Academic
Publications
Neurology International, 15, 994-1013 (2023)
Dimaras, T., Merkouris, E., Tsiptsios, D., Christidi, F., Sousanidou, A., Orgianelis, I., Polatidou, E., Kamenidis, I., Karatzetzou, S., Gkantzios, A., Ntatsis, C., Kokkotis, C., Retsidou, S., Aristidou, M., Karageorgopoulou, M., Psatha, E.A., Aggelousis, N. & Vadikolias, K.
Stroke is the leading cause of functional disability worldwide, with increasing prevalence in adults. Given the considerable negative impact on patients’ quality of life and the financial burden on their families and society, it is essential to provide stroke survivors with a timely and reliable prognosis of stroke recurrence. Leukoaraiosis (LA) is a common neuroimaging feature of cerebral small-vessel disease. By researching the literature of two different databases (MEDLINE and Scopus), the present study aims to review all relevant studies from the last decade, dealing with the clinical utility of pre-existing LA as a prognostic factor for stroke recurrence in stroke survivors. Nineteen full-text articles published in English were identified and included in the present review, with data collected from a total of 34,546 stroke patients. A higher rate of extended LA was strongly associated with stroke recurrence in all stroke subtypes, even after adjustment for clinical risk factors. In particular, patients with ischemic stroke or transient ischemic attack with advanced LA had a significantly higher risk of future ischemic stroke, whereas patients with previous intracerebral hemorrhage and severe LA had a more than 2.5-fold increased risk of recurrent ischemic stroke and a more than 30-fold increased risk of hemorrhagic stroke. Finally, in patients receiving anticoagulant treatment for AF, the presence of LA was associated with an increased risk of recurrent ischemic stroke and intracranial hemorrhage. Because of this valuable predictive information, evaluating LA could significantly expand our knowledge of stroke patients and thereby improve overall stroke care.
Neurol Sci. 2021 Nov 30
Karatzetzou S, Tsiptsios D, Terzoudi A, Aggeloussis N, Vadikolias K.
Introduction: Stroke represents a major cause of functional disability with increasing prevalence. Thus, it is imperative that stroke prognosis be both timely and valid. Up to today, several biomarkers have been investigated in an attempt to forecast stroke survivors’ potential for motor recovery, transcranial magnetic stimulation (TMS) being among them. Methods: A literature research of two databases (MEDLINE and Scopus) was conducted in order to trace all relevant studies published between 1990 and 2021 that focused on the potential utility of TMS implementation on stroke prognosis. Only full-text articles published in the English language were included. Results: Thirty-nine articles have been traced and included in this review. Discussion: Motor evoked potentials (MEPs) recording is indicative of a favorable prognosis concerning the motor recovery of upper and lower extremities’ weakness, swallowing and speech difficulties, and the patient’s general functional outcome. On the contrary, MEP absence is usually associated with poor prognosis. Relative correlations have also been made among other TMS variants (motor threshold, MEP amplitude, central motor conduction time) and the expected recovery rate. Overall, TMS represents a non-invasive, fast, safe, and reproducible prognostic tool poststroke that could resolve prognostic uncertainties in cases of stroke.
Gait & Posture, Volume 97, Supplement 1, , S57-S58 (2022)
G. Giarmatzis, S. Fotiadou, E. Giannakou, D. Tsiptsios, K. Vadikolias, N. Aggelousis
Diagnostics (Basel), 1;12(10):2392 (2022)
Kokkotis C, Giarmatzis G, Giannakou E, Moustakidis S, Tsatalas T, Tsiptsios D, Vadikolias K, Aggelousis N.
Stroke is an acute neurological dysfunction attributed to a focal injury of the central nervous system due to reduced blood flow to the brain. Nowadays, stroke is a global threat associated with premature death and huge economic consequences. Hence, there is an urgency to model the effect of several risk factors on stroke occurrence, and artificial intelligence (AI) seems to be the appropriate tool. In the present study, we aimed to (i) develop reliable machine learning (ML) prediction models for stroke disease; (ii) cope with a typical severe class imbalance problem, which is posed due to the stroke patients’ class being significantly smaller than the healthy class; and (iii) interpret the model output for understanding the decision-making mechanism. The effectiveness of the proposed ML approach was investigated in a comparative analysis with six well-known classifiers with respect to metrics that are related to both generalization capability and prediction accuracy. The best overall false-negative rate was achieved by the Multi-Layer Perceptron (MLP) classifier (18.60%). Shapley Additive Explanations (SHAP) were employed to investigate the impact of the risk factors on the prediction output. The proposed AI method could lead to the creation of advanced and effective risk stratification strategies for each stroke patient, which would allow for timely diagnosis and the right treatments.
Neurololy International 14(4):841-874. 2022
Christidi F, Tsiptsios D, Fotiadou A, Kitmeridou S, Karatzetzou S, Tsamakis K, Sousanidou A, Psatha EA, Karavasilis E, Seimenis I, Kokkotis C, Aggelousis N, Vadikolias K.
Stroke represents a major cause of mortality and long-term disability among adult populations, leaving a devastating socioeconomic impact globally. Clinical manifestation of stroke is characterized by great diversity, ranging from minor disability to considerable neurological impairment interfering with activities of daily living and even death. Prognostic ambiguity has stimulated the interest for implementing stroke recovery biomarkers, including those provided by structural neuroimaging techniques, i.e., diffusion tensor imaging (DTI) and tractography for the study of white matter (WM) integrity. Considering the necessity of prompt and accurate prognosis in stroke survivors along with the potential capacity of DTI as a relevant imaging biomarker, the purpose of our study was to review the pertinent literature published within the last decade regarding DTI as a prognostic tool for recovery in acute and hyperacute stroke. We conducted a thorough literature search in two databases (MEDLINE and Science Direct) in order to trace all relevant studies published between 1 January 2012 and 16 March 2022 using predefined terms as key words. Only full-text human studies published in the English language were included. Forty-four studies were identified and are included in this review. We present main findings and by describing several methodological issues, we highlight shortcomings and gaps in the current literature so that research priorities for future research can be outlined. Our review suggests that DTI can track longitudinal changes and identify prognostic correlates in acute and hyperacute stroke patients.
Neurol Res Pract. 2022 Dec 22;4(1):61
Kitmeridou S, Tsiptsios D, Tsalkidis D, Psatha EA, Iliopoulos I, Aggelousis N, Vadikolias K
Safety and efficacy data on intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) in case of known left ventricular thrombus (LVT) are lacking. We present the case of a 35-year-old male with disabling AIS and known LVT that was treated successfully with intravenous alteplase. Apart from neurological improvement, post-procedural full thrombus lysis was also evident. Even though performing IVT in similar instances constitutes a difficult decision for physicians, it may be reasonable in the context of acute disabling stroke
Neurol. Int. 2023, 15, 83-99
Karatzetzou S, Tsiptsios D , Sousanidou A , Fotiadou S, Christidi F , Kokkotis C , Tsamakis K , Aggelousis N , Vadikolias K.
Safety and efficacy data on intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) in case of known left ventricular thrombus (LVT) are lacking. We present the case of a 35-year-old male with disabling AIS and known LVT that was treated successfully with intravenous alteplase. Apart from neurological improvement, post-procedural full thrombus lysis was also evident. Even though performing IVT in similar instances constitutes a difficult decision for physicians, it may be reasonable in the context of acute disabling stroke
Neurol. Int. 2023, 15, 124–139
Papadopoulos C, Anagnostopoulos K, Tsiptsios D, Karatzetzou S, Liaptsi E, Lazaridou I, Kokkotis C, Makri E, Ioannidou M, Aggelousis N, Vadikolias K.
Stroke constitutes the second cause of morbidity and mortality worldwide, while also im- 13 pacting the world economy triggering substantial financial burden in the national health systems. 14 High levels of blood glucose, homocysteine and cholesterol are causative factors for atherothrom- 15 bosis. These molecules induce erythrocyte dysfunction, which could culminate in atherosclerosis, 16 thrombosis, thrombus stabilization, and post-stroke hypoxia. Glucose, toxic lipids and homocyste- 17 ine result in erythrocyte oxidative stress. This leads to phosphatidylserine exposure, promoting 18 phagocytosis. Phagocytosis by endothelial cells, intraplaque macrophages and vascular smooth 19 muscle cells contributes to expansion of the athersclerotic plaque. In addition, oxidative stress in- 20 duced- erythrocyte and endothelial cell arginase upregulation limits the pool for nitric oxide syn- 21 thesis, leading to endothelial activation. Increased arginase activity may also lead to the formation 22 of polyamines which limit the deformability of red blood cells, hence facilitating erythrophagocyto- 23 sis. Erythrocytes can also participate in the activation of platelets through release of ADP and ATP, 24 activation of death receptors and of pro-thrombin. Damaged erythrocytes can also associate with 25 neutrophil extracellular traps, and subsequently activate T lymphocytes. In addition, reduced levels 26 of CD47 protein in the surface of red blood cells can also lead to erythrophagocytosis and reduced 27 association with fibrinogen. Lastly, impaired erythrocyte 2,3 biphosphoglycerate because of obesity 28 or aging could also favor hypoxic brain inflammation after the occurrence of ischemic stroke
Neurol. Int. 2023, 15(1), 238-272
Tziaka E, Christidi F, Tsiptsios D , Sousanidou A, Karatzetzou S, Tsiakiri A, Doskas TK, Tsamakis K, Retzepis N, Konstantinidis C, Kokkotis C, Serdari A, Aggelousis N, Vadikolias K.
Stroke survivors are at increased risk of developing depression and 18 cognitive decline. Thus, it is crucial for both clinicians and stroke survivors to be 19 provided with timely and accurate prognostication of post-stroke depression 20 (PSD) and post-stroke dementia (PSDem). Several biomarkers regarding stroke 21 patients’ propensity to develop PSD and PSDem have been implemented so far, 22 leukoaraiosis (LA) being among them. Literature research of two databases 23 (MEDLINE and Scopus) was conducted to identify all relevant studies published 24 between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of a 25 preexisting (LA) as a prognostic indicator of PSD and PSDem. Only full-text articles published in English language were included. Thirty-four articles have been 27 traced and are included in the present review. LA burden, serving as a surrogate 28 marker of “brain frailty” among stroke patients, appears to be able to offer significant information into the possibility to develop PSD or being responsible for an 30 individual’s cognitive dysfunction. Determining the extent of pre-existing white 31 matter abnormalities may properly guide decision-making in an acute stroke seτting, as a greater degree of these lesions is usually coupled with neuropsychiatric 33 aftermaths, such as PSD and PSDem
BioMed. 2023; 3(3):349-368.
Tsiakiri A, Vlotinou P, Paschalidou A, Konstantinidis C, Christidi F, Tsiptsios D, Detsaridou G, Petridou A, Gkantzios A, Karatzetzou S, et al.
The purpose of the present study was to review all available work published within the last decade focusing on coping strategies in stroke caregivers and their impact on quality of Life (QoL) and psycho-emotional status. A literature search of two databases (MEDLINE, Scopus) was conducted to identify all relevant full-text English studies published between 2013–2023. Sixteen articles were traced and were finally included. Cognitive and behavioral coping strategies were beneficial for stroke caregivers’ and survivors’ QoL. The level of mutuality in the caregiver-survivor relationship was associated with the impact of depressive symptoms on caregivers’ QoL and the protective effect of mutuality on survivors’ QoL over time. The level and quality of social support were positively associated with QoL for stroke caregivers and survivors. Caregivers’ preparedness was a moderator for the impact of depression on both caregivers’ and survivors’ QoL. High levels of spirituality had a significant role in ameliorating the negative impact of depressive symptoms on the psychological and physical QoL of stroke caregivers and survivors. In conclusion, the study of coping strategies can be used as a psychological reserve in the process of stroke rehabilitation and actively contribute to improving the QoL of both caregivers and stroke survivors.
Neurology International. 2023; 15(3):926-953
Gkantzios A, Karapepera V, Tsiptsios D, Liaptsi E, Christidi F, Gkartzonika E, Karatzetzou S, Kokkotis C, Kyrtsopoulos M, Tsiakiri A, et al.
Given the expansion of life expectancy, the aging of the population, and the anticipated rise in the number of stroke survivors in Europe with severe neurological consequences in the coming decades, stroke is becoming the most prevalent cause of functional disability. Therefore, the prognosis for a stroke must be timely and precise. Two databases (MEDLINE and Scopus) were searched to identify all relevant studies published between 1 January 2005 and 31 December 2022 that investigated the relationship between thyroid hormone levels and acute stroke severity, mortality, and post-hospital prognosis. Only full-text English-language articles were included. This review includes Thirty articles that were traced and incorporated into the present review. Emerging data regarding the potential predictive value of thyroid hormone levels suggests there may be a correlation between low T3 syndrome, subclinical hypothyroidism, and poor stroke outcome, especially in certain age groups. These findings may prove useful for rehabilitation and therapy planning in clinical practice. Serum thyroid hormone concentration measurement is a non-invasive, relatively harmless, and secure screening test that may be useful for this purpose.
Journal of Personalized Medicine. 2023; 13(9):1375
Gkantzios A, Kokkotis C, Tsiptsios D, Moustakidis S, Gkartzonika E, Avramidis T, Tripsianis G, Iliopoulos I, Aggelousis N, Vadikolias K.
As a result of social progress and improved living conditions, which have contributed to a prolonged life expectancy, the prevalence of strokes has increased and has become a significant phenomenon. Despite the available stroke treatment options, patients frequently suffer from significant disability after a stroke. Initial stroke severity is a significant predictor of functional dependence and mortality following an acute stroke. The current study aims to collect and analyze data from the hyperacute and acute phases of stroke, as well as from the medical history of the patients, in order to develop an explainable machine learning model for predicting stroke-related neurological deficits at discharge, as measured by the National Institutes of Health Stroke Scale (NIHSS). More specifically, we approached the data as a binary task problem: improvement of NIHSS progression vs. worsening of NIHSS progression at discharge, using baseline data within the first 72 h. For feature selection, a genetic algorithm was applied. Using various classifiers, we found that the best scores were achieved from the Random Forest (RF) classifier at the 15 most informative biomarkers and parameters for the binary task of the prediction of NIHSS score progression. RF achieved 91.13% accuracy, 91.13% recall, 90.89% precision, 91.00% f1-score, 8.87% FNrate and 4.59% FPrate. Those biomarkers are: age, gender, NIHSS upon admission, intubation, history of hypertension and smoking, the initial diagnosis of hypertension, diabetes, dyslipidemia and atrial fibrillation, high-density lipoprotein (HDL) levels, stroke localization, systolic blood pressure levels, as well as erythrocyte sedimentation rate (ESR) levels upon admission and the onset of respiratory infection. The SHapley Additive exPlanations (SHAP) model interpreted the impact of the selected features on the model output. Our findings suggest that the aforementioned variables may play a significant role in determining stroke patients’ NIHSS progression from the time of admission until their discharge.
Neurology International. 2023; 15(3):1106-1116.
Doskas TK, Christidi F, Spiliopoulos KC, Tsiptsios D, Vavougios GD, Tsiakiri A, Vorvolakos T, Kokkotis C, Iliopoulos I, Aggelousis N, et al.
Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system (CNS), characterized by the diffuse grey and white matter damage. Cognitive impairment (CI) is a frequent clinical feature in patients with MS (PwMS) that can be prevalent even in early disease stages, affecting the physical activity and active social participation of PwMS. Limited information is available regarding the influence of MS in social cognition (SC), which may occur independently from the overall neurocognitive dysfunction. In addition, the available information regarding the factors that influence SC in PwMS is limited, e.g., factors such as a patient’s physical disability, different cognitive phenotypes, mood status, fatigue. Considering that SC is an important domain of CI in MS and may contribute to subjects’ social participation and quality of life, we herein conceptualize and present the methodological design of a cross-sectional study in 100 PwMS of different disease subtypes. The study aims (a) to characterize SC impairment in PwMS in the Greek population and (b) to unveil the relationship between clinical symptoms, phenotypes of CI, mood status and fatigue in PwMS and the potential underlying impairment on tasks of SC.
Maedica (Bucur). 2022 Mar;17(1):169-176
Vlotinou P, Tsiptsios D, Karatzetzou S, Kalogirou G, Stefas E, Aggelousis N, Vadikolias K.
Objective: Stroke represents a major cause of upper limb motor impairment among stroke survivors, resulting in functional disability and affecting negatively their quality of life. Thus, it is imperative that stroke rehabilitation be efficient. Up to the present, several intervention methods have been proposed in an attempt to improve recovery potential poststroke, transcranial direct current stimulation (tDCS) and mirror therapy (MT) being among them. The aim of this review is to investigate the utility of tDCS administration in conjunction with MT on chronic stroke population. Methods: A literature research of two databases (MEDLINE and Scopus) was conducted in order to identify all relevant studies published between January 1st 2010 and September 30th 2021 that focused on the efficacy of the combined application of tDCS and MT on upper limb rehabilitation among chronic stroke patients. Results: Three studies fulfilled the selection criteria and were included in the present review. Transcranial direct current stimulation application along with MT exhibited statistically significant increases in Box and block test, grip strength, Action research arm test score and Nottingham extended activities of daily living score within the experimental group compared to controls. The timing-dependent interaction effects seem to be of key importance, as sequentially delivered tDCS prior to MT is considered to be more advantageous and time-efficient compared to the concurrent application of tDCS and MT. Conclusions: Application of tDCS in parallel with MT represents a promising neurorehabilitation tool for post-stroke patients regarding upper limb motor performance, movement efficiency and daily function. Future studies are needed in order to clarify whether sequential or concurrent tDCS and MT application is more beneficial.
Advances in Social Sciences Research Journal, 9(6). 382-394 (2022)
Tsiakiri, A., Vlotinou, P., Kedraka, K., Tsiptsios, D., Karatzetzou, S., Mitsou, L., Tsamakis, K., Kitmeridou, S., Nikova, A., Aggelousis, N., & Vadikolias, K.
Introduction: Mild Cognitive Impairment (MCI) is a transitional stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Research interest focuses on the protection of this transition, through a combination of therapeutic interventions. Μaterials and Methods: 45 individuals with MCI who were followed up by the interdisciplinary team of our Memory School attended an online remote educational program that consisted of a series of cognitive and occupational therapy interventions designed to maintain their cognitive, executive, motor and emotional skills during the COVID-19 period. At baseline and at twelve-month follow-up all patients underwent several neuropsychological tests that included the Montreal Cognitive Assessment (MoCA), the Mini Mental State Examination (MMSE), the Functional Cognitive Assessment Scale (FUCAS), the Geriatric Depression Scale (GDS) and the Functional Rating Scale of Symptoms of Dementia (FRRSD). Also, the Barthel Index scale and the Timed Up and Go (TUG) test were utilized to assess functionality and mobility, respectively. Results: Within twelve months participants’ performance did not change significantly (MoCA; p=0.908, MMSE; p=0.625, FUCAS; p=0.782; GDS; p=0.218, FRSSD; p=0.18, Barthel Index; p=0.317, TUG; p=0.68). Results confirmed the hypothesis that cognitive, executive, motor and behavioral skills can be maintained through an online educational protocol during the COVID-19 lockdown period. Conclusions: It is proposed that similar educational protocols should be included in the design of strategic directions in the field of healthcare in MCI and dementia, especially in health crisis situations.
Neurology International 22;14(4):784-803 (2022)
Gkantzios A, Tsiptsios D, Karatzetzou S, Kitmeridou S, Karapepera V, Giannakou E, Vlotinou P, Aggelousis N, Vadikolias K.
Stroke constitutes the primary source of adult functional disability, exhibiting a paramount socioeconomic burden. Thus, it is of great importance that the prediction of stroke outcome be both prompt and accurate. Although modern neuroimaging and neurophysiological techniques are accessible, easily available blood biomarkers reflecting underlying stroke-related pathophysiological processes, including glial and/or neuronal death, neuroendocrine responses, inflammation, increased oxidative stress, blood-brain barrier disruption, endothelial dysfunction, and hemostasis, are required in order to facilitate stroke prognosis. A literature search of two databases (MEDLINE and Science Direct) was conducted in order to trace all relevant studies published between 1 January 2010 and 31 December 2021 that focused on the clinical utility of brain natriuretic peptide, glial fibrillary acidic protein, the red cell distribution width, the neutrophil-to-lymphocyte ratio, matrix metalloproteinase-9, and aquaporin-4 as prognostic tools in stroke survivors. Only full-text articles published in English were included. Twenty-eight articles were identified and are included in this review. All studied blood-derived biomarkers proved to be valuable prognostic tools poststroke, the clinical implementation of which may accurately predict the survivors’ functional outcomes, thus significantly enhancing the rehabilitation efficiency of stroke patients. Along with already utilized clinical, neurophysiological, and neuroimaging biomarkers, a blood-derived multi-biomarker panel is proposed as a reasonable approach to enhance the predictive power of stroke prognostic models.
Neurology International 14(4):923-942 (2022)
Karatzetzou S, Tsiptsios D, Sousanidou A, Christidi F, Psatha EA, Chatzaki M, Kitmeridou S, Giannakou E, Karavasilis E, Kokkotis C, Aggelousis N, Vadikolias K.
Stroke constitutes the primary source of adult functional disability, exhibiting a paramount socioeconomic burden. Thus, it is of great importance that the prediction of stroke outcome be both prompt and accurate. Although modern neuroimaging and neurophysiological techniques are accessible, easily available blood biomarkers reflecting underlying stroke-related pathophysiological processes, including glial and/or neuronal death, neuroendocrine responses, inflammation, increased oxidative stress, blood-brain barrier disruption, endothelial dysfunction, and hemostasis, are required in order to facilitate stroke prognosis. A literature search of two databases (MEDLINE and Science Direct) was conducted in order to trace all relevant studies published between 1 January 2010 and 31 December 2021 that focused on the clinical utility of brain natriuretic peptide, glial fibrillary acidic protein, the red cell distribution width, the neutrophil-to-lymphocyte ratio, matrix metalloproteinase-9, and aquaporin-4 as prognostic tools in stroke survivors. Only full-text articles published in English were included. Twenty-eight articles were identified and are included in this review. All studied blood-derived biomarkers proved to be valuable prognostic tools poststroke, the clinical implementation of which may accurately predict the survivors’ functional outcomes, thus significantly enhancing the rehabilitation efficiency of stroke patients. Along with already utilized clinical, neurophysiological, and neuroimaging biomarkers, a blood-derived multi-biomarker panel is proposed as a reasonable approach to enhance the predictive power of stroke prognostic models.
Neurolology International , 14(4), 952-980 (2022)
Christidi, F, Tsiptsios, D.; Sousanidou, A.; Karamanidis, S.; Kitmeridou, S.; Karatzetzou, S.; Aitsidou, S.; Tsamakis, K.; Psatha, E.A.; Karavasilis, E.; et al.
Stroke constitutes a major cause of functional disability with increasing prevalence among adult individuals. Thus, it is of great importance for both clinicians and stroke survivors to be provided with a timely and accurate prognostication of functional outcome. A great number of biomarkers capable of yielding useful information regarding stroke patients’ recovery propensity have been evaluated so far with leukoaraiosis being among them. Literature research of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of a current leukoaraiosis as a prognostic indicator following stroke. Only full-text articles published in English language were included. Forty-nine articles have been traced and are included in the present review. Our findings highlight the prognostic value of leukoaraiosis in an acute stroke setting. The assessment of leukoaraiosis with visual rating scales in CT/MRI imaging appears to be able to reliably provide important insight into the recovery potential of stroke survivors, thus significantly enhancing stroke management. Yielding additional information regarding both short- and long-term functional outcome, motor recovery capacity, hemorrhagic transformation, as well as early neurological deterioration following stroke, leukoaraiosis may serve as a valuable prognostic marker poststroke. Thus, leukoaraiosis represents a powerful prognostic tool, the clinical implementation of which is expected to significantly facilitate the individualized management of stroke patients.
Biomed 2023, 3, 1–20
Kokkotis C, Moustakidis S, Giarmatzis G, Giannakou E, Makri E, Sakelari P, Tsiptsios D, Karatzetzou S, Christidi F, Vadikolias K 2 and Aggelousis N
Stroke is one of the main causes of long-term disabilities, increasing the cost of national healthcare systems due to the elevated costs of rigorous treatment that is required, as well as personal cost because of the decreased ability of the patient to work. Traditional rehabilitation strategies rely heavily on individual clinical data and the caregiver’s experience to evaluate the patient and not in data extracted from population data. The use of machine learning (ML) algorithms can offer evaluation tools that will lead to new personalized interventions. The aim of this scoping review is to introduce the reader to key directions of ML techniques for the prediction of functional outcomes in stroke rehabilitation and identify future scientific research directions. The search of the relevant literature was performed using PubMed and Semantic Scholar online databases. Full-text articles were included if they focused on ML in predicting the functional outcome of stroke rehabilitation. A total of 26 out of the 265 articles met our inclusion criteria. The selected studies included ML approaches and were directly related to the inclusion criteria. ML can play a key role in supporting decision making during pre- and post-treatment interventions for post-stroke survivors, by utilizing multidisciplinary data sources.
Neurol. Int. 2023, 15, 301–317
Gkantzios A, Tsiptsios D , Karapepera V, Karatzetzou S, Kiamelidis S, Vlotinou P, Giannakou E, Karabina E, Paschalidou K, Kourkoutsakis N, Papanas N, Aggelousis N, Vadikolias K.
Ischemic stroke (IS) exhibits significant heterogeneity in terms of etiology and pathophysiology. Several recent studies highlight the significance of inflammation in the onset and progression of IS. White blood cell subtypes, such as neutrophils and monocytes, participate in the inflammatory response in various ways. On the other hand, high-density-lipoproteins (HDL) exhibit substantial anti-inflammatory and antioxidant actions. Consequently, novel inflammatory blood biomarkers have emerged, such as neutrophil to HDL ratio (NHR) and monocyte to HDL ratio (MHR). Literature research of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 30 November 2022 dealing with NHR and MHR as biomarkers for IS prognosis. Only full-text articles published in the English language were included. Thirteen articles have been traced and are included in the present review. Our findings highlight the utility of NHR and MHR as novel stroke prognostic biomarkers, the widespread application, and the calculation of whom, along with their inexpensive cost, make their clinical application extremely promising.
Neurol. Int. 2023, 15, 188-224
Sousanidou A, Tsiptsios D, Christidi F, Karatzetzou S, Kokkotis C, Gkantzios A, Bairaktaris C, Karapepera V, Bebeletsi L, Karagiannakidou I, Marinidis M, Aggelousis N and Vadikolias K
Stroke constitutes a major cause of functional disability and mortality with increasing prevalence. Thus, a timely and accurate prognosis of stroke outcome based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute markers of blood leakage from pathologically fragile small vessels. The present review evaluates whether CMBs affect ischemic and hemorrhagic stroke outcomes and explores the fundamental question of whether CMBs may shift the risk-benefit balance away from reperfusion therapy or antithrombotic use in acute ischemic stroke patients. Literature research of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 9 November 2022. Only full-text articles published in the English language were included. Forty-one articles have been traced and are included in the present review. Our findings highlight the utility of CMB assessment not only in the prognostication of hemorrhagic complications of reperfusion therapy but also in forecasting hemorrhagic and ischemic stroke patients’ functional outcomes, thus indicating that a biomarker-based approach may aid counseling for patients and families, improve the selection of more appropriate medical therapy, as well as contribute to a more accurate choice of patients for reperfusion therapy.
Diagnostics. 2023; 13(3):532
Gkantzios A, Kokkotis C, Tsiptsios D, Moustakidis S, Gkartzonika E, Avramidis T, Aggelousis N, Vadikolias K.
Despite therapeutic advancements, stroke remains a leading cause of death and long-term disability. The quality of current stroke prognostic models varies considerably, whereas prediction models of post-stroke disability and mortality are restricted by the sample size, the range of clinical and risk factors and the clinical applicability in general. Accurate prognostication can ease post-stroke discharge planning and help healthcare practitioners individualize aggressive treatment or palliative care, based on projected life expectancy and clinical course. In this study, we aimed to develop an explainable machine learning methodology to predict functional outcomes of stroke patients at discharge, using the Modified Rankin Scale (mRS) as a binary classification problem. We identified 35 parameters from the admission, the first 72 h, as well as the medical history of stroke patients, and used them to train the model. We divided the patients into two classes in two approaches: “Independent” vs. “Non-Independent” and “Non-Disability” vs. “Disability”. Using various classifiers, we found that the best models in both approaches had an upward trend, with respect to the selected biomarkers, and achieved a maximum accuracy of 88.57% and 89.29%, respectively. The common features in both approaches included: age, hemispheric stroke localization, stroke localization based on blood supply, development of respiratory infection, National Institutes of Health Stroke Scale (NIHSS) upon admission and systolic blood pressure levels upon admission. Intubation and C-reactive protein (CRP) levels upon admission are additional features for the first approach and Erythrocyte Sedimentation Rate (ESR) levels upon admission for the second. Our results suggest that the said factors may be important predictors of functional outcomes in stroke patients.
Neurology International. 2023; 15(2):661-696
Orgianelis I, Merkouris E, Kitmeridou S, Tsiptsios D, Karatzetzou S, Sousanidou A, Gkantzios A, Christidi F, Polatidou E, Beliani A, et al.
Stroke is a major cause of functional disability and is increasing in frequency. Therefore, stroke prognosis must be both accurate and timely. Among other biomarkers, heart rate variability (HRV) is investigated in terms of prognostic accuracy within stroke patients. The literature research of two databases (MEDLINE and Scopus) is performed to trace all relevant studies published within the last decade addressing the potential utility of HRV for stroke prognosis. Only the full-text articles published in English are included. In total, forty-five articles have been traced and are included in the present review. The prognostic value of biomarkers of autonomic dysfunction (AD) in terms of mortality, neurological deterioration, and functional outcome appears to be within the range of known clinical variables, highlighting their utility as prognostic tools. Moreover, they may provide additional information regarding poststroke infections, depression, and cardiac adverse events. AD biomarkers have demonstrated their utility not only in the setting of acute ischemic stroke but also in transient ischemic attack, intracerebral hemorrhage, and traumatic brain injury, thus representing a promising prognostic tool whose clinical application may greatly facilitate individualized stroke care.
BioMed. 2022; 2(4):409-421.
Giarmatzis G, Fotiadou S, Giannakou E, Kokkotis C, Fanaradelli T, Kordosi S, Vadikolias K, Aggelousis N.
Research of post-stroke locomotion via musculoskeletal (MSK) modeling has offered an unprecedented insight into pathological muscle function and its interplay with skeletal geometry and external stimuli. Advances in solving the dynamical system of post-stroke effort and the generic MSK models used have triggered noticeable improvements in simulating muscle activation dynamics of stroke populations. However, a review of these advancements to inform the scientific community has yet to be made.: PubMed and Scopus databases were used to perform a thorough literature search to identify relevant articles since 2010. Here, we review MSK methods and practices—developed in the last ten years—that have been utilized to explore post-stroke locomotion and examine how their outcomes can inform clinical practice.: Out of the 44 articles that were initially found, 19 were reviewed. The articles were categorized with respect to the type of assessment the MSK methods were used for.: This review notes the considerable competence of existing methods to address post-stroke motion deficits. However, the drawbacks in the implementation of such methods by non-experts due to the high skill demand and the lack of mature software technology for further dissemination of practices and outcomes remain non-trivial.