Frontiers in neurology
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Frontiers in neurology · Jan 2019
Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials.
Background: Endovascular therapy is the standard treatment for acute ischemic stroke (AIS) patients caused by a large vessel occlusion in the anterior circulation, whereas the impacts of general anesthesia (GA) vs. conscious sedation (CS) for such procedures remained as a continued debate. Methods: We systematically searched PubMed, Embase, and ClinicalTrials.gov. We restricted our search to RCTs that examined the clinical outcomes of endovascular therapy with GA vs. ⋯ Besides, patients in the GA group had higher odds of successful reperfusion (pooled OR = 1.80, 95% CI: 1.05-3.08, P = 0.033), but no significant differences were seen in symptomatic intracranial hemorrhage (pooled OR = 0.54, 95% CI: 0.11-2.57, P = 0.308), vessel dissection or perforation (pooled OR = 1.38, 95% CI: 0.30-6.31, P = 0.679), migration of embolus to a new territory (pooled OR = 2.28, 95% CI: 0.89-5.87, P = 0.085), post-operative pneumonia (pooled OR = 1.74, 95% CI: 0.76-4.01, P = 0.149), and all-cause mortality at 90 days (pooled OR = 0.73, 95% CI: 0.43-1.26, P = 0.263) compared with the CS group. Conclusion: Performing endovascular therapy with GA, compared with CS, improves functional independence after 90 days significantly for patients with AIS caused by a large vessel occlusion in the anterior circulation. However, additional larger and multi-center randomized controlled trials to definitively confirm our findings are warranted for the limitation of the small sample size in this study.
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Frontiers in neurology · Jan 2019
SVC Is a Marker of Respiratory Decline Function, Similar to FVC, in Patients With ALS.
Introduction: Respiratory function is a critical predictor of survival in amyotrophic lateral sclerosis (ALS). We aimed to determine if slow vital capacity (SVC) is a predictor of functional loss in ALS as compared to forced vital capacity (FVC). Methods: Consecutive ALS patients in whom respiratory tests were performed at baseline and 6 months later were included. ⋯ FVC and SVC were strongly correlated at study entry (r 2 = 0.98, p < 0.001) and FVC and SVC decays between first evaluation and 6 months after were the only significant prognostic variables of functional decay (p < 0.001). Conclusion: FVC and SVC decay are inter-changeable in predicting functional decay in ALS. Pharmacological interventions reducing the decline rate of FVC and SVC can have a positive impact on the global functional impairment, with relevant implications for clinical trials' design and interpretation.
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Frontiers in neurology · Jan 2019
Multi-Sensorimotor Training Improves Proprioception and Balance in Subacute Stroke Patients: A Randomized Controlled Pilot Trial.
Introduction: The objective was to determine whether advanced rehabilitation therapy combined with conventional rehabilitation therapy consisting of sensorimotor exercises would be superior to usual treadmill training for proprioception variation and balance ability in subacute stroke patients. Methods: Thirty subjects (post-stroke time period: 3.96 ± 1.19 months) were randomly assigned to either a multi-sensorimotor training group (n = 19) or a treadmill training group (n = 18). Both groups first performed conventional physical therapy for 30 min, after which the multi-sensorimotor training group performed multi-sensorimotor training for 30 min, and the treadmill training group performed treadmill gait training for 30 min. ⋯ Conclusions: The multi-sensorimotor training program performed on multiple types of sensory input had a beneficial effect on proprioception sense in the paretic lower limb and A-P balance. A large-scale randomized controlled study is needed to prove the effect of this training. Clinical Trial Registration: https://cris.nih.go.kr/cris/, identifier KCT0003097.