Christmas, acute ischemic stroke and stroke-related mortality in Hungary

Christmas-Related Reduction in Beta Activity in Parkinson's Disease

BACKGROUND

Subthalamic nucleus (STN) beta (13 - 35 Hz) activity is a biomarker reflecting motor state in Parkinson's disease (PD). Adaptive deep brain stimulation (DBS) aims to use beta activity for therapeutic adjustments, but many aspects of beta activity in real-life situations are unknown.

OBJECTIVE

The aim was to investigate Christmas-related influences on beta activity in PD.

METHODS

Differences in Christmas Day to nonfestive daily averages in chronic biomarker recordings in 4 PD patients with a sensing-enabled STN DBS implant were retrospectively analyzed. Sweet-spot and whole-brain network connectomic analyses were performed.

RESULTS

Beta activity was significantly reduced on Christmas Eve in all patients (4.00-9.00 p.m.: -12.30 ± 10.78%, P = 0.015). A sweet spot in the dorsolateral STN connected recording sites to motor, premotor, and supplementary motor cortices.

CONCLUSIONS

We demonstrate that festive events can reduce beta biomarker activity. We conclude that circadian and holiday-related changes should be considered when tailoring adaptive DBS algorithms to patient demands. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Diagnostic value of MRI perfusion-weighted imaging and diffusion-weighted imaging parameters in cerebral apoplexy

OBJECTIVE

To assess the clinical and prognostic value of MRI perfusion-weighted imaging (PWI) versus diffusion-weighted imaging (DWI) parameters for apparent diffusion coefficient (ADC) and cerebral blood flow (CBF) in the diagnosis of patients with ischemic stroke (IS).

METHODS

Eighty patients diagnosed with IS in the Second Affiliated Hospital of Soochow University from January 2020 to January 2021 were retrospectively analyzed and regarded as a patient group. Meanwhile, 50 patients who underwent physical examination at the Second Affiliated Hospital of Soochow University during the same period were collected, and were identified by physical examination to have atherosclerotic stenosis but not cerebral infarction, they were set as a control group. The differences of ADC and CBF between both groups were compared. The diagnostic value of ADC and CBF in diagnosing acute ischemic stroke was analyzed by receiver operating characteristic (ROC) curve. The changes of ADC and CBF before and after treatment were compared. Patients were sub-grouped according to their mRS scores, and those with scores of 0-2 were grouped into the good prognosis group while those with scores of 3-6 were grouped into the poor prognosis group, and the risk factors affecting patients' prognosis were evaluated by logistic regression. The correlation of ADC and CBF with National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores was analyzed. ADC and CBF levels were compared between deceased and surviving patients, and their predictive value was assessed by ROC curves.

RESULTS

ADC and CBF were dramatically lower in the patient group compared with the control group (P<0.05). The area under the curve (AUC) of ADC and CBF in diagnosing IS was 0.949 and 0.926. The ADC and CBF values after treatment were significantly increased as compared to before treatment (both P<0.05). Both ADC and CBF were lower in the patients of the deceased group than in those in the survival group (P<0.05). The AUC for ADC and CBF in predicting death in patients diagnosed with IS was 0.866 and 0.766, respectively. ADC, CBF was negatively correlated with patients' NIHSS and mRS scores (P<0.01). Higher pre-treatment NIHSS and admission time ≥24 h after onset were risk factors for patient prognosis, whereas higher ADC and CBF values were protective factors (all P<0.05).

CONCLUSION

ADC and CBF values are reduced in IS patients and can be used as a diagnostic and prognostic indicator of IS.

Date of birth and the incidence of acute ischemic stroke in Hungary

INTRODUCTION

The effect of the date of birth on the incidence of cardiovascular disease was confirmed in earlier studies. We aimed to determine whether the season of birth may be associated with a higher incidence of stroke in later life by analyzing thrombolysis numbers according over a ten-year period in Hungary.

PATIENTS AND METHODS

We analyzed daily thrombolysis numbers between 2007 and 2016 according to the patients' date of birth based on seasons. The correlation between cumulative thrombolysis numbers between 2007 and 2016 per month and birth numbers per month based on data of the 1949 census were also examined.

RESULTS

Our results indicate that being born in the spring and summer in the northern hemisphere may be associated with a higher frequency of ischemic stroke necessitating thrombolytic treatment. This equates to a higher risk when conception and early pregnancy occur in the summer and autumn months.

CONCLUSIONS

This, however, cannot be defined as a causal relationship if we consider the number of live births in 1949, as both measures change similarly during the year, as indicated by the strong positive correlation between thrombolysis frequency according to date of birth between 2007 and 2016 and the number of births in the 1949 census by month.

Christmas, acute ischemic stroke and stroke-related mortality in Hungary

OBJECTIVES

Risk factors for stroke include psychological effects, such as depression. Festive occasions (such as Christmas in Hungary) may carry a significant emotional impact and may therefore contribute to increased cardiovascular risk. Thrombolytic treatment of acute ischemic stroke has a narrow time window and allows for the precise assessment of stroke incidence.

MATERIALS & METHODS

We analyzed anonymized national data of the number of thrombolytic treatments for acute ischemic stroke and the number of stroke-related deaths between 1 January 2007 and 31 December 2016 in Hungary within 2-day, 5-day, and 1-month periods preceding and following 24 December each year. Analysis of subgroups based on age (below and over 65 years) and sex was also performed.

RESULTS

The number of thrombolytic treatments was higher in all three periods preceding Christmas compared to the corresponding period that follows the feast. This increase was particularly prominent in men below 65 years of age. While overall stroke-associated mortality was increased 1 month after Christmas, the death rate was higher a month before rather than after Christmas in men below 65 years of age and in women both below and over 65 years of age 5 days before Christmas.

CONCLUSIONS

These findings may predominantly relate to emotional and psychological factors. In case of women, the anxiety secondary to festive preparations, while in men below 65 years, the increased psychological stress of providing financial security for the celebration may play an important role.