Jonas Yeung

Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in Asian patients with large artery occlusive disease: a randomised study

Summary Background Acute stroke patients with large artery occlusive disease (LAOD) have a distinct pathophysiology and may respond differently to anticoagulation treatments. We compared the efficacy of a low-molecular-weight heparin (LMWH), nadroparin calcium, with aspirin in Asian acute stroke patients with LAOD. Methods Acute ischaemic stroke patients with onset of symptoms less than 48 h and LAOD (diagnosed by transcranial doppler imaging, carotid duplex scan, or magnetic resonance angiography) were recruited. Patients were randomly assigned to receive either subcutaneous nadroparin calcium 3800 anti-factor Xa IU/0·4 mL twice daily or oral aspirin 160 mg daily for 10 days, and then all received aspirin 80–300 mg once daily for 6 months. This study is registered at www.strokecenter.org/trials (number 493). Findings Among 603 patients recruited, 353 (180 LMWH, 173 aspirin) had LAOD (300 had intracranial LAOD only, 42 had both intracranial and extracranial disease, and 11 had extracranial disease only). The proportion of patients with good outcomes at 6 months (Barthel index ≥85) was 73% in the LMWH group and 69% in the aspirin group (absolute risk reduction 4%; 95% CI −5 to 13). Analysis of prespecified secondary outcome measures showed a benefit in outcome for LMWH versus aspirin on the modified Rankin scale dichotomised at 0–1 (odds ratio 1·55, 95% CI 1·02–2·35). Haemorrhagic transformation of infarct and severe adverse events were similar in both groups. Post-hoc analyses of patients without LAOD, and all treated patients, showed similar proportions with a good outcome in aspirin and LMWH groups (78% vs 79% and 73% vs 75%, respectively). Interpretation Overall, the results do not support a significant benefit of LMWH over aspirin in patients with LAOD. The benefits indicated in most outcome measures warrant further investigation into the use of anticoagulation for acute stroke in patients with large artery atherosclerosis, particularly in intracranial atherosclerosis.

Cost-effectiveness of subthalmic nucleus deep brain stimulation for the treatment of advanced Parkinson disease in Hong Kong: a prospective study.

BACKGROUND Deep brain stimulation (DBS) is an effective but costly treatment for patients with advanced Parkinson disease (PD). This study examined the cost-effectiveness of DBS in relation to its improved effectiveness to help funding decision makers decide whether the treatment should be adopted. The incremental cost-effective ratio (ICER) per quality-adjusted life year has been benchmarked as being between US

Subthalamic nucleus deep brain stimulation for Parkinson's disease: evidence for effectiveness and limitations from 12 years' experience.

50,000 and US

Eye movement parameters and cognitive functions in Parkinson's disease patients without dementia

100,000 by US agencies, whereas it is less than €30,000 per quality-adjusted life year in Europe. OBJECTIVE To provide cost-effectiveness information of subthalamic nucleus DBS for patients with advanced PD. MATERIALS Direct medical expenses during the year before the DBS treatment were used to measure the baseline cost. Cost-effectiveness was measured by the ICER for the Unified Parkinsons Disease Rating Scale Part III and the ICER for the EuroQol Groups Health-Related Quality of Life measurement. RESULTS Thirteen patients with advanced PD were recruited between January 2009 and January 2011. A 1-point improvement in the Unified Parkinsons Disease Rating Scale Part III score was associated with an ICER of US

Prevalence of neutralising antibodies to interferon-beta and clinical response in Chinese patients with relapsing multiple sclerosis

926 in the first year and US

Herbs and Rehabilitation after Stroke Study: A Multi-center, Double-blinded, Randomized Trial in Hong Kong

421 in the second year. A 1-point improvement on the EuroQol Groups Health-Related Quality of Life measurement was associated with an ICER of US

Special care units for dementia individuals with behavioural problems

123,110 in the first year and US

LRRK2 Gly2385Arg mutation and clinical features in a Chinese population with early-onset Parkinson’s disease compared to late-onset patients

62,846 in the second year. CONCLUSION Cost-effectiveness of subthalamic nucleus DBS for treatment of advanced PD is greater during a 2-year period than 1 year only. These results can be used as a reference for the use of DBS for PD in a region with public health financing.

PARK2 mutations and clinical features in a Chinese population with early-onset Parkinson’s disease

OBJECTIVE To present the result and experience of subthalamic nucleus deep brain stimulation for Parkinsons disease. DESIGN Case series. SETTING Prince of Wales Hospital, Hong Kong. PATIENTS A cohort of patients with Parkinsons disease received subthalamic nucleus deep brain stimulation from September 1998 to January 2010. Patient assessment data before and after the operation were collected prospectively. RESULTS Forty-one patients (21 male and 20 female) with Parkinsons disease underwent bilateral subthalamic nucleus deep brain stimulation and were followed up for a median interval of 12 months. For the whole group, the mean improvements of Unified Parkinsons Disease Rating Scale (UPDRS) parts II and III were 32.5% and 31.5%, respectively (P<0.001). Throughout the years, a multidisciplinary team was gradually built. The deep brain stimulation protocol evolved and was substantiated by updated patient selection criteria and outcome assessment, integrated imaging and neurophysiological targeting, refinement of surgical technique as well as the accumulation of experience in deep brain stimulation programming. Most of the structural improvement occurred before mid-2005. Patients receiving the operation before June 2005 (19 cases) and after (22 cases) were compared; the improvements in UPDRS part III were 13.2% and 55.2%, respectively (P<0.001). There were three operative complications (one lead migration, one cerebral haematoma, and one infection) in the group operated on before 2005. There was no operative mortality. CONCLUSIONS The functional state of Parkinsons disease patients with motor disabilities refractory to best medical treatment improved significantly after subthalamic nucleus deep brain stimulation. A dedicated multidisciplinary team building, refined protocol for patient selection and assessment, improvement of targeting methods, meticulous surgical technique, and experience in programming are the key factors contributing to the improved outcome.

Evidence of improved immediate verbal memory and diminished category fluency following STN-DBS in Chinese-Cantonese patients with idiopathic Parkinson’s disease

BACKGROUND Cognitive deficits and eye movement abnormalities have been demonstrated to be detectable early clinical manifestations of Parkinsons disease. Understanding the relationship between these phenotypes may yield insight into the underlying anatomical pathways, assisting in the search for simple non-invasive markers of early neurodegeneration. OBJECTIVE To explore the correlations between eye movement parameters with multi-domain cognitive functions in patients suffering from Parkinsons disease without dementia. METHOD This is a cross-sectional case-control study of Parkinsons disease patients without dementia. Participants underwent global and domain-specific cognitive tests and an eye-tracking visual search task to characterize eye movement parameters. RESULTS 62 Chinese Parkinsons disease patients without dementia and 62 sex-, age- and education-matched controls were recruited. The disease group performed worse in multiple cognitive tasks and exhibited a smaller saccadic amplitude. Negative correlations between the eye fixation duration and performance in semantic verbal fluency, verbal and visual recognition memory tasks were observed, though there was no moderation effect on the correlations due to the presence of Parkinsons disease. A common cholinergic deficit in the temporal and parietal regions may account for the observed correlations. The lack of association with predominantly frontal-executive tasks may suggest specificity of these correlations. CONCLUSION Prolonged visual fixation duration is correlated with poorer performance in semantic verbal fluency, verbal and visual recognition memory tasks in Parkinsons disease patients without dementia, although these correlations are not specific. The clinical utility of eye movement parameters as an early marker for cognitive decline in Parkinsons disease warrants further exploration in longitudinal studies.