Lancet neurology
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Have state-of-the-art clinical trials failed to deliver treatments for neurodegenerative diseases because of shortcomings in the rating scales used? This Review assesses two methodological limitations of rating scales that might help to answer this question. First, the numbers generated by most rating scales do not satisfy the criteria for rigorous measurements. ⋯ We use clinical examples to highlight concerns about the limitations of rating scales, examine their underlying rationales, clarify their implications, explore potential solutions, and make some recommendations for future research. We show that improvements in the scientific rigour of rating scales can improve the chances of reaching the correct conclusions about the effectiveness of treatments.
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The emphasis of treatments for acute ischaemic stroke during the past two decades has been on revascularisation. Endovascular treatment is a promising alternative for patients who are ineligible for standard intravenous thrombolytic therapy; however, its use is limited by the few randomised trials reported and the small number of practising neurointerventionalists. ⋯ In this Review, we summarise the findings of the major clinical trials of endovascular treatment, and show that endovascular treatment of acute ischaemic stroke is a therapeutic option for patients who are disqualified from or do not improve on treatment with intravenous alteplase. Moreover, the American Heart Association has expanded its guidelines to include endovascular stroke therapies as a treatment option.
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Review
Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis.
Stroke is often preceded by transient ischaemic attack (TIA), but studies of stroke risk after TIA are logistically difficult and have yielded conflicting results. However, reliable estimation of this risk is necessary for planning effective service provision, clinical trials, and public education. We therefore did a systematic review of all studies of stroke risk early after TIA. ⋯ The reported early risks of stroke after TIA were highly heterogeneous, but this could be largely accounted for by differences in study method, setting, and treatment, with lowest risks in studies of emergency treatment in specialist stroke services.
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Review
Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis.
Stroke is often preceded by transient ischaemic attack (TIA), but studies of stroke risk after TIA are logistically difficult and have yielded conflicting results. However, reliable estimation of this risk is necessary for planning effective service provision, clinical trials, and public education. We therefore did a systematic review of all studies of stroke risk early after TIA. ⋯ The reported early risks of stroke after TIA were highly heterogeneous, but this could be largely accounted for by differences in study method, setting, and treatment, with lowest risks in studies of emergency treatment in specialist stroke services.