Safety and efficacy of co-careldopa as an add-on therapy to occupational and physical therapy in patients after stroke (DARS): a randomised, double-blind, placebo-controlled trial

Publication date: June 2019Source: The Lancet Neurology, Volume 18, Issue 6Author(s): Gary A Ford, Bipin B Bhakta, Alastair Cozens, Suzanne Hartley, Ivana Holloway, David Meads, John Pearn, Sharon Ruddock, Catherine M Sackley, Eirini-Christina Saloniki, Gillian Santorelli, Marion F Walker, Amanda J FarrinSummaryBackgroundDopamine is a key modulator of striatal function and learning and might improve motor recovery after stroke. Previous small trials of dopamine agonists after stroke provide equivocal evidence of effectiveness on improving motor recovery. We aimed to assess the safety and efficacy of co-careldopa plus routine occupational and physical therapy during early rehabilitation after stroke.MethodsThis double-blind, multicentre, randomised controlled trial of co-careldopa versus placebo in addition to routine NHS occupational and physical therapy was done at 51 UK NHS acute inpatient stroke rehabilitation services. We recruited patients with new or recurrent clinically diagnosed ischaemic or haemorrhagic (excluding subarachnoid haemorrhage) stroke 5–42 days before randomisation, who were unable to walk 10 m or more, had a score of less than 7 points on the Rivermead Mobility Index, were expected to need rehabilitation, and were able to access rehabilitation after discharge from hospital. Participants were assigned (1:1) using stratified random blocks to receive 6 weeks of oral co-careldopa or matched placebo in addition to routine NHS physiotherapy and occupatio...
Source: The Lancet Neurology - Category: Neurology Source Type: research

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CONCLUSIONS: The prevalence of stroke in this cohort was 3.1%. Ischemic strokes had a bimodal presentation, occurring either early after SLE diagnosis or after a several-year delay. Half of the hemorrhagic strokes occurred>10 years after the diagnosis of SLE. Clinical outcome was usually good with a relatively low recurrence rate. PMID: 32151182 [PubMed - as supplied by publisher]
Source: Lupus - Category: Rheumatology Authors: Tags: Lupus Source Type: research
Authors: Baranowska B, Kochanowski J Abstract Copeptin, arginine vasopressin (AVP)-associated 39 aminoacid glycopeptide, is a C-terminal part of pro-AVP. AVP acts through V1a, V1b, and V2 receptors. The effect on V1a receptors is connected with arterial vasoconstriction, on V2 with antidiuretic action, and on V1b with the secretion of ACTH, insulin, glucagon. Copeptin is found in the circulation in equimolar amounts with AVP. It is a very stable peptide and easy to estimate. Copeptin is a good diagnostic marker in many disorders in which vasopressinergic dysfunction plays a role in pathogenesis such as a polyu...
Source: Neuroendocrinology Letters - Category: Endocrinology Tags: Neuro Endocrinol Lett Source Type: research
AbstractTranslational genomics represents a broad field of study that combines genome and transcriptome-wide studies in humans and model systems to refine our understanding of human biology and ultimately identify new ways to treat and prevent disease. The approaches to translational genomics can be broadly grouped into two methodologies, forward and reverse genomic translation. Traditional (forward) genomic translation begins with model systems and aims at using unbiased genetic associations in these models to derive insight into biological mechanisms that may also be relevant in human disease. Reverse genomic translation...
Source: Neurotherapeutics - Category: Neurology Source Type: research
Magnetic resonance imaging (MRI) has revolutionized medicine, but MRI scanners are so demanding that access to them is still a challenge. MRI machines typically require specially built rooms with magnet quench vent pipes, entry systems that check peo...
Source: Medgadget - Category: Medical Devices Authors: Tags: Emergency Medicine Neurology Neurosurgery Radiology Source Type: blogs
Time-critical acute ischemic conditions such as ST-elevation myocardial infarction and acute ischemic stroke are staples in Emergency Medicine practice. While timely reperfusion therapy is a priority, the resultant acute ischemia/reperfusion injury contributes to significant mortality and morbidity. Among therapeutics targeting ischemia/reperfusion injury (IRI), remote ischemic conditioning (RIC) has emerged as the most promising. RIC, which consists of repetitive inflation and deflation of a pneumatic cuff on a limb, was first demonstrated to have protective effect on IRI through various neural and humoral mechanisms. It...
Source: Shock - Category: Emergency Medicine Tags: Review Articles Source Type: research
ConclusionsThe SPICE multicenter study will investigate 1-year outcomes, ethical issues, as well as care pathways of acute stroke patients requiring invasive ventilation in the ICU. Gathered data will delineate human resources and facilities needs for adequate management. The identification of prognostic factors at the acute phase will help to identify patients who may benefit from prolonged intensive care and rehabilitation.Trial registration: NCT03335995.
Source: Neurocritical Care - Category: Neurology Source Type: research
This study enrolled 43 patients with VA dissection, and 63 age- and sex-matched healthy subjects were used as the controls. MRA was employed to evaluate the presence of dominant VA and the lateral shift of vertebrobasilar junction in both groups.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
The utilization and duration of left ventricular assist device (LVAD) support has increased steadily over the last decade and recent changes in the UNOS heart allocation system, implemented in October 2018, portend a further increase in the duration of mechanical circulatory support for many patients (1). Though four-year survival rates have improved to 60% following LVAD implantation, the leading cause of death in these patients is neurological injury, specifically ischemic and hemorrhagic stroke (spontaneous subarachnoid hemorrhage or intraparenchymal hemorrhage [IPH]) (2).
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Editorial Source Type: research
Conclusion Prophylactic heparin was associated with a nonsignificant increase in any hematoma enlargement and mortality, a nonsignificant reduction in extracranial hemorrhage, and a nonsignificant increase in the incidence of major disability in patients with sICH. It is probably safe to administer heparin to prevent VTE in patients with sICH. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Journal of Neurological Surgery Part A: Central European Neurosurgery - Category: Neurosurgery Authors: Tags: Review Article Source Type: research
In conclusion, isoflurane protected against BBB disruption caused by carbogen inhalation in mice and rats, but unlike isoflurane-mediated protection against ischemic BBB disruption, the effect could not be explained by anesthesia-induced hypothermia.
Source: NeuroReport - Category: Neurology Tags: Cellular, Molecular and Developmental Neuroscience Source Type: research
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