Recovery After Stroke

Steven C. Cramer, MD, MMSc, FAHA, FAAN Cerebrovascular Disease p. 415-434 April 2020, Vol.26, No.2 doi: 10.1212/CON.0000000000000838
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PURPOSE OF REVIEW This article describes restorative therapies to improve patient outcomes after stroke. These therapies contrast with acute stroke treatments such as recombinant tissue plasminogen activator (rtPA) and thrombectomy that target clots, aim to salvage threatened brain tissue to limit injury, and have a time window measured in hours. Restorative therapies target the brain, aim to promote plasticity within surviving brain tissue, and have a time window measured in days to weeks or longer.

RECENT FINDINGS A number of drugs are under study. Preclinical studies are providing attractive therapeutic candidates for translation, such as the C-C chemokine receptor 5 inhibitor maraviroc. Some drug studies have used a pragmatic approach, which is premature for the nascent field of neural repair. Substantial data support the utility of activity-dependent therapies, including constraint-induced movement therapy, with recent studies supporting the need for very high doses to generate the best functional gains. While stem cell therapies are at an early stage, mounting preclinical evidence supports the efficacy of mesenchymal stem cells; some initial human studies are supportive. Several types of brain stimulation have been examined, and in some cases initial studies are promising.

SUMMARY Improved insights into stroke recovery and its treatment have the potential to reduce disability in a large segment of stroke survivors.

Address correspondence to Dr Steven C. Cramer, Department of Neurology, University of California, Los Angeles, California Rehabilitation Institute, 2070 Century Park East, Room 919, Los Angeles, CA 90067-1907, sccramer@mednet.ucla.edu.

RELATIONSHIP DISCLOSURE: Dr Cramer has served as a consultant for AbbVie Inc; Biogen; Constant Therapeutics, LLC; Fujifilm Toyama Chemical Co, Ltd; MicroTransponder Inc; NeuroLutions; Regenera Pharma; SanBio Co, Ltd; Stemedica Cell Technologies, Inc; and TRCare, Inc. Dr Cramer has received grant or research support from SanBio Co, Ltd and the National Institutes of Health (grant R01 NR015591) and royalties from Cambridge University Press and the University of California.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Cramer reports no disclosure.

© 2020 American Academy of Neurology.