TENSION Trial: Is catheter treatment also effective in severe stroke?

TENSION Trial: Is catheter treatment also effective in severe stroke?

Research project led by the UKE: Clinical Trial in eight European countries has started

When stroke is treated by thrombectomy, blood clots are removed from the arteries of the brain with the help of a catheter in order to rebuild the blood circulation in the damaged area. So far, this therapy is only used regularly in specialized centres if the stroke had not already casued significant damage to the brain.

The research project TENSION, under the leadership of researchers of the Universitätsklinikum Hamburg-Eppendorf (UKE), will show whether patients affected by a severe stroke with already extended brain damage can also benefit from this treatment. In close collaboration with the Universitätsklinikum Heidelberg, the study has now started at 40 locations in eight countries. The project is funded by the European Union with a 6 million Euro grant.

Most strokes are caused by a blood clot (thrombus) which blocks a blood vessel in the brain so that parts of the brain can no longer be supplied with oxygen. The longer the vascular obliteration continues, the more brain tissue dies. Blood clots obstructing large brain arteries can be removed by endovascular treatment by introduction of a catheter starting from the groin into the arteries of the brain. This treatment, which is called thombectomy, is effective and has become standard of care for patients in whom only a few brain tissues are injured. Under these circumstances, patients have very good chances to live an independent and unimpeded life after a stroke. Whether this treatment can also help patients with severe strokes with already extended brain damage is still unclear. Therefore, these patients are currently not treated with thrombectomy in routine clinical practice.

“With our research project, TENSION, we aim to prove that patients with already extended lesions can also benefit from thrombectomy”, says Prof. Dr. Götz Thomalla, project Coordinator and lead-ing senior physician in the Clinic for Neurology of the UKE. “If our assumptions are true, the trial will provide evidence for effective treatment for a large number of patients with severe stroke and already extended brain damage.“

Clinical Study: 40 study sites, 714 patients

In the clinical trial, up to 714 patients who are admitted to a hospital with a stroke in one of the 40 trial sites will be enrolled. A criterion for inclusion in the study is that brain imaging should have already shown an extended area of damaged brain tissue around the affected blood vessel. Evalu-ation of the extent of the lesion will come from imaging techniques such as computed tomography and magnetic resonance tomography. “The correct evaluation of CT and MR images by the treating physician plays a crucial role here”, says Prof. Dr. Jens Fiehler, director of the Clinic of Neuroradiology at UKE and leader of the image core lab of the TENSION study and adds: “In order to guarantee a consistently high quality of image reading in all study sites, we have developed standardized training that must be passed all physicians who participate in the trial.”

Patients are randomly divided into two groups by: Both groups will receive normal medicinal therapy, but in addition, the second group will also have the clot removed by thrombectomy. After 90 days, the stroke patient’s degree of residual disability will be ranked by means of the usual scales used in stroke treatment. “The TENSION trial will answer the most urgent clinical question concern-ing the use of thrombectomy for treatment of stroke”, says Prof. Bendszus, Head of the Department of Neuroradiology at the University Hospital Heidelberg and Coordinating Investigator of the trial. “Such an interdisciplinary effort will also help us to improve the access to this effective treatment across Europe.”

The Clinical Trial is coordinated by the Universitätsklinikum Heidelberg, while the overall research project TENSION is led by the UKE.

Contact

Prof. Dr. Götz Thomalla
Klinik und Poliklinik für Neurologie
Universitätsklinikum Hamburg-Eppendorf (UKE)
Martinistr. 52
20246 Hamburg
Phone: 040 7410- 50137
thomalla@uke.de

Prof. Dr. Martin Bendszus
University Hospital of Heidelberg
Department of Neuroadiology
Im Neuenheimer Feld 400
69120 Heidelberg
Phone: +49 6221-56-7566
martin.bendszus@med.uni-heidelberg.de

Prof. Dr. Jens Fiehler
Klinik für Neuroradiologische Diagnostik und Intervention
Universitätsklinikum Hamburg-Eppendorf (UKE)
Martinistr. 52
20246 Hamburg
Phone: 040 7410- 55598
fiehler@uke.de

New ICD 11 stroke classification will support global efforts to improve prevention, treatment and outcomes

New ICD 11 stroke classification will support global efforts to improve prevention, treatment and outcomes

Written by Anita Wiseman │ First appeared on WSO blog

After sixty-two years of officially categorizing stroke as a Disease of the Circulatory System, the newly published WHO ICD 11, has correctly classified stroke as a Disease of the Nervous System

ICD 11 is a foundation document for health policy and treatment globally and the decision on stroke classification has been warmly welcomed by the World Stroke Organisation. WSO actively advocated for the change, arguing that positioning stroke as a disease of the brain will support global efforts to increase recognition of stroke and improve access to services and treatments that save lives and reduce post-stroke disabilities. Stroke was responsible for 14m deaths and 116 DALYS in 2016 alone, directing attention to the brain and what can be done to reduce premature deaths.

To find out more about why the WSO has made it a priority to achieve this change, I talked to Bo Norrving, Chair of the organization’s Global Policy Committee. Bo has also been chair of the Cerebrovascular Diseases group for the ICD 11 and is a member of the WHO Neurology Topical Advisory Group, chaired by Raad Shakir.

Why does it really matter that stroke is classified as a brain disease, not a disease of the circulatory system – aren’t the two closely related?

It’s true that there are close links between cardiovascular disease and stroke; many risk factors are shared and primary prevention will target both disorders jointly. We work closely with colleagues in the Non-Communicable Disease (NCD) and cardiovascular (CVD) sphere to advance our common prevention agenda.

The simple fact, however, is that when strokes happen, they happen in the brain.

Delivering stroke treatment early and efficiently with effective acute therapies such as thrombolytic therapy and thrombectomy, depends on the early recognition of symptoms from the brain and early actions to call an ambulance. This is why in many countries campaigns to increase public knowledge of stroke symptoms (like the FAST campaign) have been conducted. These campaigns are founded on in recognition that ‘time is brain’. Similarly, providing early treatment of transient ischemic attacks (TIAs), which are linked to stroke and are a significant contributing factor to dementia, depends on public awareness of the symptoms and rapid admittance to hospital.

The impact of delivering effective treatment for acute stroke – and the opportunity to prevent a stroke – present huge opportunities to reduce the global burden of disease and cannot be missed if we are to are to achieve global goals on NCD reduction. Thinking beyond prevention, understanding the role of the brain in residual stroke symptoms and disabilities from stroke is critically important to providing patients with effective long-term rehabilitation and support.

Classifying stroke under diseases of the circulatory system has kept stroke in the shadows where it couldn’t easily be seen or dealt with. We are delighted that this is no longer the case and that more light can be cast to the specifics of stroke and the opportunities we have to improve prevention and treatment.

How do you think this change will help with the achievement the global goal to reduce avoidable deaths from stroke?

Stroke is the second biggest killer and the largest single cause of disability worldwide and yet still struggles to get the policy attention and resources commensurate with its global impact. Identifying stroke as a disease of the brain and pulling all types of cerebro-vascular diseases into a single block in the ICD 11 will, we believe, guide policy attention to the right place and enable us to develop 21st century services for stroke.

Stroke is probably the best example there is of a non-communicable disease that is highly preventable and highly treatable. With the right focus and commitment to stroke we can make a massive impact on the achievement of global health and development goals .

SAFE Regional Conference Prague: The final for this year and the biggest one so far

SAFE Regional Conference Prague: The final for this year and the biggest one so far

On 28th June 2018 SAFE held its third and final Regional Conference of 2018. This conference was attended by delegates from 18 stroke support organisations.

Apart from an interactive session about the SSOFT project, Angels Initiative, Stroke Action Plan for Europe and other SAFE projects, the delegates had an opportunity to present their national activities, same as in the previous two Regional Conferences in Madrid and Dublin.

The fact that we had so many delegates made this Regional Conference different from the previous two, making it more similar to our Working Conference and the General Assembly.

The Regional Conference Prague was chaired by SAFE Vice President Markus Wagner from German stroke support organisation Stiftung Deutsche Schlaganfall-Hilfe.

SAFE Board member Anita Arsovska from Macedonia chaired the afternoon session with presentations from our SSOs.

You can find albums with photos from all three Regional Conferences on SAFE Facebook page.

SAFE’s regional conferences continue to be sponsored by Boehringer Ingelheim, and we are grateful for their support.

A dual-therapy approach to boost motor recovery after a stroke

A dual-therapy approach to boost motor recovery after a stroke

First appeared on ScienceDaily.com

Paralysis of an arm and/or leg is one of the most common effects of a stroke. But thanks to research carried out by scientists at the Defitech Foundation Chair in Brain-Machine Interface, in association with other members of EPFL’s Center for Neuroprothetics, the Clinique Romande de Réadaptation in Sion, and the Geneva University Hospitals, stroke victims may soon be able to recover greater use of their paralyzed limbs. The scientists’ pioneering approach brings together two known types of therapies — a brain-computer interface (BCI) and functional electrical stimulation (FES) — and has been published in Nature Communications.

“The key is to stimulate the nerves of the paralyzed arm precisely when the stroke-affected part of the brain activates to move the limb, even if the patient can’t actually carry out the movement. That helps reestablish the link between the two nerve pathways where the signal comes in and goes out,” says José del R. Millán, who holds the Defitech Chair at EPFL.

Twenty-seven patients aged 36 to 76 took part in the clinical trial. All had a similar lesion that resulted in moderate to severe arm paralysis following a stroke occurring at least ten months earlier. Half of the patients were treated with the scientists’ dual-therapy approach and reported clinically significant improvements. The other half were treated only with FES and served as a control group.

For the first group, the scientists used a BCI system to link the patients’ brains to computers using electrodes. That let the scientists pinpoint exactly where the electrical activity occurred in the brain tissue when the patients tried to reach out their hands. Every time that the electrical activity was identified, the system immediately stimulated the arm muscle controlling the corresponding wrist and finger movements. The patients in the second group also had their arm muscles stimulated, but at random times. This control group enabled the scientists to determine how much of the additional motor-function improvement could be attributed to the BCI system.

Reactivated tissue

The scientists noted a significant improvement in arm mobility among patients in the first group after just ten one-hour sessions. When the full round of treatment was completed, some of the first-group patients’ scores on the Fugl-Meyer Assessment — a test used to evaluate motor recovery among patients with post-stroke hemiplegia — were over twice as high as those of the second group.

“Patients who received the BCI treatment showed more activity in the neural tissue surrounding the affected area. Due to their plasticity, they could help make up for the functioning of the damaged tissue,” says Millán.

Electroencephalographies (EEGs) of the patients clearly showed an increase in the number of connections among the motor cortex regions of their damaged brain hemisphere, which corresponded with the increased ease in carrying out the associated movements. What’s more, the enhanced motor function didn’t seem to diminish with time. Evaluated again 6-12 months later, the patients hadn’t lost any of their recovered mobility.

Story Source: Ecole Polytechnique Fédérale de Lausanne. “A dual-therapy approach to boost motor recovery after a stroke.” ScienceDaily. ScienceDaily, 20 June 2018. <www.sciencedaily.com/releases/2018/06/180620094808.htm>.

SAFE Regional Conference Dublin: Comprehensive and insightful, according to our members

SAFE Regional Conference Dublin: Comprehensive and insightful, according to our members

On 21st June 2018 SAFE held its second Regional Conference of 2018. This conference was attended by more than 20 delegates from UK, Ireland, Greece, Cyprus, Netherlands, Belgium, Germany and France.

Once again, the SSOFT project was presented to our delegates, in a form of an interactive workshop.

This e-learning tool is available online at www.ssoft.info and can be accessed anywhere, by anyone with an Internet connection. It is designed to be compatible with multiple devices including computers, smart phones and tablets. The information is structured into six e-learning modules that cover information ranging from: introducing the key principles of an

SSO through the use of data to create effective messages, to approaches to developing positive and impactful public and health advocacy campaigns. The modules contain a mixture of videos, presentations and animations, ensuring that it is accessible for all, in particular stroke survivors.

Module 1, 2, and 3 are now available with modules 4, 5 and 6 being released between August and November this year.

SAFE President, Jon Barrick, presented SAFE’s success stories and projects from the past year, with a special focus on projects that are being developed in this year. The most important among them, the Stroke Action Plan for Europe was launched at ESOC 2018 in Gothenburg and in the EU Parliament in May 2018.  SAFE is now working on a popular version of this comprehensive document, hoping to present it towards the end of the year. The popular version will be written in a lay-friendly manner and available for our members for further translation and dissemination, as per the Burden of Stroke Report in 2017.

One of the sessions was delivered by our sponsor, Boehringer Ingelheim, bringing updates and providing information on new developments with the Angels Initiative project.

There will be a new approach in this project and the target audience will be quite different to what we are used to in the stroke world. For more information and a sneak peek into the new branding, please visit www.angels-initiative.com and join their community.

The next SAFE Regional Conference and the final one for this year will be held in Prague on 28th June.

SAFE’s regional conferences continue to be sponsored by Boehringer Ingelheim, and we are grateful for their support.