Critical differences in clots that cause a stroke

Critical differences in clots that cause a stroke

The original article was first published on ScienceDaily.com

There are two main treatments for stroke caused by a clot in a blood vessel in the brain. One treatment, mechanical thrombectomy, involves pulling the clot out with a specialized catheter that is inserted into the artery in the groin and guided by imaging to the clot. This procedure is only performed at hospitals that specialize in these techniques. The other treatment, which is more widely accessible, involves giving a patient a clot-busting drug that helps the body dissolve the clot.

Quick decision making on which treatment is best for which patient is critical because the clot deprives brain cells of oxygen causing them to die. For physicians, knowing which patients will benefit the most from the clot-buster Alteplase (also known as tPA) just got easier.

University of Calgary scientists with the Hotchkiss Brain Institute at the Cumming School of Medicine (CSM) have discovered that clots have different compositions and depending on where they are located in the brain, administering tPA can be almost as effective as thrombectomy given sufficient time.

“We’ve known that, when administered quickly, tPA can be effective in stroke, but until now, we didn’t realize how effective it can be and we didn’t understand the specific reasons why it works better in some cases than others,” says Dr. Bijoy Menon, MD, associate professor in the departments of Clinical Neurosciences, Radiology and Community Health Sciences at the CSM. “Our findings show that some clots are permeable, which allows the tPA to penetrate the blockage and dissolve it. We saw that within two hours, greater than 50 per cent of permeable blockages had dissolved.”

The UCalgary study led out of the Foothills Medical Centre is the largest of its kind to date, involving nearly 600 patients at 12 medical centres in five countries (Canada, the Czech Republic, South Korea, Spain and Turkey). The findings are published in JAMA.

“Despite earlier research on the benefit of using tPA, we know there is still some reluctance in the medical community to use it. These findings should provide physicians with definitive evidence on the value of giving patients tPA as soon as they’ve confirmed the stroke is due to a clot,” says Dr. Andrew Demchuk, MD, professor in the departments of Clinical Neurosciences and Radiology. “It’s critical that anyone showing symptoms of a stroke be given a CT-angiogram as soon as possible to confirm the blockage. The scan will guide whether tPA is likely to dissolve the clot and may inform whether the patient also needs thrombectomy.”

A CT-angiogram (computer tomography scan) is a common noninvasive diagnostic tool that allows physicians to see images of the blood vessels in the brain. Researchers found that clots in the carotid artery of the brain do not respond to tPA, and for these patients, thrombectomy is required.

“Strokes happen at anytime, anywhere. Knowing who needs thrombectomy can help physicians make better decisions on how to prioritize patient transfers to specialized centres for this procedure,” says Menon. “Data gathered in Europe showed that up to one-third of hospital transfers aren’t necessary.”

“Stroke is an important health care problem and one of the leading causes of death and disability worldwide,” says Dr. Brian H. Rowe, scientific director, Canadian Institutes of Health Research (CIHR) Institute of Circulatory and Respiratory Health, which supported this study. “Through continued scientific research, important discoveries like this one will improve our ability to match patients with the most effective treatment for this particular injury. This will help speed up recovery times, reduce the associated impacts such as paralysis, and it will improve patient outcomes and ultimately save lives.”

Drs. Menon and Demchuk add that for the science community these findings will help researchers better design studies that target dissolving the clot with new clot busting drugs or combination treatments.

Led by the Hotchkiss Brain Institute, Brain and Mental Health is one of six strategic research themes guiding the university towards its Eyes High goals. The strategy provides a unifying direction for brain and mental health research at the university and positions researchers to unlock new discoveries and treatments for brain health in our community.

Story Source: University of Calgary. “Critical differences in clots that cause a stroke: Findings will help inform physicians which treatment will work best for patients.” ScienceDaily. ScienceDaily, 12 September 2018. <www.sciencedaily.com/releases/2018/09/180912081219.htm>.

 

Why is sitting bad for you? Irish Heart Foundation just launched an innovative campaign #ChairsCanKill

Why is sitting bad for you? Irish Heart Foundation just launched an innovative campaign #ChairsCanKill

The content below was published by Irish Heart Foundation

Irish Heart Foundation launched a “Chairs Can Kill” campaign this week which hoping to help everybody in Ireland sit less and reduce their risk of heart disease and stroke. But why is sitting bad for us?

Recent research has found that sitting for prolonged periods can have a serious effect on our heart health, regardless of whether or not we are exercising [1]. Here comes the science bit: the body needs energy to stand, so to provide this, enzymes in the leg muscles capture fat from the blood to be used for fuel. When you sit for long periods of time the fat is not captured, so it remains in the blood, increasing your risk of heart disease and stroke. Sitting for long periods of time has also been shown to significantly reduce the level of HDL or good cholesterol, in your blood and this too increases your risk of heart disease and stroke [2].

Here are some general tips to help you reduce your sitting time and reduce your risk of heart disease and stroke.

General tips:

Tip 1: Track how long you sit – Do you know just how long you sit for? Use our calculator on irishheart.ie
Tip 2: Set a goal- Try and reduce the amount of time you spend seated. Set a realistic goal.
Tip 3: Break the habit- Why not stand when you can? Be aware of why and when you sit and try to break the habit.

The Irish Heart Foundation has developed a sitting time calculator to help you calculate just how many hours a day you spend sitting down. You can access the calculator here. Also, download our campaign poster and this week’s infographic here to help spread the word.

In addition, why not share the results of your sitting time calculator and see how you can reduce this over the next four weeks of the campaign. Challenge your colleagues to a ‘sit less competition’ and see who manages to reduce their sitting time the most by the end of the campaign. Make sure to let us know how you are reducing your sitting time throughout the month. You can show your support for the campaign by sharing videos and pictures on Facebook, Twitter, Instagram and LinkedIn using #chairscankill.

________________________________________
[1] Biswas et al., 2015 (doi: 10.7326/M14-1651)
[2] Kravitz, L. (2009) (https://www.unm.edu/~lkravitz/Article%20folder/sittingUNM.html)

New Economist Intelligence Unit (EIU) research looks at stroke prevention in 11 European countries

New Economist Intelligence Unit (EIU) research looks at stroke prevention in 11 European countries

Atrial fibrillation (AF) is an abnormal heart rhythm with rapid and irregular beating. It is estimated to increase the risk of stroke 3 to 5-fold and to be associated with around a quarter of all ischaemic strokes. Additionally, AF is associated with more severe strokes leading to higher mortality and disability.

With support from the BMS-Pfizer Alliance, The Economist Intelligence Unit (EIU), London, UK published a new sub-analysis that assessed how 11 EU countries (Belgium, France, Germany, Italy, the Netherlands, Norway, Russia, Spain, Sweden, Turkey and the United Kingdom) compare against European Society of Cardiology’s recommendations for stroke prevention and #AFib detection. This sub-analysis was published in the “Risk Management and Healthcare Policy” journal.

AF is often asymptomatic and screening is not routinely undertaken in Europe. Accurate information on its prevalence in the general population is therefore not widely available. Some European countries have undertaken screening studies to estimate the proportion of the population affected. They reported rates in the general population ranging from 1.3% (UK, Italy) to 3.9% (Greece), with rates being highly dependent on age. Less data is available from Central and Eastern European countries.

Due to Europe’s ageing population and AF’s strong association with age (0.7% in those aged 55-59 vs. 17.8% in those aged ≥85 years), the prevalence of AF is expected to rise. Using data from the community based Rotterdam Study and population projections from Eurostat, it was estimated that the number of adults over 55 with AF will more than double between 2010 and 2060 from 8.8 million to 17.9 million[117]. An Icelandic study projected the prevalence of AF to rise from 1.9% in 2008 to 3.5% in 2050. (Source: Burden of Stroke Report, 2017)

As stated in the Abstract of this sub-study, all 11 participating countries were found to have policies in place to manage general behavioral risk factors of noncommunicable diseases (NCD), but it was found that more needs to be done to address cardiovascular disease – specifically, stroke risk factors. Although ten of the countries in this study endorse the ESC cardiovascular clinical guidelines, implementation is lacking. Eight out of the 11 countries received the lowest score in regard to raising awareness around stroke, and 7 countries were found not to have a stroke registry. Among physicians surveyed in primary care it was reported that less than 30% of patients over 40 years old were screened for blood pressure, whereas even fewer were screened for atrial fibrillation; in 10 out of the 11 countries, less than 20% of patients over 65 years old were screened for atrial fibrillation.

The findings revealed opportunities for improvement in the primary prevention of stroke which should not be ignored, having in mind that the prevalence of AF is expected to rise significantly over the next few decades.

 

 

 

EPF Webinar: Transparent Advocacy in Patient Organisations- 14 September 2018

EPF Webinar: Transparent Advocacy in Patient Organisations- 14 September 2018

Following the publication of EPF’s Transparency Guidelines, European Patients Forum would like to invite you to join a webinar to discuss transparent advocacy in patient organisations.

Health advocacy and lobbying is at the heart of the work of many patient organisations (whether it is local, national or European). Their mission statement often includes promoting a political, regulatory, and societal environment that are more patient-centred.

This means that patient organisations engage in lobbying activities on a regular basis. They do so by contributing the specific perspective of patients and people with chronic conditions to legislative processes, but also by pushing for the recognition and for actions on topics that are not yet necessarily on the political agenda (proactive advocacy). Thanks to Vitor Teixeira from Transparency International, the EPF will share with you the benefits of transparency and advocacy as well as a few practical tips on how to enhance your transparency in advocacy activities.

Practical information

Date: Friday 14th September 2018

Time: 15.30-16.15 CEST

How to register?

Register via this link, by 12 September at the latest. Please note that you will need a strong internet connection to fully enjoy the webinar.

And if I can’t make it?

If you can’t make it at the time of the live webinar, no worries! The webinar will be recorded and made available on EPF website.

Attention network plays key role in restoring vision after brain damage

Attention network plays key role in restoring vision after brain damage

The original article first published on ScienceDaily.com

About one third of patients who have suffered a stroke end up with low vision, losing up to half of their visual field. This partial blindness was long considered irreversible, but recent studies have shown that vision training after optic nerve and brain damage can help restore or improve vision. A new study published in the journal Clinical Neurophysiology reports on key mechanisms of vision restoration: attention.

Hemianopia is a decreased vision or blindness in half the visual field, usually as a consequence of stroke or trauma to the brain. It greatly reduces quality of life, affecting patients’ reading, driving and spatial navigation.

“Knowledge in this field is still rather fragmentary, but recent studies have shown that vision can be partially restored by vision training, which improves the deficient visual field sectors,” explains Prof. Bernhard Sabel, PhD, Director of the Institute of Medical Psychology at Magdeburg University, Germany, co-investigator of the study. “Neuroimaging evidence supports a possible role of attention in this vision restoration.”

The study confirmed this hypothesis by obtaining evidence from functional magnetic resonance imaging (fMRI) that visual training led to functional connectivity reorganization of the brain´s attentional network.

Seven chronic hemianopic patients with lesions of the visual cortex took part in vision rehabilitation training for five weeks. After the pre-tests all received training sessions lasting one and a half hours per day for six days per week for five weeks. Each training session, lasting about 60 minutes, was composed of six blocks with 120 training trials each, during which participants had to respond to specially designed visual stimuli on a computer monitor. The pre- and post-test included perimetry testing, contrast sensitivity testing and fMRI scanning one or two days before and after training, respectively. Each contrast sensitivity test consisted of 420 trials in six blocks. The visual rehabilitation training was performed with one eye open, which was randomly chosen, while the non-trained eye was covered with an opaque eye patch.

After training, the patients had significantly improved visual function at the training location, and fMRI showed that the training led to a strengthening of the cortical attentional network connections between the brain region of the right temporoparietal junction (rTPJ) and the insula and the anterior cingulate cortex (ACC).

“Our MRI results highlight the role of attention and the right TPJ activation as a component of vision restoration training in hemianopia,” notes lead investigator Yifeng Zhou, DSc, of the Hefei National Laboratory for Physical Sciences at Microscale and School of Life Science, University of Science and Technology of China, Hefei, P.R. China, and State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, P.R. China. “However, it is unclear whether the rehabilitation of attentional networks is the direct result of training or the result of the rebalancing of bottom-up sensory streams, which should be investigated in future studies.”

“This discovery that the brain´s attention network is a key mechanism in partially reversing blindness is an exciting advance in the field of restoring vision in the blind, and it opens up new avenues to design new therapies that are even more effective than current methods to help people with low vision or blindness,” concludes Prof. Sabel.

Story Source: Institute for Medical Psychology, Otto-v.-Guericke University Magdeburg. “Attention network plays key role in restoring vision after brain damage: New study highlights the role of attention as a component of vision restoration training in hemianopia.” ScienceDaily. ScienceDaily, 4 September 2018. <www.sciencedaily.com/releases/2018/09/180904114753.htm>.