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Patent Foramen Ovale and Cryptogenic Stroke: The Hole Story Emerging Therapy Critiques
Despite 3 recent randomized clinical trials, the management of patients with cryptogenic stroke and patent foramen ovale remains unsettled. The primary results of Evaluation of the STARFlex Septal Closure System in Patients with a Stroke and/or Transient Ischemic Attack due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale (CLOSURE), Percutaneous Closure of Patent Foramen Ovale in Cryptogenic Stroke (PC), and Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment (RESPECT) were the same; the intent to treat analysis for the primary end point in all 3 ...
Source: Stroke - August 26, 2013 Category: Neurology Authors: Furlan, A. J., Jauss, M. Tags: Other Stroke Treatment - Medical, Other Stroke Emerging Therapy Critiques Source Type: research

Enhanced phasic GABA inhibition during the repair phase of stroke: a novel therapeutic target
Ischaemic stroke is the leading cause of severe long-term disability yet lacks drug therapies that promote the repair phase of recovery. This repair phase of stroke occurs days to months after stroke onset and involves brain remapping and plasticity within the peri-infarct zone. Elucidating mechanisms that promote this plasticity is critical for the development of new therapeutics with a broad treatment window. Inhibiting tonic (extrasynaptic) GABA signalling during the repair phase was reported to enhance functional recovery in mice suggesting that GABA plays an important function in modulating brain repair. While tonic G...
Source: Brain - January 29, 2016 Category: Neurology Authors: Hiu, T., Farzampour, Z., Paz, J. T., Wang, E. H. J., Badgely, C., Olson, A., Micheva, K. D., Wang, G., Lemmens, R., Tran, K. V., Nishiyama, Y., Liang, X., Hamilton, S. A., ORourke, N., Smith, S. J., Huguenard, J. R., Bliss, T. M., Steinberg, G. K. Tags: CNS Injury and Stroke Original Articles Source Type: research

IV tPA for acute ischemic stroke: Times are changing
Based on evidence that the administration of IV tissue plasminogen activator (tPA) improved the outcomes of selected patients with acute ischemic stroke, the US Food and Drug Administration (FDA) approved its use for this purpose in 1996, leading to a revolution in stroke care.1 Following its introduction into routine clinical practice, stroke began to be viewed as a medical emergency, similar to myocardial infarction, with effective treatment dependent or early symptom recognition and patient transport to facilities capable of conducting rapid evaluations and IV tPA administration. There were, however, considerable barrie...
Source: Neurology - November 20, 2016 Category: Neurology Authors: Goldstein, L. B. Tags: Medical care, All Cerebrovascular disease/Stroke, All epidemiology EDITORIALS Source Type: research

Recycled Translation: Repurposing Drugs for Stroke
AbstractStroke, which continues to be a leading cause of death and long-term disability worldwide, has often been described as a clinical graveyard. While multiple small molecule therapeutics have undergone clinical trials in stroke, currently only one Food and Drug Administration (FDA)-approved medication exists for the treatment of stroke, the biological, recombinant tissue plasminogen activator (rt-PA). Repurposing of therapeutics which have previously gained FDA approval for alternative indications serves as a prospective option for stroke therapeutic translation. In contrast to de novo drug development, repurposing st...
Source: Translational Stroke Research - February 26, 2022 Category: Neurology Source Type: research

IV tissue plasminogen activator use in acute stroke: What are neurologists thinking?
Stroke remains among the top 4 causes of death in the United States and, despite advances in inpatient care and rehabilitation, the leading cause of severe disability. Furthermore, despite being a proven effective therapy, tissue plasminogen activator (tPA) use remains dramatically low, in ~2% of all stroke patients in a community setting.1 In this issue of Neurology®, Shamy2 addresses the use of tPA in appropriate clinical settings and neurologists' rationale for their decisions. Given the mortality and morbidity associated with stroke, the data for substantial benefit with tPA use, and Food and Drug Administration ap...
Source: Neurology - September 23, 2013 Category: Neurology Authors: Boissy, A. R. Tags: All Cerebrovascular disease/Stroke EDITORIALS Source Type: research

Re-evaluate the Efficacy and Safety of Human Urinary Kallidinogenase (RESK): Protocol for an Open-Label, Single-Arm, Multicenter Phase IV Trial for the Treatment of Acute Ischemic Stroke in Chinese Patients
AbstractAcute ischemic stroke (AIS) is a major medical challenge in China. Thrombolytic drugs recommended for the treatment of AIS usually have a narrow time window. Human urinary kallidinogenase (HUK) was approved by the China Food and Drug Administration (CFDA) in 2005 for the treatment of mild to moderate AIS, and it is thus widely used in China. However, large-scale clinical study data for a more complete understanding of various aspects of its safety and efficacy characteristics are still unavailable. The ongoing Reevaluate the Efficacy and Safety of Human Urinary Kallidinogenase (RESK) trial is designed to reevaluate...
Source: Translational Stroke Research - March 5, 2017 Category: Neurology Source Type: research

A call for formal telemedicine training during stroke fellowship
During the 20 years since US Food and Drug Administration approval of IV tissue plasminogen activator for acute ischemic stroke, vascular neurology consultation via telemedicine has contributed to an increased frequency of IV tissue plasminogen activator administration and broadened geographic access to the drug. Nevertheless, a growing demand for acute stroke coverage persists, with the greatest disparity found in rural communities underserved by neurologists. To provide efficient and consistent acute care, formal training in telemedicine during neurovascular fellowship is warranted. Herein, we describe our experiences in...
Source: Neurology - May 8, 2016 Category: Neurology Authors: Jagolino, A. L., Jia, J., Gildersleeve, K., Ankrom, C., Cai, C., Rahbar, M., Savitz, S. I., Wu, T.-C. Tags: All Health Services Research, All Cerebrovascular disease/Stroke, All Education CONTEMPORARY ISSUES: INNOVATIONS IN EDUCATION Source Type: research

Medication Adherence and Stroke Prevention: What Real World Data Tells Us.
Authors: Hsieh CY Abstract Medication adherence, by definition,(2) is "the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen." Poor medication adherence can interfere with the ability to treat many diseases, leading to greater complications and a lower quality of life.(3) In this issue of Acta Neurologica Taiwanica, Chen et al.(4) presented the inverse association between adherence of antithrombotic agents and poor outcomes after a first-ever ischemic stroke. The findings were consistent with Sung, et al.(5) that medication nonadherence are prevalent in young adu...
Source: Acta Neurologica Taiwanica - February 7, 2020 Category: Neurology Tags: Acta Neurol Taiwan Source Type: research

Hyperbaric Oxygen Therapy in Acute Ischemic Stroke: A Review
Stroke, also known as cerebrovascular disease, is a common and serious neurological disease, which is also the fourth leading cause of death in the United States so far. Hyperbaric medicine, as an emerging interdisciplinary subject, has been applied in the treatment of cerebral vascular diseases since the 1960s. Now it is widely used to treat a variety of clinical disorders, especially hypoxia-induced disorders. However, owing to the complex mechanisms of hyperbaric oxygen (HBO) treatment, the therapeutic time window and the undefined dose as well as some common clinical side effects (such as middle ear barotrauma), the wi...
Source: Interventional Neurology - November 7, 2014 Category: Neurology Source Type: research

Tenecteplase for Acute Ischemic Stroke Treatment
Semin Neurol DOI: 10.1055/s-0040-1722722The introduction of thrombolytic therapy in the 1990s has transformed acute ischemic stroke treatment. Thus far, intravenous recombinant tissue plasminogen activator (rt-PA) also known as alteplase is the only thrombolytic proven to be efficacious and approved by the United States Food and Drug Administration. But the thrombolytic agent tenecteplase (TNK) is emerging as a potential replacement for rt-PA. TNK has greater fibrin specificity, slower clearance, and higher resistance to plasminogen activator inhibitor-1 than rt-PA. Hence, TNK has the potential to provide superior lysis wi...
Source: Seminars in Neurology - January 20, 2021 Category: Neurology Authors: Baird, Alison E. Jackson, Richard Jin, Weijun Tags: Review Article Source Type: research

The emerging role of FTY720 as a sphingosine 1 ‐phosphate analog for the treatment of ischemic stroke: The cellular and molecular mechanisms
Three important mechanisms for neuroprotective effects of FTY720 have been described. Functional antagonistic, functional agonistic and receptor-independent mechanisms. Here, we review these mechanisms in more details and describe animal model and in clinical trial studies AbstractFinding novel and effective drugs for the treatment of ischemic stroke is warranted because there is not a definitive treatment for this prevalent disease. Due to the relevance between the sphingosine 1-phosphate (S1P) receptor and several neurological diseases including ischemic stroke, it seems that fingolimod (FTY720), as an agonist of S1P rec...
Source: Brain and Behavior - May 10, 2021 Category: Neurology Authors: Maryam Naseh, Jafar Vatanparast, Ali Rafati, Mahnaz Bayat, Masoud Haghani Tags: REVIEW Source Type: research

tPA and warfarin: Time to move forward
The appropriate use of IV tissue plasminogen activator (tPA) for patients with acute ischemic stroke remains an area of active discussion among health care professionals. Since its approval in the United States by the Food and Drug Administration in 1996, the medical community has continued to review and discuss the risks vs benefits of this important therapy. Two recent publications1,2 and accompanying editorials have refocused attention on the vexing issue of using IV tPA in patients taking warfarin. The Xian et al.1 study found a 1.1% absolute increase in the risk of intracranial hemorrhage (ICH) with warfarin use (5.7%...
Source: Neurology - February 4, 2013 Category: Neurology Authors: Alberts, M. J., Naidech, A. M. Tags: All Cerebrovascular disease/Stroke EDITORIALS Source Type: research

Successful Intra-arterial Thrombolysis in a Patient with an Intracranial Meningioma
We report a case of a 78-year-old man who was seen in our emergency department within 2 hours from sudden onset of aphasia, right-sided hemiplegia, hypoesthesia, and homonymous hemianopsia. The National Institutes of Health Stroke Scale (NIHSS) score at admission was 20. Intra-arterial thrombolysis was performed with administration of .3 mg/kg of alteplase combined with mechanical thrombectomy. At discharge, his NIHSS score was 1, and after 90 days, his modified Rankin score was 1. To our knowledge, this is the first report of intra-arterial thrombolysis in a patient with acute ischemic stroke with an intracranial tumor.
Source: Journal of Stroke and Cerebrovascular Diseases - July 8, 2013 Category: Neurology Authors: Robson F. Baiense, Agessandro Abrahão, Irapuá F. Ricarte, Thiago G. Fukuda, Ricardo A. Oliveira, Gisele S. Silva, Maristela Costa, Manoel J. Teixeira Tags: Case Reports Source Type: research

FDA OKs First Vagus Nerve Stimulation System for Stroke Rehab FDA OKs First Vagus Nerve Stimulation System for Stroke Rehab
The US Food and Drug Administration has approved a first-of-its kind vagus nerve stimulation system to treat moderate-to-severe upper extremity motor deficits associated with chronic ischemic stroke.FDA Approvals
Source: Medscape Neurology and Neurosurgery Headlines - August 27, 2021 Category: Neurology Tags: Neurology & Neurosurgery News Alert Source Type: news

Sustainability of Intravenous Alteplase Administration via Telephone-Based Consult: Data from a US Health System
Despite multiple advances in management over the last few decades, acute ischemic stroke (AIS) is still associated with high morbidity and mortality.1 Intravenous alteplase (IV tPA) was shown to be efficacious and safe for AIS about a quarter century ago2 and remains the only Food and Drug Administration-approved medication for this indication. Though ideal, stroke neurologists may not be available in-person to decide whether to administer tPA to an AIS patient.
Source: Journal of Stroke and Cerebrovascular Diseases - January 27, 2022 Category: Neurology Authors: Sarah E. Nelson, Eric Aldrich, Brenda Johnson, Susan Groman, Richard E. Thompson, Victor Urrutia Source Type: research

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