The 1990s have been dubbed "The Decade of the Brain" by the American Academy of Neurology in recognition of the nearly exponential growth in neuroscience research occurring over the past decade, and in anticipation that such growth would continue into the new century. In 1999, neurologists can find comfort that this phrase was indeed aptly applied, as we have seen more significant advances in neurologic therapeutics than in any other decade.

We are honored to be able to tell you about a very significant advance in one particular area of neurology--stroke. The neurology profession, with the help of the National Stroke Association, has chosen to coin the phrase "brain attack" in recognition of what has formerly been termed "stroke." There are several important reasons for doing this. The foremost reason is that we are now able to effectively treat many strokes, and victims of stroke need to recognize the importance of their symptoms and that treatment is available.

Formerly, we couldn't do much for acute stroke, and everybody knew it. Thus, when mom or dad developed weakness or numbness on one side of the body, speech difficulty, trouble seeing or swallowing, difficulty with coordination, and so on, they would often say, "Honey, I think I'm having a stroke. I think I'll lie down for a while." Sounds bizarre, but it isn't. This really happens.

Unfortunately, too few people know that we can now treat stroke; hence the phrase "brain attack." Hopefully, through education, people will begin to respond to stroke symptoms with the urgency that they respond to "heart attack" symptoms.

With the onset of stroke-like symptoms, an emergency evaluation is critical, because the principal new medicine used in acute stroke has to be given within three hours of symptom onset. Not all persons will be candidates for such therapy, but we forfeit the opportunity to turn a potential catastrophe into a healthful outcome if we neglect prompt attention.

The "new" medicine is called "recombinant tissue plasminogen activator," or TPA, and has actually been used for a number of hears to treat heart attack. It helps the body to dissolve the blood clot (in the heart or the brain). Its use in stroke had been delayed for years, out of fear that it might cause an unacceptable high risk of bleeding in the brain. While the incidence of hemorrhage in stroke is higher when TPA is administered, the overall outcome is significantly improved. In appropriately selected candidates, TPA has significantly reduced or prevented disability that might otherwise have occurred. 

We need to remember the phrase "time is brain." This is to emphasize the point that the longer one delays medical attention, the number of brain cells at risk increases; the larger the stroke becomes; and the likelihood of safe and effective treatment diminishes.

We at SUNN have been very proactive in the use of TPA in acute stroke. The treatment protocol is demanding, but it is gratifying to witness the most significant advance in the treatment of stroke that history has ever seen, and we want to do our part to reduce the death and disability from stroke to whatever extent possible. We should recognize that while stroke is the third leading cause of death in America, it is the leading cause of disability.

This brings us to our final topic: stroke research. Considerable research is presently underway to develop medicines that, if given within 6 to 12 hours following stroke onset, will shrink the size of the stroke that might otherwise occur, or in some cases entirely prevent the stroke. Here we are not talking about clot dissolvers but another class of molecules known pharmacologically as "neuroprotectants."

When a stroke occurs, there is a dramatic increase in the affected part of the brain of an excitatory neurotransmitter known as glutamic acid. This sets in motion a cascade of events that eventually lead to the death of brain cells. A variety of medications now being studied work at various levels of this cascade to prevent cell death, even if a cell has already been deprived of blood and, hence, oxygen.

Remember "brain attack" and "time is brain." It may save your life.

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