What is new in stroke research?

An update from the 1st European Stroke Organisation Conference.

A stroke is often described as the brain equivalent of a heart attack; blood supply to part of the brain is cut off, leading to cell death and potentially life-threatening brain injury. The two main types of stroke are ischemic, where an artery to the brain is blocked, and hemorrhagic, when a blood vessel ruptures.

Every two seconds someone has a stroke, and one in six people will suffer a stroke in their lifetime. Stroke is the third leading cause of death worldwide, with over 6 million people dying from strokes each year. With an aging global population, the incidence of stroke is set to rise. These sobering statistics demonstrate its huge global impact, and emphasize how essential it is that we continue to further our understanding of stroke, with the aim of better prevention, treatment and management.

Earlier this month I attended the European Stroke Organisation Conference, held in Glasgow. Involving over 2,000 scientists, researchers, clinicians, healthcare professionals, and patients, this was the first annual meeting held by the European Stroke Organisation (ESO) covering exciting new research into stroke prevention, treatment, management and recovery.

An array of topics were covered over three days of fascinating talks and sessions, including updates on European clinical trials, rehabilitation and recovery, advances in imaging, experimental and translational medicine, and language and cognition in acute stroke.

The role of immunity, and combating free radicals

One particularly interesting aspect of the meeting was an update on developments in experimental and translational stroke medicine. Dr Costantino Iadecola, Director of the Brain and Mind Research Institute at Weill Cornell Medical College, introduced ‘Stroke research at a crossroad: Where are we headed?’, providing us with an overview of some problems we face in research, and what we now need to do.

Dr Iadecola described some systemic responses to stroke, such as the key role of immunity and the infiltration of blood-borne cells into the post-ischemic brain. With its protective-, destructive- and repair-promoting role, the immune response can be thought of as a ‘double-edged sword’; both making things worse and better in terms of the outcomes of ischemia.

the immune response can be thought of as a ‘double-edged sword’; both making things worse and better in terms of the outcomes of ischemia

Dr Constantino Iadecola

Dr Iadecola also discussed the issue of post-stroke dementia; one third of patients have persistent cognitive decline post-stroke, and we know very little of the mechanisms involved. Questions still remain such as ‘What does stroke do to the progression of pre-existing dementia?’. He concluded by arguing the importance of obtaining more data on these areas to support our ideas and move away from speculation, and that we still have a lot of work to do.

Dr Ángel Chamorro from the University of Barcelona continued with a presentation on ‘A radical approach to counteract free radicals in acute stroke therapy’. Free radicals, or reactive oxygen species, are produced following ischemic stroke, causing cellular damage.

To date, over 1,000 neuroprotective drug candidates have failed to show promise in reducing this damage in stroke, but Dr Chamorro argued that we should keep going; neuroprotection and counteracting the damaging effects of oxygen is an important avenue of research. He discussed new findings demonstrating that uric acid could improve glucose-driven oxidative stress in human ischemic stroke, and concluded by saying that for him, uric acid is a very appealing new drug candidate in stroke.

The long term effects and improving rehabilitation

Depression, cognitive impairment, impaired motor function and balance, and visual and communication problems have all been reported as long-term outcomes of stroke. Around one third of people who survive are left with a permanent disability. Another interesting aspect of the meeting was an update on some of the research taking place into rehabilitation and recovery, and what we could do to improve the lives of those who have had a stroke.

Post-stroke depression

Suicide is a rare but serious outcome of stroke, yet post-stroke depression and suicide is a relatively under-studied topic. Dr Marie Eriksson and colleagues presented a socioeconomic and nationwide perspective on this from Sweden, giving us an overview of data analysed from Riksstroke, the Swedish Stroke Register.

Looking at over 220,000 stroke patients, Eriksson and colleagues found that suicide was more common in men than women, and saw that there was a 5-fold inreased risk of suicide in patients under 55 years of age with post-stroke depression, in comparison to the general population of Sweden.

Socioeconomic position was also associated with an increased risk of suicide, for example having a lower income, or living alone. Dr Eriksson concluded by emphasising the importance of noticing these risks and considering suicide interventions in high risk groups, as part of post-stroke care.

Physical rehabilitation

There was also an array of presentations on the work being done to improve physical mobility after stroke, including a talk from Dr Friedhelm Hummel on research aimed at understanding the brain networks involved in motor function recovery in the hand. Meanwhile, Dr Lucy Jones from the University of Strathclyde presented on an early study looking at whether 3D visual feedback technologies could assist upper limb rehabilitation in patients, by allowing them and their therapists to assess their movement in real-time.

robotics are helping clinicians to be more effective and efficient in delivering patient care

Dr Hermano Igo Kreps

Another fast-developing area of research in rehabilitation is the use of robotics. Dr Hermano Igo Kreps from MIT gave us a fascinating insight into the way that robotics are helping clinicians to be more effective and efficient in delivering patient care, and showed some exciting videos of the new robots under development to assist recovery of leg and ankle movement post-stroke.

All in all, the first European Stroke Organisation Conference meeting provided a fascinating insight into our progress in stroke research, and highlighted new, promising avenues of investigation across a range of topics that could dramatically impact the field in years to come. This research is giving hope to millions of people who have been, or will be, affected by strokes. I’m already looking forward to next year’s meeting in Barcelona between 10-12 May.

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