Fluoxetine for stroke recovery improvement - the doubleblind, randomised placebo-controlled FOCUS-Poland trial.

AIM OF STUDY: The Fluoxetine Or Control Under Supervision (FOCUS)-Poland trial tested in a Polish cohort the hypothesis that fluoxetine improves recovery after stroke. CLINICAL RATIONALE FOR STUDY: Some studies have suggested that fluoxetine may improve functional outcomes after stroke, but these results needed confirmation. Between 2012 and 2014, large clinical trials were initiated by the FOCUS Trial Collaboration. Recently, results from the UK, Sweden, Australia, New Zealand and Vietnam have been published. We here present the results of the FOCUS trial conducted in Poland. MATERIAL AND METHODS: This was a randomised, double-blind, placebo-controlled study based on the FOCUS trial protocol. Patients who had a persisting neurological deficit were randomly assigned 2-15 days after stroke onset to receive for six months either fluoxetine 20 mg/day or a placebo. The primary outcome was functional status measured using the modified Rankin Scale (mRS) at six months after randomisation. Functional status at 12 months was also assessed, as was neurological deficit at six and 12 months. Data was also collected on adverse events. RESULTS: Between 19 December 2014 and 13 March 2018, 30 patients were given fluoxetine and 31 were given a placebo. For the primary outcome, the distribution across mRS categories was similar for the fluoxetine and placebo groups at six months (common odds ratio 0.88; 95% confidence interval 0.31-2.50; p = 0.81), and there was no difference at 12 months (p = 0.864). There were no differences between groups in stroke recovery or in motor function recovery of the affected hand. There were no significant differences in any other secondary outcomes at six or 12 months. Patients given fluoxetine were less likely than those given the placebo to receive new antidepressant medication within six months (2 [6.67%] vs. 4 [12.90%]). CONCLUSIONS AND CLINICAL IMPLICATIONS: Consistent with other trials based on the FOCUS protocol, fluoxetine did not improve motor recovery or general stroke outcome at six and 12 months in the Polish cohort studied. However, patients receiving fluoxetine required therapy with additional antidepressant medication less frequently.

The accuracy of prehospital diagnosis of acute cerebrovascular accidents: an observational study.

INTRODUCTION: Time to treatment is the key factor in stroke care. Although the initial medical assessment is usually made by a non-neurologist or a paramedic, it should ensure correct identification of all acute cerebrovascular accidents (CVAs). Our aim was to evaluate the accuracy of the physician-made prehospital diagnosis of acute CVA in patients referred directly to the neurological emergency department (ED), and to identify conditions mimicking CVAs. MATERIAL AND METHODS: This observational study included consecutive patients referred to our neurological ED by emergency physicians with a suspicion of CVA (acute stroke, transient ischemic attack (TIA) or a syndrome-based diagnosis) during 12 months. Referrals were considered correct if the prehospital diagnosis of CVA proved to be stroke or TIA. RESULTS: The prehospital diagnosis of CVA was correct in 360 of 570 cases. Its positive predictive value ranged from 100% for the syndrome-based diagnosis, through 70% for stroke, to 34% for TIA. Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p < 0.001). The most frequent mimics were vertigo (19%), electrolyte and metabolic disturbances (12%), seizures (11%), cardiovascular disorders (10%), blood hypertension (8%) and brain tumors (5%). Additionally, 6% of all admitted CVA cases were referred with prehospital diagnoses other than CVA. CONCLUSIONS: Emergency physicians appear to be sensitive in diagnosing CVAs but their overall accuracy does not seem high. They tend to overuse the diagnosis of TIA. Constant education and adoption of stroke screening scales may be beneficial for emergency care systems based both on physicians and on paramedics.

Knowledge of risk factors and stroke symptoms among nonstroke patients.

BACKGROUND AND PURPOSE: This study aimed to evaluate knowledge of stroke warning signs, risk factors, treatment and prevention among patients not suffering from stroke. METHODS: Patients admitted to one of five Neurology Departments in Poland for diseases other than stroke were asked to answer a questionnaire regarding awareness of cerebrovascular risk factors and stroke. The study was performed between November 1 and December 31,2008. RESULTS: 481 patients were included in the study (59.7% women). Proper definition of stroke and transient ischemic attack was given by 90.3 and 60.5% of respondents, respectively. Hypertension was reported as a risk factor by 91.1% of participants. Approximately 70% knew that hypercholesterolemia and smoking are risk factors of stroke, but only one third identified diabetes mellitus as a risk factor. Cardiac arrhythmia was recognized as a risk factor by 8.4%. Twenty-five percent of participants did not know any symptom of stroke. Identification of stroke signs was worse by participants from rural areas. Ten percent identified disturbances of consciousness, numbness, and dizziness as stroke symptoms. CONCLUSIONS: The knowledge of fundamental risk factors was sufficiently good, but recognition of cardiac arrhythmia and diabetes mellitus was unsatisfactory. The knowledge of stroke symptoms was unsatisfactory, particularly in rural areas. Additional education programs are necessary.

Incidence and case fatality rates of first-ever stroke - comparison of data from two prospective population-based studies conducted in Warsaw.

BACKGROUND AND PURPOSE: According to official statistics, the stroke mortality rate has remained high in Eastern European countries for a few decades. It has been shown that also in Poland stroke mortality failed to decline in the period 1984 to 1992. Since that time, stroke management in our country has changed, especially in the cities, where stroke units have been developed. The aim of the present study was to compare incidence and case fatality rates, estimated on the basis of two prospective population-based studies performed in Warsaw in 1991/1992 and 2005. MATERIAL AND METHODS: Incidence rates and case fatality rates for the first-ever-in-a-lifetime stroke have been estimated on the basis of two population-based studies: the Warsaw Stroke Registry (population 182 649) conducted in 1991 and 1992, and the European Register of Stroke (population 120 186) - registration in 2005. In both studies data were standardized to the European population by the direct methods. RESULTS: Contrary to the incidence rates, which did not change significantly between 1991/1992 and 2005, 30-day and 1-year case fatality rates decreased significantly from 43% to 14.9% and from 59.7% to 33.1%, respectively. CONCLUSIONS: Comparison of data from two population-based prospective stroke registries showed that stroke case fatality and mortality significantly decreased. This may be associated with the better management of patients in the acute phase of stroke and implementation of secondary prevention strategies for stroke.