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                           JeffNEWS, May 1, 1995
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Stroke Team Participates in Trials of Medications to Limit Stroke Damage
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Jefferson's recently formed multidisciplinary stroke team and
affiliates Pennsylvania Hospital and Wills Eye Hospital are
participating in clinical trials of neuroprotective drugs that could
minimize brain damage resulting from a stroke.
 
Stroke is this country's third leading killer and the primary cause
of disability, resulting in paralysis; speech, memory and thinking
problems, or coma. Every year, 550,000 people suffer a stroke; and
150,000 of them will not survive.
 
The Jefferson stroke team, under the direction of Rodney D. Bell,
MD, professor of neurology, Jefferson Medical Center, includes the
emergency department, neurology, neurosurgery, nursing service,
radiology (including neuroradiology), rehabilitation medicine, and
vascular surgery.
 
"Minimizing brain damage will reduce the devastating effects of
stroke on patients and their families," said Dr. Bell,  director of
Jefferson's Cerebrovascular Center or Stroke Center.
 
The Center, which is supported by the National Stroke Association,
has recently appointed a stroke-team coordinator, Toby Mazer, MPH.
 
The clinical trials at Pennsylvania Hospital and Wills are under the
direction of neurologist Dara G. Jamieson, MD.


Testing "Neuroprotective" Drugs
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"Researchers' expanding knowledge about how and when brain cells die
has led to the development and testing of drugs known as
"neuroprotectives." They're designed to protect the area of the brain
that lies beyond the immediate region of the stroke," said Dr. Bell.
The first two trials at Jefferson will involve testing such
medications.
 
Here's why it's necessary to protect the area beyond the immediate
region of the stroke. Brain cells in that region die relatively
quickly. This sets off a chain reaction of chemical and electrical
activity within the brain in the hours just after the stroke,
endangering the much larger area of surrounding tissue. "Every minute
that passes without treatment reduces the ability of the affected
brain cells to recover and function normally again," he said.

"Neuroprotectives are meant to interrupt or interfere with this
chain reaction, shutting it down and preventing further cell death and
damage."
 
The first trial will require that patients be seen at Jefferson and
treated within 24 hours of the onset of a stroke.
 
The second trial will use an investigational medication on patients
who can be seen and treated within six hours of a stroke's onset.


Testing Clot-Dissolving Drugs
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Lately, physicians have begun to apply to stroke the same principles
underlying the clot-dissolving drugs that have been so successful in
treating heart attacks.
 
They're now studying the use of specially formulated clot-dissolving
drugs, such as urokinase, to restore the flow of blood to stroke-
affected areas of the brain. If this effort proves successful, it may
be possible for physicians to stop a stroke in its tracks, instead of
having to deal only with its consequences. Here at Jefferson trials
for this procedure are already in progress by neurosurgeon Robert H.
Rosenwasser, MD, chief of cerebrovascular and neuroendovascular
surgery.


A New Way to View Strokes - As 'Brain Attacks'
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 "These emerging treatments have caused us to look at strokes as
'brain attacks'," Dr. Bell said. "Brain attacks, like heart attacks,
should be considered and handled as medical emergencies - something to
be dealt with immediately by patients, their families, and emergency
medical services and hospital staff."
 
Quick recognition of the symptoms of stroke and response to them are
critical, as well, to the testing and eventual use of these new,
potentially powerful stroke treatments.
 
Getting to the hospital immediately is important even in communities
that don't have active stroke treatment research trials, like
Jefferson's. The sooner stroke patients receive medical attention, the
sooner physicians can diagnose the problem and begin lifesaving
treatment.


How to Recognize a Stroke, Who's at Risk
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Stroke symptoms are subtle and often painless. It's important to
learn what they are so you can call 911 as soon as possible for
emergency medical attention if you ever experience the symptoms
yourself or notice them in someone else.
 
The most common are:
 
   o Numbness, weakness or paralysis on only one side of your body
   o Problems speaking or understanding
   o Blurred or decreased vision
   o Dizziness or loss of balance
   o Sudden severe or unexplained headache
 
Some risk factors for stroke are:
 
   o Previous stroke or stroke warning sign
   o High blood pressure
   o Smoking
   o Being more than 20 percent over your proper weight
   o Carotid artery disease
   o Heart disease, especially atrial fibrillation
   o Elevated blood cholesterol level
   o Family history of early stroke or heart disease
   o Excessive alcohol consumption
   o Diabetes
 
You can make positive lifestyle changes that could decrease your risk of
stroke, and there are also medical treatments that could be effective. Ask
your doctor for information.


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Information provided by:  Editor, JeffNEWS
                          (215) 955-6204
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