Life | Special Issue : Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches

Research

16 pages, 1396 KiB

Open AccessArticle

Can HRV Predict Prolonged Hospitalization and Favorable or Unfavorable Short-Term Outcome in Patients with Acute Ischemic Stroke?

by Joanna Aftyka, Jacek Staszewski, Aleksander Dębiec, Aleksandra Pogoda-Wesołowska and Jan Żebrowski

Life 2023, 13(4), 856; https://doi.org/10.3390/life13040856 - 23 Mar 2023

Viewed by 1396

Abstract

The aim of this study was to assess whether the heart rate variability (HRV) could predict a favorable or unfavorable stroke outcome. The endpoint was based on the National Institutes of Health Stroke Scale (NIHSS). The patient’s health condition was assessed upon discharge [...] Read more.

The aim of this study was to assess whether the heart rate variability (HRV) could predict a favorable or unfavorable stroke outcome. The endpoint was based on the National Institutes of Health Stroke Scale (NIHSS). The patient’s health condition was assessed upon discharge from the hospital. An unfavorable stroke outcome was defined as death or NIHSS ≥ 9, while NIHSS < 9 meant a favorable stroke outcome. The studied group consisted of 59 patients with acute ischemic stroke AIS (mean age of 65.6 ± 13.2; 58% were females). An original and innovative non-linear measure was used to analyze HRV. It was based on symbolic dynamics consisting of comparing the “length of the longest words” in the night recording of HRV. “The length of the longest word” meant the longest sequence of identical adjacent symbols possible for a patient. An unfavorable stroke outcome occurred in 22 patients, whereas the majority of patients (37) had a favorable stroke outcome. The average hospitalization time of patients with clinical progression was 29 ± 14 days, and with favorable outcomes was 10 ± 3 days. Patients with long words (more than 150 adjacent RR intervals having the same symbol) were hospitalized no longer than 14 days and they had no clinical progression. The patients with a favorable stroke outcome were characterized by longer words. Our pilot study may be the beginning of work on the development of a non-linear, symbolic method as a predictor of prolonged hospitalization and increased risk of clinical progression in patients with AIS. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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17 pages, 6341 KiB

Open AccessArticle

Dynamic MRI of the Mesenchymal Stem Cells Distribution during Intravenous Transplantation in a Rat Model of Ischemic Stroke

by Elvira A. Cherkashova, Daria D. Namestnikova, Ilya L. Gubskiy, Veronica A. Revkova, Kirill K. Sukhinich, Pavel A. Melnikov, Maxim A. Abakumov, Galina D. Savina, Vladimir P. Chekhonin, Leonid V. Gubsky and Konstantin N. Yarygin

Life 2023, 13(2), 288; https://doi.org/10.3390/life13020288 - 20 Jan 2023

Cited by 6 | Viewed by 2406

Abstract

Systemic transplantation of mesenchymal stem cells (MSCs) is a promising approach for the treatment of ischemia-associated disorders, including stroke. However, exact mechanisms underlying its beneficial effects are still debated. In this respect, studies of the transplanted cells distribution and homing are indispensable. We [...] Read more.

Systemic transplantation of mesenchymal stem cells (MSCs) is a promising approach for the treatment of ischemia-associated disorders, including stroke. However, exact mechanisms underlying its beneficial effects are still debated. In this respect, studies of the transplanted cells distribution and homing are indispensable. We proposed an MRI protocol which allowed us to estimate the dynamic distribution of single superparamagnetic iron oxide labeled MSCs in live ischemic rat brain during intravenous transplantation after the transient middle cerebral artery occlusion. Additionally, we evaluated therapeutic efficacy of cell therapy in this rat stroke model. According to the dynamic MRI data, limited numbers of MSCs accumulated diffusely in the brain vessels starting at the 7th minute from the onset of infusion, reached its maximum by 29 min, and gradually eliminated from cerebral circulation during 24 h. Despite low numbers of cells entering brain blood flow and their short-term engraftment, MSCs transplantation induced long lasting improvement of the neurological deficit, but without acceleration of the stroke volume reduction compared to the control animals during 14 post-transplantation days. Taken together, these findings indicate that MSCs convey their positive action by triggering certain paracrine mechanisms or cell–cell interactions or invoking direct long-lasting effects on brain vessels. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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19 pages, 1211 KiB

Open AccessArticle

Comparison of Presentation and Prognosis of Takayasu Arteritis with or without Stroke or Transient Ischemic Attack—A Retrospective Cohort Study

by Durga Prasanna Misra, Upendra Rathore, Prabhaker Mishra, Kritika Singh, Darpan R. Thakare, Manas Ranjan Behera, Neeraj Jain, Manish Ora, Dharmendra Singh Bhadauria, Sanjay Gambhir, Sudeep Kumar and Vikas Agarwal

Life 2022, 12(11), 1904; https://doi.org/10.3390/life12111904 - 16 Nov 2022

Cited by 12 | Viewed by 2310

Abstract

Takayasu arteritis (TAK) could cause a stroke or transient ischemic attack (TIA) in young individuals due to inflammatory vascular occlusion or intracerebral hemorrhage. We compared the clinical presentation, angiographic features, longitudinal patterns of disease activity, medical treatments, and survival in 34 TAK patients [...] Read more.

Takayasu arteritis (TAK) could cause a stroke or transient ischemic attack (TIA) in young individuals due to inflammatory vascular occlusion or intracerebral hemorrhage. We compared the clinical presentation, angiographic features, longitudinal patterns of disease activity, medical treatments, and survival in 34 TAK patients with stroke/TIA and 157 without stroke/TIA from a single-center retrospective cohort. TAK patients with stroke/TIA were older (p = 0.044) with a greater proportion of males (p = 0.022), more frequent vision loss (odds ratio (OR) for stroke/TIA vs. without stroke TIA 5.21, 95% CI 1.42–19.14), and less frequent pulse or blood pressure inequality (OR 0.43, 95% CI 0.19–0.96) than TAK patients without stroke/TIA. Hata’s angiographic type IIa was more common in TAK patients with stroke/TIA (OR 11.00, 95%CI 2.60–46.58) and type V in TAK patients without stroke/TIA (OR 0.27, 95% CI 0.12–0.58). Cyclophosphamide was used more often in TAK patients with stroke/TIA (p = 0.018). Disease activity at baseline, 6, 12, and 24 months of follow-up was mostly similar for both groups. Risk of mortality was similar in TAK patients with or without stroke/TIA (hazard ratio unadjusted 0.76, 95% CI 0.15–3.99; adjusted for gender, age of disease onset, delay to diagnosis, baseline disease activity, and the number of conventional or biologic/targeted synthetic immunosuppressants used 1.38, 95% CI 0.19–10.20) even after propensity score-matched analyses. Stroke or TIA does not appear to affect survival in TAK patients adversely. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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9 pages, 635 KiB

Open AccessArticle

Dabigatran in Cerebral Sinus Vein Thrombosis and Thrombophilia

by Lukas Kellermair, Matthias W. G. Zeller, Caterina Kulyk, Josef Tomasits, Tim J. von Oertzen and Milan R. Vosko

Life 2022, 12(7), 970; https://doi.org/10.3390/life12070970 - 28 Jun 2022

Cited by 1 | Viewed by 1927

Abstract

Background and Purpose: Thrombophilic gene alterations are a major risk factor for cerebral sinus vein thrombosis (CSVT). Up to 30% of all patients with cerebral sinus vein thrombosis (CSVT) are found to have thrombophilic defects such as prothrombin mutation (PTM) or factor V [...] Read more.

Background and Purpose: Thrombophilic gene alterations are a major risk factor for cerebral sinus vein thrombosis (CSVT). Up to 30% of all patients with cerebral sinus vein thrombosis (CSVT) are found to have thrombophilic defects such as prothrombin mutation (PTM) or factor V Leiden (FVL). Their repercussions on the plasma levels of dabigatran etexilate are unclear. In this prospective case–control study, we aimed to investigate whether thrombophilia in CSVT has an influence on dabigatran peak-plasma levels. Methods: We monitored 10 patients over 12 months with acute CSVT, genetic thrombophilia with off-label use of dabigatran etexilate 150 mg twice a day and measured dabigatran peak-plasma levels and radiological outcome. We also monitored patients without genetic thrombophilia with dabigatran etexilate 150 mg twice a day and compared the efficiency and dabigatran peak-plasma levels. Results: Patients with homozygote PTM had significantly lower dabigatran peak concentration compared to patients with FVL or the control group (23 ± 4.2 vs. 152.3 ± 27.5 and 159.6 ± 63.08; p-value ≤ 0.05) There was no significant difference in dabigatran etexilate plasma levels between the heterozygote PTM group compared to patients with FVL or the control group (p = 0.29). There was no correlation between dabigatran peak concentration and delayed thrombus dissolution. Conclusions: Dabigatran peak concentration was stable in patients with heterozygote FVL and heterozygote PTM, but not in homozygote PTM, compared to controls. Genetic screening for thrombophilia in patients after CSVT may be useful to make patient tailored therapeutic decisions regarding oral anticoagulation and may decrease thrombotic events. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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11 pages, 618 KiB

Open AccessArticle

Circulating miRNA-195-5p and -451a in Patients with Acute Hemorrhagic Stroke in Emergency Department

by Mauro Giordano, Maria Consiglia Trotta, Tiziana Ciarambino, Michele D’Amico, Federico Schettini, Angela Di Sisto, Valentina D’Auria, Antonio Voza, Lorenzo Salvatore Malatino, Gianni Biolo, Filippo Mearelli, Francesco Franceschi, Giuseppe Paolisso and Luigi Elio Adinolfi

Life 2022, 12(5), 763; https://doi.org/10.3390/life12050763 - 21 May 2022

Cited by 3 | Viewed by 2381

Abstract

(1) Background: In our previous study, acute ischemic stroke (AIS) patients showed increased levels of circulating miRNAs (-195-5p and -451a) involved in vascular endothelial growth factor A (VEGF-A) regulation. Here, we evaluated, for the first time, both circulating miRNAs in acute intracerebral hemorrhagic [...] Read more.

(1) Background: In our previous study, acute ischemic stroke (AIS) patients showed increased levels of circulating miRNAs (-195-5p and -451a) involved in vascular endothelial growth factor A (VEGF-A) regulation. Here, we evaluated, for the first time, both circulating miRNAs in acute intracerebral hemorrhagic (ICH) patients. (2) Methods: Circulating miRNAs and serum VEGF-A were assessed by real-time PCR and ELISA in 20 acute ICH, 21 AIS patients, and 21 controls. These were evaluated at hospital admission (T0) and after 96 h (T96) from admission. (3) Results: At T0, circulating miRNAs were five-times up-regulated in AIS patients, tending to decrease at T96. By contrast, in the acute ICH group, circulating miRNAs were significantly increased at both T0 and T96. Moreover, a significant decrease was observed in serum VEGF-A levels at T0 in AIS patients, tending to increase at T96. Conversely, in acute ICH patients, the levels of VEGF-A were significantly decreased at both T0 and T96. (4) Conclusions: The absence of a reduction in circulating miRNAs (195-5p and -451a), reported in acute ICH subjects after 96 h from hospital admission, together with the absence of increment of serum VEGF-A, may represent useful biomarkers indicating the severe brain damage status that characterizes acute ICH patients. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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10 pages, 259 KiB

Open AccessArticle

The Impact of Diabetes Mellitus and Admission Hyperglycemia on Clinical Outcomes after Recanalization Therapies for Acute Ischemic Stroke: STAY ALIVE National Prospective Registry

by Peter Janos Kalmar, Gabor Tarkanyi, Zsofia Nozomi Karadi, Laszlo Szapary and Edit Bosnyak

Life 2022, 12(5), 632; https://doi.org/10.3390/life12050632 - 25 Apr 2022

Cited by 7 | Viewed by 1946

Abstract

It was previously reported that diabetes mellitus (DM) and admission hyperglycemia (aHG) were associated with poor clinical outcomes in patients with acute ischemic stroke (AIS) who were treated with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT). Our study aimed to assess the prognostic [...] Read more.

It was previously reported that diabetes mellitus (DM) and admission hyperglycemia (aHG) were associated with poor clinical outcomes in patients with acute ischemic stroke (AIS) who were treated with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT). Our study aimed to assess the prognostic effect of DM and aHG (≥7.8 mmol/L) on clinical outcomes in patients treated with recanalization therapies (IVT and MT). Our multicentric study was based on data from the prospective STAY ALIVE stroke registry between November 2017 and January 2020. We compared the demographic data, clinical parameters and time metrics between recanalized DM and non-DM groups, and we analyzed the impact of DM and aHG on 90-day functional outcome, 90-day mortality, symptomatic intracranial hemorrhage (sICH), and successful recanalization. Statistical analyses were also performed in two subgroups: (1) patients treated with IVT alone and (2) patients treated with MT. Altogether, we included 695 patients from the three participating stroke centers in Hungary. Regarding the overall population, patients with diabetes were older (72 vs. 67 years, p < 0.001) and comorbidities were more frequent. There were significant differences in the 90-day good functional outcome (48.9% vs. 66.7%, p < 0.001), 90-day mortality (21.9% vs. 11.6%, p < 0.001) and the rate of symptomatic intracranial hemorrhaging (sICH) (7.8% vs. 2.2%, p < 0.001) between the groups. Diabetes and aHG were independently associated with a poor clinical outcome (OR 2.02, 95% CI 1.31–3.11, p = 0.001; OR 2.09, 95% CI 1.39–3.14, p < 0.001) and mortality at 3 months (OR 2.45, 95% CI 1.35–4.47, p = 0.003; OR 2.42, 95% CI 1.37–4.28, p = 0.002) and sICH (OR 4.32, 95% CI 1.54–12.09, p = 0.005; OR 4.61, 95% CI 1.58–13.39, p = 0.005) in the overall population. However, the presence of DM and aHG was not correlated with successful reperfusion (OR 0.39, 95% CI 0.09–1.67, p = 0.205; OR 0.42, 95% CI 0.09–1.97, p = 0.274) after MT. Our study revealed that diabetes and hyperglycemia on admission were correlated with poor clinical outcomes at 3 months in patients with acute stroke regardless of the recanalization method. In addition, the variables were also associated with sICH after recanalization therapies. However, successful recanalization was not associated with DM and aHG in patients who underwent MT. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

Review

Jump to: Research, Other

17 pages, 3901 KiB

Open AccessReview

The NLRP3 Inflammasome in Age-Related Cerebral Small Vessel Disease Manifestations: Untying the Innate Immune Response Connection

by Che Mohd Nasril Che Mohd Nassir, Thenmoly Damodaran, Nurul Iman Ismail, Sabarisah Hashim, Usman Jaffer, Hafizah Abdul Hamid, Muhammad Zulfadli Mehat, Anwar Norazit and Muzaimi Mustapha

Life 2023, 13(1), 216; https://doi.org/10.3390/life13010216 - 12 Jan 2023

Cited by 3 | Viewed by 2574

Abstract

In this narrative review, we present the evidence on nucleotide-binding and oligomerization (NOD) domain-like receptor (NLR) family pyrin domain (PYD)-containing 3 (NLRP3) inflammasome activation for its putative roles in the elusive pathomechanism of aging-related cerebral small vessel disease (CSVD). Although NLRP3 inflammasome-interleukin (IL)-1β [...] Read more.

In this narrative review, we present the evidence on nucleotide-binding and oligomerization (NOD) domain-like receptor (NLR) family pyrin domain (PYD)-containing 3 (NLRP3) inflammasome activation for its putative roles in the elusive pathomechanism of aging-related cerebral small vessel disease (CSVD). Although NLRP3 inflammasome-interleukin (IL)-1β has been implicated in the pathophysiology of coronary artery disease, its roles in cerebral arteriothrombotic micro-circulation disease such as CSVD remains unexplored. Here, we elaborate on the current manifestations of CSVD and its’ complex pathogenesis and relate the array of activators and aberrant activation involving NLRP3 inflammasome with this condition. These neuroinflammatory insights would expand on our current understanding of CSVD clinical (and subclinical) heterogenous manifestations whilst highlighting plausible NLRP3-linked therapeutic targets. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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19 pages, 1611 KiB

Open AccessReview

Lithium Biological Action Mechanisms after Ischemic Stroke

by Constantin Munteanu, Mariana Rotariu, Marius Turnea, Ligia Gabriela Tătăranu, Gabriela Dogaru, Cristina Popescu, Aura Spînu, Ioana Andone, Elena Valentina Ionescu, Roxana Elena Țucmeanu, Carmen Oprea, Alin Țucmeanu, Carmen Nistor Cseppento, Sînziana Calina Silișteanu and Gelu Onose

Life 2022, 12(11), 1680; https://doi.org/10.3390/life12111680 - 22 Oct 2022

Cited by 4 | Viewed by 3378

Abstract

Lithium is a source of great scientific interest because although it has such a simple structure, relatively easy-to-analyze chemistry, and well-established physical properties, the plethora of effects on biological systems—which influence numerous cellular and molecular processes through not entirely explained mechanisms of action—generate [...] Read more.

Lithium is a source of great scientific interest because although it has such a simple structure, relatively easy-to-analyze chemistry, and well-established physical properties, the plethora of effects on biological systems—which influence numerous cellular and molecular processes through not entirely explained mechanisms of action—generate a mystery that modern science is still trying to decipher. Lithium has multiple effects on neurotransmitter-mediated receptor signaling, ion transport, signaling cascades, hormonal regulation, circadian rhythm, and gene expression. The biochemical mechanisms of lithium action appear to be multifactorial and interrelated with the functioning of several enzymes, hormones, vitamins, and growth and transformation factors. The widespread and chaotic marketing of lithium salts in potions and mineral waters, always at inadequate concentrations for various diseases, has contributed to the general disillusionment with empirical medical hypotheses about the therapeutic role of lithium. Lithium salts were first used therapeutically in 1850 to relieve the symptoms of gout, rheumatism, and kidney stones. In 1949, Cade was credited with discovering the sedative effect of lithium salts in the state of manic agitation, but frequent cases of intoxication accompanied the therapy. In the 1960s, lithium was shown to prevent manic and also depressive recurrences. This prophylactic effect was first demonstrated in an open-label study using the “mirror” method and was later (after 1970) confirmed by several placebo-controlled double-blind studies. Lithium prophylaxis was similarly effective in bipolar and also unipolar patients. In 1967, the therapeutic value of lithemia was determined, included in the range of 0.5–1.5 mEq/L. Recently, new therapeutic perspectives on lithium are connected with improved neurological outcomes after ischemic stroke. The effects of lithium on the development and maintenance of neuroprotection can be divided into two categories: short-term effects and long-term effects. Unfortunately, the existing studies do not fully explain the lithium biological action mechanisms after ischemic stroke. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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Other

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15 pages, 1514 KiB

Open AccessSystematic Review

Direct Mechanical Thrombectomy Versus Prior Bridging Intravenous Thrombolysis in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

by Zahra Kolahchi, Nasrin Rahimian, Sara Momtazmanesh, Anahid Hamidianjahromi, Shima Shahjouei and Ashkan Mowla

Life 2023, 13(1), 185; https://doi.org/10.3390/life13010185 - 9 Jan 2023

Cited by 5 | Viewed by 3265

Abstract

Background: The current guideline recommends using an intravenous tissue-type plasminogen activator (IV tPA) prior to mechanical thrombectomy (MT) in eligible acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). Some recent studies found no significant differences in the long-term functional outcomes between [...] Read more.

Background: The current guideline recommends using an intravenous tissue-type plasminogen activator (IV tPA) prior to mechanical thrombectomy (MT) in eligible acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). Some recent studies found no significant differences in the long-term functional outcomes between bridging therapy (BT, i.e., IV tPA prior to MT) and direct MT (dMT). Methods: We conducted a systematic review and meta-analysis to compare the safety and functional outcomes between BT and dMT in AIS patients with ELVO who were eligible for IV tPA administration. Based on the ELVO location, patients were categorized as the anterior group (occlusion of the anterior circulation), or the combined group (occlusion of the anterior and/or posterior circulation). A subgroup analysis was performed based on the study type, i.e., RCT and non-RCT. Results: Thirteen studies (3985 patients) matched the eligibility criteria. Comparing the BT and dMT groups, no significant differences in terms of mortality and good functional outcome were observed at 90 days. Symptomatic intracranial hemorrhagic (sICH) events were more frequent in BT patients in the combined group (OR = 0.73, p = 0.02); this result remained significant only in the non-RCT subgroup (OR = 0.67, p = 0.03). The RCT subgroup had a significantly higher rate of successful revascularization in BT patients (OR = 0.73, p = 0.02). Conclusions: Our meta-analysis uncovered no significant differences in functional outcome and mortality rate at 90 days between dMT and BT in patients with AIS who had ELVO. Although BT performed better in terms of successful recanalization rate, there is a risk of increased sICH rate in this group. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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16 pages, 2570 KiB

Open AccessSystematic Review

Endovascular Treatment of Large Vessel Occlusion Strokes Caused by Infective Endocarditis: A Systematic Review, Meta-Analysis, and Case Presentation

by Ashkan Mowla, Saeed Abdollahifard, Saman Sizdahkhani, Erfan Taherifard, Fatemeh Kheshti and Kasra Khatibi

Life 2022, 12(12), 2146; https://doi.org/10.3390/life12122146 - 19 Dec 2022

Cited by 5 | Viewed by 2130

Abstract

Thromboembolic events such as acute ischemic strokes are frequently seen in patients with infective endocarditis (IE). It is generally recommended that the administration of intravenous thrombolytics is avoided in these patients as they might encounter a higher risk of intracranial hemorrhages. In this [...] Read more.

Thromboembolic events such as acute ischemic strokes are frequently seen in patients with infective endocarditis (IE). It is generally recommended that the administration of intravenous thrombolytics is avoided in these patients as they might encounter a higher risk of intracranial hemorrhages. In this setting, particularly with a large vessel occlusion (LVO), a mechanical thrombectomy may be an alternative option. In this systematic review and meta-analysis, we aimed to investigate the outcomes and safety of mechanical thrombectomies for LVO stroke patients secondary to IE. A search strategy was developed and we searched PubMed, Scopus, Web of Sciences, and Embase using the words “infective endocarditis”, “stroke”, and “mechanical thrombectomy”. Including 6 studies and 120 patients overall, this study showed that a mechanical thrombectomy might reduce the National Institute of Health Stroke Scale (NIHSS), with a weighted mean difference of −3.06 and a 95% CI of −4.43 to −1.70. The pooled rate of symptomatic intracranial hemorrhages and all-cause mortality were also determined to be 15% (95% CI: 4–47%) and 34% (95% CI:14–61%), respectively. The results of this study showed that a mechanical thrombectomy might be an effective and reasonably safe option for the treatment of LVO strokes caused by IE. However, more large-scale studies are needed to consolidate these results. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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18 pages, 3500 KiB

Open AccessSystematic Review

Proprioceptive Neuromuscular Facilitation-Based Physical Therapy on the Improvement of Balance and Gait in Patients with Chronic Stroke: A Systematic Review and Meta-Analysis

by Phan The Nguyen, Li-Wei Chou and Yueh-Ling Hsieh

Life 2022, 12(6), 882; https://doi.org/10.3390/life12060882 - 13 Jun 2022

Cited by 15 | Viewed by 14703

Abstract

The present study aims to determine the potential benefits of PNF on balance and gait function in patients with chronic stroke by using a systematic review and meta-analysis. Systematic review in the following databases: MEDLINE/PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library and Google [...] Read more.

The present study aims to determine the potential benefits of PNF on balance and gait function in patients with chronic stroke by using a systematic review and meta-analysis. Systematic review in the following databases: MEDLINE/PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library and Google Scholar. Studies up to September 2020 are included. A systematic database search was conducted for randomized control trials (RCTs) that investigated the effects of PNF intervention in patients with chronic stroke using balance and gait parameters as outcome measures. The primary outcomes of interest were Berg Balance Scale (BBS), Functional Reach Test (FRT), Timed Up and Go Test (TUG) and 10-Meter Walking Test (10MWT). Nineteen studies with 532 participants were included, of which twelve studies with 327 participants were included for meta-analysis. When the data were pooled, PNF made statistically significant improvements in balance with BBS, FRT and TUG (p < 0.05) or gait velocity with 10MWT (p < 0.001) when compared to the control. This review indicates that PNF is a potential treatment strategy in chronic stroke rehabilitation on balance and gait speed. Further high-quality research is required for concluding a consensus of intervention and research on PNF. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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16 pages, 2539 KiB

Open AccessSystematic Review

Therapeutic Effect and Optimal Electrode Placement of Transcutaneous Neuromuscular Electrical Stimulation in Patients with Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Thanh-Nhan Doan, Wen-Chao Ho, Liang-Hui Wang, Fei-Chun Chang, Trang Thi Quynh Tran and Li-Wei Chou

Life 2022, 12(6), 875; https://doi.org/10.3390/life12060875 - 10 Jun 2022

Cited by 6 | Viewed by 3902

Abstract

Background: To date, there is no conclusive evidence that transcutaneous neuromuscular electrical stimulation (TNMES) benefits patients with post-stroke dysphagia (PSD). In addition, the optimal TNMES electrode placement has not been well-established. This systematic review and meta-analysis were conducted to investigate these two research [...] Read more.

Background: To date, there is no conclusive evidence that transcutaneous neuromuscular electrical stimulation (TNMES) benefits patients with post-stroke dysphagia (PSD). In addition, the optimal TNMES electrode placement has not been well-established. This systematic review and meta-analysis were conducted to investigate these two research gaps. Methods: Five major databases were systematically searched for randomized controlled trials (RCTs) through January 2022. Effect sizes were computed using Hedges’ g statistic, which were then entered into the random-effects model to obtain pooled effect estimates. Results: Twenty-four RCTs met the eligibility criteria. On the improvement of swallowing function, TNMES alone was not superior to conventional swallowing therapies (CSTs); combined therapy of TNMES and CSTs significantly surpassed CSTs alone (standardized mean difference (SMD) = 0.91, 95% confidence interval (95% CI): 0.68 to 1.14, p < 0.0001; I² = 63%). Moreover, significant pooled effect sizes were observed in subgroups with horizontal electrode placement above the hyoid bone (SMD = 0.94, 95% CI: 0.72 to 1.16; I² = 0%) and horizontal electrode placement just above and below the hyoid bone (SMD = 0.87, 95% CI: 0.59 to 1.14; I² = 0%). The largest pooled effect size was observed in the subgroup that individualized electrode placement according to dysphagia evaluation (SMD = 1.65, 95% CI: 0.38 to 2.91; I² = 90%). Conclusion: TNMES should be used in combination with CSTs for PSD. Horizontal electrode placement should target suprahyoid muscles or both suprahyoid and thyrohyoid muscles. Full article

(This article belongs to the Special Issue Ischemic Stroke: From Pathophysiology to Novel Therapeutic Approaches)

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