The circaseptan variation of stroke onset – a hospital-based study

Introduction. Circaseptan or weekly rhythm, despite not belonging to terrestrial rhythms and being a conventional one, influences the incidence of stroke through short-term lifestyle changes. Objectives. To investigate the presence of a weekly variation pattern in the onset of cerebrovascular pathology in patients admitted to Neurology Departments I and II of the County Hospital Cluj-Napoca over the course of 2012. Material and method. The study is based on demographic data, data referring to the day of onset, the type of stroke and the subtype of ischemic stroke, collected retrospectively from the observation sheets of 1083 patients with stroke admitted through the Emergency Room to Neurology Departments I and II of the County Hospital Cluj-Napoca. Diagnosis was defined according to updated World Health Organization criteria and the Trial of ORG 10172 in Acute Stroke Treatment Classification. Results and conclusions. The circaseptan variation of stroke onset reveals two incidence peaks, one over the weekend continuing through Monday, and one in the middle of the week. Age, sex and the type/subtype of stroke enhances one of these peaks

The evolution of disability after ischemic stroke depending on the circadian variation of stroke onset

Introduction. The circadian variation of ischemic stroke onset is known, but its impact on recovery prognosis has been less studied. Materials and method. The study included 32 patients with ischemic stroke, admitted to Neurology Departments I and II of the Rehabilitation Hospital in Cluj-Napoca between 1 June 2008 and 31 December 2009 and followed up for 2 years, during 5 successive admissions. The diagnosis of ischemic stroke was defined according to updated World Health Organization criteria. The onset time of ischemic stroke was assigned to one of the following six-hour intervals: 00.01-06.00 (night), 06.01-12.00 (morning), 12.01-18.00 (afternoon) and 18.01-24.00 (evening). For each patient we recorded demographic data and the values of ADL and IADL scales on the occasion of each assessment. Statistical analysis was performed using Excel Microsoft, descriptive and one-way ANOVA test. Results and conclusions. Our study confirms the incidence pattern of ischemic stroke, with a morning peak, which is more obvious in the case of the male sex and patients aged less than 65 years. Patients with nocturnal stroke onset have a less favorable functional evolution during the second year after ischemic stroke

The influence of circadian variation in ischemic stroke onset on the evolution of the severity of the clinical picture and disability

Introduction. The chronobiology of ischemic stroke describes an occurrence pattern with the highest incidence in the morning according to most literature reports, but its influence on the evolution of the severity of the neurological picture and functional status is little studied. Materials and method. This cohort study included 63 patients with ischemic stroke admitted to the Neurology Departments I and II of the Rehabilitation Hospital in Cluj-Napoca between 1 June 2008 and 1 June 2009, who were followed up for 2 years by 5 successive evaluations. The onset time of ischemic stroke was assigned to one of the six hours intervals: 00.01- 06.00 (night), 06.01-12.00 (morning), 12.01-18.00 (afternoon) and 18.01-24.00 (evening). For each patient, the National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores were recorded on the occasion of each evaluation. Statistical analysis was performed using Excel Microsoft, descriptive and ANOVA test. Results and conclusions. Our study confirms the incidence pattern of ischemic stroke with a morning peak, which is more obvious in the case of patients aged less than 65 years. Patients with stroke onset in the nocturnal interval have a less favorable neurological and functional evolution during the second year after ischemic stroke

Music as Add-On Therapy in the Rehabilitation Program of Parkinson’s Disease Patients—A Romanian Pilot Study

Music has been proven to have therapeutic potential in neurological disorders, especially Parkinson’s disease (PD), since rhythmic auditory cueing can partially replace the progressive loss of rhythmicity and automaticity. Several reports have highlighted improvements in motor outcomes in PD patients undergoing music therapy, but only a few studies have evaluated non-motor outcomes, such as quality of life (QoL), which deteriorates with disease progression. The current pilot study aims to examine the effects of a multimodal rehabilitation program centered on physical therapy combined with listening to music on self-reported QoL in people with PD, compared to the same rehabilitation program alone. The study was conducted on patients with idiopathic PD who attended a specific rehabilitation program with a duration of 2.5 h daily for 14 days. The patients were divided into the study group (16 patients), who listened to background music during the rehabilitation program sessions, and the control group who did not listen to music during sessions. The patients were assessed using the self-report Parkinson’s Disease Questionnaire (PDQ-39) at the beginning of the program and 1 month after its initiation. The patients in the study group registered greater improvements in five of the eight areas of life assessed by PDQ-39 compared to the control group. In conclusion, listening to music combined with a multimodal rehabilitation program centered on physical therapy may be beneficial for the patients’ quality of life

Seasonal variation of stroke occurrence: a hospital based-study

Introduction. Cerebrovascular events are not randomly distributed over time. In addition to the better known circadian variation, a seasonal variation in stroke occurrence is described in different reports. The aim of our study was to investigate whether stroke with its types follows a seasonal occurrence pattern in the Cluj-Napoca area. Materials and method. The stroke event data were collected from the patient records of a consecutive series of 1083 patients admitted through the Emergency Room to the Neurology Departments I and II of the County Hospital Cluj-Napoca, between 1 January 2012 and 31 December 2012. The diagnosis of ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage was confirmed by neurologic examination and neuroimaging, according to updated World Health Organization criteria. The onset time was assigned to one of the four seasons: spring (March to May), summer (June to August), autumn (September to November) and winter (December to February). Statistical analysis was performed using Excel Microsoft. Results. All three types of stroke (ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage) showed a seasonal variation in their occurrence, with two peaks in the winter and in the summer. Conclusion. The knowledge of the seasonal variation pattern of stroke occurrence could provide a basis for preventive and therapeutic strategies in cerebrovascular patholog

Implications of Circadian Rhythm in Stroke Occurrence: Certainties and Possibilities

Stroke occurrence is not randomly distributed over time but has circadian rhythmicity with the highest frequency of onset in the morning hours. This specific temporal pattern is valid for all subtypes of cerebral infarction and intracerebral hemorrhage. It also correlates with the circadian variation of some exogenous factors such as orthostatic changes, physical activity, sleep-awake cycle, as well as with endogenous factors including dipping patterns of blood pressure, or morning prothrombotic and hypofibrinolytic states with underlying cyclic changes in the autonomous system and humoral activity. Since the internal clock is responsible for these circadian biological changes, its disruption may increase the risk of stroke occurrence and influence neuronal susceptibility to injury and neurorehabilitation. This review aims to summarize the literature data on the circadian variation of cerebrovascular events according to physiological, cellular, and molecular circadian changes, to survey the available information on the chronotherapy and chronoprophylaxis of stroke and its risk factors, as well as to discuss the less reviewed impact of the circadian rhythm in stroke onset on patient outcome and functional status after stroke