22. European Stroke Conference 825 Rehabilitation and reorganisation after stroke Hemorrhagic stroke and epilepsy: prevalence and associated factors in patients with severe brain injuries. S. Micheli1, F. Corea2, P. Brustenghi3, E. Todeschini4, S. Baratta5, M. Zampolini6, F. Pezzella7 S.C. Riabilitazione Intensiva Neuromotoria, Trevi, ITALY1, Brain Injury and Stroke Unit, San Giovanni Battista Hospital, Foligno, ITALY2, Brain Injury and Stroke Unit, San Giovanni Battista Hospital, Foligno,, ITALY3, S.C. Riabilitazione Intensiva Neuromotoria, Trevi, ITALY4, S.C. Riabil-itazione Intensiva Neuromotoria, Trevi, ITALY5, Brain Injury and Stroke Unit, San Giovanni Battis-ta Hospital, F., ITALY6, Neurofisiologia, San Matteo Hospital, Spoleto, ITALY7 Background: Stroke and is the leading cause of severe brain injuries in patients admitted in Rehabil-itation. Epilepsy is the leading co-morbidity to interfere with the recovery process. Methods: We retrospectively reviewed the prevalence of epilepsy in patients admitted in our Depart-ment (year 2011) with a prolonged comatose state at onset and thereby classified as Severe Brain Injuries (SBI). All patients underwent to clinical evaluation, standard EEG monitoring and neuroim-aging 782 © 2013 S. Karger AG, Basel Scientific Programme investigation. Results: There were 61 patients with SBI (mean LCF: 5; mean age 55 years) admitted during the study period; 16 had a clinical diagnosis of epilepsy. Spontaneous cerebral hemorrhage with sur-gical treatment was the most frequent condition associated to seizures (n=5), followed by ischemic stroke (n=3), infection (n=3), TBI (traumatic brain injuries n=2), cancer (n=1), cardiac arrest (n=1); mielinolisis of pons (n=1). The more frequent type of epilepsy was generalized convulsive (62%); 5 patients had simple partial seizures, and 1 had complex partial seizures. The prevalence of epilepsy in the traumatic brain injury group was 11% while in the hemorrhagic stroke group was 37% (chi square test p<0.05). The majority of patients with epilepsy required a multiple antiepileptics drugs for seizures control. Levetiracetam and Valproic acid were the most used drugs. Conclusions: Our clinical record confirm the remarkable prevalence of epilepsy in SBI compared to general stroke case-series and the relevance of the association between cerebral hemorrhages and epilepsy. Surgical evacuation and cortical involvement represent further risk factors. 826 Rehabilitation and reorganisation after stroke Access visits: Results from the HOme VIsit after Stroke (HOVIS) Study N. Sprigg1, A. Compton2, C. Edwards3, K. Fellows4, P. Whitehead5, A Drummond6 University of Nottingham, Nottingham, UNITED KINGDOM1, University of Nottingham, Not-tingham, UNITED KINGDOM2, University of Nottingham, Nottingham, UNITED KINGDOM3, University of Nottingham, Nottingham, UNITED KINGDOM4, University of Nottingham, Notting-ham, UNITED KINGDOM5, University of Nottingham, Nottingham, UNITED KINGDOM6 Background An access visit (AV) to the patient’s home is completed by the Occupational Therapist (OT) to as-sess the environment, usually for discharge planning, and is sometimes referred to as an environ-mental visit. In contrast to home visits (HV), patients are not present on access visits. The aim of this study was to identify current practice in relation to access visits for people with stroke and ex-plore professional views of them. Method Multi-modal study: Postal questionnaire and semi-structured interviews from the HOme VIsit after Stroke (HOVIS) Study (ISRCTN62250268). We surveyed lead OTs in 184 stroke units in England via postal questionnaire. Stroke units were asked how many AVs had been performed in comparison to HVs over a 2 month period (mean, stan-dard deviation- SD). Semi-structured interviews were completed firstly with 6 experts (UK and Australia) and secondly with 20 senior OTs working with stroke in-patients, from a range of UK locations. The interviews explored their views regarding pre-discharge HVs and AVs. The interviews were analysed using the-matic analysis. Results Responses were analysed from 85 stroke units (47%) from ten regions across England. The mean number of AVs performed in 2 months per unit was 7.2 (SD 8.4) compared to 7.1 (mean 6.3) HVs. Rehabilitation units performed similar numbers of HVs (11.8, SD 7.7) and AVs (11.4, SD 10.3). Acute stroke units performed fewer visits overall, but more AVs (3.9, SD 5.6) than HVs (2.5, SD 4.1). Qualitative themes identified that AVs inform therapy goals early in the patient journey, especially for dependent patients needing equipment. AVs can be either a precursor or alternative to HVs, as some patients are not appropriate for HV. Reservations exist about performing AVs instead of HVs in patients suitable for HV, sacrificing quality of care for cost savings. Conclusion The results suggest that Avs are commonly performed after stroke, at least as frequently as HVs. However there is currently a lack of evidence for cost effectiveness of HV or AV.
Karger_ESC London_2013
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