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Filioglo A, Simaan N, Honig A, Heldner MR, von Rennenberg R, Pezzini A, Padjen V, Rentzos A, Altersberger VL, Baumgartner P, Zini A, Grisendi I, Aladdin S, Gomori JM, Pilgram-Pastor SM, Scheitz JF, Magoni M, Berisavac I, Nordanstig A, Psychogios M, Luft A, Gentile M, Assenza F, Arnold M, Nolte CH, Gamba M, Ercegovac M, Jood K, Engelter ST, Wegener S, Forlivesi S, Zedde M, Gensicke H, Tatlisumak T, Cohen JE, Leker RR. Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration. J Neurol Sci 2022; 432:120081. [PMID: 34920158 DOI: 10.1016/j.jns.2021.120081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. METHODS Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. RESULTS Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. DISCUSSION Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.
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Affiliation(s)
- A Filioglo
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - N Simaan
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Honig
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - M R Heldner
- Department of Neurology, University Hospital Bern, Switzerland
| | - R von Rennenberg
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy
| | - V Padjen
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Rentzos
- Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - V L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - P Baumgartner
- University Hospital Zurich and University of Zurich, Switzerland
| | - A Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - I Grisendi
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Aladdin
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - J M Gomori
- Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Pilgram-Pastor
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - M Magoni
- U.O Vascular Neurology, Stroke Unit, ASST Spedali Civili, Brescia, Italy
| | - I Berisavac
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Nordanstig
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland
| | - A Luft
- University Hospital Zurich and University of Zurich, Switzerland
| | - M Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - F Assenza
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Arnold
- Department of Neurology, University Hospital Bern, Switzerland
| | - C H Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Center for Stroke Research, Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Gamba
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - M Ercegovac
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K Jood
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - S Wegener
- University Hospital Zurich and University of Zurich, Switzerland
| | - S Forlivesi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - M Zedde
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - H Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - T Tatlisumak
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J E Cohen
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - R R Leker
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Assenza G, Mecarelli O, Lanzone J, Assenza F, Tombini M, Di Lazzaro V, Pulitano P. The ROME (Retrospective Observational Multicenter study on Eslicarbazepine) study: Efficacy and behavioural effects of Eslicarbazepine acetate as adjunctive therapy for adults with partial onset seizures in real life. Seizure 2018; 58:35-40. [PMID: 29649684 DOI: 10.1016/j.seizure.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Eslicarbazepine acetate (ESL) is a third-generation member of the dibenzazepine family approved in 2009 by the European Medicines Agency with the indication of adjunctive therapy in adult people with partial-onset seizures (PPOS). We aimed at assessing the ESL impact on seizure frequency and quality of life in PPOS with a particular attention to sleepiness and depression. METHODS We evaluated 50 adult PPOS (>18 years; 48 ± 14 years-old; 23 males) treated with adjunctive ESL for ≥2months with a retrospective multi-centric design. Clinical files of the last 2 years were reviewed checking for monthly seizure frequency, treatment retention rate, adverse drug reactions (ADRs), concomitant anti-epileptic drugs and behavioural scales for sleepiness (Stanford Sleepiness Scale, SSS, and Epworth Sleepiness Scale, ESS), depression (Beck Depression Inventory-II, BDI) and overall quality of life (QOLIE-31). RESULTS At the end of 96 ± 28 days of ESL treatment, the mean seizure reduction was 56%; 60% of patients had seizure reduction above 50%, with a 31% of the whole population becoming seizure free. We reported 16 ADRs with 4 hyponatremia. Retention rate was 76%. Patient reported less sleepiness after ESL (SSS, p = 0.031; ESS, p = 0.0000002). Before ESL, 38% of patients had pathologic BDI scores, which normalized in most of them (73%) after ESL (BDI improvement, p = 0.000012). These scores resulted in an amelioration of quality of life (QOLIE-31, p = 0.000002). CONCLUSIONS ESL is a safe and effective anti-epileptic drug in a real life scenario, with an excellent behavioural profile for the overall quality of life and, in particular, for sleepiness and depression.
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Affiliation(s)
- G Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - O Mecarelli
- Department of Neurology and Psychiatry, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - J Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - F Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - M Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - V Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - P Pulitano
- Department of Neurology and Psychiatry, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
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