22. European Stroke Conference 582 © 2013 S. Karger AG, Basel Scientific Programme 19 Rehabilitation and reorganisation after stroke Combined Transcranial Direct Current Stimulation and Virtual Reality of Arm Training in Stroke Patients S.J. Lee1, M.H. Chun2, J.H. Yi3 Asan Medical Center, Seoul, SOUTH KOREA1, Asan Medical Center, Seoul, SOUTH KOREA2, Asan Medical Center, Seoul, SOUTH KOREA3 Objective Cathodal transcranial direct current stimulation (tDCS) may have implications as an adjuvant ther-apy for the upper arm after stroke. Virtual reality (VR) allows users “real time” feedback on perfor-mance, which could be used for upper arm improvement after stroke. Brain stimulation using tDCS, in combination with VR which facilitates to use arm movement, may be a new treatment option to promote arm function. The aim of this study is to investigate the effect of combined tDCS and VR therapy of arm training in subacute stroke patients. Methods Forty five patients with subacute stroke were enrolled. All patients were randomly assigned to one of three groups; Group A: combined cathodal tDCS and VR, Group B: VR only group, Group C: tDCS only group. tDCS was done using Phoresor II Auto Model PM850. VR was done using VR system. In group A, cathodal tDCS was applied simultaneously during VR therapy. Manual motor test (MFT), Fugl-Meyer scale (FMS), Box and block test was used to assess arm and hand function. To evaluated activity of daily living, modified Barthel index (MBI) was used. All evaluations were measured in all subjects before and immediately after treatment. Results After treatment, all groups showed significant improvements in MFT, FMS, and MBI. The three groups showed a slight increase in Box and block test, however, only group A showed statistical significance. When treatment effects were compared among the three groups, MFT and FMS were significantly higher in group A than the other two groups. Post hoc test showed that the treatment ef-fects of MFT and FMS were higher in group B than group C. Conclusion Our results show beneficial effect of VR and tDCS on upper extremity function in patients with subacute stroke. Combined tDCS and VR therapy is safe, and easy to apply in a clinical setting. We suggest that this combination therapy would be a helpful method to enhance motor function of arm in patients with subacute stroke. 18 Rehabilitation and reorganisation after stroke Prediction of early ischemic stroke recurrence with multiparametric perfusion markers in symptomatic large artery disease E.B. Cho1 Samsung Medical Center, SEOUL, SOUTH KOREA1 BACKGROUND Ischemic stroke secondary to large artery atherosclerosis has more early recurrence compared to oth-er stroke subtypes. Using perfusion imaging, we sought to predict the early stroke recurrence, within 90 days after index stroke, in patients with large artery atherosclerosis stroke. METHODS Among 798 consecutive patents admitted from January 2009 to March 2012 within 72 hours of symptom onset, we reviewed 170 patients with large artery atherosclerosis stroke. Patients with an-terior circulation stroke were included for reliable visual assessment of intracranial perfusion status. Early stroke recurrence was defines clinical incident that is clearly attributable to a new area of brain infarction visualized by imaging as spatially distinct from the index lesion. Cox regression analysis was used to identify clinical and imaging predictors of recurrent stroke. The ROC curve analysis was performed for the significant predictors from multivariate Cox regression model. RESULTS Of one hundred one patients included, 17 (15.3%) developed stroke recurrence within 90 days after index stroke. In the univariate Cox regression analysis, diabetes mellitus (Hazard ratio HR 2.50, 95% Confidence interval CI 0.92-6.76), hyperintense vessel on FLAIR(HR 4.71, 95% CI 1.53- 14.46), dark vessel sign on gradient-echo (GRE) (3.08, 1.17-8.09), Time to peak (TTP) delay (8.10, 1.07-61.09), increased cerebral blood volume (CBV) (12.20, 1.62-92.12) and cerebral blood flow (CBF) (7.08,1.62-31.01) might correlate with early stroke recurrence. In the multivariate analysis, diabetes mellitus (3.05, 1.12-8.28, p=0.029), and hyperintense vessel on FLAIR (4.71,1.38-13.31, p=0.012) were identified as predictors of early stroke recurrence. The AUC was 0.62 (95% CI 0.47- 0.76) for diabetes and 0.69 (95% CI 0.55-0.82) for the presence of hyperintense vessel on FLAIR. The sensitivity/specificity of each predictor was 0.65/0.58 for diabetes and 0.76/0.61 for hyperin-tense vessel on FLAIR. CONCLUSION The presence of diabetes mellitus and hyperintense vessel on FLAIR in the acute setting may be good indicators of early stroke recurrence.
Karger_ESC London_2013
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