Medicine's Next Big Thing? Stroke Stopper -- Research Summary

BACKGROUND: Stroke is the number one cause of disability among adults in the United States, according to the National Stroke Association, and the potential effects of these dangerous blood clots don’t end there. Strokes leave some with cognitive problems, difficulty speaking and even the inability to speak. Experts say many strokes are silent and lead to dementia or other problems.

SYMPTOMS: In stroke treatment, time is everything. In fact, it's so important, stroke experts like to use the phase, "time is brain." Because every minute counts, it's important to recognize the symptoms of a stroke. The American Heart Association says to look out for the following: sudden trouble seeing in one or both eyes; sudden confusion, trouble speaking or understanding; sudden numbness or weakness of the face, arm or leg, especially on one side of the body; trouble walking; dizziness; loss of balance or coordination; or a sudden, severe headache with no known cause. Not all warning signs take place during every stroke.

TREATMENT: Ischemic strokes, or strokes caused by a blood clot in the brain, account for about 80 percent of strokes. Treatments for its less common relative, hemorrhagic stroke, are limited. Even for ischemic stroke, the list of options for treatment is far too short. Medications are the first line of attack against stroke damage. At this time, the only FDA-approved clot-busting drug is tissue plasminogen activator (tPA). tPA has enzymes naturally found in the body that convert plasminogen into another enzyme to dissolve blood clots. Research shows the drugs increase a stroke patient's chances of recovery with little or no disability by 33 percent. In order to work, tPA has to be administered within three hours of stroke symptom onset. The most common complication of the drug is brain hemorrhage. Because of this dangerous potential complication and the small window of time tPA can work, only two percent of Americans who suffer acute strokes receive the medication. Other lines of attack against stroke include blood-thinning medications like aspirin. Although they play more of a preventive role, these medications can be administered during or immediately after a stroke to prevent further clot formation. In some cases, stroke patients are operated on after the incident. The MERCI Retriever, FDA approved in 2004, is a device used by interventional radiologists to remove blood clots in the brain. In cerebral angioplasty, physicians place balloons, stents and/or coils in the brain's blood vessels to prevent clots.

NEW OPTIONS: Numerous stroke treatments used in combination with tPA or alone are under investigation for safety and efficacy. Some physicians are looking at an approach that combines tPA with additional treatment through a catheter at the site of the brain clot. Others are studying hypothermia, a neuroprotective technique. This involves cooling down the body to slow down brain damage after a stroke. The more common method of induced hypothermia takes place by using cooling blankets, while a less traditional approach involves inserting cold saline into the body intravenously.

A new method of stroke treatment that is showing promise uses the tetracycline antibiotic called minocycline (Minocin). This more than 30-year-old antibiotic has been shown in previous research to protect nerve cells and prolong the survival of animals with ALS, stroke, trauma, Huntington's disease and Parkinson's disease, according to the ALS Association. Researchers are administering minocycline very shortly after stroke in slightly higher doses and following the progress of patients who receive the treatment. Investigators hope the drug will prove as effective in humans as it has been in rats by blocking the dangerous side effect of tPA, blocking brain inflammation and preventing apoptosis, or cell suicide.

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Lindsay Braun at lbraun@ivanhoe.com.

FOR MORE INFORMATION, PLEASE CONTACT:

David Hess, MD
Medical College of Georgia
 (706) 721-1691
http://www.mcg.edu