The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

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Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association

The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue

https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000375

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association

Unified Parkinson's Disease Rating Scale

Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention? Methods: The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention Results and Recommendations: The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A) Frovatriptan is effective for prevention of menstrual migraine (Level A) Lamotrigine is ineffective for migraine prevention (Level A)

https://n.neurology.org/content/neurology/78/17/1337.full.pdf

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society

Clinical profile of Monomelic Amyotrophy (MMA) and role of persistent viral infection

A change in sleep patterns often accompanies the onset of adolescence. Declining parental involvement in bedtime routines, increasing academic pressure, emergence of several distracters such as social media, Internet, electronic gadgets and cell phones have contributed in the shift towards later bedtimes from pre-adolescent to adolescent years. As a result, sleep debt accumulates over time leading to sleep deprivation which can have disastrous consequences on the physical, emotional and cognitive functioning of the individual. Chronic sleep deprivation leads to insufficient sleep which is major sleep problem faced by adolescents today. Sleep assessment is done using subjective and objective methods. Subjective methods include clinical sleep history taking which include physical examination, psychosocial history, interviews regarding bedtime routines and nocturnal behaviour. Several parent rated and self-rated questionnaires are also used for screening sleep disorders such as sleep-related breathing difficulties, restless legs syndrome, delayed sleep phase syndrome and narcolepsy. Objective methods include sleep diaries/sleep logs, actigraphy, polysomnography and multiple sleep latency tests. Early intervention at the school level (pre-adolescent stage) is important for inculcating healthy sleep habits. Sleep education during early years can help prevention of sleep problems as many of these problems are maintained due to maladaptive sleep hygiene practises. This chapter focuses on adolescent sleep struggles specifically insufficient sleep and discusses intervention strategies which include sleep education, stimulus control and sleep hygiene, troubleshooting adolescent’s difficulties in adhering to treatment guidelines, barriers to treatment followed by conclusions and future directions.

Management of Sleep Problems

An otherwise healthy 35-year-old woman presented with a 1-year history of headache, a holocranial dull ache with 1 to 2 episodes per month, each lasting 1 to 2 hours. There was no photophobia, phonophobia, nausea, vomiting, fever, seizure, or loss of consciousness. In the month before presentation, headache became severe and continuous. Neurologic examination revealed bilateral papilledema. MRI showed multiple intraventricular neurocysticercal cysts in the fourth and right lateral ventricles with scolices (figures 1 and 2). Such a finding has been reported rarely in the literature.1 Treatment options include surgery (ventriculostomy or shunt; cystectomy) or medical management (cysticidal agents, corticosteroids, antiepileptic drugs).2

https://n.neurology.org/content/neurology/81/10/936.full.pdf

Multiple intraventricular neurocysticerci

Objective: Obstructive sleep apnea (OSA) is commonly found in patients with stroke; however, most of these patients are undiagnosed because they do not seekhelp for the same. As part of a prevalence study, we conducted polysomnography (PSG) recordings in consecutive patients of stroke presenting to our department. We conducted this comparative study to assess for any clinical and PSG differences between these patients and those directly presenting to our sleep disorders clinicfor OSA. Methods: We analyzed various clinical and PSG features of consecutive patients of stroke with sleep-disordered breathing admitted between September 2009 and February 2010 consecutively.PSG was carried out after 6 weeks or more of the stroke for all patients. An equal number of patients presenting with sleep apnea at our sleep disorders clinic, during the same period, formed the control population. Results: We included 12 male patients of stroke with sleep-disordered breathing[apnea– hypopnea index (AHI) >5] on PSG and compared them with 12 male patients who had presented for OSA, confirmed on PSG (AHI>5).We found no significant difference in sleep architecture and respiratory parametersbetween these two groups. However, we found more patientswith body mass index of>24 kg/m2among those seeking help for OSA (n=8) versus those with stroke and OSA (n=3). The former also had significantly higher Epworth sleepiness scale score(p =0.006). ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Clinical and polysomnographic features of patients with OSAHS versus patients of stroke detected to have OSA

Address for correspondence Dr. Garima Shukla Associate Professor, Dept. of Neurology Room # 2, 6th Floor, Neurosciences Center All India Instt. of Medical Sciences, New Delhi 29 Phone: +91 11 26593785 Fax: +91 11 26588166 Email: garimashukla@hotmail.com Sleep-disordered breathing (SDB) is being increasingly recognized as a vascular risk factor implicated in the whole spectrum of vascular diseases ranging from coronary heart disease and congestive cardiac failure to hypertension and stroke. It is important not only with respect to the magnitude of risk it raises, but also as an effectively treatable risk factor. In the instance of cerebrovascular disease, the evidence has moved from the initial dilemma of SDB as cause or consequence of stroke to that of a definitive risk requiring appropriate means of therapy. In the following review we will be discussing the weight of evidence linking SDB with cerebrovascular disease, and the issues pertaining to evidences generated by treatment trials.

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Garima Shukla

Papers

Clinical profile of Monomelic Amyotrophy (MMA) and role of persistent viral infection

Management of Sleep Problems

Multiple intraventricular neurocysticerci

Clinical and polysomnographic features of patients with OSAHS versus patients of stroke detected to have OSA

Recognizing the importance of sleep-disordered breathing in cerebrovascular disease - an update