Stroke is the fourth leading cause of death in the United States and a leading cause of adult disability. Although the CDC reports indicate that stroke mortality has decreased, more than 795,000 strokes are still reported each year. NINDS, the lead institute for stroke at the National Institutes of Health, supports research to enhance what is known about stroke. Some of this research is already changing the way stroke is treated. With much work ahead of us, however, NINDS is conducting a planning effort to identify priorities for future research and we are asking for input from the community (http://www.ninds.nih.gov/strokerfi).
Several recent advances from NINDS funded clinical trials will have a direct impact on the way physicians care for stroke patients. In the Locomotor Experience Applied Post-Stroke (LEAPS) study, investigators found that stroke patients who received intensive physical therapy in the home improved their ability to walk as well as those treated with a more complex rehabilitation program involving a body weight-supported treadmill. They also found that patients improved even when they began the program 6 months after having a stroke (see primary results here). The study was co-funded by the National Institute for Child Health and Human Development National Center for Medical Rehabilitation Research.
As a result of the NINDS’ trial of Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS), investigators determined that aggressive medical management was better at preventing stroke than surgically opening the narrowed brain arteries which are a major cause of stroke. Study patients in the two groups are still being following for long-term risk assessment. The risk reduction achieved with medical approaches were better than expected and are now being considered in other stroke prevention studies (see primary results here).
More recently, the Warfarin-Aspirin Reduced Cardiac Ejection Fraction (WARCEF) trial compared warfarin to aspirin as a means of preventing stroke in patients who have a weakened heart and therefore a higher risk of stroke due to blood clots traveling to the brain. The trial showed that warfarin and aspirin were equally effective in preventing stroke, heart attack and major bleeding, but that warfarin was superior to aspirin in the long-term, and also in preventing stroke throughout the trial. This trial answered an important question for both the vascular neurology and cardiology fields that will directly impact patient care.
The NINDS is currently leading a stroke planning effort to help identify the highest priorities that are most likely to further advance stroke research over the next 5 – 10 years. This process is building upon the work completed by the Stroke Progress Review Group, which produced 3 comprehensive reports over the last decade highlighting major advances and opportunities in stroke research. Public input is being sought through a Request for Information on how to advance stroke science in the areas of prevention, treatment and recovery and this input will be considered as part of the ongoing process to identify major stroke research priorities. If you are interested in contributing, please access the NIH Guide notice NOT-NS-12-009. The deadline has been extended to July 8th for submitting responses to the RFI. Go to: http://www.ninds.nih.gov/strokerfi.
Last updated February 3, 2014