A great paper from the Dana Foundation. I'll comment on several sections. Full paper available at link.
http://www.dana.org/media/detail.aspx?id=44906
Few medical conditions, neurological or otherwise, exact a greater public-health toll than stroke, a fact underscored by a
new published report
on the global burden of stroke. An acute brain injury that may begin
insidiously years prior, stroke is now the second leading cause of death
and the third most common cause of disability worldwide. Nearly 17
million people in the world will have a first stroke in the next year,
and 33 million people are stroke survivors.
In the U.S., stroke is
the No. 1 cause of serious long-term disability. Approximately 800,000
strokes occur annually in this country, and about 130,000 people die
annually from stroke. The risk of stroke has decreased by roughly 70
percent in the U.S. since incidence was first tracked in the mid-1900’s,
a downward trend that has not plateaued, suggesting there is still room
for improvement. Stroke risk factors are well known, and experts
estimate that 80 percent of strokes could be prevented with better
management of hypertension, blood lipids, and glucose.
Getting Aggressive About Prevention
“Most
people believe there could be substantial, dramatic stroke reduction if
we just really aggressively managed the risk factors we currently know
about,” says Walter Koroshetz, M.D., deputy director of the National
Institute for Neurological Disorders and Stroke and a member of the Dana
Alliance for Brain Initiatives. “In many diseases, you need a major
scientific breakthrough to make a difference. That’s not true with
stroke.”
Except you could reduce stroke risk by hundreds of percents following these;
Green tea and coffee
20% -
Green tea, coffee may reduce stroke risk by 20 percent
Potassium
21% Why eat three bananas a day?
Marijuana buds
50% A Marijuana Bud A Day Keeps The Stroke Away
Mediterranean diet
30% -
Mediterranean Diet Proven Key In Avoiding Heart Disease And Stroke
lycopene - tomatoes
55% -
Tomatoes Linked to Lower Stroke Risk
Fish
6% -
Does Eating Two Fish a Day REALLY Keep the Chance of Stroke Away?
Total 307%
Opening the Window for Acute Treatment
Public-health
advocates have tried for years to drive home the message that strokes
require immediate medical attention, ever since a treatment became
available that could help some people with ischemic stroke, which occurs
when blood flow to part of the brain is restricted by a clot or
narrowed blood vessel. Tissue plasminogen activator, or tPA, is still
the only drug approved for treating acute stroke, but its use is
severely limited, largely because published guidelines call for it to be
administered within three hours of stroke onset for most patients. Some
experts have criticized these guidelines and are calling for them to be
revised.
With a pathetic 12% efficacy that means that they are lying about 88% of the results
Public Awareness Still Lacking
The
advent of tPA has triggered a system-wide reorganization of stroke
urgent care that is still evolving nearly 17 years later. For example,
specialized stroke centers have been established where expert care,
along with the tools and technologies for swift, accurate diagnosis, is
readily available. A tiered system based on minimum requirements, much
like the system that designates hospitals as Level 1-4 trauma centers
depending on their capabilities, is being put in place for stroke care
as well, so that patients can be transported to the most advanced center
in their area. While there have been vast improvements, a number of
obstacles remain. Primary among them is public awareness, experts say.
“Public
knowledge about stroke is still very low,” says Caplan. “This is the
more difficult problem, because a lot of people don’t know they’ve had a
stroke.”
The real problem here is that there is no easy objective way to diagnose a stroke. Friends have been in ERs for hours because the stroke hadn't established severe enough effects to be obvious. That should be accomplished with the tricorder possibly thru one of these 17 ways.
Better Rehab Through Brain Science
The
Global Burden of Disease report underscores the dichotomy between
richer, developed countries like the U.S., where the majority of people
who suffer a stroke survive, and poorer, developing countries where
people are more likely to die from a stroke. While cutting stroke deaths
is a major global-health goal, better recovery and rehabilitation
strategies are desperately needed to address the ever-growing population
of stroke survivors who struggle to function with varying degrees of
disability.
“We have in the U.S. alone 800,000 people who have a
stroke each year. So the question becomes, what can be done to return
functional recovery to those patients?” says Koroshetz. “That’s where
the really interesting science is, because it intersects with the area
of neuroplasticity–how the brain learns to function for a particular
purpose and how it rewires itself to get lost function back.”
You have this all wrong, you need to stop the neuronal cascade of death resulting in much less death and disability. The silo of rehabilitation is not where the breakthroughs are going to occur because no one knows exactly how to make neuroplasticity repeatable.
Brain Recovery Not Passive
Armed with such
investigational tools, neuroscience has already revealed some
fundamental principles of recovery in the brain. “The general rule, at
least in the cortex, is that somehow the brain recovers function after
an initial injury, whether it’s a stroke or some other lesion,” says
Koroshetz. “Now people are studying how that happens, and the hope is
that we can translate that to therapeutic strategies.”
One key
finding already, Koroshetz says, is that recovery from injury is not
“passive.” Rather, it requires enhancement by active exposure to sensory
stimuli or motor practice. He points to the
LEAPS study,
which was the first large randomized, controlled clinical trial that
investigated recovery of locomotor function in people who had had a
stroke. The NIH-funded study compared two fairly intensive therapies:
treadmill walking vs. strength and balance training performed at home
with a physical therapist. A third group, serving as controls, received
“standard of care”–whatever physical therapy or rehab they were getting
as part of their regular medical care.
‘Standard of Care’ Substandard?
What the hell is the standard of care for stroke? Does anyone know?
