European Stroke Scale Scores Research Articles

Safety and efficacy of tight versus loose glycemic control in acute stroke patients: A meta-analysis of randomized controlled trials.

Hyperglycemia is associated with worse stroke outcomes, but it is uncertain whether tight glycemic control during the acute stroke period is associated with a better outcome. We conducted a meta-analysis to compare the effect of tight glycemic control versus loose glycemic control in the acute phase of stroke patients. A literature search was performed to identify randomized controlled trials comparing the safety and efficacy of tight glycemic control with a relatively loose control of blood glucose of acute stroke (ischemic or hemorrhagic) patients within 24 h after stroke onset. We required that the blood glucose level of the patients should not be lower than 6.11 mmol/L at the time of enrollment, and for the intensive blood glucose control range, we defined the blood glucose level as lower than that of the control group. The primary efficacy outcome measure was deaths from any cause at 90 days. Secondary efficacy outcomes comprised the number of participants with modified Rankin score (mRS). We define mRS scores 0-2 as favorable scores, recurrent stroke, and the National Institute of Health Stroke Scale or the European Stroke Scale scores. We defined the number of participants with hypoglycemia as our primary safety outcome. Subgroup analysis was performed according to age, the variety of interventions, maintained glucose level, and status of hypoglycemia on National Institute of Health Stroke Scale (NIHSS) scores or European Stroke Scale (ESS) scores. Fifteen randomized controlled trials (RCTs) with 2957 participants meeting the including criteria were identified and included in this meta-analysis, although not all included data on every outcome measure. Data on the primary efficacy endpoint, mortality at 90 days, was available in 11 RCTs, a total of 2575 participants. There was no significant difference between the intervention and control groups (odds ratio (OR): 1.00; 95% confidence interval (CI): 0.81-1.23; P = 0.99). For secondary endpoints, there was no difference between intervention and control groups for a mRS from 0 to 2 (OR: 0.96; 95% CI: 0.80-1.15; P = 0.69; data from 9 RCTs available), or recurrent stroke (OR: 1.34; 95% CI: 0.92-1.96; P = 0.13; data from 3 RCTs available). For NIHSS scores or ESS scores, there was a small difference in favor of intensive controls (standardized mean difference: -0.29; 95% CI: -0.54 to -0.04; P = 0.02). There was a marked increase in hypoglycemia with tight control: (OR of 9.46 (95% CI: 4.59-19.50; P < 0.00001; data from 9 RCTs available). There was no difference between tight and loose glycemic control on mortality, independence, or recurrent stroke outcome in acute stroke, but an increase in hypoglycemia. There was a small effect improvement on neurological scales, but the relevance of this needs to be confirmed in future adequately powered studies.

Effect of comprehensive nursing on the quality of life and swallowing function in individuals diagnosed with ischemic stroke.

Ischemic stroke (IS) is a widely recognized disease characterized by high prevalence, mortality, morbidity, disability, and recurrence rates. It ranks prominently in terms of mortality, constituting 60%-80% of stroke cases. To explore the impact of comprehensive nursing care on the quality of life and swallowing function in individuals diagnosed with IS. This study comprised 172 patients with IS admitted to our hospital between February 2018 to March 2021. The participants were divided into two groups, namely the control group (n = 80) receiving routine care and the research group (n = 92) receiving comprehensive care. Various assessment scales, including the standard swallowing function assessment scale (SSA), National Institutes of Health Stroke scale (NIHSS), European stroke scale (ESS), self-rating anxiety scale (SAS), self-rating depression scale (SDS), Barthel index (BI), and the motor function assessment scale (MAS), were employed to evaluate the improvement in swallowing function, neurological deficits, clinical outcomes, anxiety, depression, daily living activities, and motor function before and after care. Furthermore, the study compared the occurrence of adverse reactions during the nursing period, life quality before and after the intervention, rehabilitation compliance, and nursing satisfaction between the two groups. After the nursing intervention, the research group exhibited significantly improved SSA and NIHSS scores compared to the control group (P < 0.05). Moreover, both groups demonstrated significant reductions in SAS and SDS scores (P < 0.05), with the research group showing more obvious advantages (P < 0.05). Compared to the control group, the research group displayed significantly better ESS, BI, and MAS scores (P < 0.05), coupled with a lower incidence of adverse reactions (P < 0.05). Additionally, the research group demonstrated markedly higher levels of life quality, rehabilitation compliance, and nursing satisfaction compared to the control group (P < 0.05). Comprehensive nursing effectively improved swallowing function, quality of life, and patient satisfaction, highlighting its clinical significance.

Human urinary kallidinogenase in treating acute ischemic stroke patients: analyses of pooled data from a randomized double-blind placebo-controlled phase IIb and phase III clinical trial

ABSTRACTObjectives: Intravenous thrombolysis and thrombectomy are recommended for patients whose stroke onsets are within first 6 h, and very few options are available for patients whose stroke onset is more than 6 h, which includes most ischemic stroke patients. Human urinary kallidinogenase (HUK) showed potential clinical benefits in acute ischemic stroke patients. This study aims to investigate the safety and clinical benefits of HUK in ischemic stroke patients.Patients and methods: Patients were recruited for a multicenter double-blind, placebo-controlled phase II b and phase III trial. Neurophysiological outcomes were assessed by the European Stroke Scale (ESS) and the functional outcomes were assessed by the activity of daily living scale (ADL). Safety was monitored by recording adverse events.Results: The improvements in ESS scores and ADL scores in the HUK group were significantly greater than that in patients receiving placebo. Furthermore, HUK treatment was also associated with a lower rate of disable, according to ADL. HUK-related adverse events occurred at a low rate, in 1.73% of HUK-treated patients.Conclusion: HUK is safe and provides potential clinical benefits as a treatment for acute ischemic stroke. Further large post-marketing observational studies are needed.

Two-year safety and clinical outcomes in chronic ischemic stroke patients after implantation of modified bone marrow-derived mesenchymal stem cells (SB623): a phase 1/2a study.

The aim of this study was to evaluate the safety and clinical outcomes associated with stereotactic surgical implantation of modified bone marrow-derived mesenchymal stem cells (SB623) in patients with stable chronic ischemic stroke. This was a 2-year, open-label, single-arm, phase 1/2a study; the selected patients had chronic motor deficits between 6 and 60 months after nonhemorrhagic stroke. SB623 cells were administered to the target sites surrounding the subcortical stroke region using MRI stereotactic image guidance. A total of 18 patients were treated with SB623 cells. All experienced at least 1 treatment-emergent adverse event (TEAE). No patients withdrew due to adverse events, and there were no dose-limiting toxicities or deaths. The most frequent TEAE was headache related to the surgical procedure (88.9%). Seven patients experienced 9 serious adverse events, which resolved without sequelae. In 16 patients who completed 24 months of treatment, statistically significant improvements from baseline (mean) at 24 months were reported for the European Stroke Scale (ESS) score, 5.7 (95% CI 1.4-10.1, p < 0.05); National Institutes of Health Stroke Scale (NIHSS) score, -2.1 (95% CI -3.3 to -1.0, p < 0.01), Fugl-Meyer (F-M) total score, 19.4 (95% CI 9.9-29.0, p < 0.01); and F-M motor scale score, 10.4 (95% CI 4.0-16.7, p < 0.01). Measures of efficacy reached plateau by 12 months with no decline thereafter. There were no statistically significant changes in the modified Rankin Scale score. The size of transient lesions detected by T2-weighted FLAIR imaging in the ipsilateral cortex at weeks 1-2 postimplantation significantly correlated with improvement in ESS (0.619, p < 0.05) and NIHSS (-0.735, p < 0.01) scores at 24 months. In this completed 2-year phase 1/2a study, implantation of SB623 cells in patients with stable chronic stroke was safe and was accompanied by improvements in clinical outcomes.Clinical trial registration no.: NCT01287936 (clinicaltrials.gov).

Nutech Functional Score: A New Functional Scoring System for Patients With Cerebrovascular Accidents

Background: Stroke or cerebrovascular accident happens when a part of the brain gets poor supply of blood that leads to either hemorrhage or blockage due to deoxygenation. To measure stroke outcomes, various stroke scales are invented in the last few decades. The present study has compared a novel stroke scale, Nutech functional score (NFS) to that with the most widely used and globally recognized European stroke scale (ESS). Methods: NFS has been designed with 22 different parameters taking into consideration its ability to measure neurological as well as functional impairments associated with stroke. Each symptom has been assigned scores (1, 2, 3, 4, 5) that runs in direction from extreme bad (1) to normal (5). The scores are converted to numeric values using an empirical formula. We have compared both the NFS and ESS scores for measuring stroke outcomes. Results: NFS is able to assess motor, sensory and autonomic parameters for stroke patients. It assesses not only the clinical symptoms but the overall change in quality of life. ESS fails to measure all kinds of functional parameters and it involves tedious calculations. Conclusion: NFS has proven to be a much simpler and efficient scoring system in comparison with ESS which is a 14-point stroke scale. NFS is a multiple use scale which can measure more parameters than ESS and can be used universally to assess the patients suffering with stroke. J Neurol Res. 2015;5(4-5):246-251 doi: http://dx.doi.org/10.14740/jnr352w

Study pattern of snoring and associated risk factors among medical students

Snoring can impair lifestyle and cause late cardiopulmonary complications. Early detection of snoring and timely intervention during adolescence can avoid complications. A single center prospective cross-sectional study was conducted in 548 undergraduate 17-25 years old undergraduate medical students of CSM Medical University, Lucknow, who were interviewed on the basis of the modified Berlin Questionnaire along with their room-partners describing their snoring habits. Ninety-seven (17.7%) subjects were found to be snorers. Risk factors viz. day time sleepiness (European Stroke Scale (ESS) scores), smoking habits, alcohol intake, neck size and BMI were observed. The proportion of males, smokers, BMI, neck size and ESS scores were significantly (p < 0.001) higher in snorers than non snorers. Logistic regression found sex (OR = 5.73, 95% CI = 2.11-15.61), smoking (OR = 2.20, 95% CI = 0.97-5.62), BMI (OR = 3.16, 95% CI = 1.09-7.36) and neck size (OR = 2.03, 95% CI = 0.79-6.35) as significant (p < 0.01) independent risk factors for snoring. A clinically significant form of Sleep Disordered Breathing (Habitual snoring, ESS score ≥ 11 and BMI ≥ 25 kg/m2) was suspected in 4 (0.7%) students. The findings of this study may also be validated in the general population. The study concluded that male undergraduate medical students are at a high risk for developing snoring habits.

Effects of HELP Therapy on Acute Ischemic Stroke and Vascular Endothelial Cell Function

To evaluate the therapeutic effects of the HELP system (heparin-induced extracorporeal low-density lipoprotein-apolipoprotein(a)-fibrinogen precipitation) in patients with acute ischemic stroke and probe into its possible mechanism, 10 patients with acute ischemic stroke were included in this study and received the HELP therapy in addition to low molecular weight dextran, salvia miltiorrhiza and aspirin. Matched with gender, age, European Stroke Scale (ESS) and fibrinogen, 20 patients with cerebral infarction treated with low molecular heparin were chosen as controls during the same period. We compared the efficacy and prognosis between the two groups. In order to clarify the effects of HELP treatment on endothelial function, human umbilical vein endothelial cells (HUVEC) were cultured with the serum of pre- and post-HELP therapy and control patients, then endothelial permeability and biomarkers of endothelial dysfunction or activation in the supernatant of incubated HUVEC, such as soluble thrombomodulin (sTM), soluble intracellular adhesion molecule-1 (sICAM-1) and monocyte chemoattractant protein-1 (MCP-1), were tested. Twenty-one days after treatment, ESS scores in the HELP group (70.4 +/- 23.06) were higher than those in control group (60.7 +/- 18.94), but there was no statistical significance (P > 0.05). In the HELP group, total efficacy rate reached 60% with ESS score (6 cases of recovery and efficacy, 4 cases of inefficacy), while it was 40% in control group (8 cases of recovery and efficacy, 12 cases of inefficacy), but unfortunately there was no significant difference between both groups using the chi(2)-test (P > 0.05). Interestingly, with the activities of daily living (ADL) score, the efficacy rate in the HELP group (60%) was markedly higher than that in the control group (20%) (P < 0.05). Furthermore, Pearson correlation analysis showed that the therapeutic window (the time from the patient's onset to receiving the therapy) was correlated to final ADL scores (P = 0.044) and the mean therapeutic window was 14.08 +/- 3.41 h in patients who achieved efficacy criteria. After therapy, no difference was found in hemorheology, fibrinogen, blood lipid, oxidized low-density lipoprotein (oxLDL) or C-reactive protein (CRP) in the control group, while there was a significant decrease in the HELP group immediately after treatment (P < 0.01). But the hospital stay time was similar between the HELP group and the controls (23.11 +/- 10.65 vs. 21.53 +/- 8.73 days; P > 0.05) and 21 days later, the dimension of the largest cross-sectioned infarction area by CT scan did not significantly change for the two groups' of patients (P > 0.05). When cultured with the patient's serum after HELP therapy, the concentration of sTM, sICAM-1, and MCP-1 in the supernatant of cultured HUVEC remained unchanged at 24 h (P > 0.05), while it was remarkably higher when HUVEC was cultured with the serum of the controls and patients before HELP therapy (P < 0.01), except for sTM. The endothelial permeability was also improved after the HELP treatment. With the effects of improving hemorheology, decreasing acute phase reactive proteins such as CRP and fibrinogen, ameliorating endothelial cell function, HELP system may be a novel therapy for acute ischemic stroke.

Neurotransplantation for patients with subcortical motor stroke: a Phase 2 randomized trial

No definitive treatment exists to restore lost brain function following a stroke. Transplantation of cultured neuronal cells has been shown to be safe and effective in animal models of stroke and safe in a Phase 1 human trial. In the present study the authors tested the usefulness of human neuron transplantation followed by participation in a 2-month stroke rehabilitation program compared with rehabilitation alone in patients with substantial fixed motor deficits associated with a basal ganglia stroke. Human neuronal cells (LBS-Neurons; Layton BioScience, Inc.) were delivered frozen and then thawed and formulated on the morning of surgery. The entry criteria in this randomized, observer-blinded trial of 18 patients included age between 18 and 75 years, completed stroke duration of 1 to 6 years, presence of a fixed motor deficit that was stable for at least 2 months, and no contraindications to stereotactic surgery. Patients were randomized at two centers to receive either 5 or 10 million implanted cells in 25 sites (seven patients per group) followed by participation in a stroke rehabilitation program, or to serve as a nonsurgical control group (rehabilitation only; four patients). The surgical techniques used were the same at both centers. All patients underwent extensive pre- and postoperative motor testing and imaging. Patients received cyclosporine A for 1 week before and 6 months after surgery. The primary efficacy measure was a change in the European Stroke Scale (ESS) motor score at 6 months. Secondary outcomes included Fugl-Meyer, Action Research Arm Test, and Stroke Impact Scale scores, as well as the results of other motor tests. Nine strokes were ischemic in origin and nine were hemorrhagic. All 14 patients who underwent surgery (ages 40-70 years) underwent uncomplicated surgeries. Serial evaluations (maximum duration 24 months) demonstrated no cell-related adverse serological or imaging-defined effects. One patient suffered a single seizure, another had a syncopal event, and in another there was burr-hole drainage of an asymptomatic chronic subdural hematoma. Four of seven patients who received 5 million cells (mean improvement 6.9 points) and two of seven who received 10 million cells had improved ESS scores at 6 months; however, there was no significant change in the ESS motor score in patients who received cell implants (p = 0.756) compared with control or baseline values (p = 0.06). Compared with baseline, wrist movement and hand movement scores recorded on the Fugl-Meyer Stroke Assessment instrument were not improved (p = 0.06). The Action Research Arm Test gross hand-movement scores improved compared with control (p = 0.017) and baseline (p = 0.001) values. On the Stroke Impact Scale, the 6-month daily activities score changed compared with baseline (p = 0.045) but not control (p = 0.056) scores, and the Everyday Memory test score improved in comparison with baseline (p = 0.004) values. Human neuronal cells can be produced in culture and implanted stereotactically into the brains of patients with motor deficits due to stroke. Although a measurable improvement was noted in some patients and this translated into improved activities of daily living in some patients as well, this study did not find evidence of a significant benefit in motor function as determined by the primary outcome measure. This experimental trial indicates the safety and feasibility of neuron transplantation for patients with motor stroke.