Stroke & Seizures

MDNG Hospital Medicine, December 2010, Volume 4, Issue 6

//Medical WebsitesNIH Stroke Scale

At this site, the AHA’s Professional Education Center offers versions of the National Institutes of Health (NIH) Stroke Scale for the mobile device—including the iPhone—and computer. With this CME/CE certified program, health care providers can learn how to administer the stroke scale, which is considered to be “a critical component of acute stroke assessment.” Included are instructions on how to access the mobile course from the iPhone.

Stroke Guidelines and Consensus Statements

Visit this site from the Internet Stroke Center to find a collection of guidelines from the AHA, American Academy of Neurology, American College of Cardiology, European Stroke Initiative, and the National Heart, Lung, and Blood Institute, among others, to guide you in the prevention and treatment of stroke. Guidelines are divided into several categories covering areas such as acute stroke management, stroke recovery, diagnosis, imaging, and pediatric stroke. Some of the most recent additions include “Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage Stroke,” “Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack,” and “Recommendations for the Establishment of Stroke Systems of Care.”

//The Educated PatientStroke Family Caregiving for African-Americans

Despite the fact that “African-Americans are three to four times more likely to have a stroke” than Caucasians, they are “less likely to receive or ask for information on how to decrease, prevent, or manage this disability,” according this site, which provides guidance for stroke patients and their loved ones on issues such as the family’s role in recovery, adjusting to home life, and the importance of asking for help. Here, caregivers can read about how to manage challenges in memory, how to recognize signs of depression, and how to deal with incontinence.

//Online CMEDynamic Volume Computed Tomography in StrokeCredits: 1.50

Fee: None

Expires: June 23, 2011

Multimedia: Audio/Video

In this webcast, Jeffrey T. Dardinger, MD, and Kenneth V. Snyder, MD, PhD, review the appropriate application of dynamic volume computed tomography (CT) in stroke patients, application of computed tomography dose protocols in order to improve patient outcomes while managing healthcare costs, and appropriate use of CT perfusion in decision making regarding immediate revascularization of acute stroke patients. The authors also describe new volume computed tomography imaging techniques for diagnosis and treatment, and different models of analysis of CT perfusion data.

//VideosAre Incidental Brain MRI Findings of Concern in Children?

Although incidental findings on brain MRI scans are seen in only a minority of children, and most of the findings are benign, it is still critical that clinicians are prepared to address these results, according to John J. Strouse, MD, of Johns Hopkins University School of Medicine in Baltimore. This video provides guidance for unexpected MRI findings, citing information from a study published in Pediatrics.

Optimal Time to Resume Warfarin after Brain Bleed

This short video, which is accompanied by an article, examines when warfarin therapy can be safely resumed following an intracranial hemorrhage. The risks of recurrent intracranial hemorrhage versus stroke over a 3-year timeframe are lowest when warfarin is restarted between 10 and 30 weeks after discontinuation, according to results from a study published in Stroke, which are featured in the video.

//eAbstractsLatency to First Seizure after Temporal Lobectomy Predicts Long-term OutcomeJournal: Epilepsia (October 2010)

Authors: Buckingham S, Chervoneva I, Sharan A, et al.

Purpose: To determine the prognostic significant of the time from surgery to first seizure relapse in predicting long-term impact in patients.

Results: Retrospective analysis of patients who reported at least one complex partial seizure or generalized tonic-clonic seizure after anterior temporal lobectomy showed that “the latency from surgery to the first postoperative disabling seizure was significantly associated with long-term outcome.” Longer latency was associated with higher odds of being seizure-free or improved relative to the unimproved state, while “shorter latency increased the likelihood of achieving the worst prognosis.”

Correlation between Serum Selenium Level and Febrile SeizuresJournal: Pediatric Neurology (November 2010)

Authors: Mahyar A, Ayazi P, Fallahi M, Javadi A.

Purpose: A case-control study was conducted in the Children’s Hospital in Qazvin, Iran, to assess the association between serum selenium level and simple febrile seizures in children

Results: A comparison of serum selenium levels in 30 children who experienced simple febrile seizures with those of febrile children without seizure showed that levels were significantly lower in those who had simple febrile seizures. Researchers concluded that there seems to be “an association between serum selenium deficiency and simple febrile seizures.” Further study, however, is recommended.

//Clinical TrialsStrength, Flexibility, and Balance Therapy after Stroke (HEALTHY)Study Type: Interventional

Age/Gender Requirements: 18 years (male/female)Sponsor: Department of Veterans Affairs

Purpose: To develop and test a yoga exercise intervention in a large VA trial for veterans who have survived a transient ischemic attack (TIA) to manage secondary stroke risk factors. In the study, investigators aim to determine the feasibility of an 8-week yoga based intervention for veterans with stroke; establish an appropriate dosing strategy for a post-TIA, 8-week yoga exercise intervention for a future VA yoga implementation trial; and estimate the effect size of yoga on the mean change in systolic blood pressure to determine the appropriate VA trial sample size.

Pharma FocusLyrica (pregabalin) and Neurontin (gabapentin)

//Clinical TrialsComparative Study of Pregabalin and Gabapentin as Adjunctive Therapy in Subjects with Partial SeizuresStudy Type: Interventional

Age/Gender Requirements: 18-80 years (male/female)

Sponsor: Pfizer

Purpose: This randomized, double-blind, multisite trial seeks to compare the efficacy of pregabalin versus gabapentin as adjunctive therapy in patients with partial seizures. Subjects must be diagnosed with epilepsy with partial seizures, as defined in the International League Against Epilepsy (ILAE) classification, and partial seizures may be simple or complex, with or without secondary tonic-clonic generalization.

//eAbstractsA Comparison of the Pharmacokinetics and Pharmacodynamics of Pregabalin and GabapentinJournal: Clinical Pharmacokinectics (October 1, 2010)

Authors: Bockbrader H, Wesche D, Miller R, et al.

Purpose: To compare the pharmacokinetics of pregabalin and gabapentin, two drugs that “share a similar mechanism of action, inhibiting calcium influx and subsequent release of excitatory neurotransmitters,” yet differ in their pharmacokinetic and pharmacodynamic characteristics. “Gabapentin is absorbed slowly after oral administration, with maximum plasma concentrations attained within 3—4 hours,” while “orally administered pregabalin is absorbed more rapidly, with maximum plasma concentrations attained within 1 hour.”

Results: Both drugs show dose-response relationships in the treatment of postherpetic neuralgia and partial seizures; a pregabalin dosage of 450 mg/day appears to reduce neuropathic pain comparably to the predicted maximum effect of gabapentin, while as an antiepileptic, “pregabalin may be more effective based on the magnitude of the reduction in the seizure frequency.” Researchers concluded that “pregabalin appears to have some distinct pharmacokinetic advantages over gabapentin that may translate into an improved pharmacodynamic effect.”