Therapies Targeting Stroke Recovery

Abstract

Stroke recovery therapeutics include many classes of intervention and numerous treatment targets. Stroke is a very heterogeneous disease. As such, stroke recovery therapeutics benefit from a personalized medicine approach that considers intersubject differences, such as in infarct location or stroke severity, when assigning treatment. Prediction of treatment responders can be improved by incorporating biological measures, such as neural injury and neural function, as the bedside behavioral phenotype has an incomplete relationship with the biological events underlying stroke recovery. Another ramification of high variability between patients is the need to examine effects of restorative therapies in relation to dose, time poststroke, and stroke severity in clinical trials. For example, enrollment across a wide time interval poststroke or in a population with a very broad range of deficits means high variance across patients in the biological state of the brain. The doses of rehabilitation therapy being studied are often low; it takes substantial practice to acquire a skill in the healthy brain; this is more, not less, pronounced after a stroke. Recognition and treatment of poststroke depression represents a major unmet need. These points are considered in the context of a review of recent advances in stroke recovery therapeutics.

Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

“…Precision medicine, on the other hand, uses “big data” from clinical and multimodal MRI to tailor the treatment and prevention strategies to each patient’s specific needs. 20,57,58 Ultimately, these big data sets allow us to classify pheno(sub)types at a participant-specific level and to identify those who do and do not respond to an evidence-based intervention.…”

Integrated analysis of single cell‐RNA sequencing and Mendelian randomization identifies lactate dehydrogenase B as a target of melatonin in ischemic stroke

“…The conventional treatments for IS consist of mechanical thrombectomy and intravenous thrombolysis 3,4 . In contrast, the emerging treatment approaches encompass cellular therapy and noninvasive brain stimulation 5 . Nevertheless, the effectiveness of thrombolysis interventions is limited by the narrow time window, typically within 4.5 h, and sometimes extended up to 6 h, 6 therefore, to predict the occurrence of ischemic stroke is very critical in clinical session.…”

Explainable machine learning for long-term outcome prediction in two-center stroke patients after intravenous thrombolysis

“…The average stroke incidence is 120-180/100,000/year, being greater for men (Thayabaranathan et al, 2022). The traditional treatments of ischemic stroke are mechanical thrombectomy and intravenous thrombolysis (Berkowitz et al, 2014;Alet et al, 2020), while the novel treatment strategy include cellular therapy and non-invasive brain stimulation (Richards and Cramer, 2023). However, due to the limited time window for the thrombolysis interventions, generally within 4.5 h and extended 6 h (Qingke et al, 2021), the early prediction of clinical outcomes in stroke patients is essential in post-stroke management.…”