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Abstract Details

Patterns of Domain-Specific Recovery Over 90 days from Acute Ischemic Stroke Onset
Cerebrovascular Disease and Interventional Neurology
P15 - Poster Session 15 (12:00 PM-1:00 PM)
4-017

Explore the prevalence of deficits across different domains (motor arm, motor leg, language, sensory, and attention) for acute ischemic stroke (AIS) patients and their evolution over time.
The NIHSS is subdivided into several neurological domains. Recovery within individual domains has been rarely investigated in AIS patients and so little is known about their natural history. However, such knowledge could be useful for clinical practice, research, and trial design. 
Publically available data sets from 4 randomized controlled trials of AIS (NINDS-tPA, ALIAS-2, IMS-III, and DEFUSE-3) were obtained.  Two trials targeted patients with large vessel occlusion (LVO), and for the two that did not (NINDS-tPA and ALIAS-2), this was approximated by restricting inclusion in current analyses to subjects with baseline NIHSS > 8.  Variables were reclassified as motor arm, motor leg, language, sensory, and attention, based on the NIHSS subscores at baseline, 24 hours post-onset, acute care discharge, and 90-days post-onset.  We compared the patterns of domain distributions and recovery over time among the 4 trials.    
We included 473 patients from NINDS-tPA, 572 from ALIAS-2, 645 from IMS-III and 162 from DEFUSE-3.  Those who died or were lost to follow-up were excluded at relevant time points, with no imputation of missing values.  At baseline, deficits in motor arm were the most prevalent (95-96%), followed by motor leg (90-92%) and sensory (67-76%).  Depending on the trial, there was variable prevalence of language (56-63%) and attention (56-67%) deficits.  For each domain, there was a consistent stair-step pattern of change across time (with significant difference for every trial).  By 90-days, attention was the least prevalent (13-32%) of the 5 domains in these trials
In AIS patients who are likely to have an LVO and survive to 90-days, there is a consistent pattern of domain-specific prevalence and recovery of deficits.  
Authors/Disclosures

PRESENTER 		No disclosure on file
No disclosure on file
Adam De Havenon, MD, FÂ鶹´«Ã½Ó³»­ (Yale University) Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has or had stock in Certus.Dr. De Havenon has or had stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
John Cole, MD (UMD SOM) Dr. Cole has nothing to disclose.
No disclosure on file
Steven C. Cramer, MD, FÂ鶹´«Ã½Ó³»­ Dr. Cramer has received personal compensation for serving as an employee of University of California. An immediate family member of Dr. Cramer has received personal compensation for serving as an employee of University of California. Dr. Cramer has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Astellas, Alevian, Bayer, BlueRock Therapeutics, BrainQ, Constant Therapeutics, Medtronic, MicroTransponder, Myomo, Myrobalan, NeuroTrauma Sciences, Simcere, and TRCare. Dr. Cramer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MUSC. Dr. Cramer has stock in Constant Therapeutics, Panaxium, and TRCare. The institution of Dr. Cramer has received research support from NIH; PCORI; Veterans Administration.
Bradford B. Worrall, MD, MSc, FÂ鶹´«Ã½Ó³»­ (University Of Virginia Health System) The institution of Dr. Worrall has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Â鶹´«Ã½Ó³»­. The institution of Dr. Worrall has received research support from NIH. The institution of Dr. Worrall has received research support from AHA/ASA.