CHARLESTON, S.C.- Newly developed drugs may be able to reduce the complications of stroke significantly, provided patients are treated quickly enough, reported researchers at the 20th International Joint Conference on Stroke and Cerebral Circulation.

Until recently the only thing physicians could do for a patient having a stroke was to provide blood thinning agents including warfarin and aspirin. However, clinical studies now underway suggest that so called clot-busters, which have significantly improved survival for heart attack patients, may also benefit patients with stroke. Moreover, a new class of neuroprotective drugs now in clinical trials may also be able to prevent or reduce the after effects of stroke.

"With the development of new drugs, a whole new opportunity arises for treating stroke, just as it did for heart attack," reported Rashmi Kothari, M.D., of the University of Cincinnati College of Medicine.

Strokes result when the blood flow to the brain is interrupted either by a blood clot in one of the critical carotid arteries, or a hemorrhage in the blood vessels feeding the brain. The reduction in blood flow can result in the death of nerve cells which in turn produces the post-stroke problems of partial paralysis, speech defects and vision impairment.

The death of nerve cells seen in stroke occurs almost immediately. Therefore it is critical that patients be treated before irreversible damage occurs to the brain. This means paramedics and emergency room patients, as well as patients and their families, will have to become more expert at recognizing the early signs of stroke.

"Since there wasn't much we could do before, stroke was not seen as a high priority in the emergency room like trauma. But we are getting close to finding something that works, so we will need to make stroke more of a priority," said Dr. Kothari.

Recent clinical trials with promising stroke treatments has already laid some of the groundwork. In these trials a 'stroke team' including specially trained nurses, emergency physicians, neurologists and radiologists jumps into action as soon as a potential stroke patient arrives in the emergency room.

A University of Texas study showed that hospitals without stroke teams took half an hour from arrival to examination of the patient. The time from arrival to diagnostic brain scan was 100 minutes. however, the study showed that hospitals that did have stroke teams were able to reduce the time to exam by 13 minutes and the time to brain scan by 63 minutes.

"The stroke team is an example of a policy change in which the stroke patient is treated like a trauma patient and given high priority," reported Patti Bratina, R.N., of the University of Texas Health Science Center in Houston.

In the past decade scientists have gained considerable insight into the acute neurotoxic molecular processes which accompany traumatic brain injury and related conditions such as stroke and subarachnoid hemorrhage. These studies have led to a rejection of the old doctrine that the brain is incapable of self repair in favor of the notion of neuronal plasticity.

Neuroprotective drugs now under investigation function either by stimulating production of neurochemical reparative molecules or by inhibiting the production of chemicals associated with neuronal destruction. Many of these agent exert their effects by 'scavenging' free oxygen radicals, molecules believed to play a significant role in the destruction of neuronal process in the acute stage of brain trauma. The clot-buster drugs, in contrast, simply dissolve the clot wherever it happens to be.

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