Clinical significance of self-descriptive apathy assessment in patients with neurological form of Wilson's disease.

BACKGROUND AND AIM: Apathy is one of the neuropsychiatric symptoms of Wilson's disease (WD) which typically affects the brain's fronto-basal circuits. Lack of agreed diagnostic criteria and common use of self-description assessment tools lead to underestimation of this clinical phenomenon. The aim of this study was to investigate whether subjective and informant-based clinical features of apathy in patients with WD enable clinicians to make a valid diagnosis. METHODS: Multiple aspects of goal-oriented behavior were assessed in 30 patients with the neurological form of WD and 30 age-matched healthy participants using two questionnaires, the Lille Apathy Rating Scale (LARS) and the Dysexecutive Questionnaire (DEX). Both included a self-descriptive and a caregiver/proxy version. Cognitive functioning was estimated with the use of Addenbrooke's Cognitive Examination-Revised. RESULTS: Patients obtained significantly worse scores on all clinical scales when more objective measures were considered. Features of apathy and executive dysfunction were revealed in patients' caregiver versions of LARS and DEX, which may indicate poor self-awareness of patients with WD. Roughly 30% of participants were likely to present with clinically meaningful symptoms, independent of cognitive dysfunction. CONCLUSIONS: Methods relying on self-description appear inferior to informant-based scales when diagnosing apathy. More objective criteria and measurement tools are needed to better understand this clinical syndrome.

Enhancing and accelerating stroke treatment in Eastern European region: Methods and achievement of the ESO EAST program.

INTRODUCTION: Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern Europe. Here, we describe its methods and milestones. PATIENTS AND METHODS: The ESO EAST program is using an implementation strategy based on a 'detecting-understanding-reducing disparities' conceptual framework: stroke care quality is first measured (after developing a platform for data collection), gaps are identified in the current service delivery, and ultimately feedback is provided to participating hospitals, followed by the application of interventions to reduce disparities. The ESO EAST program is carried out by establishing a stroke quality registry, stroke management infrastructure, and creating education and training opportunities for healthcare professionals. RESULTS: Program management and leadership infrastructure has been established in 19 countries (Country Representatives in 22 countries, National Steering Committee in 19 countries). A software platform for data collection and analysis: Registry of Stroke Care Quality was developed, and launched in 2016, and has been used to collect data from over 90,000 patients from >750 hospitals and 56 countries between September 2016 and May 2019. Training in thrombolysis, nursing and research skills has been initiated. DISCUSSION: ESO EAST is the first pan-Eastern European (and beyond) multifaceted quality improvement intervention putting evidence-informed policies into practice. Continuous monitoring of stroke care quality allows hospital-to-hospital and country-to-country benchmarking and identification of the gaps and needs in health care.

Cardiac assessment in Wilson's disease patients based on electrocardiography and echocardiography examination.

INTRODUCTION: Wilson's disease (WD) is a rare genetic disorder that leads to impairments in copper metabolism. Patients principally exhibit liver and neuropsychiatric symptoms, but because copper also accumulates in all body organs, other (typically milder) clinical symptoms can occur. To date, cardiac involvement has not been thoroughly investigated in patients with WD. This study aimed to evaluate heart structure and function in patients with WD with commonly available diagnostic methods. MATERIAL AND METHODS: We compared 125 WD patients with an age- and sex-matched control group. Patients with WD were grouped according to their dominant symptoms - neurologic or hepatic. All subjects underwent clinical, electrocardiographic (ECG), and echocardiographic examinations. RESULTS: All subjects had sinus rhythm on electrocardiography. The only ECG parameter that differed between patients with WD and the control group was the QRS prolongation (92.0 vs. 86.4 ms; p < 0.05). On echocardiography patients with WD exhibited more hypertrophy in the left ventricle than controls (posterior wall in diastole: 1.0 vs. 0.93; p < 0.01) and the left ventricle hypertrophy was more pronounced in the neurologic than in the hepatic subgroup (1.05 vs. 0.96 cm; p < 0.01). Left ventricular systolic function was similar in the WD and the control group (ejection fraction: 67.5% vs. 67.7%). On tissue Doppler echocardiography patients with WD demonstrated slowing of myocardial relaxation, which was more evident in the neurologic group. CONCLUSIONS: Heart involvement in WD was manifested mainly by mild left ventricular hypertrophy and subclinical changes in diastolic function, particularly in the patients with the neurologic form of disease.

Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study.

BACKGROUND: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. METHODS: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. FINDINGS: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14-1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12-1·72) irrespective of other patient and service characteristics. INTERPRETATION: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes. FUNDING: Chest, Heart and Stroke Scotland.

Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial.

BACKGROUND: Tranexamic acid can prevent death due to bleeding after trauma and post-partum haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in adults with stroke due to intracerebral haemorrhage. METHODS: We did an international, randomised placebo-controlled trial in adults with intracerebral haemorrhage from acute stroke units at 124 hospital sites in 12 countries. Participants were randomly assigned (1:1) to receive 1 g intravenous tranexamic acid bolus followed by an 8 h infusion of 1 g tranexamic acid or a matching placebo, within 8 h of symptom onset. Randomisation was done centrally in real time via a secure website, with stratification by country and minimisation on key prognostic factors. Treatment allocation was concealed from patients, outcome assessors, and all other health-care workers involved in the trial. The primary outcome was functional status at day 90, measured by shift in the modified Rankin Scale, using ordinal logistic regression with adjustment for stratification and minimisation criteria. All analyses were done on an intention-to-treat basis. This trial is registered with the ISRCTN registry, number ISRCTN93732214. FINDINGS: We recruited 2325 participants between March 1, 2013, and Sept 30, 2017. 1161 patients received tranexamic acid and 1164 received placebo; the treatment groups were well balanced at baseline. The primary outcome was assessed for 2307 (99%) participants. The primary outcome, functional status at day 90, did not differ significantly between the groups (adjusted odds ratio [aOR] 0·88, 95% CI 0·76-1·03, p=0·11). Although there were fewer deaths by day 7 in the tranexamic acid group (101 [9%] deaths in the tranexamic acid group vs 123 [11%] deaths in the placebo group; aOR 0·73, 0·53-0·99, p=0·0406), there was no difference in case fatality at 90 days (250 [22%] vs 249 [21%]; adjusted hazard ratio 0·92, 95% CI 0·77-1·10, p=0·37). Fewer patients had serious adverse events after tranexamic acid than after placebo by days 2 (379 [33%] patients vs 417 [36%] patients), 7 (456 [39%] vs 497 [43%]), and 90 (521 [45%] vs 556 [48%]). INTERPRETATION: Functional status 90 days after intracerebral haemorrhage did not differ significantly between patients who received tranexamic acid and those who received placebo, despite a reduction in early deaths and serious adverse events. Larger randomised trials are needed to confirm or refute a clinically significant treatment effect. FUNDING: National Institute of Health Research Health Technology Assessment Programme and Swiss Heart Foundation.

Measurement of urinary copper excretion after 48-h d-penicillamine cessation as a compliance assessment in Wilson's disease.

Treatment of Wilson's disease (WD) with anti-copper agents is effective in most compliant patients. During long-term treatment with chelating agents, a two-day interruption of the treatment should result in normal urinary copper concentrations (<50 µg/dl). The aim of this study was to establish the usefulness of this method as a compliance assessment in these patients. We examined consecutive patients treated with d-penicillamine (DPA) undergoing routine follow-up studies at our center. We performed 24-h urinary copper excretion analysis 48 h after interruption of chelating therapy. Thirty-two patients were enrolled. After DPA cessation, normalization of copper excretion was observed in 91% of reportedly compliant patients. The specificity and sensitivity values of this test were 87% and 77%, respectively. Measurement of 24-h urinary copper excretion after a 48-h interruption of DPA therapy in patients with WD is a reliable method for confirming patients' compliance.

Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers.

BACKGROUND AND PURPOSE: The outcome in acute stroke strongly depends on patient-related issues, as well as on the availability of human and diagnostic resources. Our aim was to evaluate safety and effectiveness of intravenous alteplase for stroke according to the time of admission to the hospital. MATERIALS AND METHODS: We analyzed the data of all acute stroke patients treated with alteplase between October 2003 and December 2010, contributed to the Safe Implementation of Thrombolysis for Stroke registry from 27 Polish stroke centers. According to the time of admission we distinguished between: (1) non-working days (Friday 14:30-Monday 08:00 plus national holidays); (2) out-of-office hours (non-working days plus 14:30-08:00 during working days); and (3) night hours (time from 23:00 to 06:00). Patients admitted during regular working hours (Monday 08:00-Friday 14:30, excluding national holidays) were used as the reference. RESULTS: Of 1330 patients, 448 (32.5%) were admitted on non-working days, 868 (65.3%) at out-of-office hours, and 105 (7.9%) during night hours. In multivariate logistic regression, none of the evaluated periods showed association with symptomatic intracranial hemorrhage, 7-day mortality, and neurological improvement ≥4 points in the National Institutes of Health Stroke Scale score at day 7. Patients admitted during night hours had lower odds (OR 0.53, 95% CI: 0.29-0.95, p=0.032) for achieving favorable outcome (modified Rankin Scale score 0-2). CONCLUSIONS: There is no bad time for thrombolysis. Stroke centers should feel confident about the treatment outside regular working hours, irrespective of equipment and staff availability. However, it may be reasonable to pay additional attention during nighttime.

Role of preexisting disability in patients treated with intravenous thrombolysis for ischemic stroke.

BACKGROUND AND PURPOSE: Little is known about the effect of thrombolysis in patients with preexisting disability. Our aim was to evaluate the impact of different levels of prestroke disability on patients' profile and outcome after intravenous thrombolysis. METHODS: We analyzed the data of all stroke patients admitted between October 2003 and December 2011 that were contributed to the Safe Implementation of Treatments in Stroke-Eastern Europe (SITS-EAST) registry. Patients with no prestroke disability at all (modified Rankin Scale [mRS] score, 0) were used as a reference in multivariable logistic regression. RESULTS: Of 7250 patients, 5995 (82%) had prestroke mRS 0, 791 (11%) had prestroke mRS 1, 293 (4%) had prestroke mRS 2, and 171 (2%) had prestroke mRS≥3. Compared with patients with mRS 0, all other groups were older, had more comorbidities, and more severe neurological deficit on admission. There was no clear association between preexisting disability and the risk of symptomatic intracranial hemorrhage. Prestroke mRS 1, 2, and ≥3 were associated with increased risk of death at 3 months (odds ratio, 1.3, 2.0, and 2.6, respectively) and lower chance of achieving favorable outcome (achieving mRS 0-2 or returning to the prestroke mRS; 0.80, 0.41, 0.59, respectively). Patients with mRS≥3 and 2 had similar vascular profile and favorable outcome (34% versus 29%), despite higher mortality (48% versus 39%). CONCLUSIONS: Prestroke disability does not seem to independently increase the risk of symptomatic intracranial hemorrhage after thrombolysis. Despite higher mortality, 1 in 3 previously disabled patients may return to his/her prestroke mRS. Therefore, they should not be routinely excluded from thrombolytic therapy.

Organization of acute stroke services in Poland - Polish Stroke Unit Network development.

BACKGROUND AND PURPOSE: According to the recommendations of stroke organizations, every stroke patient should be treated in a specialized stroke unit (SU). We aimed to evaluate the development of the SU network in Poland during the past decade. MATERIAL AND METHODS: In Poland, stroke is treated mainly by neurologists. A questionnaire evaluating structure and staff of neurological departments was sent to all neurological departments in 2003, 2005 and 2007. In 2010, we collected data based on information from the National Health Fund. We divided departments into categories: with a comprehensive SU, with a primary SU unit, and departments without an SU. Primary SUs were further divided into class A SUs (fulfilling criteria of the National Programme of Prevention and Treatment of Stroke Experts - eligible for thrombolysis), class B (conditionally fulfilling criteria), and class C (not fulfilling criteria). RESULTS: Final analyses included 87.4% of departments (194/222) in 2003, 85.5% of departments (188/220) in 2005, and 83.1% of departments (182/219) in 2007. According to the above-mentioned classification there were 20 class A SUs in 2003, 58 in 2005 and 5 comprehensive and 51 class A SUs in 2007. In 2012, based on information from the National Health Fund there were 150 SUs, all fulfilling criteria for thrombolysis, 9 of them comprehensive SUs. CONCLUSIONS: The SU network in Poland is developing dynamically but thrombolysis and endovascular procedures are done too rarely. Now it is necessary to improve quality of stroke services and to make organizational changes in the in-hospital stroke pathways as well as to organize continuous education of medical staff.

Stroke care in Central Eastern Europe: current problems and call for action.

Stroke is a major medical problem and one of the leading causes of mortality and disability all over in Europe. However, there are significant East-West differences in stroke care as well as in stroke mortality and morbidity rates. Central and Eastern European countries that formerly had centralized and socialist health care systems have serious and similar problems in organizing health and stroke care 20 years after the political transition. In Central and Eastern Europe, stroke is more frequent, the mortality rate is higher, and the victims are younger than in Western Europe. High-risk patients live in worse environmental conditions, and the socioeconomic consequences of stroke further weaken the economic development of these countries. To address these issues, a round table conference was organized. The main aim of this conference was to discuss problems to be solved related to acute and chronic stroke care in Central and Eastern European countries, and also, to exchange ideas on possible solutions. In this article, the discussed problems and possible solutions will be summarized, and introduce 'The Budapest Statement of Stroke Experts of Central and Eastern European countries'.

Development of early comprehensive stroke inpatient rehabilitation in Poland - current status and future requirements.

BACKGROUND AND PURPOSE: Every stroke patient should undergo early rehabilitation. We aimed to evaluate accessibility, development and needs in early stroke inpatient rehabilitation in Poland. MATERIAL AND METHODS: A questionnaire evaluating rehabilitation departments was prepared and sent (in 2004 and 2008) to rehabilitation wards in Poland, where stroke patients are treated and undergo early rehabilitation. We divided departments into classes: class A - having comprehensive rehabilitation (physiotherapy minimum 60 minutes/day, speech therapy minimum 30 minutes/5 days/week, rehabilitation of other cognitive impairments minimum 30 minutes/5 days/week, group physiotherapy); B - having the possibility of all types of therapy, but done less frequently; C - physiotherapy and speech therapy; D - physiotherapy and cognitive rehabilitation; E - only physiotherapy. RESULTS: In 2004, we obtained responses from 115 of 172 (66.9%) rehabilitation departments. According to prespecified criteria there were 11 class A, 31 class B, 28 class C, 4 class D, and 41 class E wards. In 2008, we received response from 89 of 149 (59.7%) rehabilitation departments. According to prespecified criteria there were 17 class A, 40 class B, 22 class C, 0 class D, and 10 class E wards. In 2004, 159 beds and in 2008, 294 beds in class A departments were available for stroke patients. The minimal number of needed but lacking beds was 604 in 2004 and 469 in 2008. CONCLUSIONS: Development of departments providing early comprehensive stroke rehabilitation from 2004 to 2008 is marked, but still insufficient. In 2008, 19% of rehabilitation departments could provide comprehensive stroke rehabilitation and this was 38.5% of beds actually needed.

Development of the stroke unit network in Poland--current status and future requirements.

BACKGROUND AND PURPOSE: According to the World Health Organization establishments and European Stroke Initiative recommendations, every patient with stroke should be treated by a specialized stroke team or in a specialized stroke unit. We aimed to evaluate the development of the stroke unit network in Poland and accessibility of stroke units in 2005. MATERIAL AND METHODS: Questionnaires evaluating structure and staff of neurological departments were sent to all neurological departments in Poland in the second quarter of 2005. We divided departments into the following categories: those having a class A stroke unit (fulfilling criteria of experts of the National Programme of Prevention and Treatment of Stroke) class B stroke unit (conditionally fulfilling those criteria), class C stroke units (not fulfilling the criteria), and departments without stroke units. The classification was presented to the chief consultant in neurology of each voivodship in December 2005 for verification of the data. RESULTS: We received enquiries from 180 out of 220 (81.8%) departments. Consultants included data of a further 8 departments which did not respond to the questionnaire (188 - 85.5%). 105 departments declared having a stroke unit (58 class A units, 40 class B units, and 7 class C units). 83 other departments do not have stroke units. The most frequent problem that plays a role in classification of departments was the deficit of staff or lack of equipment. It is assessed that the supplementation of diagnostic equipment and staff in existing stroke units and the establishment of 27 new stroke units is required to satisfy current needs. CONCLUSIONS: The development of the stroke unit network in Poland is proceeding dynamically. There are 105 stroke units in Poland but 45% of them require additional diagnostic equipment and staff.

[An evaluation of the accessibility of early post-stroke comprehensive rehabilitation in Poland]. / Ocena dostepnosci wczesnej kompleksowej rehabilitacji poudarowej w Polsce.

BACKGROUND AND PURPOSE: According to the European Stroke Initiative recommendations every stroke patient should undergo rehabilitation; its program should be tailored according to the individual needs of the patient. The aim of our study was to evaluate the accessibility of comprehensive early stroke rehabilitation at neurological departments in Poland. MATERIALS AND METHODS: We have sent a questionnaire evaluating neurological and rehabilitation departments in Poland, where stroke patients are treated and undergo early rehabilitation. We divided them into 5 categories -- classes from A to F: class A -- having comprehensive rehabilitation (kinesitherapy minimum 60 minutes/day, speech therapy minimum 30 minutes for 5 days a week and rehabilitation of other cognitive impairments and group kinesitherapy at rehabilitation departments); B -- having the possibility of all types of therapy, but is done less frequently; C -- kinesitherapy and speech therapy; D -- kinesitherapy and cognitive rehabilitation; E -- only kinesitherapy. We also separated neurological departments without trained rehabilitation staff. RESULTS: We obtained responses from 191 of 215 (88.8%) neurological departments. According to criteria: 26 class A, 38 class B, 50 class C, 2 class D, 73 class E, 2 without specialized rehabilitation staff. We received filled questionnaires from 115 of 172 (66.9%) rehabilitation departments. According to criteria: 11 class A, 31 class B, 28 class C, 4 class D and 41 class E. CONCLUSION: Only 14% of all neurological departments and 10% of rehabilitation departments administered comprehensive early stroke rehabilitation in Poland. Improvement of comprehensive rehabilitation accessibility in Poland is necessary for lowering the number of disabled post-stroke patients.

Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischaemic stroke in the international stroke trial.

AIM: We sought to determine whether there were differences between men and women with acute stroke in their baseline characteristics and outcome in a large cohort of patients randomized in the International Stroke Trial (IST). METHODS: Of the 19,435 patients randomized in the IST, 17,370 had an ischemic stroke confirmed by CT scan or autopsy (8,003 female and 9,367 male). In males and females, we compared baseline characteristics (age, frequency of atrial fibrillation, pre-stroke administration of aspirin and systolic blood pressure, conscious level, stroke syndrome) and outcome at 14 days and 6 months (death, complications, dependency, recovery, place of residence). We developed a specific logistic regression model to adjust for case-mix in order to evaluate the separate influence of gender on outcome. RESULTS: Female patients were older, suffered more frequently from atrial fibrillation, had higher systolic blood pressure at randomization and generally had more severe strokes (a higher proportion were unconscious or drowsy or had a total anterior circulation syndrome). Females had higher 14-day and 6-month case fatality and were more likely to be dead or dependent at six months (and consequently more likely to require institutional or residential care). Gender was an independent predictor of death or dependency at 6 months. CONCLUSIONS: The adverse effect of female gender on outcome indicates that further research to explore the underlying biological mechanism is justified, and that more intensive acute and long-term treatment may be needed to improve outcome among female patients with stroke.

[Evaluation of the accessibility of stroke units in Poland]. / Ocena zabezpieczenia chorych z udarem mózgu w zakresie dostepnosci pododdzialów udarowych w Polsce.

BACKGROUND AND PURPOSE: According to the World Health Organization (WHO) assumptions every patient with a stroke should be treated by a specialized stroke team or in a specialized stroke unit. The aim of our study was to evaluate the accessibility and eligibility of stroke units in Poland. MATERIALS AND METHODS: We have developed a questionnaire evaluating the structure and staff of neurological departments. The questionnaire was sent to all neurological departments in Poland in the last quarter of 2003. We grouped the departments in 5 categories: having a stroke unit of class A (fulfilling the criteria of the Experts of the National Program of Prevention and Treatment of Stroke guidelines), class B (conditionally fulfilling the criteria), class C (not fulfilling the criteria), departments having stroke units without a separate structure and departments without stroke units. The classification was shown to each provincial consultant in order to verify our data in January 2004. RESULTS: We have received replies from 194 of 222 (87.4%) departments. 97 departments declared having a stroke unit: 20 -- class A, 56 -- class B, 14 -- class C and 7 -- stroke units without a separate structure. The remaining 97 departments do not have any stroke units. The most frequent problem that plays a role in the classification of departments was the deficit of staff or equipment. CONCLUSIONS: The stroke unit network in Poland is developing dynamically, but a significant number of the existing stroke units need more diagnostic equipment, staff and structural changes.

Underfunding of stroke research: a Europe-wide problem.

BACKGROUND AND PURPOSE: Previous studies in the United States and the United Kingdom have shown that stroke research is underfunded compared with coronary heart disease (CHD) and cancer research despite the high clinical and financial burden of stroke. We aimed to determine whether underfunding of stroke research is a Europe-wide problem. METHODS: Data for the financial year 2000 to 2001 were collected from 9 different European countries. Information on stroke, CHD, and cancer research funding awarded by disease-specific charities and nondisease-specific charity or government- funded organizations was obtained from annual reports, web sites, and by direct communication with organizations. RESULTS: There was marked and consistent underfunding of stroke research in all the countries studied. Stroke funding as a percentage of the total funding for stroke, CHD, and cancer was uniformly low, ranging from 2% to 11%. Funding for stroke was less than funding for cancer, usually by a factor of > or =10. In every country except Turkey, funding for stroke research was less than that for CHD. CONCLUSIONS: This study confirms that stroke research is grossly underfunded, compared with CHD and cancer, throughout Europe. Similar data have been obtained from the United States suggesting that relative underfunding of stroke research is likely to be a worldwide phenomenon.

The polish experience in early stroke care.

Stroke units are being organised in Poland since 1997. To ensure easy access to stroke care, 120 specialised units need to be created. There were 23 stroke units in Poland in the year 2000. Only 12 of them fulfilled the criteria of a standard stroke unit. Significant differences in stroke fatality were noted between well- and as yet insufficiently organised units. These results indicate a need for monitoring the implementation of the basic standards in stroke units.

[Open trial of the effectiveness of interferon beta 1a (Avonex) in multiple sclerosis. Clinical assessment using motor coordination tests]. / Badanie otwarte oceny skutecznosci interferonu beta 1A (Avonexu) w stwardnieniu rozsianym. Ocena kliniczna z wykorzystaniem testów parametrycznych funkcji ruchowych i koordynacyjnych.

OBJECTIVE: The aim of the study was to evaluate clinical efficacy and safety of interferon beta 1A (Avonex) in the Polish population of remitting-relapsing multiple sclerosis (RR MS) patients. MATERIAL AND METHODS: The study was organized as an open, multi-center trial with 126 RR MS patients. Intramuscular Avonex was administered once a week in the dose of 30 mcg. The treatment duration was 24 months. The annual relapse rate (ARR), proportion of relapse-free patients, the average change in EDSS scores between the baseline and the study completion, and the proportion of patients who deteriorated on the EDSS scale during the treatment were used as evaluation parameters. Additionally, to obtain quantitative data, the 9HPT and 25 FW test results were taken into account. RESULTS: A significant decrease in the ARR was noted in the course of treatment (from 1.47 in the 2-year period preceding the study to 0.38). The mean EDSS score for the whole group was higher by 0.13 on the study completion. However, patients without motor deficits (EDSS < 2.0) at baseline improved by 0.25 on the EDSS during the treatment, while those with motor deficits (EDSS 2.0 to 4.0)--deteriorated by 0.65. In the period under study 45.8% of the patients remained stable, 26.7% improved and 27.5% deteriorated on the EDSS. The mean duration of the 9HPT test performance increased by 0.67 sec for the dominant, and by 0.97 sec for the non-dominant hand from the baseline to post-treatment evaluation. But again, in patients without any motor deficits the mean time of 9HPT test performance was shorter post-treatment than at baseline for the dominant and non-dominant hand, while in those with motor deficits it was longer for both hands on the study completion. The mean performance time on the 25 FW test was longer by 0.74 sec on the study completion for the whole group, but in patients without motor deficits the increase in the 25 FW performance time was significantly smaller than in those with baseline EDSS scores ranging from 2.0 to 4.0. Avonex did not cause any significant abnormalities in laboratory parameters monitored during the treatment, and no significant side effects were observed except for flu-like symptoms following an Avonex injection. CONCLUSION: Results of this study confirmed a beneficial effect of 1FNb 1A (Avonex) in the dose of 30 mcg per week on the clinical status of MS patients. The findings indicate a better treatment outcome in patients with less pronounced neurological deficits at baseline.