People who are having a stroke now have access to a new, FDA-approved drug that reduces the chance of permanent disability. The therapy is available through a new Brain Attack Team at the University of Maryland Medical Center and at other hospitals around the country. To receive the therapy, people must get to one of those hospitals within three hours after stroke symptoms begin.
"This is an entirely new approach to the treatment of stroke," says Marian LaMonte, M.D., director of the Brain Attack Team and assistant professor of Neurology at the University of Maryland School of Medicine. "Before this new clot-busting drug was approved, we had no way to actively intervene to prevent disability in people whose strokes were caused by a blockage in a blood vessel," she says.
The new stroke drug is Activase, also known as tissue plasminogen activator, or TPA. The FDA approved its use for stroke in June 1996, after a major study sponsored by the National Institute of Neurological Disorders and Stroke. That study found that patients treated with Activase were at least 33 percent more likely to have little or no disability compared to patients who received a placebo.
Activase, which is also widely used to treat heart attacks, is given intravenously. It assists the body in quickly breaking up a clot that is blocking a blood vessel. When such a clot forms to cause a stroke, brain tissue becomes starved of oxygen and begins to die. The Activase therapy is only approved for stroke patients who arrive at a medical center within three hours after the start of stroke symptoms.
The University of Maryland Medical Center's Brain Attack Team swings into action as soon as a stroke patient arrives at the hospital's emergency department. The patient has a complete neurological evaluation as well as a CT scan to rule out bleeding in the brain and laboratory tests. The results are available within 30 minutes, which is a very fast turn-around time.
"Time is of the essence in order to prevent damage from stroke, just as it is with heart attacks," says Brian Browne, M.D., director of Emergency Medicine at the University of Maryland Medical Center. "Since we are able to provide a rapid diagnosis and start therapy quickly, we hope to spare many patients from suffering major impairments that will impact the quality of their lives."
Stroke is the leading cause of serious disability among adults in the United States, according to the American Heart Association. An estimated one-third of stroke survivors need help caring for themselves and 20 percent need help when walking. About 500,000 Americans suffer a stroke each year.
In addition to a rapid evaluation, the new approach to stroke treatment also requires a support network for patients who may develop bleeding complications from the new drug therapy. The University of Maryland Medical Center's Brain Attack Team includes neurosurgeons, neuroradiologists, and other specialists who are available 24 hours a day, to provide a safe environment for administering Activase.
Not all patients are able to take the drug, because of other health problems including uncontrolled high blood pressure or impaired blood clotting. But the medical center's Brain Attack Team is involved is studying several investigational drugs that may also prevent disability from stroke.
"Essentially, we have something to offer almost any patient in the early stages of a stroke," says Dr. LaMonte. The team is studying another clot-busting drug, Prourokinase, that is delivered directly at the site of the clot from a catheter that is threaded up blood vessels to the brain.
Other studies at the medical center involve so-called "neuroprotective" agents. When a stroke occurs and brain tissue begins to die, that dying tissue releases harmful chemicals that further injure brain tissue. Investigational drugs, called Cerestat and Cervene, are designed to protect nearby brain cells from these toxic by-products of a stroke. The researchers are also studying whether it is beneficial and safe to give Activase from three to five hours after the beginning of a stroke, since it is currently only being given within the first three hours. Symptoms of a stroke include sudden weakness or numbness of the face, arm, or leg, especially on one side of the body; difficulty speaking or understanding speech; sudden vision problems, especially in one eye; unexplained dizziness or loss of coordination; and sudden or severe headaches.
"Now that treatment to prevent disability is available, people need to realize that stroke is an emergency. We can offer them the most help if they come to see us right away. If they wait instead and hope that the symptoms will just go away, it may be too late to prevent a serious disability that would dramatically change their quality of life," says Dr. LaMonte.