Opinion statement
The improvement of recovery after stroke remains one of the main priorities for patients with stroke. Acute de-occlusion of the artery should improve patient outcome and recovery. Recent data and meta-analysis confirmed the efficacy of IV thrombolysis when administered to selected patients less than 4.5 hours after the onset of ischemic stroke even in patients aged > 80 years. IV thrombolysis with rTPA is currently the only validated treatment for the acute phase of ischemic stroke. This has lead to a major public health effort to create stroke treatment units in developed countries. Mechanical thrombectomy is not yet validated despite major support from clinicians and the industry overall. Many other treatment options are currently being tested in various other therapeutic areas. Some data show clearly that some of these options are now close to clinical significance: specific and adapted rehabilitation procedures that will include a rationale in patients’ care management, use of monoaminergic drugs like SSRIs with improvement of motor recovery through a specific action on cortical excitability, cortical stimulation or inhibition with magnetic or electric techniques with the aim of modifying functional inter cortical balance and connections, and clinical and bio markers of recovery that would help to ensure appropriate individual care of each patient. Finally, repair therapies with the aim of restoring the brain-damaged networks could be useful in patients with persistent severe deficits. Several classes are under study for brain repair, including the use of stem cells, growth factors, and small molecules, but these are still at a preclinical level of development.
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Rha J-H, Saver JL. The impact of recanalization on ischemic stroke outcome. A meta-analysis. Stroke. 2007;38:967–73.
Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000213. doi:10.1002/14651858.CD000213.pub2. [IST-3] collaborative group: a randomised controlled trial. Lancet Neurol Published Online May 23, 2012 doi:10.1016/S0140-6736(12)60768-5
[IST-3]collaborative group: a randomised controlled trial . Lancet Neurol Published Online May 23, 2012 doi:10.1016/S0140-6736(12)60768-5. This papers shows that patients over 80 can benefit from IV thrombolysis at the acute phase of their stroke.
Wardlaw JM, Murray V, Berge E, del Zoppo GJ, Sandercock P, Lindley RL, Cohen G. Recombinant tissue plasminogen activator for acute ischemic stroke: an updated review and meta-analysis. analysis. Lancet Neurol. 2012. doi:10.1016/S0140-6736(12)60738-7. Published Online May 23, 2012.
Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C. Intra-arterialprourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. JAMA. 1999;282:2003–11.
Costallat V, Machi P, Lobotesis K, Maldonado I, Vendrell JF, Riquelme C, Mourand I, Milhaud D, Héroum C, Perrigault PF, Arquizan C, Bonafé A. Rescue, Combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the Solitaire device: a prospective 50-patient single-center study. Stroke. 2011;42:1929–35.
Chollet F, Tardy J, Albucher JF, Thalamas C, Berard E, Lamy C, Bejot Y, Deltour S, Jaillard A, Niclot P, Guillon B, Moulin T, Marque P, Pariente J, Arnaud C, Loubinoux I. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol. 2011 Feb;10(2):123-30. Epub 2011 Jan 7. This paper shows that a three-month treatment with fluoxetine augment motor recovery after ischemic stroke in hemiplegic patients.
Mikami K, Jorge RE, Adams HP Jr, Davis PH, Leira EC, Jang M, Robinson RG. Effect of Antidepressants on the Course of Disability Following Stroke. Am J Geriatr Psychiatry. 2011 Feb 24. This paper suggests that SSRI effect on recovery after stroke persists 9 months after the treatment has been stopped.
Hoyer EH, Celnik PA. Understanding and enhancing motor recovery after stroke using transcranial magnetic stimulation. Restor Neurol Neurosci. 2011;29(6):395–409.
Corti M, Patten C, Triggs W. Repetitive transcranial magnetic stimulation of motor cortex after stroke: a focused review. Am J Phys Med Rehabil. 2012;91(3):254–70.
Dimyan MA, Cohen LG. Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke. Neurorehabil Neural Repair. 2010;24(2):125–35. Epub 2009 Sep 18.
Zimerman M, Heise KF, Hoppe J, Cohen LG, Gerloff C, Hummel FC. Modulation of Training by Single-Session Transcranial Direct Current Stimulation to the Intact Motor Cortex Enhances Motor Skill Acquisition of the Paretic Hand. Stroke. 2012 May 22. [Epub ahead of print]
Reis J, Fritsch B. Modulation of motor performance and motor learning by transcranial direct current stimulation. Curr Opin Neurol. 2011;24(6):590–6. A review of the potential effect of TDCS on motor function and learning.
Ackerley SJ, Stinear CM, Barber PA, Byblow WD. Combining theta burst stimulation with training after subcortical stroke. Stroke. 2010;41(7):1568–72. Epub 2010 May 20.
Talelli P, Wallace A, Dileone M, Hoad D, Cheeran B, Oliver R, Vandenbos M, Hammerbeck U, Barratt K, Gillini C, Musumeci G, Boudrias MH, Cloud GC, Ball J, Marsden JF, Ward NS, Di Lazzaro V, Greenwood RG, Rothwell JC. Theta Burst Stimulation in the Rehabilitation of the Upper Limb: A Semirandomized, Placebo-Controlled Trial in Chronic Stroke Patients. Neurorehabil Neural Repair. 2012 Mar 12. [Epub ahead of print]
Koch G, Bonnì S, Giacobbe V, Bucchi G, Basile B, Lupo F, Versace V, Bozzali M, Caltagirone C. θ-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect. Neurology. 2012;78(1):24–30. Epub 2011 Dec 14.
Lo AC, Guarino PD, Richards LG, Haselkorn JK, Wittenberg GF, Federman DG, Ringer RJ, Wagner TH, Krebs HI, Volpe BT, Bever Jr CT, Bravata DM, Duncan PW, Corn BH, Maffucci AD, Nadeau SE, Conroy SS, Powell JM, Huang GD, Peduzzi P. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med. 2010;362(19):1772–83. Epub 2010 Apr 16. Erratum in: N Engl J Med. 2011 Nov 3;365(18):1749.
Duncan PW, Sullivan KJ, Behrman AL, Azen SP, Wu SS, Nadeau SE, Dobkin BH, Rose DK, Tilson JK, Cen S, Hayden SK, LEAPS Investigative Team. Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med. 2011;364(21):2026–36. Key paper for the use of devices in post stroke patients. It shows that treadmill program has no effect on walking recovery.
Bernhardt J, Thuy MNT, Collier JM, Legg LA. Very early versus delayed mobilisation after stroke. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006187. doi:10.1002/14651858.CD006187.pub2.
Sirtori V, Corbetta D, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in stroke patients. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004433. doi:10.1002/14651858.CD004433.pub2.
Platz T, van Kaick S, Mehrholz J, Leidner O, Eickhof C, Pohl M. Best conventional therapy versus modular impairment-oriented training for arm paresis after stroke: a single-blind, multicenter randomized controlled trial. Neurorehabil Neural Repair. 2009 Sep;23(7):706–16. Epub 2009 Jun 18. A positive trial in favor of modular impairment-oriented training. It underlines that rehabilitation procedures should be adapted individually to each patients’ deficit.
Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD008349. doi:10.1002/14651858.CD008349.pub2.
Bowen A, Knapp P, Gillespie D, Nicolson DJ, Vail A. Non-pharmacological interventions for perceptual disorders following stroke and other adult-acquired, non-progressive brain injury. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD007039. doi:10.1002/14651858.CD007039.pub2.
Barclay-Goddard RE, Stevenson TJ, Poluha W, Thalman L. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD005950. doi:10.1002/14651858.CD005950.pub4.
Gopurappilly R, Pal R, Mamidi MK, Dey S, Bhonde R, Das AK. Stem cells in stroke repair: current success & future prospects. CNS Neurol Disord Drug Targets. 2011;10(6):741–56.
Stinear C. Prediction of recovery of motor function after stroke. Lancet Neurol. 2010 Dec;9(12):1228-32. Epub 2010 Oct 27. A review of different elements to predict recovery and to adapt the care management of the patients.
Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G. Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke: the EPOS cohort study. Stroke. 2010;41:745–50.
DeVetten G, Coutts SB, Hill MD, et al. Acute corticospinal tract Wallerian degeneration is associated with stroke outcome. Stroke. 2010;41:751–6.
Marshall RS, Zarahn E, Alon L, Minzer B, Lazar RM, Krakauer JW. Early imaging correlates of subsequent motor recovery after stroke. Ann Neurol. 2009;65:596–602.
Saur D, Ronneberger O, Kümmerer D, Mader I, Weiller C, Klöppel S. Early functional magnetic resonance imaging activations predict language outcome after stroke. Brain. 2010;133(Pt 4):1252–64. Epub 2010 Mar 18.
Di Lazzaro V, Profice P, Pilato F, et al. Motor cortex plasticity predicts recovery in acute stroke. Cereb Cortex. 2010;20:1523–58.
Puig J, Pedraza S, Blasco G, Daunis-I-Estadella J, Prados F, Remollo S, Prats-Galino A, Soria G, Boada I, Castellanos M, Serena J. Acute damage to the posterior limb of the internal capsule on diffusion tensor tractography as an early imaging predictor of motor outcome after stroke. AJNR Am J Neuroradiol. 2011;32(5):857–63. Epub 2011 Apr 7.
Whiteley W, Wardlaw J, Dennis M, Lowe G, Rumley A, Sattar N, Welsh P, Green A, Andrews M, Sandercock P. The use of blood biomarkers to predict poor outcome after acute transient ischemic attack or ischemic stroke. Stroke. 2012;43(1):86–91. Epub 2011 Oct 20.
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Chollet, F., Albucher, JF. Strategies to Augment Recovery After Stroke. Curr Treat Options Neurol 14, 531–540 (2012). https://doi.org/10.1007/s11940-012-0196-3
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DOI: https://doi.org/10.1007/s11940-012-0196-3