Department of Neurology and Toulouse Institute for Neurosciences, Hôpital Purpan, Place du Docteur Baylac, 31059, Toulouse, France,
Curr Treat Options Neurol. 2012 Dec;14(6):531-40. doi: 10.1007/s11940-012-0196-3.
The improvement of recovery after stroke remains one of the main priorities for patients with stroke. Acute de-occlusion of the artery should improve patient outcome and recovery. Recent data and meta-analysis confirmed the efficacy of IV thrombolysis when administered to selected patients less than 4.5 hours after the onset of ischemic stroke even in patients aged > 80 years. IV thrombolysis with rTPA is currently the only validated treatment for the acute phase of ischemic stroke. This has lead to a major public health effort to create stroke treatment units in developed countries. Mechanical thrombectomy is not yet validated despite major support from clinicians and the industry overall. Many other treatment options are currently being tested in various other therapeutic areas. Some data show clearly that some of these options are now close to clinical significance: specific and adapted rehabilitation procedures that will include a rationale in patients' care management, use of monoaminergic drugs like SSRIs with improvement of motor recovery through a specific action on cortical excitability, cortical stimulation or inhibition with magnetic or electric techniques with the aim of modifying functional inter cortical balance and connections, and clinical and bio markers of recovery that would help to ensure appropriate individual care of each patient. Finally, repair therapies with the aim of restoring the brain-damaged networks could be useful in patients with persistent severe deficits. Several classes are under study for brain repair, including the use of stem cells, growth factors, and small molecules, but these are still at a preclinical level of development.
改善中风后的恢复仍然是中风患者的主要重点之一。急性动脉再通应改善患者的预后和恢复。最近的数据和荟萃分析证实，在缺血性中风发作后 4.5 小时内对选定的患者进行 IV 溶栓治疗，即使在年龄>80 岁的患者中，也是有效的。IV 溶栓联合 rTPA 目前是治疗缺血性中风急性期的唯一经证实的治疗方法。这导致了在发达国家建立中风治疗单位的重大公共卫生努力。尽管临床医生和整个行业都大力支持，但机械取栓术尚未得到验证。许多其他治疗方法目前正在不同的治疗领域进行测试。一些数据清楚地表明，其中一些方法现在接近临床意义：特定和适应的康复程序，将包括在患者的护理管理中的合理理由，使用单胺能药物，如 SSRIs，通过对皮质兴奋性的特定作用来改善运动恢复，使用磁或电技术进行皮质刺激或抑制，以改变功能皮质间平衡和连接，以及临床和生物标志物的恢复，这将有助于确保每个患者的个性化护理。最后，修复受损大脑网络的修复疗法可能对持续存在严重缺陷的患者有用。正在研究几类用于脑修复的方法，包括使用干细胞、生长因子和小分子，但这些仍处于临床前的开发阶段。
