European journal of neurology : the official journal of the European Federation of Neurological Societies
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Multicenter Study
Intravenous thrombolytic therapy in patients with stroke mimics: baseline characteristics and safety profile.
The decision to treat with intravenous (i.v.) rt-PA a patient with acute cerebral ischaemia is based on clinical and imaging criteria recorded in emergency. In such an emergency situation stroke mimics may sometimes be misdiagnosed, and lead to an erroneous prescription of rtPA. The objective of this study was to determine the baseline profile and the outcome in patients with stroke mimics who received i.v. rtPA. ⋯ Patients with stroke mimics have a good safety profile when treated with rt-PA. In case of doubt, physicians should not postpone thrombolysis, because its potential benefit in confirmed ischaemic stroke might be higher than the risk of complications in stroke mimics. A combined analysis of such small series of cases would be useful to have a better delineation of the clinical profile of these patients.
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Editorial Comment
Evaluate symptomatic therapy in MS: can clinical trials be fine-tuned?
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Randomized Controlled Trial
A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®) ), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis.
Spasticity is a disabling complication of multiple sclerosis, affecting many patients with the condition. We report the first Phase 3 placebo-controlled study of an oral antispasticity agent to use an enriched study design. ⋯ The enriched study design provides a method of determining the efficacy and safety of nabiximols in a way that more closely reflects proposed clinical practice, by limiting exposure to those patients who are likely to benefit from it. Hence, the difference between active and placebo should be a reflection of efficacy and safety in the population intended for treatment.
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There is increasing evidence that the genetic variation in the genes coding for pro-inflammatory markers and matrix metalloproteinase may play an important role in the pathogenesis of various human diseases including stroke. The aim of this study was to evaluate the association of genetic variants within the genes encoding tumor necrosis factor-α (TNF-α) and matrix metalloproteinase-3 (MMP-3), with stroke. ⋯ TNF-α +488 G/A variant is an important risk factor for ischemic stroke in the South Indians from Andhra Pradesh, whereas MMP-3-1612 5A/6A polymorphism is not associated with stroke in the same population.
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Clinical and radiological features of patients with unclear-onset stroke do not differ significantly from those with known-onset stroke. There is a lack of evidence for the safety and efficacy of thrombolysis in patients with unclear-onset stroke. We sought to provide supportive data on the safety and efficiency of thrombolysis in patients with unclear-onset stroke. ⋯ The results of this study suggest that thrombolysis in unclear-onset stroke could be independently associated with favorable outcomes at 3 months and that thrombolysis based on repeat imaging appears to be safely applied to patients with unclear-onset stroke.