Background and Purpose-With the advent of time-dependent thrombolytic therapy for ischemic stroke, it has become increasingly important for stroke patients to arrive at the hospital quickly. This study investigates the association between the use of emergency medical services (EMS) and delay time among individuals with stroke symptoms and examines the predictors of EMS use. Methods-The

Objective:To assess the determinants of prehospital delay for patients with presumed acute cerebral ischemia (ACI) in order to provide the background necessary to develop interventions to shorten such delays. Methods: A prospective registry of patients presenting to the ED with signs and symptoms of stroke was established at a university hospital from July 1995 to March 1996. Trained nurses performed a structured ED interview, which assessed prehospital delay and potential confounders. Results: The median delay (interquartile range) from symptom onset to ED arrival for all patients seeking care for stroke-like symptoms (n = 152) was 3.0 hours (1.5-7.8 hr). The median delay from symptom onset to ED arrival was less in cases where a witness first recognized that there was a serious problem than it was when the patient first identified the problem. A heightened sense of urgency by the patient about his or her symptoms, and use of 91 ]/emergency medical services (EMS) transport were also associated with rapid arrival in the ED within 3 hours of symptom onset. After adjusting for all predictor variables in a multivariable logistic regression model, only recognition of symptoms by a witness and calling 9 1 1EMS transport remained statistically significant. Conclusions: These data suggest that future efforts to intervene on prolonged prehospital delay for patients with ACI should include strategies for the community as a whole as well as persons at risk for stroke and should reinforce the use of 91 1 and EMS transport.

Background and Purpose-Although patterns of stroke occurrence and mortality have been well studied, few epidemiological data are available regarding the clinical characteristics of stroke events. Methods-We evaluated hospitalized stroke events reported in the Atherosclerosis Risk in Communities (ARIC) Study to describe the clinical characteristics of incident stroke. Confirmed stroke cases (nϭ474) were evaluated for stroke symptoms (headache, vertigo, gait disturbance, convulsions) and stroke signs (hemianopia, diplopia, speech deficits, paresis, paresthesia/sensory deficits) and their univariate associations with race, sex, and stroke subtype. Results-Over 9.2 years of follow-up, 402 (85%) ischemic and 72 (15%)

Abstract. Objective: To delineate components of delay within the hospital ED for patients presenting with symptoms of stroke. Methods: A prospective registry of patients presenting to the ED with signs or symptoms of stroke was established at a university hospital from July 1995 to March 1996. The ED arrival time, time to being seen by an emergency physician (EP), time to CT scan, and time to neurology consultation were obtained by medical record review. Results: The median delay (interquartile range) from ED arrival to being seen by an EP for the 170 eligible subjects was 0.42 (0.20 -0.75) hours. The median delay to CT scan was 1.88 hours (1.25 -2.67) and the median delay to neurology consultation was 2.42 hours (1.50 -3.48). Age, race, sex, and hospital discharge diagnosis had little influence on delay. Subjects arriving by emergency medical services (EMS) had a significantly shorter time to being seen by an EP (0.33 vs 0.50 hours) when compared with those who arrived by other means. Time to CT scan was shorter by 0.5 hours for patients arriving by EMS as well. These differences persisted when stratified by out-of-hospital delay times. Conclusions: These data suggest that arriving by EMS is associated with shorter times to being seen by an EP and receiving a CT scan. The influence of EMS on delays associated with rapid medical care of stroke patients reaches beyond the out-of-hospital transport phase.

Epilepsy is the fourth most common neurological disorder in the US, affecting nearly 2.5 million Americans. The economic impact of epilepsy represents estimated direct and indirect costs of 12.5 billion dollars per year. Patients with this disorder experience increased morbidity and mortality with long term fatality rates of 24%. Multiple diagnostic tools are used to identify and classify the seizure type/syndrome, etiology and localization of seizures, including electroencephalogram (EEG), magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT), magneto encephalogram (MEG), and neuropsychiatric testing. Despite 29 different antiepileptic medications that are available in the US, one third of patients remain refractory to pharmacological treatment. In these intractable epilepsy patients, non-pharmacological treatments can be considered. Commonly used non-pharmacological treatment options for epilepsy include epilepsy surgery, neurostimulation therapy, and diet therapy. Review of Epilepsy -Etiology, Diagnostic Evaluation and Treatment

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