Urgent Treatment of Minor Strokes Improves Outcomes
NEW YORK, February 4 (Reuters Health)—Urgent evaluation and treatment of patients with minor strokes and transient ischemic attacks (TIAs) in a specialist outpatient clinic can reduce future hospital bed-days, costs, and disability at six months, new research shows.
In the initial analysis of the Early use of eXisting PREventive Strategies for Stroke (EXPRESS) study, urgent assessment and treatment cut the 90-day risk of repeat stroke by roughly 80%. In the current analysis, Dr. Peter M. Rothwell, from John Radcliffe Hospital, Oxford, UK, and colleagues looked at the impact on hospital admission, costs, and disability.
EXPRESS involved a comparison of stroke outcomes between April 2002 and September 2004, before the set-up of specialist outpatient clinics designed to expedite stroke treatment and assessment, and afterwards during the period October 2004 to March 2007. Unlike the standard clinics, these clinics did not require an appointment, and primary care doctors were advised to send all patients with suspected stroke or TIA to them immediately.
As reported in the March issue of the Lancet Neurology, the urgent stroke clinics were associated with significant reductions in the 90-day risk of fatal or disabling stroke and hospital admissions for recurrent stroke. Reductions in the overall and vascular-related number of hospital bed days also occurred, from 1957 to 672 bed days after the clinics began. For each patient referred to an urgent stroke clinic, a cost savings of £624 ($887) was realized, the report indicated.
Further studies are needed to assess the long-term benefits of urgent assessment and treatment of strokes in specialist clinics, the authors concluded.
In a related editorial, Dr. Naeem Dean and Dr. Ashfaq Shuaib, from Royal Alexandra Hospital and the University of Alberta, Edmonton, Canada, commented that “the care of patients with stroke and the prevention of further events in patients who present with TIA, will, unfortunately, always be suboptimum as long as we fail to equate TIA and stroke care in line with the way we manage patients with acute coronary disorders.”
They added, “We hope that the research work emanating from several stroke centers ... will bring awareness to this underrecognized and poorly treated but common condition.”
Lancet Neurol. 2009;8(3):218-219, 235-243.
Both Cortical and Subcortical Atrophy Involved in Amnesia of MS
NEW YORK, February 6 (Reuters Health)—Memory impairment in multiple sclerosis (MS) correlates with both mesial temporal (MTL) and deep grey matter (DGM) atrophy, researchers from the State University of New York at Buffalo have observed.
“We have compared the relative clinical significance of MTL and DGM atrophy and found evidence supporting significant and distinct contributions of each region to MS-associated memory disorder,” Dr. Ralph H. B. Benedict and colleagues reported in the February issue of the Journal of Neurology, Neurosurgery, and Psychiatry.
In the study, 50 patients with MS underwent structural brain MRI and neuropsychologic testing. The results suggest that DGM atrophy is the primary predictor of impairment in new learning and acquisition, whereas MTL atrophy plays a more critical role in the retention of recently learned information, as measured by 20- to 25-minute delayed recall and recognition tasks.
“This paper makes an important conceptual point—that the dementia of MS includes clinical features that are related to frontal-subcortical circuitry and MTL cortex pathology,” Dr. Benedict noted in comments to Reuters Health. “Understanding that MS patients can present with either or both helps doctors correctly describe and explain the cognitive presentation of MS patients, and in turn, provide better management of this aspect of the illness,” he added.
The current findings, the investigators said, “support a rationale for therapies directed at both the encoding and consolidation aspects of memory in MS.”
J Neurol Neurosurg Psychiatry. 2009;80(2):201-206.