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Stroke (Ischemic, Thrombotic, Embolic, and Transient Ischemic Attack)
Conventional Therapies to Prevent
Another Stroke
There are conventional drugs that can be prescribed to reduce the risk of a second stroke: (1) anti-platelet drugs such as Trental (pentoxifylline) and Ticlid (ticlopidine) inhibit abnormal platelet aggregation, thereby reducing the risk of a new blood clot forming in the brain; (2) anticoagulant drugs such as heparin or Coumadin interfere with the initiation of the coagulation cascade, and significantly reduce the risk that a blood clot will form. The use of anticoagulant drugs involves frequent blood testing and adjusting of dose since the anti-coagulating response to these drugs varies between individuals. These drugs DON'T do anything to the clots that may already have been formed. The side effects of anticoagulant drugs mandates careful monitoring, and some people avoid these drugs because of the risk of serious side effects.
For those who have high or borderline high blood pressure, precise management of anti-hypertensive drug therapy is critical. ( Refer to the Hypertension protocol for further information.)
INtegrated or Alternative Treatment Therapies
In the 1960s hypertension was identified as a treatable risk factor for stroke, and the decline in the incidence of and mortality from a stroke began when doctors began implementing aggressive anti-hypertensive therapies. In the 1970s aspirin was first demonstrated effective in preventing strokes, though few doctors prescribe aspirin even to this day to reduce the risk of ischemic stroke. Cigarette smoking has been proven conclusively as a major risk factor for stroke, and smoking cessation produces a significant risk reduction within 2 years.
Researchers now believe there are an immense number of mechanisms at work causing brain cell damage and death following a stroke. Each of these mechanisms represents a potential route for intervention, as well as prevention. Given the multidimensional nature of ischemic brain cell injury, stroke experts predict that no single drug will be able to completely protect the brain during a stroke. More likely, a combination of agents will be necessary for full recovery potential.
Most strokes culminate in a core area of cell death (infarction) in which blood flow is so drastically reduced that the cells usually cannot recover. This threshold seems to occur when cerebral blood flow is 20% of normal or less. Brain cells ultimately die as a result of the actions of calcium-activated proteases (enzymes which digest cell proteins), lipases (enzymes which digest cell membranes), and free radicals formed as a result of the ischemic cascade.
Without neuroprotective agents, nerve and brain cells may be irreversibly damaged within several minutes. This knowledge is leading to unprecedented therapy development. Expanding knowledge regarding the nature of ischemic brain cell injury is leading researchers to focus on the development of calcium antagonists, glutamate antagonists, antioxidants, and other types of neuroprotective agents. As discussed above, the use of Hydergine to treat acute stroke may be the most effective therapy to combine with t-PA to prevent permanent brain damage.
Piracetam, a nootropic medication similar to pyroglutamate (an amino acid), would be useful in the treatment of ischemic stroke if it were approved in the United States for acute use. Piracetam appears to protect brain cells from injury and death during a stroke, thereby lessening the potential for permanent neurological damage. The recommended dosage for piracetam is 4800 mg taken orally. A recent Belgian study indicated that piracetam may be very beneficial if administered within seven hours after the onset of a stroke. Piracetam is not currently available in the United States, but has been successfully used in Europe for 25 years as reported in the Journal of Pharmacopsychiatry, March 1999.
Any disruption of blood flow to the brain causes massive free radical damage that induces much of the re-perfusion injury to brain cells characteristic of strokes. When blood flow is interrupted and subsequently restored (re-perfused), tissues release iron that provides a catalyst for the formation of free radicals that often permanently damage brain cells. The Life Extension Foundation has spent millions of dollars conducting research that involves developing methods of protecting the brain cells from injury caused by blood-flow disruption. The use of antioxidant nutrients, drugs, and hormones, along with specific calcium-channel blockers and cell membrane-stabilizing agents, provides enormous protection to brain cells.
If you know an ischemic stroke is occurring, large quantities of antioxidant vitamins and herbs such as ginkgo biloba would be of benefit. Magnesium in an oral dose of 1500 mg is a safe nutrient to relieve an arterial spasm, a common problem in thrombotic strokes. If you take high-potency antioxidant nutrients at least 3 times a day, your chances of fully recovering from an ischemic stroke may be significantly improved.
An analysis of 18 trials documented a 23% reduction in stroke risk with anti-platelet agents. The drug ticlopidine was found to be the most effective anti-platelet agent, but its adverse side effects frequently restrict its long-term use. A more benign approach such as use of aspirin or nutrients like ginkgo biloba, melatonin, fish oil, and garlic, as well as green tea extract, may be as effective and are free of side effects.
Benefits of Low Dose Aspirin
Low-dose aspirin is the anti-platelet agent of choice for stroke prevention. The Second European Stroke Prevention Study reported risk reductions for aspirin treatment, when compared with a placebo, to be as high as 27.6% (Acta Neurol. Scand., 1999, [Jan] 99[1]:54-60).
Aspirin has shown such a potent effect in preventing strokes that the use of anticoagulants such as heparin to treat ischemic strokes decreased from 1985 to 1990, whereas the use of aspirin increased by more than 50% as reported in the Minnesota Stroke Survey published in the Journal of Stroke and Cerebral Diseases, 1998.
A study on patients who had survived a stroke or transient ischemic attacks (TIAs) showed that the use of a low-dose aspirin (50 mg) reduced the incidence of stroke by 18 to 28% when study participants consumed aspirin over a period of time. This study was reported in Thrombosis Research (1998,15; 92 [1 Suppl. 1]:S1-6).
Benefits of Ginkgo Biloba
The conclusions of a January 1999 report of 40 clinical trials published in the journal Neuroreport stated that "positive results have been reported for ginkgo biloba extracts in the treatment of cerebral insufficiency."
Earlier 1995 double-blind placebo-controlled trials of ginkgo biloba extract involving 55 patients with acute cerebral ischemia showed a significant improvement in cognitive function-based Matthews scale cognitive assessment (J. Assoc. Physicians India, [Nov] 1995; 43 [11]:760-63).
Gingko biloba was used with heart patients in a treadmill test in France, and the doctors concluded "In a comparison of the differences before and after treatment, the areas of ischemia decreased by 38%" after its use (Angiology [USA], 1994, 45 [6]:413-17).
A French study of mice at the Universite de la Mediterranee, Marseille, France in 1998 says that "neuroprotective drugs such as ginkgo biloba extract could prevent the ischemia-induced impairment."
Ginkgo appears not only to protect against free radicals and abnormal blood clotting, but also to enhance neuronal metabolic rates that are severely impaired as a result of ischemic insult.
Benefits of Melatonin
Consideration should now be given to the use of melatonin as part of an integrated treatment for thrombotic stroke according to a 1998 report which says "Melatonin is one of the most powerful scavengers of free radicals. Because it easily penetrates the blood-brain barrier, this antioxidant may, in the future, be used for the treatment of Alzheimer's and Parkinson's diseases, stroke, nitric oxide, neurotoxicity and hyperbaric oxygen exposure." (Biol. Signals Recept., July1998, 7:4,195-219)
Another study at the University of Texas Health Sciences Center in San Antonio, Texas reporting in the November 1998 Journal of Neuroscience Research indicates "Considering melatonin's relative lack of toxicity and ability to enter the brain, these (study) results along with previous evidence suggest that melatonin, which is a natural substance, may be useful in combating free radical-induced neuronal injury in acute situations such as strokes."
In laboratory experiments funded by the Life Extension Foundation, where severe brain ischemia is artificially induced, the addition of melatonin to a "cocktail" of antioxidants, calcium-channel antagonists and cell membrane stabilizing agents provides significant protection against brain damage. It is unfortunate that conventional emergency rooms may not incorporate melatonin into the treatment of stroke for many years to come.
Mid-Life Blood Pressure a New
Risk Factor for Stroke
A 30-year study of male twins showed that elevated blood pressure in mid-life predisposed men to accelerated brain aging and an increase in strokes later in life. Men with even mildly elevated blood pressure 25 years before showed smaller brain volumes and more strokes compared to their twin brothers who did not have the elevation in blood pressure. This study, published in the 1999 Journal of Stroke, emphasized the importance of aggressively treating elevated blood pressure even if it is not grossly abnormal. Refer to the Hypertension protocol for information about blood pressure control therapies and diets.
Conclusion
Ischemic stroke is a medical emergency. Time to treatment of this "brain attack" is important, as what is done once in the emergency room. Request t-PA and Hydergine therapy as suggested in this protocol.
The risk factors for ischemic strokes are hypertension, arteriosclerosis, and blood that has a propensity to clot abnormally inside vessels. Blood components that increase the risk of abnormal arterial clotting include elevated levels of LDL cholesterol, homocysteine, or fibrinogen. Drug and alcohol abuse, age, gender, and race are also factors.
Some indications of ischemic stroke risk are transient ischemic attacks (TIAs)--"mini-strokes" that produce stroke-like symptoms, but no lasting damage.
Symptoms for thrombotic stroke are (1) sudden trouble standing or walking, dizziness, loss of balance or coordination; (2) sudden numbness of the face or weakness of the arm or leg, especially on one side of the body; (3) sudden confusion, trouble speaking or understanding; (4) sudden trouble seeing in one or both eyes; (5) sudden, very severe headaches with no known cause. Diagnosis of thrombotic strokes is by Doppler ultrasonography, CT scan, and MRI.
Treatment for thrombotic strokes depends on the underlying cause. Treatment of early-stage ischemic stroke should include t-PA and Hydergine. Surgery may be needed in some cases to remove any blockage of blood vessels going to the brain. Doctors may prescribe anti-coagulation and platelet aggregation inhibitor drugs to reduce the risk of a first or secondary stroke in high-risk individuals. Additionally, aspirin, ginkgo biloba, melatonin, fish oil, garlic, and green tea extract may be taken to reduce the damage from, or recurrence of, ischemic strokes.
Hydergine and piracetam may be beneficial to stroke patients. The FDA has not approved Hydergine for the treatment of strokes, but it should be available through the hospital pharmacy, and patients or their family should request its use. Piracetam may be beneficial in preventing permanent neurological damage following a stroke. Piracetam is not currently available in the United States.
Promise of a New Protein Therapy for Stroke
Researchers at Columbia University in New York have discovered that nerve cells surrounding the area of the brain affected by a stroke display a certain protein on their surface after a stroke occurs. Results of a study in mice show that in a response known as the complement cascade, the protein basically calls the body's own immune system in to destroy its own cells. If activation of this immune mechanism can be prevented, these neurons and the brain can be protected from the body's own immune systems normally damaging response.
In their July 1999 study reported in Science magazine, the researchers found that injecting a protein called sCR1 into mice 45 minutes after a stroke reduced the impact of the complement cascade. The researchers were not only able to impede even more brain damage; by modifying the protein, they also were able to reduce potentially damaging blood clots by stopping white blood cells and platelets from accumulating in arteries.
We will continue to follow this important research, and report to you on new research or on this protein's availability for use.
Summary
The symptoms of thrombotic strokes include nausea and dizziness; sudden, severe headaches; weakness, numbness; paralysis, particularly to one side of the body; partial or total loss of sight in one eye.
Diagnostic procedures for thrombotic strokes include ultrasound, CT scan, and MRI.
Treatment of thrombotic strokes consists of medication, natural supplements, and surgical interventions, based on the underlying cause. Controlling hypertension is essential prevention in the occurrence of ischemic strokes.
Hydergine, an antioxidant medication that protects brain cells, may be given in an acute situation. The recommended dosage is 10 mg given sublingually and 10 mg administered orally. Because the FDA has not approved Hydergine for this purpose, the patient or patient's advocate should request that the medication be given.
Piracetam, a nootropic medication, may be useful in the prevention of thrombotic strokes because it appears to protect brain cells from injury during the stroke event. The recommended dosage for piracetam is 4800 mg a day, administered orally.
- Consider low dose aspirin, 1/4 tablet a day with a heavy meal.
- Consider Ginkgo biloba: 120 mg a day (preventive dose) and 120-240 mg daily (therapeutic dose). Note: Some clinicians routinely prescribe ginkgo for patients age 50 and older. Ginkgo biloba improves circulation and memory; reduces platelet aggregation, arrhythmias, and fibrinogen levels. Ginkgo bilobahas antioxidant activity; prevents capillary fragility; lessens angina attacks, dyspnea, and intermittent claudication; and decreases the area in the brain plundered by a stroke.
- Consider Garlic:1-2 Kyolic caplets (1000 mg) twice daily with meals or 2-8 capsules of Pure-Gar Caps (900 mg) daily with food. Garlic acts as a hypotensive; decreases fibrinogen; protects against LDL oxidation and arterial wall damage; inhibits platelet aggregation.
- Consider fish oil concentrate, 4 to 10 capsules of a highly concentrated supplement. Blends of fish oils are available, supplying varying amounts of EPA and DHA which modulate blood lipids and body weight; improve heart function; lessen risk of restenosis and strokes; inhibit platelet clumping; have hypotensive and anti-inflammatory activity; reduce fibrinogen, homocysteine, and C-reactive protein levels; and improve insulin sensitivity.
- Consider green tea extract 350 mg daily. of a 95% Each capsule should provide 95% active polyphenols. Green tea has antithrombotic, antioxidant, hypotensive, anti-inflammatory, ACE inhibiting, calcium and iron antagonistic, diuretic, and beta-adrenergic receptor blocking properties.
- Consider taking 500 mcg to 3 mg of melatonin (at night)
- Tocotrienols inhibit platelet-clumping; reduce cholesterol, have antioxidant activity; and protect against further free radical-induced brain cell injury. A suggested daily dosage is 100 IU mixed tocopherols and 100 IU tocotrienols if the person is healthy, young, and without a family history of heart disease, and 200 IU of mixed tocopherols and 200 IU of tocotrienols for young adults with some cardiac risk factors or healthy people (50 years of age) without risk factors. 400 IU of mixed tocopherols and 400 IU of tocotrienols for people who have a personal or family history of cardiac disease. This dosage is appropriate for senior subjects and severely stressed or poorly nourished individuals.
100-200 mg of palm oil tocotrienols per day is suggested.
(To learn about therapies that may protect arteries prior to a thrombotic stroke, or to reduce the risk of further disease or stroke attacks, refer to the protocols on treating Atherosclerosis, Hypertension, and Thrombosis Prevention. To learn more about therapies that may restore neurological function following thrombotic stroke, refer to the protocol for Age-Associated Mental Impairment.)
FOR MORE INFORMATION:
Refer to the Cardiovascular Disease: Comprehensive Analysis
Contact the National Institute of Neurological Disorders and Stroke, 800-352-9424.
Product availability
Low dose aspirin, ginkgo biloba, garlic extract, fish oil concentrate, green tea extract, and melatonin can be ordered by calling 1-800-544-4440. Hydergine tablets and Piracetam can be ordered from offshore suppliers who will ship to the United States for personal use. For a list of offshore suppliers of these medications phone 1-800-544-4440, or order online. |