Welcome to the WSC 2022 Interactive Program

Background and Aims

Recovery after stroke is often heterogeneous. Quantitative Electroencephalography (QEEG) is a standardized, economical and non-invasive assessment tool for post-stroke prognosis. The study aims to systematically review the literature for evidence of post-stroke motor recovery as assessed by modified Rankin scale (mRS), Fugl-Meyer assessment (FMA) and National Institute of Health Stroke Scale (NIHSS) and correlate them with prognostic ability of QEEG derived indices in patients with stroke

Methods

This systematic review of all available studies that clinically assess motor recovery in patients with stroke, while using EEG to extract QEEG indices to correlate with functional outcome. The articles were selected according to the following criteria: studies including both resting and active QEEG (robotic rehabilitation, hand grip exercises, others); both acute and chronic first ever strokes; studies having clinical follow up at least after 7 days (FMA, NIHSS, mRS) with >10 patients (with and without controls)

Results

According to the search criteria 216 abstracts were screened, 13 studies met the inclusion criteria with a total of 671 patients. Eight studies included only ischemic stroke patients, seven were combined ischemic stroke and intracerebral hemorrhage. QEEG indices for prognostication include Delta Theta to Alpha Beta Ratio (DTABR) (n=6); pairwise derived Brain Symmetry Index (pdBSI) (n=5); Brain Symmetry Index (BSI) (n=4), Delta Alpha Ratio (DAR) (n=4). Outcome measures in different studies were NIHSS (n=7), mRS (n=5) and Fugl-Meyer scale (n=4)

Conclusions

This systematic review suggests that QEEG indices may be promising prognostic indicator in subjects with stroke

Background and Aims

Process Evaluation (PE) is performed to investigate trial activities to verify their implementation to interpret and explain outcomes and provide input for future planning. Complex intervention has numerous characters and outcomes are produced due to external determinants and applied context. Secondary disease prevention trials are pharmacologic and behavioural including using internet and mobile technology.

Aim of review is to broadly investigate PEs performed on complex secondary disease prevention trials requiring behaviour change with emphasis on rehabilitation, stroke, internet and mobile based interventions.

Methods

Based on recommendations for scoping reviews in Systematic Reviews guidelines, literature review was undertaken on electronic databases – PubMed, Web of science and Cochrane library from year 2012 to 2021. Following data were extracted: type of prevention trial, multi /single centre, PE tools, analysis method and drawbacks.

Results

There were 17 trials identified where PE was performed according to given key words. These were divided into 5 categories according to type of trial –

General rehabilitation & prevention

Rehabilitation & prevention- internet delivered

Mobile health led non-stroke disease prevention

Stroke rehabilitation

Mobile phone based stroke rehabilitation.

Most trials were multicentre (n=12) which conducted evaluation with mixed methods (MMs) approach (n=13). Thematic analysis was performed in 5 and realist in 5. Major drawbacks of evaluations were lack of detailed analysis (n=10), positive bias (n=3), quantitative data not evaluated (n=2) and finite pilot study (n=2).

Conclusions

Findings suggest that PE is purposeful when performed using MMs and analysed with robust theoretical frameworks with triangulation of qualitative and quantitative data with trial results.

Background and Aims

Dl-3-n-butylphthalide (NBP) is widely used as a neuroprotective drug in patients with ischemic stroke. A previous review suggested NBP is safe and effective, but could not conclude whether it decreased risk of death or disability. We performed an updated review of safety and efficacy.

Methods

We identified RCTs that compared NBP with placebo or no NBP treatment in patients with ischemic stroke. Methodological quality was assessed using the RoB2, and data were meta-analyzed using RevMan.

Results

Our review included 57 RCTs involving 8,747 patients. Twenty trials examined NBP as a capsule, 29 as an injection, and 8 as sequential therapy. Meta-analysis of two trials showed that NBP treatment was associated with a reduction in the composite outcome of death and dependency (RR 0.59, 95% CI 0.42-0.83). Meta-analysis of 10 trials showed that NBP reduced the risk of death (RR 0.32, 95% CI 0.13-0.75). Meta-analysis of 4 trials showed that NBP reduced the risk of dependency (MD -0.80, 95% CI -0.88--0.72). Meta-analysis of 46 trials found that NBP reduced neurological deficit (MD -3.39, 95% CI -3.76--3.03). Of the adverse events, the most frequent were elevated transaminase, rash and gastrointestinal discomfort, and no serious adverse events were reported.

Conclusions

This update of a systematic review in 2010 confirms that NBP can help acute ischemic stroke patients regain the ability to perform activities of daily living, reduce their neurological deficit and short-term death rates. However, there was insufficient evidence on the efficacy of NBP in reducing the chance of long-term death and dependence after ischemic stroke.