Introduction: In the post-acute phase of a stroke, some of the most difficult symptoms (fatigue, headache, cognitive lapses, emotional outbursts, somato-sensory changes and dizziness) are often elusive and difficult to capture and quantify. Retrospective reports/scales lack sensitivity and specificity for neuro-psychological behavior intervention (BI) as a supplement to medication management. We hypothesized that symptoms occur in cycles, provoked by an activity pattern or circadian rhythm, which could be a focus for a BI.
Method: Post-stroke patients were prospectively recruited to use electronic diary (e-diary) to quantify a primary symptom 3 times per day (TD), for each day of the week (DW), up to 12 weeks (n=30).
Results: Cluster analysis shows a majority of patients (89%) to have a statistically significant cyclical pattern, specifically: 63% DW; 48% TD, 17% both; 89% either DW or TD, as shown in Fig 1. DW cyclical patterns can be simple (one high phase/week), or complex (2/week) with a relative risk of high to low phases of 2 to 1 or greater. A few patients (7%) demonstrated a “random” fixed pattern (i.e., non-cyclical 2 to 1 or greater high-low DW variations).
Conclusion: Common cyclical patterns of elusive symptom expression post stroke can be reliably quantified and analyzed by prospective e-diary, like a “fitbit” for the brain. Recognition of these patterns for elusive symptoms can serve as the basis for formulating more effective BI as a supplement, or alternative, to medication management post stroke.