ISC 2015 Thursday Science Roundup

– Hi. I’m Dr. Joe Broderick. We’re here today on Thursday at a very exciting
International Stroke Conference. And we would like to tell you about some of the highlights
today that have gone on. First though I would like to say I guess I’m from the
University of Cincinnati and I’ll have some of my
colleagues introduce themselves. – My name is Dr. Isha Sharzia I’m a Vascular Neurology
Fellow at Columbia University. – My name is Jesse Dawson
and I’m a Stroke Physician and Academic at the University
of Glasgow, in Scotland. – So, that’s who we are and maybe I’ll start
talking a little bit about something I just presented
just a few moments ago, which was a collaboration between the MR CLEAN investigators
and the IMS3 Investigators. And what we did is we pooled
our data from both trials and back last spring, before MR CLEAN even knew their results, we decided on a couple
of groups of patients that we wanted to look at together that showed evidence of
potential benefit in IMS3. And these were people
who had the severest, the worst strokes, as measured by united stroke scale score of greater than or equal to 20. We were also going to
be looking at patients who had vascular occlusions
diagnosed at the baseline. And also patients with internal
corotid artery occlusions. But today’s talk was pretty
much focued on these patients with the most severe strokes. So what happened with
these most severe strokes was that when you put those two together we found that patients who
got into vascualar therapy after IVTPA, and everybody had gotten IVTPA within three hours, that they did better on
average than patients who had just gotten IVTPA alone. And the difference, the
absolute difference, was about 10 to 11 percent between those that got into
vascular therapy and just IVTPA. And that was pretty consistent, no matter how we did the analysis. Whether we looked at the range of handicap or disability on the
modified rank and scale, or whether we looked at those people who were just functionally independent as measured by a ranking of zero to two. So, again, it was very
exciting, very consistent, and both trials gave
pretty much the same result even though MR CLEAN had newer technology. So that was very comforting to see and I think the bottom line means that for the very severe
patients, what we really need to be thinking about
is how we can get them to the right place, to
get into vascular therapy as quickly as possible, assuming that we’re also
getting IVTPA started as quickly as possible and that’s going to be one of the challenges over the next four to five years is how we reorganize our system of care from when the patient first has their stroke signs and
symptoms and they call 911 to where then they’re picked up and brought to whatever hospital. Do you want to talk a
little bit about your study? – Sure, sure. So we wanted to look at dietary patterns, specifically the
Mediterranean dietary pattern and how that is associated
with all strokes. There’s been a lot of studies out there in the past decade or so, that has looked at
Mediterranean dietary pattern and how it’s related to
cardiovascular diseases and cardiovascular events,
cancer, Alzheimers, etcetera. But they haven’t really specifically looked at stroke sub-types. So we wanted to see the relationship between this Mediterranean diet pattern, which emphasizes plant-based
foods; vegetables, fruits, cereals, legumes and de-emphasizes meats
and saturated fatty acids and we chose the
California Teachers Study, which is a large cohort
of about 133,000 women. And we created a
Mediterranean diet score that had been validated in the past. And we found out that women who adhered to the highest score, or
to the highest form of Mediterranean dietary pattern
actually did very well and they had very low
risk of ischemic stroke and all strokes. However, we didn’t really
find a new relationship with hemmorrhagic stroke and
Mediterranean diet pattern, possibly because the number of patients with hemorrhagic stroke was very low. So, this has a lot of
implications in this society given that only one percent, well maybe less than one
percent of U.S. adults age 50 and above have an ideal diet. And this is based on the
report that just came out. And it basically tells us that we really need to focus on diet
as a very potentially strong, modifiable risk factor in the community. – Well that’s great. I actually have to say that when I talk to my patients, that’s the diet I recommend. And that was based upon
the Random Mires trial that was done earlier that
showed decreased risk of stroke. – Absolutely – And so, I think it’s very
exciting and the fact is we’ve got a lot of work to do. – We do. – We do. – Absolutely. – Dr. Dawson would you like to
talk a little bit about what – Sure, thank you. So we performed a small study at the opposite end of a
patient’s stroke journey. And that’s on patients who’d been left with chronic arm problems
after an ischemic stroke. We explored the potential
for a new implantable nerve stimulation system to
augment recovery after stroke. So we took 20 patients at least six months
after an ischemic stroke and we randomized
intensive physical therapy or intensive physical therapy with the implantation of the
nerve stimulation system. The patients each had six
weeks of physical therapy which incorporated two hour
sessions three days a week. Roughly three to four
hundred therapy movements were perfomred in each session and in the patients with the implantable
nerve stimuation system, they had a brief period
of nerve stimulation and performed with each movement, so three or four hundred
stimulations per session. The nerve stimulation that we used was a vagus nerve stimulation system so it sets just under the
collarbone on the left-jand side, a little bit like a cardiac pacemaker. And there’s a tunneled lead that connects the vagus nerve on the left-hand side of the neck. The reason why we wanted
to explore this is we know from pre-clinical experiments, that when you stimulate the vagus nerve you get a release of pro and
neuroplasticity mediators surges cooling over the cerebral cortex and we hope that therefore
by overloading the brain with these neurotransmitters,
during specific movements, curing a therapy task we could
drive the brain to recover in that specific way. And indeed there are numerous
and animal experiments from the University of Texas that show good, promising ,pre-clinical data. The aim of of our study
was initially just to show that this was a
feasible and safe thing to do in a chronic stroke population. There are some sensitivities
around general anesthetic and implanting devices and
in this patient group certainly we found it to be very feasible. Every patient completed the
entire therapy protocol. We saw no serious adverse device effects. There were no worrying
safety signals from the trial And very encouragingly we saw that when we used one of the
measures the upper extremity fugl-meyer’s score baseline and compared the change in values over the course of the therapy period, we saw a much bigger change
in the VNS treatment groups of the patients who had
the nerve stimulation. And that change was on
average, six point, seven point greater than the VNS which is well above the minimum, clinically significant difference. So we saw very positive efficacy
data from the small trial. And when we looked in
detail at the patients who responded to VNS
and looked at their MRIs the structural integrity of
their corticospinal tracks and the size of their infarcts, we found that we were able
to get clinical responses in patients with very, very
adverse baseline MRI factors that we didn’t see in
any control patients. So what we hope is, that we’ll verify this in subsequent studies. But what we hope is that
we’re able to translate some patients that wouldn’t respond to normal physical therapy measures to a clinical response maintain their neuroplasticity changes. – Wow, that’s very, very exciting. – Fascinating. – I know a lot of people
doing stimulation through here but in some respects it’s
easier that you can do it through here because you
have to wear something or try to keep doing it and it’s a little bit harder
when you’re doing the therapy – Absolutely – Where as this you’re not thinking about while you’re doing the therapy. – It’s much more user
friendly in that regard. The negative side of
the implantable system is the patient needs an intervention, an operation. But it’s a single, one-off intervention and then thereafter it’s just
a normal therapy session. And the therapist just has a push button that activates the device. – Actually I guess they
would have that removed I would assume. – They could, absolutely. – Well great, wow those
were some of the exciting results of the conference. For those of you who are here we hope you continue to
enjoy the last day, tomorrow and we look forward also
to seeing you next year. Thank you. – Thank you.

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