Stroke and dementia rank among the most pressing health issues in Europe. Cerebral small vessel diseases (SVDs) have emerged as a central link between these two major co-morbidities. SVDs account for more than 30% of strokes and at least 40% of dementia cases. They encounter multiple distinct diseases that can be separated based on their underlying genetic defects, risk factors, and clinical presentations. Despite this profound impact on human health, there are no treatments with proven efficacy against SVDs. The network “Small vessel diseases in a mechanistic perspective: Targets for Intervention in Stroke and Dementia(SVDs@target)” brings together top scientists with a wide range of complementary expertise. We spoke with Danielle Kerkhofs, PhD candidate from the Maastricht University about this project and the latest developments.
SAFE: If you were to explain the project’s aim to a person without any medical background, what would you say?
DK: The SVDs@target project aims to elucidate underlying mechanisms of cerebral Small Vessel Disease (cSVD) and discover new treatment options for this disease. CSVD is an umbrella term used for different pathologies affecting the smallest vessels in the brain. It contributes to a quarter of all strokes and almost 45% of all dementia’s. With revealing the underlying mechanisms of the disease we hope to create possibilities to develop new treatments specific for CSVD.
SAFE: What types of partner do you need to carry out a project like this?
DK: The partners that we need for this project should have both clinical as pre-clinical research experience. To further reveal the underlying mechanism of the disease we need to start at a basic level, followed by clinical studies in patients. I think this balance between the pre-clinical and clinical research is one of the strengths of this project.
SAFE: Can you briefly describe your role in the project?
DK: I am working as a PhD student on this project at Maastricht University, participating both in pre-clinical as clinical studies. Our main research topic in Maastricht is to investigate the specific role of inflammation, and more specific different immune cell populations, in the development of cSVD. Further I participate in the clinical studies Investigate@SVDs and TREAT-SVDs.
SAFE: What personally attracted you to be in this project?
DK: What I really like in this project is the internationally collaboration between the different research groups and the focus on both preclinical as clinical work.
SAFE: When this project ends, what do you expect to change, i.e. how it will reflect on stroke treatment?
DK: This project will give us more insight in the mechanisms underlying the pathogenesis of cSVD. The acquired knowledge will hopefully make the next step possible were we can investigate more specific treatments that can reduce progression of the disease. Further this new knowledge can also provide us new chances for earlier detection of the disease.
SVDs@Target has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 666881.
by ESO | 12.3.2020 | ESO |
Due to the latest developments regarding the COVID-19 outbreak, and in an effort to prevent spreading the virus and for the sake of event participants, the European Stroke Organisation together with the World Stroke Organization, have decided to postpone the ESO-WSO 2020 Conference, scheduled to take place in Vienna from 12-15 May 2020.
The new dates for ESO-WSO 2020 are 6-9 November. Answers to FAQ related to this postponement can be found on the conference website.
The conference will take place at the same venue, Austria Center Vienna and current registrations will be transferred to the new Conference dates.
In the coming weeks we will be updating the website with new registration deadlines, new programme scheduling and additional information.
Image by ESO.
First published on ARNI Institute for Stroke Rehabilitation website | March 9, 2020
Neuromodulatory non-invasive brain stimulation (NIBS) techniques are experimental therapies for improving motor function after stroke. The aim of neuromodulation is to enhance adaptive or suppress maladaptive processes of post-stroke reorganisation. However, results on the effectiveness of these methods, which include transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are mixed. It’s posited that recent developments in NIBS technology will likely contribute to individualised therapy. Moving beyond single-area stimulation, targeting specific muscle groups that play different roles in post-stroke motor recovery (for example, finger flexors vs. extensors) may well be possible using multi-locus TMS. NIBS in stroke faces a challenge reminiscent of the development of other stroke therapies, such as thrombolysis and mechanical thrombectomy, where early studies were largely mixed before patient selection and individualising protocols were refined to determine its therapeutic potential.
So, researchers at UCL want to find out:
- How brain activity changes after someone has a stroke.
- If weak, non-invasive brain stimulation could encourage the brain into a pattern of brain activity which is useful for upper limb rehabilitation.
Please follow this link to red the full article.
Image by Gerd Altmann from Pixabay
First published by ESO | 6.3.2020
Author: Dr Nicolas Martinez-Majander, Department of Neurology, Helsinki University Hospital, Finland
Incidence of young-onset ischemic stroke is currently about 13/100 000 per year in high-income countries and has been increasing since 1980s. In young patients, stroke affects social life, family, and working ability for years after the event. In addition to well-known risk factors, such as diabetes mellitus, hypertension, and hypercholesterolemia, young patients also have unconventional, age-specific risk factors such as pregnancy and puerperium. However, there are still many unanswered questions in terms of risk factors for stroke in the young, and so far study results have been inconsistent.
Ischemic stroke during and after pregnancy
Both pregnancy and puerperium are associated with an increased risk of all stroke subtypes. In a single-center Canadian study, most ischemic strokes occurred during the third trimester, around delivery, or during postnatal period with an incidence of 18 strokes per 100.000 deliveries.(1) Furthermore, of all thromboembolisms during pregnancy, stroke contributed to 12% of them.(2) Up to 25% of ischemic strokes during pregnancy can be associated with eclampsia.(3)Other risk factors for ischemic stroke during pregnancy include e.g. hypertension, diabetes, age over 35 years, black ethnicity, migraine headaches, thrombophilia, smoking, alcohol, and other substance abuse.(4) Kittner et al. also showed that the relative risk of ischemic stroke was up to 8.7 (95% CI, 4.6-16.7) during puerperium.3
The choice of secondary prevention depends mostly on the stroke etiology and gestational age. Aspirin in low daily doses is usually the drug of choice especially during the second and third trimester, but there are inconsistent results regarding its teratogenic effects during the first trimester.5 If anticoagulation is indicated, e.g. in high-risk source of cardioembolism, then low-molecular-weight heparin would be recommended instead of novel anticoagulants or warfarin which crosses placenta and is found to be potentially teratogenic. A few case reports and retrospective studies have shown that in acute treatment, intravenous thrombolysis (rtPA) might be safe during pregnancy, but since these women were excluded from all the randomized clinical trials, pregnancy is still a formal contraindication of rtPA. The same applies to mechanical thrombectomy and treatment decisions should be made on an individual basis for each patient.
You can read the full article and references here.
Illustration: Image by ekseaborn0 from Pixabay