Smi Choi-Kwon

Poststroke depression and emotional incontinence Correlation with lesion location

Objective: To correlate the location of stroke with poststroke depression (PSD) and emotional incontinence (PSEI). Methods: The authors prospectively studied 148 patients (94 men and 54 women, mean age 62 years) with single, unilateral stroke (126 infarcts and 22 hemorrhages) at 2 to 4 months poststroke with regard to the presence of PSD (using Diagnostic and Statistical Manual of Mental Disorders IV criteria and Beck Depression Inventory) and PSEI. The lesion location was analyzed by CT or MRI. Results: Twenty-seven patients (18%) had PSD and 50 (34%) had PSEI. The presence of PSD and PSEI was not related to the nature, laterality, or size of the lesion. The frequency of PSEI, but not of PSD, was higher in women than in men and in ischemic rather than hemorrhagic stroke (p < 0.05). Although both PSD and PSEI were related to motor dysfunction and location (anterior versus posterior cortex) of the lesion, location was a stronger determinant for PSD (p < 0.05). The prevalence of PSD/PSEI in each location was 75%/100% in frontal lobe of anterior cerebral artery territory, 50%/0 in temporal lobe, 30%/40% in frontal–middle cerebral artery territory, 13%/0 in occipital lobe, 19%/45% in lenticulocapsular area, 11%/16% in thalamus, 16%/53% in pontine base, 36%/55% in medulla, and 0/22% in cerebellum. Parietal and dorsal pontine lesions were not associated with PSD or PSEI. PSEI was more closely associated with lenticulocapsular strokes than was PSD (p < 0.01). Conclusion: Development of PSD and PSEI is strongly influenced by lesion location, probably associated with the chemical neuroanatomy related to the frontal/temporal lobe–basal ganglia–ventral brainstem circuitry. Although the lesion distribution is similar, PSEI is more closely related to lenticulocapsular strokes than is PSD.

Poststroke Fatigue: Characteristics and Related Factors

Background and Purpose: Poststroke fatigue (PoSF) is a common, but poorly studied problem. The purpose of the present study was to elucidate the characteristics of and the factors associated with PoSF. Methods: We studied 220 consecutive outpatients at an average of 15 months after the onset of stroke. The presence of poststroke depression (PSD) and poststroke emotional incontinence were identified with the use of a standardized questionnaire. The presence of PoSF was assessed using the visual analogue scale and Fatigue Severity Scale. The presence of prestroke fatigue (PrSF) was also assessed. The impact of PoSF on patients’ daily activities was also assessed using the Fatigue Impact Scale. Results: One hundred and twenty-five patients (57%) had PoSF, 83 (38%) had PrSF and 53 (24%) had PSD. Thirty-six percent of the patients without PrSF and 50% of the patients without PSD had PoSF. The impact of PoSF on patients’ daily activities was more severe in the physical domain as compared with the psychological or cognitive domains (p < 0.01). Multivariate analyses showed that the presence of PrSF (p < 0.01, OR 33.5), high modified Rankin scale (MRS; p < 0.05, OR 3.3), PSD (p < 0.05, OR 2.7) were independently associated with PoSF. Cessation of cigarette smoking (p < 0.05) and the presence of PrSF (p < 0.01) were independently related to PoSF in patients without PSD while decrease in sexual activities (p < 0.05) and the presence of dysarthria (p < 0.05) were related to PoSF in patients without PrSF. Conclusions: Fatigue is a fairly common sequela of stroke patients, exerting an impact on their daily activities, especially physical ones. PrSF is the most important factor related to PoSF, followed by high MRS and PSD. Nevertheless, the causes of PoSF appear multifactorial. Strategies to improve the PoSF should be individualized according to the causative factors.

Factors affecting the quality of life in patients with epilepsy in Seoul, South Korea

Objectives – The level of, and factors affecting the quality of life (QOL) in patients with epilepsy may be different in Korea where social prejudice toward them is still pronounced. However, these issues have not yet been addressed properly.

Fluoxetine Treatment in Poststroke Depression, Emotional Incontinence, and Anger Proneness A Double-Blind, Placebo-Controlled Study

Background and Purpose— The efficacy and safety of the selective serotonin reuptake inhibitor fluoxetine have rarely been studied in the treatment of poststroke emotional disturbances. Methods— Stroke patients (152) who had poststroke depression (PSD), emotional incontinence (PSEI), or anger proneness (PSAP) were studied. PSD was evaluated by Beck Depression Inventory and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PSEI by Kim’s criteria, and PSAP was assessed by Spielberger Trait Anger Scale. Subjects were randomly given either fluoxetine 20 mg/day (n=76) or placebo (n=76) for 3 months. Follow-up evaluations were done 1, 3, and 6 months after the beginning of the treatment. The primary outcome measurement was the scores of emotional disturbances at each follow-up assessment. The secondary outcome measurements were the percentage changes of the scores and the subjective responses of the patients. Results— Although patients in the fluoxetine group more often dropped out because of adverse effects, fluoxetine administration was generally safe. Fluoxetine significantly improved PSEI and PSAP, whereas no definitive improvement of PSD was found. Improvement of PSAP was noted even at 3 months after the discontinuation of the treatment. Conclusions— Fluoxetine is efficacious in the treatment of PSEI and PSAP. Its effect on PSD is not solidly confirmed.

Poststroke Fatigue: An Emerging, Critical Issue in Stroke Medicine:

Poststroke fatigue is a common and disabling condition. However, few studies on or therapeutic trials addressing poststroke fatigue have appeared in the literature. We aimed to review the prevalence, natural course, potential predisposing factors (physiological, psychocognitive, and organic), and pharmacological and nonpharmacological treatments of poststroke fatigue. Using PubMed CINAHL and PsycINFO, we reviewed all the available literature on poststroke fatigue and related issues. The prevalence of poststroke fatigue ranges from 23% to 75%, depending on the definition of fatigue and the characteristics of the patients included. Post-stroke fatigue seems to be of complex etiology. Predisposing factors were physiological ones including functional disability, prestroke fatigue, medical comorbidities, medication, sleep disturbances, and nutritional problems; psychocognitive ones including depression and cognitive dysfunction; and organic ones including damage to particular brain areas with consequent neurochemical alterations, perfusion deficit, and neuroinflammation. Poststroke fatigue is a persistent and debilitating symptom in some patients, and can have adverse affects on patients neurological recovery, quality of life, and mortality. Few therapeutic trials have been reported, and the therapy was rarely successful, possibly because of the complex nature of poststroke fatigue. Poststroke fatigue is a common and frequently disabling problem of complex etiology. Further studies are urgently needed to improve our understanding of the pathophysiology of post-stroke fatigue and to develop better treatments for this condition.

Fluoxetine Is Not Effective in the Treatment of Poststroke Fatigue: A Double-Blind, Placebo-Controlled Study

Background and Purpose: Although poststroke fatigue (PoSF) is common, pharmacological interventions to improve PoSF have rarely been carried out. The purpose of the present study was to evaluate the therapeutic effect of fluoxetine on PoSF. Methods: We studied 83 consecutive outpatients with PoSF at an average of 14 months after the onset of stroke. The presence of poststroke depression, poststroke emotional incontinence and poststroke anger proneness was also evaluated with the use of a standardized questionnaire. The presence of PoSF and prestroke fatigue was assessed. The visual analogue scale (VAS) and Fatigue Severity Score (FSS) were used to assess PoSF. The subjects were given either 20 mg/day of fluoxetine (n = 40) or placebo (n = 43) for 3 months. Follow-up evaluations were done 3 and 6 months after the beginning of the treatment. Results: The initial mean fatigue VAS score and the mean overall FSS score were 5.4 ± 2.0 and 4.4 ± 1.2, respectively. There were no differences in the number of patients with PoSF between the fluoxetine group and the placebo group at 3 and 6 months after the treatment. The percent changes in VAS scores and FSS at all follow-up assessments were not significantly different either. However, fluoxetine significantly improved poststroke emotional incontinence (p < 0.05) and poststroke depression (p = 0.05) in the patients with PoSF. Conclusions: Fluoxetine does not improve PoSF, although some concomitant emotional disturbances improved significantly. Our results suggest that PoSF may be associated with diverse etiologies but not closely related to serotonergic dysfunction. Further studies are required to elucidate the causative factors and to find an appropriate treatment for PoSF.

Familiarity with, knowledge of, and attitudes toward epilepsy in residents of Seoul, South Korea

Background and purpose – The aim of this study was to investigate the perceptions of epilepsy in Seoul, South Korea, a country where social stigma toward epilepsy is still pronounced.

Poststroke Emotional Incontinence and Decreased Sexual Activity

Background: Although poststroke depression has been shown to be related to decreased sexual activity (SA), the relationship between poststroke emotional incontinence (EI) and SA has not been properly investigated. Methods: We examined 70 nondepressed, sexually active patients with first-ever stroke approximately 3 months after stroke and conducted a follow-up interview approximately 2 years after stroke in 55 of them. EI (excessive/inappropriate laughing/crying) and SA (libido, coital frequency, erectile function) were assessed with the use of a standardized questionnaire. Results: Of these 70 patients, 24 (34%) had EI 3 months after stroke, which had resolved 2 years after stroke. Libido, coital frequency and erectile function were reported to have declined in 49, 65 and 26% of the patients, respectively, 3 months after stroke, and in 44, 49 and 20% of the patients 2 years after stroke. Multivariate analyses showed that low coital frequency before stroke (CFBS) was significantly (p < 0.05) related to decreased poststroke coital frequency, while the presence of EI (p < 0.05) and low CFBS (p < 0.05) was significantly associated with decreased erectile function 3 months after stroke. Two years after stroke, the presence of EI 3 months after stroke was significantly related to decreased libido, coital frequency and erectile function (p < 0.05 each). Age, gender, laterality of stroke, Barthel Index score, motor dysfunction and the presence of hypertension and diabetes mellitus were not independently related to SA 3 months and 2 years after stroke. Conclusion: The presence of EI is a factor related to decreased poststroke SA, more so in chronic than in subacute stages.

Poststroke depression and emotional incontinence Factors related to acute and subacute stages

Objectives: To investigate the characteristics and prevalence of poststroke depression (PSD) and poststroke emotional incontinence (PSEI) and the factors related to these conditions at admission and 3 months after stroke. Methods: We evaluated 508 consecutive patients with acute ischemic stroke for PSD and PSEI at admission and 3 months later. PSD was evaluated using the Beck Depression Inventory, and PSEI was evaluated using Kims criteria. Blood samples were collected and genotyped for the promoter region of the serotonin transporter protein (5-HTTLPR) and the number of tandem repeats within intron 2 (STin2 VNTR). Perceived social support (the ENRICHD Social Support Inventory) was also measured. Results: PSD and PSEI were present in 13.7% and 9.4% of patients, respectively, at admission and in 17.7% and 11.7%, respectively, at 3 months after stroke. Multivariate analyses showed that PSD at admission was associated with the NIH Stroke Scale score at admission (p < 0.001), whereas PSD at 3 months was associated with the presence of microbleeds (p < 0.01) and perceived low social support (p < 0.001). In contrast, only lesion location (p = 0.022) was associated with PSEI at admission, whereas modified Rankin Scale score (p = 0.019), STin2 VNTR (p = 0.040), and low social support (p = 0.042) were related to PSEI 3 months after stroke. Conclusions: Diverse factors such as neurologic dysfunction, lesion location, microbleeds, genetic traits, and social support are differently related to acute and subacute emotional disturbances. Strategies to prevent or manage these problems should consider these differences.

Dietary supplementation of (+)-catechin protects against UVB-induced skin damage by modulating antioxidant enzyme activities

Purpose: The aim of this study was to investigate the effects of dietary supplementation with (+)‐catechin on cutaneous antioxidant enzymes and the skin damage caused by UVB irradiation.