Management of patients with stroke: Is it time to expand treatment options?

Abstract

Approximately 700,000 people in the United States have an ischemic stroke annually. Substantial research has tested therapies for the very early treatment of ischemic stroke but, to date, only intravenous thrombolysis and intra-arterial measures to restore perfusion have shown success. Despite a 15-year effort to increase the use of these therapies, only approximately 5% of patients with stroke are currently being treated. Although most patients with stroke have some neurological recovery, more than half of stroke survivors have residual impairments that lead to disability or long-term institutionalized care. Laboratory research has demonstrated several mechanisms that help the brain to recover after a stroke. New pharmacological and cell-based approaches that are known to promote brain plasticity are emerging from laboratory studies and may soon expand the window for stroke treatment to restore function. It is time to build on this knowledge and to translate the understanding of recovery after stroke into the clinical setting. Measures that might augment recovery should become a major focus of clinical research in stroke in the 21st century.

Effects of Postinfarct Myelin-Associated Glycoprotein Antibody Treatment on Motor Recovery and Motor Map Plasticity in Squirrel Monkeys

“…There was a significant effect of group (F [1,5] . That is, performance was better in the experimental group on day 3 (experimental group=1.55+0.22; control group=3.44+0.73) and day 9 (experimental group=1.01+0.06; control group=1.92+0.60).…”

“…With respect to secondary end points, there was a significant effect of group (F [1,5] Figure 4B). Assessing reach and retrieval times separately, there was a significant effect of time for both reach (F [3,15]=8.217; P=0.0018) and retrieval (F [3,15]=12.904; P=0.0002) but there was no effect of group nor group X time interaction.…”

“…Assessing reach and retrieval times separately, there was a significant effect of time for both reach (F [3,15]=8.217; P=0.0018) and retrieval (F [3,15]=12.904; P=0.0002) but there was no effect of group nor group X time interaction. Bonferroni comparisons indicate that time to reach was significantly greater on day 3 than on preinfarct day 1 (t [1,15] …”

“…1 This device consisted of a Plexiglas board attached to the front of the monkey's home cage, with five food wells drilled into its surface. Each well was 5mm in depth and varied in diameter from 25-9.5 mm (designated wells 1-5 respectively).…”

“…As our understanding of regenerative mechanisms that underlie the recovery of function matures, it is expected that approaches to target long-term recovery will receive increasing attention. 1 This study focuses on GSK249320, a monoclonal antibody that blocks the axon outgrowth inhibition molecule, myelin-associated glycoprotein (MAG). Brain levels of MAG spontaneously increase after a stroke.…”