Mansur A. Kutlubaev

Part II: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies

Background We previously published a systematic review in 2005 on factors associated with the development of depression in people with stroke. Aim To update and expand that review to include published data on the impact of depression on stroke outcome. Methods We included all published observational studies (to May 31, 2013) with prospective consecutive recruitment of people with a clinical diagnosis of stroke where an attempt was made to assess the variables associated with, or predictive of, the development of depression. Results We included data from 23 studies including 18 374 people. Depression after stroke was associated with prestroke depression, more severe neurological deficit and physical disability in the acute phase, and later after stroke. No consistent relationship between depression and demographic parameters or stroke features was identified. The review of the impact of depression on stroke outcome included data from 14 cohorts, including 4498 people, and found that depression was negatively associated with functional outcome in stroke survivors. Conclusions Early identification of patients at high risk of depression after stroke, those with a history of depression and physical disability after stroke, would enable the early implementation of effective management and prevention strategies for depression. The reciprocal relationship between depression and physical disability highlights the need for interventions that reduce disability after stroke, which may in turn improve mood and overall recovery for an increasingly large number of stroke survivors.

Selective Serotonin Reuptake Inhibitors for Stroke Recovery A Systematic Review and Meta-analysis

Each year, about 16 million people in the world experience a first-ever stroke. Of these, about 5.7 million die and another 5 million remain disabled.1 Although there are effective treatments that restore brain perfusion and minimize complications and recurrent stroke, there is no treatment proven to facilitate neurological recovery after stroke. A recent small trial demonstrated that the selective serotonin reuptake inhibitor (SSRI) fluoxetine, commonly used to treat depression, improved motor recovery and reduced dependency after stroke when given to people without depression.2 Experimental studies reporting neurogenic and neuroprotective effects of SSRIs3,4 provide a plausible mechanism of action. Our objective was to systematically review and perform a meta-analysis of all (published and unpublished) randomized controlled trials of SSRI compared with control, given within the first year of stroke, to determine the effect on dependency, disability, and other important clinical outcomes. ### Searches and Study Selection Extensive literature searches were performed between August 2011 and March 2012 (see Data in online-only Data Supplement); this included searching the gray literature. Two review authors scrutinized the searches of Cochrane Stroke Group, CENTRAL, CCDAN and the trials registers, and applied inclusion criteria. One review author scrutinized the other searches and applied inclusion criteria. We included all randomized controlled trials in patients with a clinical diagnosis of stroke, in which SSRIs were given within the first year of stroke, for any clinical indication. The control arm included usual care or a placebo. Any drug classified as an SSRI (for example fluvoxamine, fluoxetine, sertraline, citalopram, escitalopram, and paroxetine) given at any dose, by any mode of delivery, was included. Drugs with mixed effects were not included. Two review authors independently extracted data, except for papers in Chinese, for which 1 review author extracted data. ### Outcomes The primary outcomes were dependence and disability. The secondary outcomes were neurological …

Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies

PURPOSE To determine the frequency of false positive diagnoses of epilepsy and to explore its imitators and consequences. METHOD A systematic review of all published observational studies (to November 2015) was conducted to determine the proportion of false positive diagnoses of epilepsy. We included studies of people of all ages receiving a diagnosis of epilepsy. All observational study designs were included with the exception of case-reports and case series with fewer than 3 participants. RESULTS Data were available from 27 studies (31 reports), reporting considerably varied frequencies of false positive diagnoses. The frequency of false positive diagnosis range from 2% to 71%. The data also suggest that syncope and psychogenic non-epileptic paroxysmal events were the commonest imitators of epilepsy. Misdiagnosis led to mismanagement with anti-epileptic drugs (AEDs) and affected legal driving status and employment. CONCLUSIONS False positive diagnosis of epilepsy is common, even though there is considerable heterogeneity across studies. All potential imitators should be considered and clinicians should be cautious introducing AEDs without a definite diagnosis given the risk of side effects, and the possible impact on legal driving status and employment.

Fatigue after stroke – perspectives and future directions

Fatigue is a common consequence of stroke and adversely affects long-term outcomes. It is associated with a number of psychological and biological factors. Nevertheless, its mechanisms are not well understood. There may be subtypes of post-stroke fatigue e.g. primary and secondary, subjective fatigue and activity-dependent fatigability – but further research is needed to determine whether such subtypes exist. There is very limited evidence for treatment of fatigue after stroke. Psychosocial treatments and physical activity are promising method for its management. Other potentially effective treatment options include mind-body interventions, and use of psychostimulants. More research is needed in this area.

One step closer to understanding poststroke fatigue

Pathologic fatigue is common in neurologic disorders and can be defined as “a state of weariness unrelated to previous exertion levels which is usually not ameliorated by rest.”[1][1] A case definition for poststroke fatigue (PSF) has been developed,[2][2] based on this definition,[1][1] to