ESOC 2024 Session Report: “Hyperacute Management”

 This is ABSOLUTELY APPALLING! 'Management' NOT RECOVERY! I don't think there is a stroke association in the world that has any clue on what survivors want(100% recovery) and are working towards that!

ESOC 2024 Session Report: “Hyperacute Management”

• Christian Boehme, MD, PhD @chris7ianb

Originally published June 4, 2024 10.1161/blog.20240603.559421

European Stroke Organisation Conference
May 15–17, 2024

Session: Hyperacute Management

The session on hyperacute management was chaired by Else Charlotte Sandset (Oslo, Norway) and Marc Ribo (Barcelona, Spain).

Yijun Zhang (Beijing, China) kicked off the session with “Edaravone Dexborneol In Treatment Of Large Artery Atherosclerosis Stroke.” Edavarone, a free radical scavenger of reactive oxygen species and reactive nitrogen species which penetrates the blood brain barrier, holds promise as a potential neuroprotective agent and has been widely used in Japan, China, and India. Dr. Zhang emphasized the importance of large artery atherosclerosis, which is the most frequent etiology of ischemic stroke in the Chinese population. This study was a post hoc analysis of the TASTE trial and the TASTE-SL trial and assessed the effects of edaravone dexborneol in 658 patients with large artery atherosclerosis-etiology stroke with treatment <48 hours of onset and a duration of 2 weeks.  Treatment significantly increased rates of excellent functional outcome on the mRS scale with no difference in safety outcomes after 90 days. These results have to be validated in the future.

Next, Yufei Wei (Beijing, China) presented “Timing Of Antihypertensive Treatment Initiation In Anterior Versus Posterior Circulation Acute Ischemic Stroke.” This post hoc analysis of the CATIS-2 trial analyzed outcomes of anterior and posterior circulation strokes. The rate of death and major disability (mRS³3) was 12.4% in anterior circulation stroke and 8.3% in posterior circulation stroke regarding early antihypertensive treatment. Wei concluded that anterior circulation stroke patients are more susceptible to blood pressure fluctuations, which lead to a passive decrease in cerebral perfusion. This may exacerbate secondary neuronal damage in the ischemic penumbra. Further studies are needed to explore the underlying mechanisms of these findings.

Davide Carone from Oxford, United Kingdom, presented “Patients Randomized To Glenzocimab Suffered Less Hemorrhagic Transformation With Greater Benefit In Larger Baseline Infarct Core.” The ACTISAVE trial did not result in better outcomes when using glenocizumab, which was presented in the main session. Carone showed data which support the hypothesis that mechanical thrombectomy-related ICH is moderated by glenocizumab (frequency and size). Additionally, glenocizumab reduced the risk of hemorrhagic transformation associated with larger infarcts at admission. Also, the influence of hemorrhage on functional outcome is moderated by glenocizumab. Carone concluded that, despite a moderate imbalance of baseline characteristics of the two groups, glenocizumab-treated patients had a trend for smaller lesion volumes at 24 hours after treatment compared to placebo. The smaller follow-up infarct volumes are likely due to both having less hemorrhagic transformation (frequency and volume) and ischemic injury. These data suggest a more pronounced effect in patients with larger infarct cores. Finally, Carone concluded that a reduction in hemorrhagic transformation volume can drive safer clinical outcomes.

Greg Albers from Stanford, United States, presented “Secondary Analyses From The Timeless Trial” where tenecteplase was investigated against placebo in the late time window of intravenous thrombolysis. In the subgroup of M1 occlusions only, use of tenecteplase resulted in a higher proportion of favorable functional outcome (mRS 0-2) at 3. On the contrary, in the M2 occlusion subgroup, there was no difference in achievement of favorable functional outcome. In wake-up stroke patients, final infarct volume growth showed a trend in favor for tenecteplase not reaching statistical significance. Three-month mRS ordinal shift and functional independence were numerically higher and infarct growth was less in patients with M1 occlusion treated with tenecteplase compared to placebo.

“Intravenous Thrombolytic Is Associated With Increased First Pass Effect In Thrombectomy” was presented by Steven Bush from Parkville, Australia. This sub study from the IRIS collaboration investigated if bridging thrombolysis increased the likelihood of angiographic first pass effect (FPE), which is considered to have beneficial effects on outcomes and safety. Bridging thrombolysis increased the likelihood of FPE by 27% translating to a Number Needed to Treat from 4 to move 1 patient into the FPE group. The odds of a patient having a favorable functional outcome at 3 months increased by 170% with FPE when compared to non-FPE thrombectomy. For patients that achieved eTICI2c or 3 revascularization, the odds of experiencing a favorable functional outcome increased by 40% when FPE was achieved. In these patients, the risk for developing an ICH or procedural complications decreased by 45% with FPE, but FPE had no impact on death or symptomatic ICH. Bush concluded that bridging thrombolysis significantly increases the chance of achieving a first pass effect, and the benefit of it on functional outcomes and safety was confirmed, even after adjusting for TICI score and procedural times of endovascular treatment.

João Pedro Marto from Lisbon, Portugal, presented results from the ETIICA Study – “Endovascular Treatment For Isolated Cervical Internal Carotid Artery Occlusion.” In 998 included patients from multiple international centers, no difference in 3-month mRS, 3-month favorable outcome (mRS 0-2), or 3-month mortality was observed in patients treated with endovascular treatment and thrombolysis compared to best medical treatment alone. Furthermore, the risk of intracerebral hemorrhage was higher in the group treated with thrombectomy. Marto concluded that in patients with isolated cervical internal artery occlusion, endovascular treatment was associated with similar chance of disability and mortality but resulted in a potentially higher risk of ICH. Further RCTs are warranted to find the optimal treatment for isolated cervical internal artery occlusion patients.

Nabila Wali from Amsterdam, the Netherlands, presented “Admission Systolic Blood Pressure And Outcomes After Endovascular Treatment In Acute Ischemic Stroke: A Cohort Study From The Eva-Trisp Collaboration.” This study found that both lower and higher admission systolic blood pressure was associated with poor functional outcome (mRS >2) with the threshold ~ 150 mmHg. The same applied to diastolic blood pressure ~ 80 mmHg. Lower systolic blood pressure was associated with higher mortality, and higher systolic blood pressure was associated with higher NIHSS after 24 hours and increased sICH-risk. Each 10-mmHg decrease, or increase showed a significant effect on 3-month poor functional outcome (mRS >2). Wali concluded that EVT was most effective in patients with a systolic blood pressure ~ 150 mmHg.

Davide Strambo from Lausanne, Switzerland, completed the session with “Influence Of Stroke Severity And Occlusion Site On Endovascular Therapy Effect For Posterior Cerebral Artery Occlusion Strokes,” a secondary analysis of the PLATO study. This study investigated if in acute ischemic stroke from isolated posterior cerebral artery occlusion, the association of endovascular treatment plus medical management is modified by baseline stroke severity and the segment of arterial occlusion within PCA (P1 or P2-segment). Of 1059 patients, 35% received EVT; IVT was administered in 40% of each study group. In patients with a moderate to severe baseline stroke severity (NIHSS >6), EVT was associated with a higher odds for functional independence at 3 months, whereas in patients with milder strokes (NIHSS <7), EVT was associated with a worse outcome, compared to those with medical management. There were no differences in ordinal mRS shift, excellent outcome, independence, sICH, or mortality when comparing P1 and P2-segment occlusions. Strambo concluded that in isolated posterior cerebral artery occlusion, baseline NIHSS appears to be an important modifier of the association of EVT and outcomes. EVT was associated with more favorable disability outcomes than medical management only in moderate-to-severe strokes. The risk of symptomatic intracerebral hemorrhage was increased with EVT irrespective of baseline stroke severity. Mortality was higher with EVT compared to medical management in both minor and severe stroke, but to a greater extent in the latter group. These results might be important for  hypothesis generating and clinical trial design in future randomized trials of EVT in isolated posterior cerebral artery occlusions. The reasons why sICH risk was increased are subject to further investigation. In my opinion, the lower sensitivity of non-contrast CT in the posterior circulation might underestimate early ischemic lesions, and, therefore, sICH risk might be increased in patients with a longer onset-to-recanalization time. Secondly, differences in autoregulation properties and lower sympathetic nervous activity of the posterior circulation arteries compared to anterior circulation arteries might play a role in higher sICH risk after reperfusion in posterior circulation stroke.

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"ESOC 2024 Session Report: “Hyperacute Management”", American Heart Association Blogs, June 4, 2024, DOI: 10.1161/blog.20240603.559421,

• Christian Boehme, MD, PhD

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Worldwide Survey on Approach to Thrombolysis in Acute Ischemic Stroke With Large Vessel Occlusion

 It's very obvious here that there is NO PROTOCOL for this, so stroke patients are at the whims of their ER doctors. Hope your whimsical doctor makes the right choice for you to be on the path to 100% recovery.

Worldwide Survey on Approach to Thrombolysis in Acute Ischemic Stroke With Large Vessel Occlusion

Nishita Singh, MD https://orcid.org/0000-0003-3647-0904, Nima Kashani, MD https://orcid.org/0000-0002-9752-784X, Alonso G. Zea Vera, MD https://orcid.org/0000-0002-8172-3117, Aleksander Tkach, MD https://orcid.org/0009-0009-4063-4431, and Aravind Ganesh, MD, PhD https://orcid.org/0000-0001-5520-2070Authors Info & Affiliations

August 2024 issue

14 (4)

https://doi.org/10.1212/CPJ.0000000000200317

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Abstract

Background and Objectives

With recent trials suggesting that endovascular thrombectomy (EVT) alone may be noninferior to combined intravenous thrombolysis (IVT) with alteplase and EVT and that tenecteplase is non-inferior to alteplase in treating acute ischemic stroke, we sought to understand current practices around the world for treating acute ischemic stroke with large vessel occlusion (LVO) depending on the center of practice (IVT-capable vs IVT and EVT-capable stroke center).

Methods

The electronic survey launched by the Practice Current section of Neurology: Clinical Practice included 6 clinical and 8 demographic questions. A single-case scenario was presented of a 65-year-old man presenting with right hemiplegia with aphasia with a duration of 1 hour. Imaging showed left M1-MCA occlusion with no early ischemic changes. The respondents were asked about their treatment approach in 2 settings: the patient presented to (1) the IVT-only capable center and (2) the IVT and EVT-capable center. They were also asked about the thrombolytic agent of choice in current and ideal circumstances for these settings.

Results

A total of 203 physicians (42.9% vascular neurologists) from 44 countries completed the survey. Most participants (55.2%) spent ≥50% of their time delivering stroke care. The survey results showed that in current practice, more than 90% of respondents would offer IVT + EVT to patients with LVO stroke presenting to either an EVT-capable (91.1%) or IVT-only–capable center (93.6%). Although nearly 80% currently use alteplase for thrombolysis, around 60% would ideally like to switch to tenecteplase independent of the practice setting. These results were similar between stroke and non-stroke neurologists.

Discussion

Most physicians prefer IVT before EVT in patients with acute ischemic stroke attributable to large vessel occlusion independent of the practice setting.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Back behind the wheel: After stroke, Huntley man relearns how to drive to regain independence lost

You'll want this to learn to drive so ask your doctor for EXACT STROKE PROTOCOLS TO RETURN TO DRIVING.

Health goes downhill when older adults stop driving

Maybe your doctor can look at these and actually help you get back to driving.

Predicting road test performance in drivers with stroke

Stroke survivor, researchers encourage patients to discuss driving with their doctors

Stroke survivors more likely to make dangerous driving errors

The latest here:

Back behind the wheel: After stroke, Huntley man relearns how to drive to regain independence lost 

Posted June 03, 2024 4:38 pm

By Janelle Walker

Dan Davis didn’t seem like a candidate for a stroke. The Huntley man didn’t smoke and rarely drank alcohol.

But nearly a year ago, on June 28, Davis was getting ready for work when he suddenly collapsed. His wife, who has a medical background, called 911 but already realized what it was — a stroke.

Davis retained his cognitive abilities through his 27-day hospital stay.

What the stroke took from the now 47-year-old was strength on his right side. It also threatened to take away his independence.

Could the working father of two sons continue to drive when his right foot could no longer work the gas and brakes in his car?

“I was dependent on my wife to take me places. Even getting down the stairs … I had to quickly assess how I lived my life and think more carefully about it than I did before,” Davis said. “Every move I make, I have to assess if it is feasible to do it.”

It’s Karyn Silvestri’s job to determine whether Davis will be able to get behind the wheel of a car again.

Silvestri, an occupational therapist at Northwestern Medicine, exclusively works with people — both teens and adults with acquired or congenital disabilities — to determine if they can drive and help them learn to drive with adapted vehicles. Some have had a traumatic brain injury or, like Davis, a stroke.

Silvestri says she is one of just a handful of occupational therapists in Illinois who is also a licensed driving instructor. She has clients come from Indiana and Wisconsin.

“There are not enough to serve the clientele that really needs driving rehabilitation services,” Silvestri said.

Her role is twofold, Silvestri said. First, she evaluates clients to determine if they can safely drive. Then, she works with them to ensure they can pass the state’s driver examination, often with a vehicle adapted for them.

Much of the behind-the-wheel training happens in parking lots at Northwestern Woodstock Hospital or Marianjoy Hospital in Wheaton. They don’t use simulators, but real vehicles the drivers will be using that better represent what being behind the wheel feels like, Silvestri said.

These days, a majority of his driving is going to Marianjoy for his rehab appointments, Davis said. Getting behind the wheel with Silvestri to practice was “like being a 16-year-old again, learning how to do this.”

His car is adapted with a knob on the left side of the steering wheel — his stronger hand — allowing him to steer. Instead of using his right foot for the brake and gas pedals, Davis now uses his left foot. It helps, Davis said, that he had 30 years of driving experience.

“How to turn — that doesn’t go away. The muscle memory resides in me,” he said. “But the nerves … it was like being a 16-year-old. The stakes are high, and you don’t want to fail those tests.”

After practicing with Silvestri and re-memorizing the rules of the road, Davis aced his driving test. He’s had his license back — with a C restriction requiring a mechanical aid or adaptive devices — for three months. He has driven about 3,000 miles since then, running errands and getting back to a little normalcy.

He has to think about where he is going, too — not how to get there, but what will be required of him when he gets there.

“Keep in mind the independence you gain [by driving], but you also have to be conscious of what you have to face where you are going,” Davis said. Those obstacles might be getting from a parking garage to his destination.

“Stepping onto a curb — I have to think about it. If I have to carry something heavy, I have to plan it out more than I did a few months ago,” he said.

Davis is hoping for surgery for a device that will help his nervous system operate his right side again, but insurance would not approve it. As a right-handed person, not having control over that side of his body has made everything from writing to reading a book a lot harder, Davis said.

“Even eating dinner. I am good at left-handed eating,” Davis said, “but for things like cutting my meat … I am figuring it out.”

NYU Tandon researchers develop technology that may allow stroke patients to undergo rehab at home

 Oh jeez, are you that fucking stupid that tracking wrist movements does ANYTHING AT ALL to get survivors recovered? And you're using a healthy subject to suggest stroke recovery! My God, I'd fire everyone here!

NYU Tandon researchers develop technology that may allow stroke patients to undergo rehab at home

Newswise — For survivors of strokes, which afflict nearly 800,000 Americans each year, regaining fine motor skills like writing and using utensils is critical for recovering independence and quality of life. But getting intensive, frequent rehabilitation therapy can be challenging and expensive.

Now, researchers at NYU Tandon School of Engineering are developing a new technology that could allow stroke patients to undergo rehabilitation exercises at home by tracking their wrist movements through a simple setup: a smartphone strapped to the forearm and a low-cost gaming controller called the Novint Falcon.

The Novint Falcon, a desktop robot typically used for video games, can guide users through specific arm motions and track the trajectory of its controller. But it cannot directly measure the angle of the user's wrist, which is essential data for therapists providing remote rehabilitation.

In a paper presented at SPIE Smart Structures + Nondestructive Evaluation 2024,  the researchers proposed using the Falcon in tandem with a smartphone's built-in motion sensors to precisely monitor wrist angles during rehab exercises.

"Patients would strap their phone to their forearm and manipulate this robot," said Maurizio Porfiri, NYU Tandon Institute Professor and director of its Center for Urban Science + Progress (CUSP), who is the paper’s senior author. "Data from the phone's inertial sensors can then be combined with the robot's measurements through machine learning to infer the patient's wrist angle."

The researchers collected data from a healthy subject performing tasks with the Falcon while wearing motion sensors on the forearm and hand to capture the true wrist angle. They then trained an algorithm to predict the wrist angles based on the sensor data and Falcon controller movements.

The resulting algorithm could predict wrist angles with over 90% accuracy, a promising initial step toward enabling remote therapy with real-time feedback in the absence of an in-person therapist.

"This technology could allow patients to undergo rehabilitation exercises at home while providing detailed data to therapists remotely assessing their progress," Roni Barak Ventura, the paper’s lead author who was an NYU Tandon postdoctoral fellow at the time of the study. "It's a low-cost, user-friendly approach to increasing access to crucial post-stroke care."

The researchers plan to further refine the algorithm using data from more subjects. Ultimately, they hope the system could help stroke survivors stick to intensive rehab regimens from the comfort of their homes.

"The ability to do rehabilitation exercises at home with automatic tracking could dramatically improve quality of life for stroke patients," said Barak Ventura. "This portable, affordable technology has great potential for making a difficult recovery process much more accessible."

This study adds to NYU Tandon’s body of work that aims to improve stroke recovery. In 2022, Researchers from NYU Tandon began collaborating with the FDA to design a regulatory science tool based on biomarkers to objectively assess the efficacy of rehabilitation devices for post-stroke motor recovery and guide their optimal usage. A study from earlier this year unveiled advances in technology that uses implanted brain electrodes to recreate the speaking voice of someone who has lost speech ability, which can be an outcome from stroke.

In addition to Porfiri and Barak Ventura, the study’s authors are Angelo Catalano, who earned an MS from NYU Tandon in 2024, and Rayan Succar, an NYU Tandon PhD candidate. The study was funded by grants from the National Science Foundation. 

 

Dietary Caffeine and Brain Dopaminergic Function in Parkinson Disease

 Whatever this means I'm still going to be doing a 12 cup pot of coffee daily to prevent Parkinsons!

Parkinson’s Disease May Have Link to Stroke March 2017

How coffee protects against Parkinson’s Aug. 2014  

The latest here:

Dietary Caffeine and Brain Dopaminergic Function in Parkinson Disease

Emmi K Saarinen BM, Tomi Kuusimäki MD, PhD, Kari Lindholm RN, Kalle Niemi MD, Emma A Honkanen MD, PhD, Tommi Noponen PhD, Marko Seppänen MD, PhD … See all authors

First published: 20 May 2024

https://doi.org/10.1002/ana.26957

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Abstract

Objective

This study was undertaken to investigate the effects of dietary caffeine intake on striatal dopamine function and clinical symptoms in Parkinson disease in a cross-sectional and longitudinal setting.

Methods

One hundred sixty-three early Parkinson disease patients and 40 healthy controls were investigated with [¹²³I]FP-CIT single photon emission computed tomography, and striatal dopamine transporter binding was evaluated in association with the level of daily coffee consumption and clinical measures. After a median interval of 6.1 years, 44 patients with various caffeine consumption levels underwent clinical and imaging reexamination including blood caffeine metabolite profiling.

Results

Unmedicated early Parkinson disease patients with high coffee consumption had 8.3 to 15.4% lower dopamine transporter binding in all studied striatal regions than low consumers, after accounting for age, sex, and motor symptom severity. Higher caffeine consumption was further associated with a progressive decline in striatal binding over time. No significant effects of caffeine on motor function were observed. Blood analyses demonstrated a positive correlation between caffeine metabolites after recent caffeine intake and dopamine transporter binding in the ipsilateral putamen.(So tell us in understandable words; is caffeine good for Parkinson's patients? Or are you that incompetent you can't figure that out?)

Interpretation

Chronic caffeine intake prompts compensatory and cumulative dopamine transporter downregulation, consistent with caffeine's reported risk reduction in Parkinson disease. However, this decline does not manifest in symptom changes. Transiently increased dopamine transporter binding after recent caffeine intake has implications for dopaminergic imaging guidelines. ANN NEUROL 2024

Caffeine (1,3,7-trimethylxanthine) is the most extensively consumed psychostimulant worldwide.¹ Together with its various acute effects on wakefulness, motor coordination, and blood pressure,² regular consumption has been hypothesized to reduce the risk of Parkinson disease (PD).³ This caffeine-induced risk reduction seems dose-dependent and has been observed in both case–control^{4, 5} and epidemiological studies, including prospectively followed cohorts.^6-10 Experiments with animal models, such as the 1-methyl-4-phenyl 1,2,3,6-tetrahydropyridine (MPTP) neurotoxin and alpha-synuclein models, have additionally provided evidence of the neuroprotective effects of caffeine in PD-type neurodegeneration.^{11, 12} Notably, decaffeinated coffee fails to provide the same protective benefits, highlighting the specific mechanistic role of caffeine itself rather than other chemical compounds present in coffee and caffeine-containing products.¹³

Although the positive effects of caffeine on PD prevention are well documented, the impact of caffeine on symptomatic individuals already diagnosed with PD is unclear despite several studies on this topic. In one controlled randomized trial of PD patients undergoing 6–18 months of treatment with caffeine, there was no clinical improvement, but there was increased dyskinesia, leading to the conclusion that caffeine cannot be recommended as symptomatic therapy for parkinsonism.¹⁴ However, this trial focused on symptomatic therapy and did not address the potential of caffeine for disease modification. On the other hand, a meta-analysis of 4 studies with follow-up periods ranging from 4 to 10 years suggested that caffeine consumption in patients with early PD may slow disease progression.¹⁵ Nevertheless, only 4 studies were included in the meta-analysis, and there was substantial heterogeneity in the parameters used to assess both caffeine consumption and PD progression in these studies, which limits the generalizability of their findings.

Caffeine-induced modification of the nigrostriatal dopamine system could be one of the underlying factors in the possible protection against PD. Caffeine modulates dopaminergic function in the central nervous system by interacting with adenosine receptors, which are colocalized and functionally interact with dopamine receptors.^{16, 17} This adenosine–dopamine interaction has been proposed to play a role in the pathogenesis and treatment of PD,^{11, 18, 19} leading to the testing of multiple adenosine A_2A receptor antagonists as potential PD treatments.²⁰ Human dopaminergic functional imaging studies focusing on caffeine have indicated that typical dietary doses of caffeine can increase postsynaptic dopamine D2/D3 receptor availability.^{21, 22} However, the results of presynaptic dopamine transporter (DAT) imaging studies in PD patients have yielded mixed results, with one study reporting no significant changes in striatal DAT binding after chronic coffee consumption,²³ whereas another has observed lower caudate nucleus DAT binding in coffee-drinking PD patients than in nonconsumers.²⁴ The long-term effects of caffeine consumption on brain presynaptic dopamine function or PD progression have not yet been examined.

Our study was designed to test the hypothesis that caffeine improves dopaminergic function in PD patients and enhances motor function in the long term. To elucidate this matter, we conducted a study to investigate the dopaminergic effects of caffeine in PD patients in a cross-sectional and longitudinal setting using conventionally available brain DAT imaging.

 

More at link.

How does climate change affect stroke risk?

If the WSO had competently solved stroke to 100% recovery it wouldn't make  a difference.  But they are completely incompetent in that regard!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind?  You'll want 100% recovery when you are the 1 in 4 per WHO that has a stroke!

 

How does climate change affect stroke risk?

Panel rejects psychedelic drug MDMA as a PTSD treatment in possible setback for advocates

 Damn! What is your competent? doctors treatment for your PTSD then? Your doctor better have one or incompetence reigns!

Since there is a 23% chance of stroke survivors getting PTSD what is your doctor's treatment plan?

Maybe these?

Microbiome and Diet Could Mitigate PTSD Symptoms October 2023 

Psychoactive Ibogaine and Magnesium Show Promise for PTSD January 2024

Harnessing Psilocybin to Treat PTSD

Treating PTSD With Ecstasy? You Might Have Some Questions. May 2018

Ecstasy Was Just Labelled a 'Breakthrough Therapy' For PTSD by The FDA August 2017 

The latest here:

Panel rejects psychedelic drug MDMA as a PTSD treatment in possible setback for advocates

WASHINGTON (AP) — A first-of-a-kind proposal to begin using the mind-altering drug 

WASHINGTON (AP) — A first-of-a-kind proposal to begin using the mind-altering drug MDMA as a treatment for PTSD was roundly criticized Tuesday — a potentially major setback to psychedelic advocates who hope to win a landmark federal approval and bring the banned drugs into the medical mainstream.

A panel of advisers to the Food and Drug Administration voted 10-1 against the overall benefits of MDMA when used to treat post-traumatic stress disorder. They cited flawed study data, questionable research conduct and significant drug risks, including the potential for heart problems, injury and abuse.

“It seems like there are so many problems with the data — each one alone might be OK, but when you pile them on top of each other … there’s just a lot of questions I would have about how effective the treatment is,” said Dr. Melissa Decker Barone, a psychologist with the Department of Veterans Affairs.

The FDA is not required to follow the group’s advice and is expected to make its final decision by August, but the negative opinion could strengthen agency's rationale for rejecting the treatment.

MDMA is the first in a series of psychedelics — including LSD and psilocybin — that are expected to come before the FDA for review in the next few years as part of a resurgence of interest into the drugs’ medical potential, which advocates claim could transform the treatment of mental health disorders.

But FDA advisers spent most of Tuesday’s meeting leveling pointed criticisms at the research submitted on MDMA, which is sometimes called ecstasy or molly. Panelists pointed to flawed studies that could have skewed the results, missing follow-up data on patient outcomes and a lack of diversity among participants. The vast majority of patients were white, with only five Black patients receiving MDMA, raising questions about the generalizability of the results.

“The fact that this study has so many white participants is problematic because I don’t want something to roll out that only helps this one group,” said Elizabeth Joniak-Grant, the group’s patient representative.

The FDA advisers also drew attention to allegations of misconduct in the trials that have recently surfaced in news stories and a report by the nonprofit Institute for Clinical and Economic Review, which evaluates experimental drug treatments. The incidents include a 2018 report of apparent sexual misconduct by a therapist and her husband while treating a patient.

Lykos Therapeutics, the company behind the study, said it previously reported the incident to the FDA and regulators in Canada, where the therapist is based.

Lykos is essentially a corporate spinoff of the nation’s leading psychedelic advocacy group, the Multidisciplinary Association for Psychedelic Studies, or MAPS, which funded the studies. The group was founded in 1986 to promote the benefits of MDMA and other mind-altering substances.

Lykos said in a statement after the meeting that it would work with regulators to address the panel's concerns.

“While we are disappointed in the vote, we are committed to continuing to collaborate with the FDA with their ongoing review of our (drug application) over the coming weeks,” the company stated. FDA is expected to issue its decision by Aug. 11.

The overwhelmingly negative panel ruling could further derail financial investments in the fledgling psychedelic industry, which has mainly been funded by a small number of wealthy backers. Dozens of startup companies have launched in recent years seeking to study psilocybin, ketamine and others drugs for conditions like depression and addiction, though many have struggled to raise money.

MDMA doesn't cause the visual hallucinations commonly associated with psychedelics. Instead, its main effect is triggering feelings of intimacy, connection and euphoria. When used to enhance talk therapy, the drug appears to help patients process their trauma and let go of disturbing thoughts and memories.

But the panel struggled with the reliability of the results reported by Lykos, given the difficulties of objectively testing psychedelic drugs.

Because MDMA causes intense, psychological experiences, almost all patients in two key studies of the drug were able to guess whether they had received the MDMA or a dummy pill. That’s the opposite of the approach generally required for high-quality drug research, in which bias is minimized by “blinding” patients and researchers to whether they received the drug under investigation.

“I’m not convinced at all that this drug is effective based on the data I saw,” said Dr. Rajesh Narendran, a University of Pittsburgh psychiatrist who chaired the panel.

Panelists also noted the difficulty of knowing how much of patients’ improvement came from MDMA versus simply undergoing the extensive therapy, which totaled more than 80 hours for many patients. Results were further marred by other complicating factors, including a large number of patients who had previously used MDMA or other psychedelics drugs recreationally.

Nearly three dozen public speakers addressed the panel during a comment period, including veterans who said they benefitted from MDMA therapy, medical professionals who advised against its use and journalists and independent researchers who detailed the allegations of misconduct in the trials.

The meeting concluded with several experts encouraging Lykos and the FDA to continue studying psychedelics for PTSD, citing the field’s potential to help patients.

“I think this is a really exciting treatment and I’m encouraged by the results to date," said Dr. Paul Holtzheimer of the VA’s National Center for PTSD, “but from a safety and efficacy standpoint I feel it’s still premature.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

as a treatment for PTSD was roundly criticized Tuesday — a potentially major setback to psychedelic advocates who hope to win a landmark federal approval and bring the banned drugs into the medical mainstream.

A panel of advisers to the Food and Drug Administration voted 10-1 against the overall benefits of MDMA when used to treat post-traumatic stress disorder. They cited flawed study data, questionable research conduct and significant drug risks, including the potential for heart problems, injury and abuse.

“It seems like there are so many problems with the data — each one alone might be OK, but when you pile them on top of each other … there’s just a lot of questions I would have about how effective the treatment is,” said Dr. Melissa Decker Barone, a psychologist with the Department of Veterans Affairs.

The FDA is not required to follow the group’s advice and is expected to make its final decision by August, but the negative opinion could strengthen agency's rationale for rejecting the treatment.

MDMA is the first in a series of psychedelics — including LSD and psilocybin — that are expected to come before the FDA for review in the next few years as part of a resurgence of interest into the drugs’ medical potential, which advocates claim could transform the treatment of mental health disorders.

But FDA advisers spent most of Tuesday’s meeting leveling pointed criticisms at the research submitted on MDMA, which is sometimes called ecstasy or molly. Panelists pointed to flawed studies that could have skewed the results, missing follow-up data on patient outcomes and a lack of diversity among participants. The vast majority of patients were white, with only five Black patients receiving MDMA, raising questions about the generalizability of the results.

“The fact that this study has so many white participants is problematic because I don’t want something to roll out that only helps this one group,” said Elizabeth Joniak-Grant, the group’s patient representative.

The FDA advisers also drew attention to allegations of misconduct in the trials that have recently surfaced in news stories and a report by the nonprofit Institute for Clinical and Economic Review, which evaluates experimental drug treatments. The incidents include a 2018 report of apparent sexual misconduct by a therapist and her husband while treating a patient.

Lykos Therapeutics, the company behind the study, said it previously reported the incident to the FDA and regulators in Canada, where the therapist is based.

Lykos is essentially a corporate spinoff of the nation’s leading psychedelic advocacy group, the Multidisciplinary Association for Psychedelic Studies, or MAPS, which funded the studies. The group was founded in 1986 to promote the benefits of MDMA and other mind-altering substances.

Lykos said in a statement after the meeting that it would work with regulators to address the panel's concerns.

“While we are disappointed in the vote, we are committed to continuing to collaborate with the FDA with their ongoing review of our (drug application) over the coming weeks,” the company stated. FDA is expected to issue its decision by Aug. 11.

The overwhelmingly negative panel ruling could further derail financial investments in the fledgling psychedelic industry, which has mainly been funded by a small number of wealthy backers. Dozens of startup companies have launched in recent years seeking to study psilocybin, ketamine and others drugs for conditions like depression and addiction, though many have struggled to raise money.

MDMA doesn't cause the visual hallucinations commonly associated with psychedelics. Instead, its main effect is triggering feelings of intimacy, connection and euphoria. When used to enhance talk therapy, the drug appears to help patients process their trauma and let go of disturbing thoughts and memories.

But the panel struggled with the reliability of the results reported by Lykos, given the difficulties of objectively testing psychedelic drugs.

Because MDMA causes intense, psychological experiences, almost all patients in two key studies of the drug were able to guess whether they had received the MDMA or a dummy pill. That’s the opposite of the approach generally required for high-quality drug research, in which bias is minimized by “blinding” patients and researchers to whether they received the drug under investigation.

“I’m not convinced at all that this drug is effective based on the data I saw,” said Dr. Rajesh Narendran, a University of Pittsburgh psychiatrist who chaired the panel.

Panelists also noted the difficulty of knowing how much of patients’ improvement came from MDMA versus simply undergoing the extensive therapy, which totaled more than 80 hours for many patients. Results were further marred by other complicating factors, including a large number of patients who had previously used MDMA or other psychedelics drugs recreationally.

Nearly three dozen public speakers addressed the panel during a comment period, including veterans who said they benefitted from MDMA therapy, medical professionals who advised against its use and journalists and independent researchers who detailed the allegations of misconduct in the trials.

The meeting concluded with several experts encouraging Lykos and the FDA to continue studying psychedelics for PTSD, citing the field’s potential to help patients.

“I think this is a really exciting treatment and I’m encouraged by the results to date," said Dr. Paul Holtzheimer of the VA’s National Center for PTSD, “but from a safety and efficacy standpoint I feel it’s still premature.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

UK Stroke Support groups in your area

The need to have these stroke support groups means your stroke association has completely failed at their job of getting survivors 100% recovered! Are they even working towards that goal? If not, you need to take over them and get them run by survivors.

 UK  Stroke Support groups in your area

Influence of Time to Achieve Target Systolic Blood Pressure on Outcome After Intracerebral Hemorrhage: The Blood Pressure in Acute Stroke Collaboration

 We've known of the need for a blood pressure management protocol for decades and once again fail to do the proper research to GET THERE!

Influence of Time to Achieve Target Systolic Blood Pressure on Outcome After Intracerebral Hemorrhage: The Blood Pressure in Acute Stroke Collaboration

Xia Wang,

Jie Yang,

Tom J. Moullaali,

Else Charlotte Sandset,

Lisa J. Woodhouse,

Zhe Kang Law,

Hisatomi Arima,

Kenneth S. Butcher,

Candice Delcourt,

Leon Edwards,

Salil Gupta,

… See all authors

Originally published27 Feb 2024https://doi.org/10.1161/STROKEAHA.123.044358Stroke. 2024;55:849–855

Abstract

OBJECTIVE:

To investigate whether an earlier time to achieving and maintaining systolic blood pressure (SBP) at 120 to 140 mm Hg is associated with favorable outcomes in a cohort of patients with acute intracerebral hemorrhage.

METHODS:

We pooled individual patient data from randomized controlled trials registered in the Blood Pressure in Acute Stroke Collaboration. Time was defined as time form symptom onset plus the time (hour) to first achieve and subsequently maintain SBP at 120 to 140 mm Hg over 24 hours. The primary outcome was functional status measured by the modified Rankin Scale at 90 to 180 days. A generalized linear mixed models was used, with adjustment for covariables and trial as a random effect.

RESULTS:

A total of 5761 patients (mean age, 64.0 [SD, 13.0], 2120 [36.8%] females) were included in analyses. Earlier SBP control was associated with better functional outcomes (modified Rankin Scale score, 3–6; odds ratio, 0.98 [95% CI, 0.97–0.99]) and a significant lower risk of hematoma expansion (0.98, 0.96–1.00). This association was stronger in patients with bigger baseline hematoma volume (>10 mL) compared with those with baseline hematoma volume ≤10 mL (0.006 for interaction). Earlier SBP control was not associated with cardiac or renal adverse events.

CONCLUSIONS:

Our study confirms a clear time relation between early versus later SBP control (120–140 mm Hg) and outcomes in the one-third of patients with intracerebral hemorrhage who attained sustained SBP levels within this range. These data provide further support for the value of early(What is the exact definition of early?) recognition, rapid(What is the exact definition of rapid?) transport, and prompt(What is the exact definition of prompt?) initiation of treatment of patients with intracerebral hemorrhage. Until you answer these questions you don't have a protocol, you have useless guidelines!

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Brain Tissue Oxygenation

How EXACTLY is your doctor ensuring a good supply of oxygen to your brain immediately post stroke? Doing ANYTHING AT ALL?  

• oxygen delivery (27 posts to January 2020) Many ideas in here, if your doctor isn't already using them to save neurons immediately post stroke; you don't have a functioning stroke doctor!

Brain Tissue Oxygenation

• Chapter
• First Online: 01 June 2024

• pp 159–172
• Cite this chapter

Principles and Practice of Neurocritical Care

• Toby Jeffcote &
• Andrew Udy 

• 14 Accesses

Abstract

The brain represents 2% of body weight, but consumes 20% of the body’s oxygen supply as a result of its high metabolic demand. This chapter reviews the physiological determinants of cerebral oxygenation, and the role that ischaemia and hypoxia play in the two pathologies most commonly encountered in the neurocritical care unit - traumatic brain injury (TBI) and sub-arachnoid haemorrhage (SAH). It focuses primarily on the emerging technique of brain tissue oxygen monitoring (PbtO2) which is increasingly used to guide treatment in neurocritical care settings. Despite enormous potential, this method faces significant challenges associated with the complex interplay of systemic and local factors affecting cerebral perfusion and oxygenation. The chapter documents the evolution of PbtO2 monitoring and the evidence for its use. It illustrates how this technique has the potential to enhance clinical management strategies and significantly improve patient outcomes from acute brain injury.

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The relationship between rehabilitation motivation and upper limb motor function in stroke patients

 You don't understand ONE GODDAMN THING ABOUT SURVIVOR MOTIVATION, DO YOU? You create 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE! 

The problem is stroke researchers are not motivated to solve stroke. What the fuck is your solution to that failure? We still don't know how to motivate stroke medical 'professionals' to solve stroke to 100% recovery!

The relationship between rehabilitation motivation and upper limb motor function in stroke patients

Wenxi Li^1,2†Guangyue Zhu^2†Yang Lu²Jinglei Wu²Zhuoxin Fu²Junyi Tang²Guohui Zhang^1*Dongsheng Xu^2,3*

• ¹Department of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, China
• ²Department of Rehabilitation, Shanghai University of Traditional Chinese Medicine, Shanghai, China
• ³Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China

Objective: Insufficient motivation among post-stroke survivors may be an important factor affecting their motor function recovery. This study seeks to investigate the relationship between motivation and functional recovery in stroke patients undergoing rehabilitation training.

Materials and methods: 103 stroke patients with upper limb impairments were studied during their hospital stays. Assessments were done before and after rehabilitation training to measure motivation, emotional state, motor function, and independence in daily activities. Data analysis was conducted to examine the distribution of these factors among the participants. Pearson and Spearman correlation analyses were used to study the relationships between motivation, emotional state, and motor function. Patients were divided into high and low motivation groups based on the Rehabilitation Motivation Scale (RMS), and chi-square and rank-sum tests were used to compare functional differences before and after treatment among patients with varying levels of motivation.

Results: 66 participants were found to have low motivation in the initial assessment of the RMS (64.08%). Consistency in motivation levels was observed among patients with high motivation (r = 0.648, P<0.001). Apathy was identified as the main factor affecting motivation in patients with low motivation (p = 0.027), while depression and anxiety were not significantly correlated. Motivation was strongly linked to improvements in upper limb motor function, daily living activities, and self-exercise duration (p < 0.001) for stroke patients undergoing rehabilitation. Post-training, there was a notable increase in motivation, motor function, and independence in daily activities (p < 0.001). Increased rehabilitation motivation was linked to better upper limb motor function and daily independence in patients, particularly those with low motivation. This correlation was significant for both the FMA-UE and FIM scores.

Discussion: Old patients with poor upper limb motor function often have low motivation, which hinders their recovery. Using strategies to boost motivation in stroke patients with impaired upper limb function could greatly improve their rehabilitation and motor skills. It is crucial to prioritize these intervention strategies.

Conclusion: Enhancing rehabilitation motivation in stroke patients with low motivation and upper limb motor impairments can foster the restoration of their functional capabilities.

Pre-thrombolysis serum sodium concentration is associated with post-thrombolysis symptomatic intracranial hemorrhage in ischemic stroke patients

 Useless with no information on maintaining serum sodium concentrations to the right level!

Pre-thrombolysis serum sodium concentration is associated with post-thrombolysis symptomatic intracranial hemorrhage in ischemic stroke patients

Xiaolan WuZhuangzhuang Jiang^*Dongjuan XuRufang ZhangHongfei Li

• Department of Neurology, Dongyang People’s Hospital, Affiliated to Wenzhou Medical University, Dongyang, China

Background and aim: Symptomatic intracranial hemorrhage (sICH) was the most serious complication associated with alteplase intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients. However, the relationship between serum sodium levels and post-thrombolysis symptomatic intracranial hemorrhage has not been investigated. Therefore, the aim of this study was to investigate the relationship between pre-thrombolysis serum sodium levels and sICH after IVT, as well as to explore the optimal pre-thrombolysis serum sodium levels for lowering the risk of sICH following IVT.

Methods: From July 1, 2017 to April 30, 2023, out-of-hospital AIS patients who received IVT in the emergency department were enrolled in this study. Serum sodium levels were measured at admission prior to IVT, and National Institutes of Health Stroke Scale scores were continuously assessed during and after thrombolysis. Routine follow-up neuroimaging was performed between 22 to 36 h after IVT. Initially, three logistic regression models and restricted cubic splines (RCS) were established to investigate the relationship between serum sodium levels and post-thrombolysis sICH. Furthermore, to evaluate the predictive value of serum sodium for post-thrombolysis sICH, we compared area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI) before and after incorporating serum sodium into traditional models. Finally, subgroup analysis was conducted to explore interactions between serum sodium levels and other variables.

Results: A total of 784 AIS patients who underwent IVT were enrolled, among whom 47 (6.0%) experienced sICH. The median serum sodium concentration for all patients was 139.10 [interquartile ranges (IQR): 137.40–141.00] mmol/L. Patients who developed sICH had lower serum sodium levels than those without sICH [138.20(IQR:136.00–140.20) vs. 139.20(IQR:137.40–141.00), p = 0.031]. Logistic regression analysis (model 3) revealed a 14% reduction in the risk of post-thrombolysis sICH for every 1 mmol/L increase in serum sodium levels after adjusting for confounding variables (p < 0.001). The risk of post-thrombolysis sICH was minimized within the serum sodium range of 139.1–140.9 mmol/L compared to serum sodium concentration below 137.0 mmol/L [odds ratio (OR) = 0.33, 95% confidence interval (CI): 0.13–0.81] in model3. Furthermore, there was a significant trend of decreasing risk for sICH as serum sodium concentrations increased across the four quartiles (P for trend = 0.036). The RCS analysis indicated a statistically significant reduction in the risk of sICH as serum sodium levels increased when the concentration was below 139.1 mmol/L. Incorporating serum sodium into traditional models improved their predictive performance, resulting in higher AUROC and NRI values. Subgroup analysis suggested that early infarct signs (EIS) appeared to moderate the relationship between serum sodium and sICH (p < 0.05).

Conclusion: Lower serum sodium levels were identified as independent risk factors for post-thrombolysis sICH. Maintaining pre-thrombolysis serum sodium concentrations above 139.1 mmol/L may help reduce the risk of post-thrombolysis sICH.