STROKE
STROKE: s
troke has reached epidemic proportions, with 600,000 newly-reported cases in europe
each year.
Despite the increased incidence of stroke, however, death rates have been declining for two decades, mainly due to major advances in prevention, treatment and rehabilitation. Here are some of the most successful…
Mechanical endovascular thrombectomy About 85 per cent of strokes are ischemic, and the most severe ischemic strokes are caused by large vessel occlusion due to either artery- to-artery embolism or cardiac embolism. early treatment is essential to rescue potentially salvageable tissue. until recently, the only proven treatment for acute ischemic stroke was intravenous thrombolysis with recombinant tissue- type plasminogen activator (tPA).
However, since December 2014, several randomised controlled trials have demonstrated the efficacy and safety of mechanical endovascular thrombectomy. The clinical benefit of endovascular thrombectomy when performed within six hours after the onset of stroke symptoms is now well established.
Dual antiplatelet therapy with clopidogrel and aspirin A 2018 study (Amarenco et al) highlighted the importance of secondary prevention in reducing the risk of recurrent stroke. It showed how high the risk is of suffering an additional stroke after a small stroke or a transitory ischaemic attack (TIA).
The study analysed data from around 3,800 patients at a five-year follow- up. Almost thirteen per cent of patients - 469 people - either had a stroke or developed an acute coronary syndrome, or had died within five years of the original stroke event.
Personalising stroke treatment using brain computer interfaces Research in The Journal of Physiology has revealed that after only one hour of training with a brain computer interface (BCI), there were significant changes in people’s brains, suggesting that BCIs could be personalised for treating stroke and other brain disorders.
A BCI allows humans to control devices using only their thoughts. The technology works by measuring the electrical activity of the brain using a non- invasive technique called an electroencephalography (eeG) and translating it by means of artificial intelligence (AI) into an action, such as communication with a computer or the movement of a prosthetic arm.
A collaboration between researchers at the Max Planck Institute for Human Cognitive and Brain sciences, the Technical university of Berlin in Germany and the Public university of Navarra in spain, investigated the impact of two different BCIs on the human brain.
‘The spatial specificity of BCI effects, such as that a visual task impacts the visual areas in the brain, opens up the opportunity of tailoring BCI-based therapeutic approaches individually,’ said Arno Villringer, one of the study’s authors. ‘In other words, we may be able to personalise treatment for stroke patients according to where in the brain they have damage.’
16 - PHARMACY IN FOCus
Latest developments in treatment
THeRe ARe MORe THAN 100,000 sTROKes IN THe uK eACH YeAR BuT, THANKs TO NeW TReATMeNT OPTIONs, DeATH RATes CONTINue TO FALL…
In the study, a cohort of almost 4,900 patients was accompanied for 90 days following a minor cerebral infarction or a transitory ischaemic attack, and given either clopidogrel and aspirin, or just aspirin and a placebo. Only five per cent of patients in the first group suffered a cerebral infarction, heart attack, or died as a result of an ischaemic problem in the monitoring period, ie, 121 out of 2,432 patients. In the control group (aspirin and placebo) 6.5 per cent (160) of 2,499 patients went on to experience major ischaemic events. Major haemorrhage occurred in 23 patients in the clopidogrel-aspirin group, compared with just ten in the aspirin-placebo group.
Embolic stroke: rivaroxaban increases haemorrhage risk The results of a study investigating prevention of embolic strokes of unknown cause (Hart et al) revealed scant evidence of benefits: contrary to hopes, the orally administered factor Xainhibitor rivaroxaban, a blood thinning agent, proved no better than aspirin. In fact, it was shown to increase the risk of haemorrhage.
Around a fifth of all strokes are caused by embolisms, and survivors have an elevated risk of suffering another stroke due to the formation of a blood clot. More than 7,000 stroke patients were enrolled in the study and treated with rivaroxaban (at a dose of 15mg per day) or aspirin (100mg per day) for an average of eleven months. The number of recurrent ischaemic events was virtually the same in both groups (158 in the rivaroxaban group, 156 in the aspirin group).
However, major bleeding occurred in 62 patients in the rivaroxaban group, which was almost three times as
many as in the aspirin group, where 23 patients suffered from haemorrhage.
VNS combined with conventional rehabilitation can double rate of recovery But a recent pilot study published in the journal stroke, found that combining conventional rehabilitation therapy with vagus nerve stimulation (VNs) more than doubled the rate of recovery in stroke patients with upper limb impairment. Impaired use of the upper limb is one of the most common symptoms after stroke, and improving upper limb function is a priority for many patients. VNs paired with movement has been shown to drive task-specific plasticity in the motor cortex in rodent models and improve forelimb function after experimental stroke.
STATISTICS • There are more than 100,000 strokes in the uK each year – that is around one stroke every five minutes
• There are more than 1.2 million stroke survivors in the uK.
• stroke is the fourth biggest killer in the uK: fourth in england and Wales, and the third biggest killer in scotland and Northern Ireland.
•More than 400 children have a stroke every year in the uK.
•More than eight out of ten people in england, Wales and Northern Ireland, who are eligible for the emergency clot-busting treatment, thrombolysis, receive it. In scotland, only one in ten of all patients receive the treatment.
• The cost of stroke to society is around £26 billion each year.
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