A stroke causes the death of brain cells.
In the US, stroke is the fifth major cause of death and the leading cause of disability.
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptures. Brain cells die in the part of the brain that is cut off from the blood and oxygen supply.
An ischemic stroke is caused by a clot obstructing blood flow to the brain; hemorrhagic stroke results when a blood vessel ruptures and prevents blood flow to the brain. A transient ischemic attack (TIA), or "mini stroke," is caused by a temporary clot.
According to the American Stroke Association (ASA), a stroke affecting the right side of the brain will affect the left side of the body. It can lead to paralysis on the left side, vision problems, memory loss and a quick, inquisitive behavioral style.
A stroke in the left side of the brain can cause paralysis on the right side of the body, speech and language problems, memory loss and a slow, cautious behavioral style.
Limited rehabilitation sparks search for drug
Speech and physical therapies traditionally have been the mainstays of stroke rehabilitation programs. But about 1 in 3 stroke patients suffer depression, limiting their ability to participate in rehabilitation, and more than half of stroke survivors are left with some neurological impairment.
The limitations of rehabilitation efforts have sparked an interest in finding other ways to enhance neurological recovery, and scientists have reviewed a number of existing therapies, such as antidepressants, to improve motor recovery and Alzheimer's disease drugs to boost recovery from aphasia, which involves difficulty in speaking, writing and understanding spoken and written language.
But there are conflicting findings from studies of these and other drugs given to recovering stroke patients, and they have not yet been clearly proven to be of benefit to patients recovering from strokes.
There is growing evidence that the class of antidepressants known as selective serotonin reuptake inhibitor (SSRIs), such as Prozac, Paxil and Celexa, may enhance neurological recovery beyond their effect on mood.
Another type of antidepressant, norepinephrine reuptake inhibitor (NRI) has also shown benefit.
SSRIs and Alzheimer's drugs look promising
The current study was carried out by neurologists Dr. Xabier Beristain and Dr. Esteban Golombievski, of Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine in Chicago, IL.
- Stroke affects about 795,000 Americans a year; that means one stroke every 40 seconds
- Stroke kills nearly 129,000 Americans a year; that means one death every 4 minutes
- About 40% of stroke deaths occur in males and 60% occur in females.
The team analyzed 56 clinical trials of SSRIs, and found that the drugs appear to improve dependence, disability, neurological impairment, anxiety and depression after stroke.
There is also growing evidence that Alzheimer's disease drugs, known as acetylcholinesterase inhibitors (including Aricept, Exelon and Razadyne), can improve aphasia in stroke patients.
A second type of Alzheimer's medication under study is memantine (Namenda). When used in combination with therapy, memantine has shown language benefits lasting at least a year when compared with a placebo. But clinical evidence of memantine for stroke recovery remains limited.
Limitations to this study include the fact that the original studies had different designs. So far, most studies of drugs potentially useful for stroke recovery have been small, employing different methodologies and time windows between the stroke and the clinical intervention. There are currently several studies under way in this field.
Drs. Beristain and Golombievski conclude:
"We need well-designed, large clinical trials with enough power to establish the usefulness of medications as adjuvants to rehabilitation before we can routinely recommend the use of these agents to enhance neurological recovery after stroke."
Medical News Today recently reported on how work stress may be linked to increased risk of stroke.