Background: Suggestive findings of an earlier study that prenatal nutritional deficiency was a determinant of schizophrenia prompted us to undertake a second test of the hypothesis using more precise data on both exposure and outcome. Methods: Among persons born in the cities of western Netherlands during 1944 through 1946, we compared the risk for schizophrenia in those exposed and unexposed during early gestation to the Dutch Hunger Winter of 1944/1945. The frequency of hospitalized patients with schizophrenia at age 24 to 48 years in the exposed and unexposed birth cohorts was ascertained from a national psychiatric registry. Results: The most exposed birth cohort, conceived at the height of the famine, showed a twofold and statistically significant increase in the risk for schizophrenia (relative risk [RR] = 2.0; 95% confidence interval [CI] = 1.2 to 3.4;P<.01) in both men (RR = 1.9; 95% CI = 1.0 to 3.7;P=.05) and women (RR = 2.2; 95% CI = 1.0 to 4.7;P=.04). Among all birth cohorts of 1944 through 1946, the risk for schizophrenia clearly peaked in this exposed cohort. Conclusion: Prenatal nutritional deficiency may play a role in the origin of some cases of schizophrenia.

Background: The two-thirds of patients with epilepsy who become seizure-free have a quality of life (QOL) similar to the general population. The major treatment challenge is patients with refractory epilepsy. Whereas neurologists typically focus on seizure reduction in the treatment of these patients, results of studies relating seizure frequency to QOL are conflicting. As depression is associated with reduced QOL in epilepsy and antiepileptic medications (AEDs) can cause depression, it is important to determine the relative roles of depression and seizure frequency in QOL in refractory epilepsy. Methods: Prospective evaluation was conducted of patients with refractory epilepsy being admitted to an inpatient video-EEG monitoring unit. The impact of clinical variables (age, sex, marital status, seizure frequency, duration and type of seizure disorder, seizure localization, number of AEDs, depression) on QOL was analyzed. Results: Depression was a powerful predictor of QOL (n = 122, β = −35.8, p < 0.0001). No other variable predicted QOL. Depression was common (54%), severe (19% with suicidal thoughts), underdiagnosed (37%), and largely untreated (17% on antidepressants). Conclusions: Treatment of depression may be inadequately prioritized in the management of intractable epilepsy.

Background and Purpose—: This study evaluated the use of an artificial intelligence platform on mobile devices in measuring and increasing medication adherence in stroke patients on anticoagulation therapy. The introduction of direct oral anticoagulants, while reducing the need for monitoring, have also placed pressure on patients to self-manage. Suboptimal adherence goes undetected as routine laboratory tests are not reliable indicators of adherence, placing patients at increased risk of stroke and bleeding. Methods—: A randomized, parallel-group, 12-week study was conducted in adults (n=28) with recently diagnosed ischemic stroke receiving any anticoagulation. Patients were randomized to daily monitoring by the artificial intelligence platform (intervention) or to no daily monitoring (control). The artificial intelligence application visually identified the patient, the medication, and the confirmed ingestion. Adherence was measured by pill counts and plasma sampling in both groups. Results—: For all patients (n=28), mean (SD) age was 57 years (13.2 years) and 53.6% were women. Mean (SD) cumulative adherence based on the artificial intelligence platform was 90.5% (7.5%). Plasma drug concentration levels indicated that adherence was 100% (15 of 15) and 50% (6 of 12) in the intervention and control groups, respectively. Conclusions—: Patients, some with little experience using a smartphone, successfully used the technology and demonstrated a 50% improvement in adherence based on plasma drug concentration levels. For patients receiving direct oral anticoagulants, absolute improvement increased to 67%. Real-time monitoring has the potential to increase adherence and change behavior, particularly in patients on direct oral anticoagulant therapy. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02599259.

Background: Early seizure (ES) has been reported in 2% to 6% of strokes and is a predictor of recurrent seizures. Acute stroke has been reported to cause 22% of all cases of status epilepticus in adults. The determinants of ES and status epilepticus (SE) after stroke, however, are not well understood. Methods: An incidence study was conducted to identify all cases of first stroke in adult residents of northern Manhattan. Cases of ES and SE within 7 days of stroke were identified through medical record review. Statistical analyses were performed using univariate and multivariate logistic regression models. Results: The cohort consisted of 904 patients; ES occurred in 37 (4.1%). The frequency of ES by stroke subtype and location was deep infarct 0.6% (2/356), lobar infarct 5.9% (20/341), deep intracerebral hemorrhage (ICH) 4.0% (4/101), lobar ICH 14.3% (7/49), and subarachnoid hemorrhage 8.0% (4/50). SE occurred in 10 patients (1.1%), representing 27.0% of patients with ES. Diabetes, hypertension, current smoking, alcohol use, age, gender, and race/ethnicity were not significant determinants of ES. In a subgroup of patients who had an NIH stroke scale (NIHSS) score recorded, NIHSS score was not an independent predictor of ES in multivariate analysis. After accounting for stroke severity, ES was not a predictor of 30-day case fatality. Conclusions: Lesion location and stroke subtype are strong determinants of ES risk, even after adjusting for stroke severity. ES does not predict 30-day mortality. SE occurs in more than one-quarter of patients with ES.

Black and Hispanic Americans have a greater risk of primary intracerebral hemorrhage (ICH) than whites. Deep ICH is most often associated with hypertension, while lobar ICH is associated with cerebral amyloid angiopathy. The authors conducted a population-based incidence study to directly compare the incidence of deep vs lobar ICH in all three race-ethnic groups. The authors used an active hospital and community surveillance program and autopsy reports to identify incident ICH cases among white, black, and Caribbean Hispanic adults in Northern Manhattan between July 1993 and June 1997. Incidence rates were adjusted for age and sex to the 1990 US Census. CIs for risk ratios (RR) were calculated with Byar's chi2 approximation of the Poisson distribution. The authors identified 155 cases of ICH for an annual incidence of 30.9/100,000 (26.7 to 35.0). Men had a higher risk of ICH than women (RR 1.5, 95% CI 1.2 to 1.8), driven entirely by the incidence of deep ICH (RR 1.8) rather than lobar ICH (RR 1.0). Compared with whites, RR for blacks was all ICH 3.8 (2.2 to 8.9), deep 4.8 (2.3 to 21.1), lobar 2.8 (1.2 to 14.4); RR for Hispanics was all 2.6 (1.4 to 6.1), deep 3.7 (1.7 to 16.5), lobar 1.4 (0.4 to 7.4). ICH is a heterogeneous disease with deep and lobar subtypes distinguishable on an epidemiologic basis. The different patterns of these two subtypes in our race-ethnically diverse population lend credence to the notion that ICH should no longer be treated as a single entity.

Background: Brain arteriovenous malformations (AVMs) represent a potential source of intracranial hemorrhage, especially in young adults, but prospective population-based incidence data on AVM hemorrhage are lacking. We investigated the incidence of first-ever AVM hemorrhage in adults based on population data from the Northern Manhattan Stroke Study (NOMASS). Methods: NOMASS is a prospective, population-based, stroke incidence survey collecting all hospitalized and nonhospitalized cases with first-ever (incident) stroke over the age of 20 in a ZIP code-defined area. All patients undergo CT and/or MR brain imaging and clinical data are systematically collected from the medical records. For this study, data on all cases with incident intracranial hemorrhage, i.e. any intracerebral, intraventricular and/or subarachnoid hemorrhage, occurring between July 1, 1993 and June 30, 1997 were used. Patients with intracranial hemorrhage due to trauma, tumor or intracranial vascular malformations other than a previously unknown AVM were excluded from the study. Results: Of the 207 patients diagnosed with a first-ever intracranial hemorrhage, 3 cases (1.4%) with an underlying brain AVM were identified. The crude incidence rate for first-ever AVM hemorrhage in our adult population was 0.55 per 100,000 person-years (95% confidence interval 0.11–1.61). Conclusions: Our results support prior findings from retrospective surveys. Population-based studies providing a prospective design for AVM detection and diagnosis are needed to confirm the data.