Stroke clinical registries are critical for systems planning, quality improvement, advocacy and informing policy. We describe the methodology and evolution of the Registry of the Canadian Stroke Network/Ontario Stroke Registry in Canada.

At the launch of the registry in 2001, trained coordinators prospectively identified patients with acute stroke or transient ischemic attack (TIA) at comprehensive stroke centers across Canada and obtained consent for registry participation and follow-up interviews. From 2003 onward, patients were identified from administrative databases, and consent was waived for data collection on a sample of eligible patients across all hospitals in Ontario and in one site in Nova Scotia. In the most recent data collection cycle, consecutive eligible patients were included across Ontario, but patients with TIA and those seen in the emergency department without admission were excluded.

Between 2001 and 2013, the registry included 110,088 patients. Only 1,237 patients had follow-up interviews, but administrative data linkages allowed for indefinite follow-up of deaths and other measures of health services utilization. After a hiatus, the registry resumed data collection in 2019, with 13,828 charts abstracted to date with a focus on intracranial vascular imaging, identification of intracranial occlusions and treatment with thrombectomy.

The Registry of the Canadian Stroke Network/Ontario Stroke Registry is a large population-based clinical database that has evolved throughout the last two decades to meet contemporary stroke needs. Registry data have been used to monitor stroke quality of care and conduct outcomes research to inform policy.

In 2016, the Ontario Ministry of Health and Long-Term Care implemented the Provincial Strategy for Epilepsy Care to increase epilepsy surgery use in Ontario, Canada. The objectives of this study were to assess whether the use of (1) epilepsy surgery, including (a) its receipt and (b) assessments for candidacy, and (2) other healthcare for epilepsy, including (a) neurological consultations, (b) emergency department (ED) visits and (c) hospital admissions, changed since its implementation.

We used linked health administrative data and an interrupted time series design. Annual cohorts were created for July 1st to June 30th of each year from 2007 to 2019, comprising patients with drug-resistant epilepsy eligible for publicly funded prescription drug coverage with no cancer history. We used segmented Poisson regression models to assess whether the annual rates of each outcome changed between the period before the Provincial Strategy was implemented (July 2007–June 2016) and the period after.

There was a level increase in the rate of epilepsy surgery of 48% (95% CI: 0%, 118%) and slope decreases in the rates of neurological consultations, ED visits and hospital admissions for epilepsy of 10% (95% CI: −15%, −5%), 10% (95% CI: −20%, 1%) and 7% (95% CI: −12%, −1%) per year, respectively, associated with the Provincial Strategy.

The Provincial Strategy may be associated with an increased rate of epilepsy surgery and reduced rates of other healthcare use for epilepsy. Other regions experiencing low epilepsy surgery rates may benefit from similar interventions.

Cerebral microbleeds are associated with an increased risk of hemorrhagic transformation (HT) following acute ischemic stroke. We investigated whether the effect of dabigatran (vs. aspirin) in patients with acute minor non-cardioembolic ischemic stroke/transient ischemic attack (TIA) is modified by baseline microbleeds on MRI.

The Dabigatran Treatment of Acute Stroke II trial randomized 305 patients with acute minor non-cardioembolic ischemic stroke/TIA to dabigatran (150/110 mg twice daily) or aspirin (81 mg daily) for 30 days. Microbleeds were centrally adjudicated in patients with an interpretable blood-sensitive sequence on baseline MRI. In this post hoc analysis, we used multivariable regression models to determine the association between microbleeds and any incident HT on day-30 MRI and excellent functional outcome (modified Rankin scale = 0–1) at 90 days.

A total of 251 (82.3%) participants (mean age = 66 ± 13 years, 36% women, median [IQR] onset-to-randomization time = 40[27–55] hours; median [IQR] NIHSS = 1 [0–2]) were included, of whom 82 (33%) had microbleeds. On day-30 MRI, 6% (n = 14) developed HT, and 80% (n = 191) achieved 90-day mRS of 0–1. We found no association between microbleed presence and HT (adjusted OR = 0.84; 95%CI:0.21–3.25) or excellent functional outcome (adjusted RR = 1.09; 95%CI:0.94–1.26). The rate of HT in patients with microbleeds was 3% with dabigatran and 4% with aspirin (OR = 0.85; 95%CI:0.11–6.75). Excellent functional outcome occurred in 74% and 84% of dabigatran and aspirin-treated patients, respectively (RR = 0.88; 95%CI:0.69–1.12). The presence, severity or location of microbleeds did not modify the effect of dabigatran on these outcomes (p-interaction > 0.05).

Early dabigatran treatment appears safe in patients with acute minor non-cardioembolic ischemic stroke/TIA and hemorrhage-prone cerebral small vessel disease marked by microbleeds on MRI.

Secondary stroke prevention can reduce subsequent vascular events, mortality and accumulation of disability. Current rates of adherence to secondary stroke prevention indicators are unknown. Our aim was to evaluate secondary stroke prevention care in Ontario, Canada.

A retrospective cohort study using health administrative databases included all adults discharged alive following an ischemic stroke from April 2010 to March 2019. Indicators of secondary stroke prevention, including laboratory testing, physician visits and receipt of routine influenza vaccinations, were evaluated among survivors in the one year following a stroke event. The use of medication was also assessed among individuals over the age of 65 years and within subgroups of stroke survivors with diabetes and atrial fibrillation.

After exclusions, 54,712 individuals (mean age 68.4 years, 45.7% female) survived at least one year following their stroke event. In the 90 days following discharge from the hospital, most individuals (92.8%) were seen by a general practitioner, while 26.2% visited an emergency department. Within the year following discharge, 66.2% and 61.4% were tested for low-density lipoprotein and glycated hemoglobin, respectively, and 39.6% received an influenza vaccine. Among those over the age of 65 years, 85.5% were prescribed a lipid-lowering agent, and 88.7% were prescribed at least one antihypertensive medication. In those with diabetes, 70.3% were prescribed an antihyperglycemic medication, while 84.9% with atrial fibrillation were prescribed an anticoagulant.

Secondary stroke prevention, especially for important laboratory values, remains suboptimal, despite thorough best practice guidelines. Future studies should explore barriers to better secondary stroke care.

Migraine management involves a wide range of clinical rehabilitation practices. This variability hampers the clinical applicability of these protocols. Before proposing any recommendations for migraine interventions, one needs to identify how interventions are generally structured. This study aimed to systematically map the activities in multidisciplinary rehabilitation programs for people with migraine.

We conducted a scoping review from January 2002 to April 2024 in MEDLINE®, CINAHL, Academic Search Complete, AMED, APA PsycInfo and Academic Search Complete databases. Search terms were related to (i) migraine or headache, (ii) intervention and (iii) multidisciplinary or interdisciplinary care. Language and population inclusion criteria were applied. Two researchers independently screened titles, abstracts and full-text articles and extracted data according to three topics: (i) activities and their modalities, (ii) professionals involved and (iii) tools used.

The activities identified ranged from medication management and a variety of exercise types and lifestyle changes using education strategies to stress management techniques. Psychological interventions were rarely defined and appeared to overlap with education and stress management techniques. Information on treatment delivery was scarce. Professionals from many disciplines were mentioned. The outcomes assessed included migraine or headache characteristics, psychological symptoms, disability and quality of life. No explicit theoretical models were found.

The results highlight the heterogeneity of activities in multidisciplinary interventions for people with migraine. Operationalizing an intervention based on a theoretical model is essential for allowing replications, evaluation and implementation in rehabilitation settings.

PRKN-related parkinsonism represents one of the most common types of genetically determined Parkinson’s disease (PD). However, the literature among the Asian ethnicity, particularly in the Indian context, is limited.

To study the clinico-genetic profile of patients with PRKN-related parkinsonism and to review the previously reported cases of PRKN-related parkinsonism from Asia.

A retrospective chart review from a tertiary neurology centre of patients with genetically confirmed PRKN-related parkinsonism. Additionally, we consolidated the Asian cohort from a detailed systematic review of the literature. We utilised the Movement Disorders Society gene cohort for comparison with the world literature.

We recruited 16 cases (males = 10, Early onset Parkinson disease (21 to <50 years age at onset)) of PRKN-related parkinsonism with a median age at onset of 28.5 years (range 14–46). Symptoms included parkinsonism (n = 15), dystonia (n = 10), postural instability (n = 7), freezing of gait (n = 5) and non-motor symptoms (NMS) (n = 10). The commonest symptom at onset was tremors (n = 10). Levodopa responsiveness was observed in all cases with drug-induced dyskinesia in eight (50%). Thirteen cases were homozygous, while three were compound heterozygotes, resulting in 19 variants (novel = 5). Exon deletion was the most common (n = 12). The extended Asian cohort comprising 294 cases had a high prevalence of EOPD (n = 186/257, 72.4%) and familial cases (n = 166/252, 65.9%). Deletion/duplication was the common mutation detected (n = 215, 73.1%). The presumed familial cases had a significantly higher frequency of rest tremors, bradykinesia, postural instability, NMS, dyskinesia and sleep disorders.

This largest single-centre study from India adds 16 new cases and five novel variants to PRKN literature. In addition, it consolidates the Asian cohort of PRKN elucidating its unique attributes.

Parkinson disease (PD) is a neurological disorder that affects more than 10 million people worldwide, impacting both quality of life and marital relationships. Divorce rates are higher in Western compared to Eastern countries. However, it is unclear if there are differences in marital status after PD onset between the two regions.

We searched MEDLINE and Embase from inception to March 31, 2024. Original studies discussing marital status in participants with PD were included. An unmarried status includes single, widowed, divorced or separated. Outcomes included the prevalence of being unmarried, measured as proportions, and the risk ratio (RR) of being unmarried in participants with PD relative to controls.

Out of 567 studies screened initially, 55 studies involving 3,723,966 participants were included. The prevalence of being unmarried was evaluated in 55 studies (25.16%; 95% CI: 21.52–29.18). The prevalence of being unmarried was significantly higher in countries in the West compared to the East (28.83%; 95% CI: 25.09–32.89 vs 17.47%; 95% CI: 12.10–24.57, p < 0.01). Compared to controls, the risk of being unmarried in PD participants after the onset of PD was significantly higher in the East (RR: 1.21, 95% CI: 0.91–1.60) compared to the West (RR: 0.87, 95% CI: 0.65–1.15).

Our meta-analysis showed significantly higher rates of being unmarried in Western compared to Eastern countries. After PD onset, participants in the East were at significantly higher risk of being unmarried compared to participants in the West, suggesting that differences in cultural practices, societal norms and healthcare systems may affect marital status outcomes in PD participants.

We sought to compare whether quality of life (QOL) in patients with subjective cognitive impairment (SCI) who performed normally on a neuropsychological battery significantly differed from those diagnosed with mild cognitive impairment (MCI), Alzheimer’s disease (AD) or non-Alzheimer’s dementia (non-AD) at initial assessment in a Rural and Remote Memory Clinic (RRMC).

610 patients referred to our RRMC between 2004 and 2019 were included in this study. We compared self-reported and caregiver-reported patient QOL scores in those with SCI (n = 166) to those diagnosed with MCI (n = 98), AD (n = 228) and non-AD (n = 118).

Patients with SCI self-reported significantly lower QOL compared to patients with AD. Interestingly, the reverse was seen in caregivers: SCI caregivers rated patient QOL higher than AD caregivers. Patients with SCI also reported lower QOL than patients with MCI. SCI caregivers reported higher patient QOL than their non-AD counterparts. Caregiver-rated patient QOL was higher in those with MCI compared to AD. Patients with MCI self-reported higher QOL scores compared to patients with non-AD dementias. Similarly, MCI caregivers reported higher patient QOL than non-AD caregivers. No other comparisons were statistically significant.

Although they lacked clinically significant cognitive deficits, patients with SCI self-reported significantly lower QOL than patients with MCI and AD. Conversely, caregiver-reported patient QOL was higher for patients with SCI than for patients with AD and non-AD. This shows that SCI seriously impacts QOL. More research is needed on how we can better support patients with SCI to improve their QOL.

Treatment of acute ischemic stroke is highly time dependent, which relies heavily on each hospital’s ability and capacity. Designated stroke centers have been established across Canada, but there is still a divide between urban and rural hospitals. This study aims to understand the similarities and differences in their stroke treatment process workflow, incorporation of best practices and data collection.

Interviews were conducted with clinicians in stroke centers across Canada to identify similarities and differences between provinces and hospital treatment capability. Semi-structured interviews were completed from September 15 to November 3, 2023, with clinicians and stroke coordinators using snowball and purposive sampling techniques. The interviews were analyzed using thematic analysis.

Fourteen participants were interviewed with representatives from four primary stroke centers and three comprehensive stroke centers across five provinces. Five primary themes were identified: 1) management of resources, 2) standardization of tasks, 3) data collection, 4) tool integration into workflow and 5) teamwork and experience. Participants in primary centers described limited resources to follow the patient through the entire treatment process, reliance on pre-notification times to prospectively search necessary patient information, using software to aid in calculating National Institute of Health Stroke Scale and being more cautious toward treating thrombolytics. Both center types discussed challenges with complete and accurate data collection.

The overall stroke treatment process and information required across primary and comprehensive centers are similar. However, differences occur in the process due to limitations in resources, pre-arrival notification time, completeness and accuracy of data collected and comfort in treating with thrombolytics.

Published guidelines for conducting clinical trials for migraine therapeutics recommend recruiting participants based on disease epidemiology and including sex/gender-based subpopulation analyses. These recommendations aim to improve the quality and generalizability of migraine clinical trials. The aim of this study was to summarize participant demographics in migraine clinical trials for FDA-approved calcitonin gene-related peptide (CGRP)-targeting drugs (receptor antagonists [gepants], CGRP peptide or receptor monoclonal antibodies [mAbs]) and assess the use of sex/gender-based subpopulation analyses in these studies.

We conducted a review of industry-sponsored migraine clinical trials for FDA-approved CGRP-targeting medications. Demographic data (sex and/or gender) from phase II or III trials were abstracted, and the use of sex/gender-based analyses was recorded.

Fourteen trials of gepants were included in this analysis. Participants who were identified as females or women were more likely to participate in these trials (87.0 ± 2.2%). Twenty-four trials of CGRP mAbs were reviewed. These studies also reported that participants were predominantly identified as female or women (84.9 ± 2.3%). None of the clinical trials reviewed reported sex/gender-based analyses of their results.

This study suggests that men are underrepresented in migraine CGRP clinical trials. Greater attention to sex and gender is needed in migraine clinical trial design so that they better align with current recommendations made by headache societies and regulatory agencies.