European data, at least from Western Europe, are relatively good on migraine prevalence but less sound for tension-type headache (TTH) and medication-overuse headache (MOH). Evidence on impact of headache disorders is very limited. Eurolight was a data-gathering exercise primarily to inform health policy in the European Union (EU). This manuscript reports personal impact. The study was cross-sectional with modified cluster sampling. Surveys were conducted by structured questionnaire, including diagnostic questions based on ICHD-II and various measures of impact, and are reported from Austria, France, Germany, Italy, Lithuania, Luxembourg, Netherlands, Spain and United Kingdom. Different methods of sampling were used in each. The full methodology is described elsewhere. Questionnaires were analysed from 8,271 participants (58% female, mean age 43.4 y). Participation-rates, where calculable, varied from 10.6% to 58.8%. Moderate interest-bias was detected. Unadjusted lifetime prevalence of any headache was 91.3%. Gender-adjusted 1-year prevalences were: any headache 78.6%; migraine 35.3%; TTH 38.2%, headache on ≥15 d/mo 7.2%; probable MOH 3.1%. Personal impact was high, and included ictal symptom burden, interictal burden, cumulative burden and impact on others (partners and children). There was a general gradient of probable MOH > migraine > TTH, and most measures indicated higher impact among females. Lost useful time was substantial: 17.7% of males and 28.0% of females with migraine lost >10% of days; 44.7% of males and 53.7% of females with probable MOH lost >20%. The common headache disorders have very high personal impact in the EU, with important implications for health policy.
The aim of the present study was to determine the value of immunogenetic risk factors and to estimate their relationship with the clinical features and disability status of patients with multiple sclerosis in a Lithuanian population.This was a prospective study of 80 patients with multiple sclerosis. The diagnosis of multiple sclerosis was based on the revised McDonald criteria. Oligoclonal bands (OCBs) of immunoglobulin G (IgG) were tested using isoelectric focusing and IgG specific immunofixation. HLA DRB1 alleles were genotyped using polymerase chain reaction.Of all patients, 55% were positive for OCBs and 56% for HLA DRB1*1501. OCB-positive patients with multiple sclerosis had higher EDSS scores than their OCB-negative counterparts at onset of the disease (3.93±1.21 and 3.36±0.96 points, respectively; P=0.02) and during the last visit (4.31±2.06 and 3.09±1.98 points, respectively; P=0.009). The mean relapse rate was higher in the OCB-positive group compared with OCB-negative group (1.45±0.69 and 0.58±0.64, respectively; P=0.001). OCB-positive patients had higher IgG index compared with OCB-negative patients (P=0.0001). No relationship was found between HLA DRB1*1501 antigen status and the clinical features or EDSS score, and presence or absence of OCB in the present subset of patients with multiple sclerosis.The presence of oligoclonal bands in the cerebrospinal fluid of the patients with multiple sclerosis was associated with the greater number of exacerbations, higher degree of disability, and higher IgG index. There were no significant associations between the presence of HLA DRB1*1501 allele and the clinical symptoms, course of disease, or disability score.
Background: Evaluation of smell function is essential especially in cases of gradual deterioration, e.g., in neurodegenerative diseases, where rates of unawareness of the disorder are high and the importance of screening for olfactory dysfunction is increasing. To date, none of the tests for evaluation of olfactory dysfunction has been validated in Lithuania. The aim of the study was to develop a Lithuanian version of Sniffin’ Sticks 12 (SS12) odor identification test. Materials and Methods: The study was performed in 4 stages. The first stage included translation and back-translation from German, pilot group testing and language adaptation of the original SS12 test. In the second stage a survey group of 99 subjects was questioned for familiarity with the descriptors, used in the original version of the test. In the third stage after replacement of the least familiar distracters, a modified version of SS12 was created. Original and modified versions of SS12 were tested on 112 and 119 healthy subjects accordingly. The fourth stage of the study proved necessary as neither of the two SS12 versions turned out to be valid. After another round of replacement of the misleading distracters the second modified version of SS12 was created and it was tested on 115 healthy subjects. Results: Unsatisfactory correct identification rates of less than 75 percent in the same one item (lemon) were observed using both original and modified SS12 versions. With the second modification of distracters of SS12, identification of lemon increased significantly and overcame 75 percent. The decrease of SS12 scores in relation to age was ascertained in the study sample. Gender and smoking status did not prove to be independent predictors of SS12 scores in multiple linear regression analysis. Conclusion: The study presents an olfactory testing tool, which is adapted and modified culturally for use in the Lithuanian population.
Tyrimo tikslas. Nustatyti sąsajas tarp gyvenimo kokybės, socialinių ir demografinių veiksnių persirgusiųjų galvos smegenų insultu bei kontrolinėje grupėse. Tirtųjų kontingentas ir tyrimo metodai. Atvejų grupę sudarė 25–84 metų 508 Kauno miesto gyventojai, persirgę pirmuoju galvos smegenų insultu. Kontrolinę grupę sudarė pagal amžių ir lytį atitinkantys atsitiktinai atrinkti 508 Kauno miesto gyventojai iš nesirgusių galvos smegenų insultu populiacijos. Tyrimui atlikti naudotas SF-12 gyvenimo kokybės klausimynas. Analizuota tiriamųjų gyvenimo kokybė, fizinė ir psichinė sveikata atsižvelgiant į socialinius ir demografinius veiksnius. Rezultatai. Nustatyta statistiškai reikšminga atvirkštinė fizinės sveikatos įverčio priklausomybė nuo amžiaus: Spirmeno koreliacijos koeficientai persirgusiųjų galvos smegenų insultu ir kontrolinėje grupėse: r=–0,34 (p<0,05) ir r=–0,64 (p<0,05). Palyginus vyrų ir moterų fizinės sveikatos įverčius, nustatyta, kad vyrų fizinės sveikatos įvertis statistiškai reikšmingai didesnis nei moterų (p=0,0005) tik kontrolinėje grupėje, o tarp persirgusių galvos smegenų insultu vyrų ir moterų statistiškai reikšmingo skirtumo nenustatyta. Persirgusių galvos smegenų insultu lietuvių fizinė sveikata geresnė nei kitų tautybių asmenų (p=0,008). Tiriamieji, gyvenantys ne vieni, savo fizinę sveikatą vertino geriau tiek kontrolinėje (p=0,01), tiek persirgusiųjų galvos smegenų insultu (p=0,008) grupėse. Dirbančiųjų fizinė sveikata geresnė tiek persirgusiųjų galvos smegenų insultu, tiek kontrolinėje grupėse (p=0,005 abiejose grupėse). Išvados. Su amžiumi fizinė sveikata persirgusiųjų galvos smegenų insultu ir kontrolinėje grupėse blogėjo. Turintys aukštesnįjį išsimokslinimą, gyvenę ne vieni, dirbantys vyrai ir moterys tiek persirgusiųjų galvos smegenų insultu, tiek kontrolinėje grupėse savo gyvenimo kokybę fizinės sveikatos srityje vertino geriau nei turintys žemesnį išsimokslinimą, gyvenę vieni arba nedirbantys.
To assess prospectively the accuracy and precision of a method for noninvasive intracranial pressure (ICP) measurement compared with invasive gold standard CSF pressure measurement.
Methods:
Included were 62 neurologic patients (37 idiopathic intracranial hypertension, 20 multiple sclerosis, 1 Guillain-Barré syndrome, 1 polyneuropathy, and 3 hydrocephalus). The average age was 40 ± 12 years. All patients had lumbar puncture indicated as a diagnostic procedure. ICP was measured using a noninvasive ICP measurement method, which is based on a two-depth high-resolution transcranial Doppler insonation of the ophthalmic artery (OA). The OA is being used as a natural pair of scales, in which the intracranial segment of the OA is compressed by ICP and the extracranial segment of the OA is compressed by extracranial pressure (Pe) applied to the orbit. The blood flow parameters in both OA segments are approximately the same in the scales balance case when Pe = ICP. All patients had simultaneous recording of noninvasive ICP values and invasive gold standard CSF pressure values.
Results:
Analysis of the 72 simultaneous paired recordings of noninvasive ICP and the gold standard CSF pressure showed good accuracy for the noninvasive method as indicated by the low mean systematic error (0.12 mm Hg; confidence level [CL] 0.98). The method also showed high precision as indicated by the low SD of the paired recordings (2.19 mm Hg; CL 0.98). The method does not need calibration.
Conclusion:
The proposed noninvasive ICP measurement method is precise and accurate compared with gold standard CSF pressure measured via lumbar puncture.
Background There is a lack of reliable epidemiological data on long-term survival trends of first-ever stroke patients in Lithuanian population. Aims To evaluate trends in long-term survival after stroke and to determine the influence of some sociodemographic and lifestyle factors, time and subtype of stroke, and stroke care on survival. Methods All stroke events included in Kaunas stroke register database were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2011. Death time was confirmed by the Office for National Death Statistics. Estimates of stroke long-term survival data and factors influencing survival changes were made by applying the Kaplan-Meier and Cox regression analysis. Results During the study period, 4,129 persons aged 25–64 years suffered from a first-ever stroke: 2,215 (53.6%) of them were men and 1,914 (46.4%)—women. Ischemic stroke was significantly more frequent in males than in females (80.6% and 78.6%, respectively, p<0.05) and subarachnoid hemorrhage was more common in women than in men (9.0% and 7.0% respectively, p <0.05). Of all first-ever stroke patients, 3,272 (79.2%) survived 1 year and 2,905 (70.4%) survived 5 years after stroke onset. The 1- and 5-years survival rate after a first-ever stroke in women was significantly higher as compared with that in men (Log-rank test p = 0.0001). The older (55–64 year) persons had poorer 1-year and 5-years survival rate as compared with persons in the younger (25–54 years) age group (Log-rank test p = 0.0001). Among persons with a first-ever stroke who had their stroke in 2007–2011, 1- and 5-year survival rate was higher compared with that in persons who had had a stroke in 1986–1990 and in 1997–2001 (Log-rank test p = 0.0001). The persons with a first-ever ischemic stroke had a better chance to survive first 1- and 5-years after stroke compared with persons who had intracerebral or subarachnoid haemorrhage. Only female gender was associated with higher 1- and 5-year survival rate after first-ever stroke. The older age, previous myocardial infarction and diabetes mellitus were associated with lower 1- and 5-year survival rate after first-ever stroke. Conclusions This population-based study of patients with first-ever stroke demonstrated that the long-term survival was better in women than men, and improved significantly in both men and women during the past decade. Long-term survival was better of those with first-ever ischemic stroke and of younger age– 25 to 54 years.
One of the life-threatening complications of hyperemesis gravidarum is Wernicke's encephalopathy, the main etiological factor of which is a lack of thiamine (vitamin B1). Most frequently Wernicke's encephalopathy is found among persons suffering from excessive drinking. The aim of the report was to present a case of Wernicke's encephalopathy induced by hyperemesis gravidarum. The course of the disease, clinical signs, diagnostics, treatment and its results are presented. Also a review of the literature on Wernicke's encephalopathy secondary to hyperemesis gravidarum is introduced.
Abstract Background: The impact of weather on morbidity from stroke was analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily number of strokes may be associated with global changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic stroke (IS) and haemorrhagic stroke (HS) and the teleconnection pattern. Methods: The study was conducted in Kaunas city, Lithuania, from 2000 to 2010. The daily numbers of IS, subarachnoid haemorrhages (SAH), and intracerebral haemorrhages (ICH) were obtained from Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression, adjusting for the linear trend, month, and other weather variables. Results: During the study period, we analysed 4,038 cases (2,226 men and 1,812 women) of stroke. Of these, 3,245 (80.4%) cases were IS, 533 (13.2%) cases were ICH, and 260 (6.4%) cases were SAH. A change in mean daily atmospheric pressure of >3.9 hPa was associated with the risk of SAH (RR=1.49, 95% CI 1.14-1.96), and a stronger El Niño event had a protective effect against SAH (RR=0.34, 95% CI 0.16-0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR=1.13, 95% CI 1.04-1.23). The risk of IS was negatively associated with Arctic Oscillation indices (RR=0.97, 95% CI 0.94-0.99). During November-March, a positive North Atlantic Oscillation (NAO) was associated with HS (RR=1.29, 95% CI 1.03-1.62), and a negative association between the NAO index and IS (RR=0.92, 95% CI 0.85-0.99) was found. Conclusions: The results of our study provided new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnection indices is not identical for different types of stroke. Emergency services should be aware of the fact that specific weather conditions are more likely to prompt calls for more severe strokes.
Headache disorders and psychiatric disorders are both common, while evidence, mostly pertaining to migraine, suggests they are comorbid more often than might be expected by chance. There are good reasons for establishing whether they are: symptoms of comorbid illnesses may summate synergistically; comorbidities hinder management, negatively influencing outcomes; high-level comorbidity indicates that, where one disease occurs, the other should be looked for. The Eurolight project gathered population-based data on these disorders from 6624 participants. Eurolight was a cross-sectional survey sampling from the adult populations (18–65 years) of 10 EU countries. We used data from six. The questionnaire included headache-diagnostic questions based on ICHD-II, the Headache-Attributed Lost Time (HALT) questionnaire, and HADS for depression and anxiety. We estimated odds ratios (ORs) to show associations between migraine, tension-type headache (TTH) or probable medication-overuse headache (pMOH) and depression or anxiety. pMOH was most strongly associated with both psychiatric disorders: for depression, ORs (vs no headache) were 5.5 [2.2–13.5] (p < 0.0001) in males, 5.5 [2.9–10.5] (p < 0.0001) in females; for anxiety, ORs were 10.4 [4.9–21.8] (p < 0.0001) and 7.1 [4.5–11.2] (p < 0.0001). Migraine was also associated with both: for depression, ORs were 2.1 [1.3–3.4] (p = 0.002) and 1.8 [1.1–3.1] (p = 0.030); for anxiety 4.2 [2.8–6.3] (p < 0.0001) and 2.4 [1.7–3.4] (p < 0.0001). TTH showed associations only with anxiety: ORs 2.5 [1.7–3.7] (p < 0.0001) for males, 1.5 [1.1–2.1] (p = 0.021) for females. Participants with migraine carried 19.1 % probability of comorbid anxiety, 6.9 % of depression and 5.1 % of both, higher than the representative general-population sample (14.3, 5.6 and 3.8 %). Probabilities in those with MOH were 38.8, 16.9 and 14.4 %; in TTH, they did not exceed those of the whole sample. Comorbid psychiatric disorder did not add to headache-attributed productive time losses, but weak associations existed (R 2 = 0.020–0.082) for all headache types between lost productive time and probabilities of depression and, less so, anxiety. In this large study we confirmed that depression and especially anxiety are comorbid more than by chance with migraine, and showed the same is true, but more strongly, with MOH. Arguably, migraine patients and, more certainly, MOH patients should be screened with HADS in pursuit of best outcomes.
The need for stroke care is escalating with an ageing population, yet methods to estimate the delivery of effective care across countries are not standardised or robust. Associations between quality and intensity of care and stroke outcomes are often assumed but have not been clearly demonstrated.To examine variations in acute care processes across six European populations and investigate associations between the delivery of care and survival.Data were obtained from population-based stroke registers of six centres in France, Lithuania, UK, Spain, Poland and Italy between 2004 and 2006 with follow-up for 1 year. Variations in the delivery of care (stroke unit, multidisciplinary team and acute drug treatments) were analysed adjusting for case mix and sociodemographic factors using logistic regression methods. Unadjusted and adjusted survival probabilities were estimated and stratified by levels of Organised Care Index.Of 1918 patients with a first-ever stroke registered, 30.7% spent more than 50% of their hospital stay in a stroke unit (13.9-65.4%) among centres with a stroke unit available. The percentage of patients assessed by a stroke physician varied between 7.1% and 96.6%. There were significant variations after adjustment for confounders, in the organisation of care across populations. Significantly higher probabilities of survival (p<0.01) were associated with increased organisational care.This European study demonstrated associations between delivery of care and stroke outcomes. The implementation of evidence-based interventions is suboptimal and understanding better ways to implement these interventions in different healthcare settings should be a priority for health systems.
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