Therapies Targeting Stroke Recovery

Lorie G. Richards, PhD; Steven C. Cramer, MD

Disclosures

Stroke. 2023;54(1):265-269. 

In This Article

Abstract and Introduction

Abstract

Stroke recovery therapeutics include many classes of intervention and numerous treatment targets. Stroke is a very heterogeneous disease. As such, stroke recovery therapeutics benefit from a personalized medicine approach that considers intersubject differences, such as in infarct location or stroke severity, when assigning treatment. Prediction of treatment responders can be improved by incorporating biological measures, such as neural injury and neural function, as the bedside behavioral phenotype has an incomplete relationship with the biological events underlying stroke recovery. Another ramification of high variability between patients is the need to examine effects of restorative therapies in relation to dose, time poststroke, and stroke severity in clinical trials. For example, enrollment across a wide time interval poststroke or in a population with a very broad range of deficits means high variance across patients in the biological state of the brain. The doses of rehabilitation therapy being studied are often low; it takes substantial practice to acquire a skill in the healthy brain; this is more, not less, pronounced after a stroke. Recognition and treatment of poststroke depression represents a major unmet need. These points are considered in the context of a review of recent advances in stroke recovery therapeutics.

Introduction

Stroke recovery therapeutics remains a field with numerous classes of intervention, some of which are reviewed below. This class of therapies benefits from a personalized medicine approach, where differences such as infarct location are considered in treatment assignment.

A common issue is that patients often receive a limited dose of rehabilitation therapy, both in clinical practice and in research trials. Imagine an Emergency Room where a patient with an ischemic stroke of 1-hour duration is given a mere 0.3 mg/kg dose of IV tPA (intravenous tissue-type plasminogen activator) because that is all insurance will pay for, or because that is all that is available. Unthinkable! Yet when it comes to dosing many forms of rehabilitation therapy during stroke recovery, that is the analogy that many patients face.

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