Joint Statement of the WSO, ESO, EAN and WFN on Stroke on the Occasion of the 68th WHO-Europe Meeting

Joint Statement of the WSO, ESO, EAN and WFN on Stroke on the Occasion of the 68th WHO-Europe Meeting

Published by ESO | 25.9.2018

This statement was jointly prepared by the World and European Stroke Organizations (WSO and ESO), the World Federation and the European Academy of Neurology (WFN and EAN) all of which are specialty societies for neurology and brain health.


NCDs continue to increase worldwide. Cardiovascular diseases, stroke and dementia are a major concern. Stroke is now ranked the 2nd greatest cause of both disability and death worldwide.

Stroke threatens everyone. Stroke causes paralysis of limbs, impairs vision, gait, language and cognition. It contributes to dementia. Of particular concern is the increasing stroke burden in young adults and its effect on keeping employment, as more than 40% of working age adults with stroke fail to return to work.

The burden of stroke disproportionately affects people living in countries with limited resources, also in Europe. Most stroke survivors carry lifelong physical, cognitive, mental, and socio-economic burdens. A significant proportion of European and Global NCD burden can be attributed to stroke and stroke-related dementia. This issue of NCDs, including stroke and dementia, is highlighted at this month’s UN High Level Meeting in New York.

The importance of stroke is acknowledged by the WHO in ICD 11 where stroke is now included as a disease of the nervous system. This most important change will have dramatic impact on the promotion of brain health and the distribution of resources.

For stroke prevention, it is important to know that 90 % of strokes are linked to 10 modifiable risk factors including hypertension, smoking, obesity, physical inactivity, and unhealthy diet. The same factors apply to ischemic heart disease, the other main cause of global disability and death. The occurrence of an acute stroke has to be considered a major emergency which needs a seamless chain of interventions until recovery. Quality care needs to be provided timely by competent personnel and teams across the whole pathway in an organized and audited manner. This kind of access to adequate stroke expertise should be independent of region, time of day and socio-economic status. These stroke facts were highlighted during last year’s WFN World Brain Day.

Dementia on the other hand is growing globally with ageing populations, and stroke contributes with other NCDs such as hypertension, heart disease, chronic kidney disease and diabetes mellitus to the development of dementia. Rates of dementia may be reduced by modifying these risk factors and both stroke and dementia may be prevented through coordinated action.

Developments in vascular neurology has made stroke and dementia preventable, treatable and increasingly reversible, thus reducing the burden on patients, families and societies. To ensure these developments are more evenly distributed, we will require national, regional and global efforts to increase awareness, make available quality acute stroke treatment, primary and secondary prevention and rehabilitation.

ESO and the patient organization SAFE (Stroke Action for Europe – have just finalized the Action Plan for Stroke in Europe 2018-2030, which is aligned with the UN’s Sustainable Development Goals. The plan has four overarching goals:

1) to reduce the absolute number of strokes in Europe by 10%

2) to treat 90 % or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care

3) to have national plans for stroke encompassing the entire chain of care, and 4) to fully implement national strategies for multisector public health interventions In this context WSO, ESO, EAN and WFN call upon the WHO European Regional Committee to support its member states to increase their efforts based on these three domains:

Awareness: WHO-Europe should help to strengthen programs that increase awareness of stroke, as risk factors, therapy and rehabilitation.
Access: We will support WHO-Europe with its efforts to remove financial barriers for patients for prevention, detection and treatment of NCDs, including European wide health coverage.
Action: The neurology specialist societies will support WHO-Europe in the development of regional and national strategies, to develop the health-relatedSustainable Development Goals, with the goal to reduce premature deaths caused by NCD by one-third by 2030.

Enhanced rehab for stroke doubles movement recovery

Enhanced rehab for stroke doubles movement recovery

First appeared on

A novel therapy technique invented by researchers at The University of Texas at Dallas has been shown in a pilot study to double the rate of upper limb recovery in stroke patients, a leap forward in treating the nearly 800,000 Americans who suffer strokes each year.

The results of the study, funded by UT Dallas spinoff company MicroTransponder of Austin, Texas, were published Sept. 27 in the journal Stroke.

The findings indicate that targeted plasticity therapy — which involves stimulation of the vagus nerve — paired with traditional motor-skill rehabilitation is not only safe, but also twice as effective as rehab alone.

Dr. Jane Wigginton, the chief medical officer at UT Dallas’ Texas Biomedical Device Center (TxBDC) and an associate professor of emergency medicine at UT Southwestern Medical Center, led the Dallas site of the clinical trial, which involved 17 people across the country who had suffered a stroke.

“Stroke is too common and too debilitating for us to tolerate the status quo,” Wigginton said. “Patients need a real solution so they can get back to fully living their lives.”

Dr. Michael Kilgard, associate director and chief science officer of the TxBDC, invented targeted plasticity therapy (TPT). Kilgard, who is also the Margaret Fonde Jonsson Professor in the School of Behavioral and Brain Sciences (BBS), said the study results further validate the theories that he and his colleagues based their TPT work on beginning in 2009.

“We set out to design an approach that could transform long-term care and restore quality of life to patients for whom that has thus far been impossible,” said Kilgard, who was not involved in the clinical trial. “These results show our method has immense potential. We’re excited about what this could mean for millions of stroke patients worldwide.”

Researchers affiliated with the TxBDC and BBS developed the therapy technique, which pairs physical movements with precisely timed vagus nerve stimulation (VNS) — electrical stimulus of the nerve via a device implanted on the nerve in the neck.

The vagus nerve controls the parasympathetic nervous system, overseeing many unconscious functions such as circulation and digestion. Stimulating the nerve initiates neural plasticity — reorganization of the brain’s circuitry. The idea behind TPT is that synchronizing VNS with movement accelerates plasticity in a damaged brain, and with it, recovery.

A stroke occurs when blood flow to the brain is interrupted because of a blockage or a ruptured blood vessel. Limb mobility can be affected when nerve cells are damaged. Such forms of brain trauma are often treated with rehabilitation that includes repeated movement of the affected limb in an effort to regain motor skills. The approach is thought to work by helping the brain reorganize.

Several studies of Kilgard’s technique in animal models have previously demonstrated that it is effective in recovering limb function after stroke. A small clinical trial in Europe also provided encouraging data for its potential use in humans.

In 2009, UT Dallas licensed its VNS technique as a stroke and tinnitus treatment to MicroTransponder, which sponsored the new double-blind, placebo-controlled study. Neither the researchers nor the study subjects knew who was getting VNS stimulation and who was not.

Each study subject was a stroke patient whose stroke occurred between four months and five years prior to selection. After they had a VNS device implanted, the subjects received six weeks of in-clinic rehab followed by a home exercise program. About half were treated with active VNS while the rest received control VNS. All were assessed one, 30 and 90 days after therapy with a widely used, stroke-specific measure of performance impairment.

In addition to showing that the technique is safe, the researchers found that subjects receiving active VNS scored more than twice as high as control subjects at the 30- and 90-day intervals, opening the way for larger, more extensive clinical trials, Kilgard said. One such trial is in the recruitment phase and includes a study site in Dallas.

Story Source: University of Texas at Dallas. “Enhanced rehab for stroke doubles movement recovery.” ScienceDaily. ScienceDaily, 27 September 2018. <>.

Mediterranean-style diet may lower women’s stroke risk

Mediterranean-style diet may lower women’s stroke risk

The original article first published on

One of the largest and longest-running efforts to evaluate the potential benefits of the Mediterranean-style diet in lowering risk of stroke found that the diet may be especially protective in women over 40 regardless of menopausal status or hormone replacement therapy, according to new research in the American Heart Association’s journal Stroke.

Researchers from the Universities of East Anglia, Aberdeen and Cambridge collaborated in this study using key components of a traditional Mediterranean-style diet including high intakes of fish, fruits and nuts, vegetables, cereal foods and potatoes and lower meat and dairy consumption.

Study participants (23,232 white adults, 40 to 77) were from the EPIC-Norfolk study, the United Kingdom Norfolk arm of the multicenter European Prospective Investigation into Cancer study. Over a 17-year period, researchers examined participants’ diets and compared stroke risk among four groups ranked highest to lowest by how closely they adhered to a Mediterranean style diet.

In participants, who most closely followed a Mediterranean-style diet, the reduced onset of stroke was:

  • 17 percent in all adults;
  • 22 percent in women; and
  • 6 percent in men (which researchers said could have been due to chance).

“It is unclear why we found differences between women and men, but it could be that components of the diet may influence men differently than women,” said Ailsa A. Welch, Ph.D., study lead author and professor of nutritional epidemiology at the University of East Anglia, United Kingdom. “We are also aware that different sub-types of stroke may differ between genders. Our study was too small to test for this, but both possibilities deserve further study in the future.”

There was also a 13 percent overall reduced risk of stroke in participants already at high risk of cardiovascular disease across all four groups of the Mediterranean-diet scores. However, this was driven mainly by the associations in women who showed a 20 percent reduced stroke risk. This benefit appeared to be extended to people in low risk group although the possibility of chance finding cannot be ruled out completely.

“Our findings provide clinicians and the public with information regarding the potential benefit of eating a Mediterranean-style diet for stroke prevention, regardless of cardiovascular risk,” said Professor Phyo Myint, M.D., study co-author and former British Association of Stroke Physicians Executive Committee member, University of Aberdeen, Scotland.

“A healthy, balanced diet is important for everyone both young and old,” said Professor Ailsa Welch.

Researchers used seven-day diet diaries, which they said had not been done before in such a large population. Seven-day diaries are more precise than food-frequency questionnaires and participants write down everything they eat and drink over the period of a week.

“The American Heart Association recommends a heart-healthy and brain-healthy dietary pattern that includes a variety of fruits and vegetables, whole grains, low-fat dairy products, fish, poultry, beans, non-tropical vegetable oils and nuts and limits saturated fat, trans fat, sodium, red meat, sweets and sugar-sweetened beverages; this dietary pattern reduces risk factors and risk for heart disease and stroke, “said Eduardo Sanchez, M.D., MPH, the American Heart Association’s chief medical officer for prevention and chief of the Association’s Centers for Health Metrics and Evaluation, who was not a part of this study. “This study provides more evidence that supports AHA’s recommendation,” said Sanchez.

Story Source: American Heart Association. “Mediterranean-style diet may lower women’s stroke risk.” ScienceDaily. ScienceDaily, 20 September 2018. <>.


The Burden of Stroke in Europe Report now in Greek language

The Burden of Stroke in Europe Report now in Greek language

Conducted by King’s College London on behalf of SAFE in May 2017, the Burden of Stroke Report has now been translated into Greek language. Manuscript translation editing was done by Hariklia Proios, PhD CCC-SLP,  Ast. Professor of neurocognitive sciences and rehabilitation, Anna Tsiakiri, PhD Psychologist, Aikaterini Kiriakidou, MD Special Neurologist, Konstantinos Charalampopoulos, MD PhD Special Neurologist and Kalliopi Tsakpounidou, MSc PhD Candidate.

The book will be distributed to the public by the H.N.S.-Hellenic Neurological Society (H.N.S.), the Hellenic Neuropsychological Society (H.NP.S.), the Hellenic Society of Vascular and Endovascular surgery (H.S.V.S.) and the Hellenic (Greek) Stroke Society (Hellenic Society of Cerebrovascular Diseases).

It was presented for the first time in August 31st, 2018, in the board meeting of SAFE in Grand Hotel Palace in Thessaloniki, Greece and will be published by EKDOSEIS GUTENBERG, Printing & Publishing Company – Athens. The aim of the publication is to inform Greek society about the burden of stroke and decrease the rate of this health emergency.

SAFE launches a website for stroke prevention

SAFE launches a website for stroke prevention

Reliable, easy to use information on 10 modifiable stroke risk factors all in one place:

Brussels, 17/09/2018: A SAFE-owned website on stroke prevention and modifiable stroke risk factors goes live today at
“We know from the INTERSTROKE study that 10 modifiable risk factors are responsible for 90% of strokes. Our goal is to increase awareness and behaviour change by creating an online resource that will collate all relevant information on the most common risk factors such as: hypertension, physical activity, diet, obesity, smoking, cholesterol, heart disease, alcohol, stress and diabetes.”- said Jon Barrick, the President of SAFE.

This website is a platform which contains all the relevant information on stroke risk factors in an easy and simple format for a range of audiences. All information presented here are in a form appropriate for people with busy lifestyles, unable to digest too much detail at one time, as well as people with disabilities.

Prior to developing this website, our research showed that it was difficult to find consistent and coherent information about stroke prevention in one place online. The problem is that the information is spread across a vast range of different locations: websites, blogs, news portals and e- documents. In addition, many of them are not in a format appropriate for people with disabilities, for example sight impairment.

Note: This website is developed and owned by Stroke Alliance for Europe – SAFE, supported by an educational grant from AMGEN. SAFE retains full editorial control over the content of this website.

About SAFE

The Stroke Alliance for Europe (SAFE) a non-profit-making organisation formed in 2004. It is the voice of stroke patients in Europe, representing a range of patient groups from 30 European countries. SAFE’s goal is to decrease the number of strokes in Europe by advocating for better prevention, access to adequate treatment, post-stroke care and rehabilitation.
For more information about SSOFT and SAFE, please visit

About Amgen

Amgen is committed to unlocking the potential of biology for patients suffering from serious illnesses by discovering, developing, manufacturing and delivering innovative human therapeutics. This approach begins by using tools like advanced human genetics to unravel the complexities of disease and understand the fundamentals of human biology. Amgen focuses on areas of high unmet medical need and leverages its expertise to strive for solutions that improve health outcomes and dramatically improve people’s lives. A biotechnology pioneer since 1980, Amgen has grown to be one of the world’s leading independent biotechnology companies, has reached millions of patients around the world and is developing a pipeline of medicines with breakaway potential.
In May 2018, Amgen received European Commission approval for Repatha® (evolocumab) to prevent heart attack and stroke in adults with established cardiovascular disease.
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