that gender and age might influence certain blood test indicators. Notably, a significant difference in D-dimer levels between patient groups with and without complications was observed, suggesting its potential as a biomarker for complication risk. Logistic regression model analysis further confirmed the significant positive correlation between elevated D-dimer levels and CVST risk, also noting that increases in plateletcrit and platelet distribution width were positively correlated with CVST risk. Moreover, through correlation analysis using point biserial correlation coefficient and Spearman’s correlation coefficient, significant correlations were found among blood test indicators, and between these indicators and CVST status. MRI and MRV, as key imaging tools for diagnosing CVST, directly display thrombus formation, further enhancing diagnostic accuracy. Conclusion: Blood biochemical markers and imaging (MRI and MRV) are vital in diagnosing CVST, aiding in faster, accurate clinical decision-making and better patient outcomes.