Tag: Stroke

Botulinum Toxin after Stroke

When a stroke leaves a patient with disabling spasticity, botulinum toxin type A (BotoxTM, Allergan) may help restore enough muscle function to make life easier. In a multicenter trial of 126 patients, those who were given one-time intramuscular injections of botulinum toxin type A experienced greater improvement in flexor tone in the wrist and fingers at all follow-up visits through 12 weeks compared with patients who received placebo. Each patient (or care-giver) chose a principal target of treatment from four areas of disability: hygiene (e.g., ease of cleaning and nail trimming), dressing, limb position, and pain. At week six, 40 of 64 patients given botulinum toxin type A reported improvement in the individual principal target of treatment compared with 17 of 62 in the placebo group. No major adverse events were associated with the injection.
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The researchers point out that botu-linum toxin type A has a localized effect, which minimizes the risk of systemic adverse events.

The “Polypill” for Heart Disease and Stroke

single pill might be able to reduce heart attacks and strokes by more than 80%, concludes a study from England. Heart attacks, stroke, and other pre­ventable cardiovascular diseases kill or seriously affect 50% of people in Britain.

Professor Nicholas Wald and Malcolm Law propose a “polypill” that would contain six active components—aspirin, a cholesterol-lowering drug, three blood pressure-lowering drugs at half the standard dose, and folic acid. The pill would be taken daily by all people aged 55 and over and is expected to have a huge effect on preventing disease in the Western world.
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Their radical strategy is based on evidence from more than 750 trials involving 400,000 participants.

These medications are well tolerated, and new problems are unlikely because they have been studied extensively and have often been used in combination.

Inflammatory Enzyme Lp-PLA2: Risk Factor for Stroke

High levels of an enzyme called lipo-protein-associated phospholipase A2 (Lp-PLA2), which is believed to trigger a cascade of inflammatory events in atherosclerosis, can independently predict an increased risk of stroke. Findings were presented at the American Heart Association’s Scientific Sessions 2004 by researchers from the Atherosclerosis Risk in Communities (ARIC) study.

Middle-aged participants with the highest levels of Lp-PLA2had a statistically significant doubled risk of having an ischemic stroke over a period of six years compared with those with the lowest levels of the enzyme even when traditional cardiovascular risk factors (systolic blood pressure, smoking status, and diabetes) and the risk marker of systemic inflammation (C-reactive protein) were accounted for. Patients with the highest Lp-PLA2 and C-reactive protein levels had more than an 11-fold increased risk of stroke than those with the lowest levels.
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Lp-PLA2 helps to process a form of low-density lipoprotein-cholesterol (LDL-C) into products within atherosclerotic plaques and is believed to trigger a cascade of inflammatory events. Atherosclerosis accounts for 50% of all deaths in Western countries.

Alteplase (rt-PA) and Stroke In the Emergency Room

Nearly half of emergency physicians are reluctant—even resistant—to use recombinant tissue-plasminogen activator (rt-PA) (e.g., alteplase [Activase®, Genentech]) to treat acute ischemic stroke, even in patients at risk, according to a survey by researchers from the University of Michigan Health System and the American College of Emergency Physicians in Dallas. And that’s likely to be an underestimate, they add. Stroke is the primary cause of adult disability in the U.S and third most common cause of …