Læknablaðið : fylgirit - 01.05.2002, Síða 26

ABSTRACTS / 3 3RD SNC & 2ND SCNN
may negatively affect the potential for functional outcome in the
recovery process. In a recent article, the frequency of dysphagia was
found to be 40 % among patients with an overall severe stroke.
Among persons with stroke under rehabiiitation, 80 % were subject
to eating difficulties and 52,5% were unable to eat without assis-
tance. It was also concluded that most patients with dysphagia could
be identified through systematic interviews and observations of test
swallowing. Dysphagia is considered to be only one type of eating
difficulty, but also disturbed functions in one arm, perceptual prob-
lems, concentration problems as well as confusion and depression
may have an impact on eating. These difficulties are of interest
when considering the broader concept of ‘eating difficulties’, and
are of importance for nurses in practice who have to make sure that
patients eat.
Studies show that eating training can be successful if the training is
individualised through an accurate diagnostic procedure. It has been
indicated that the efficacy of a training program depends not only on
the content of the training program but also on the relationship
between patient and trainer. The use of dialogues is suggested as
possible means of reaching mutual agreement, taking the patient’s
individuality and the complex disturbances in motor function into
account in order to reach the point where different treatments can be
successful in promoting recovery. In my presentation, I will further
illuminate experiences of living with eating difficulties among
persons with stroke, describe important aspects in assessment (inter-
views, observations, tests and dialogues), and present examples of
individualised interventions based on research in the area.
L25 - To Love and Be Loved. Sexuality, Stroke, and Quality of
Life
Johnson J
Nurse consultant, Health Ouest, Minneapolis, Minnesota. USA
The majority of stroke survivors live with some form of permanent
disability. They often struggle with the many ways their quality of
life has been altered by the stroke event. There is difficulty in adjus-
ting to changes in mobility, vocational and social roles. Even when
physical recovery is good, psychological recovery is often guarded.
Most stroke survivors experience some loss of self, loss of physical
and mental functions, loss of work, loss of relationships and an
overall sense of loss of control over life. Depression and anxiety are
identified as common. There is always a lingering fear of a recurring
stroke.
How do these changes affect a person’s sexuality? Having a
chronic illness, such as a stroke, does not take away a person’s
desire to love and to be loved. Sexuality involves many levels of
activity and behavior starting with self-love (self-esteem and self-
image) and expands to include loving others and acts of loving
together (intimacy, sexual activity). It is a complex phenomenon,
which pervades our biological being, our sense of self and the way
in which we relate to each other. During the acute phase of survival,
the stroke survivor’s anxiety about the outcome of the stroke and
fears about functional abilities may well supersede concerns of
sexuality. However, once survival is assured, many questions and
concems arise about resuming life and living!!
In 1997 through 2000 an informal survey was conducted with
nearly 100 community dwelling stroke survivors and their signifi-
cant others. Questions were asked relating to changes in their sense
of self, their need for intimacy, their sexual practices, etc. Most of
the respondents indicated that they would have liked knowing
more about potential sexual problems and would have welcomed
the opportunity to discuss their personal concerns. Many reported
having unanswered questions and yet were hesitant to ask them.
Only 2 respondents remember the topic of sexuality ever being
discussed by any health care provider at any time in their stroke
recovery. It seems clear from these respondents that most health
professionals do not discuss sexual concerns and yet it would be
welcomed by the stroke survivors and their significant others.
This presentation will expand on the findings in this survey and
present the PLISSIT model that is used for helping people express
their sexual concerns. StrokeWise, a 16-hour patient education
course taught to stroke survivors and family members includes a
session on self-esteem and intimacy. The components of this session
will be reviewed and participants be given opportunity to consider
some of the teaching strategies.
Quality of life, the ultimate goal of stroke rehabilitation services
should encompass the sexual concerns of stroke survivors and their
significant others. These concerns need to be identified and dealt
with through accurate information, counseling, and supportive
programs. This domain of care should be embraced as an essential
and integral component of rehabilitation.
DOCTORS PLATFORM SESSION
26 - Topiramate treatment of epilepsy in five mentally retarded
patients with unilateral mesial temporal sclerosis
Arvio M* *, Sillanpáá M"
*Páájarvi Centre for Mentally Retarded, Lammi, Finland, **Departments of Child
Neurology and Public Health, Turku University, Finland
Objective: To study the effectiveness of topiramate as an adjunctive
drug in temporal lobe epilepsy (TLE), associated with unilateral
mesial temporal sclerosis (MTS).
Subjects and methods: Five adults with nonspecific mental retarda-
tion, difficult-to-treat TLE since childhood and MTS. Effects of
topiramate as an add-on drug on seizure frequency was retrospec-
tively analysed.
Results: On topiramate treatment with clinical daily dosages, two
patients became seizure-free. In one patient the seizure reduction
was >75%, and in two >50%. A previous antiepileptic theray could
be reduced. The patient data are presented in table 1.
Conclusion: Topiramate add-on therapy seems effective and allows
reduction of polytherapy in mentally retarded patients with TLE
associated with MTS.
27 - Cholinergic system modulates auditory processing in
elderly subjects: a combined MEG/EEG-study
Pekkonen E12-3, Jááskeláinen IP2, Kaakkola S1, Ahveninen J1-3
'Department of Neurology, Helsinki University Central Hospital, Finland, 'BioMag
Laboratory, Medical Engineering Centre, Helsinki University Central Hospital,
Finland, 3Cognitive Brain Research Unit, Department of Psychology, University of
Helsinki, Finland
Objective: Auditory event-related potential (ERP) components P50
and specifically N100 index preattentive auditory processing under-
26 Læknablaðið/Fylgirit 43 2002/88