Lee, Tsong-Hai and Uchiyama, Shinichiro and Kusuma, Yohanna and Chiu, Hou Chang and Navarro, Jose C. and Tan, Kay Sin and Pandian, Jeyaraj and Guo, Liang and Wong, Yoko and Venketasubramanian, Narayanaswamy and Panel, Asian Stroke Advisory (2024) A systematic-search-and-review of registered pharmacological therapies investigated to improve neuro-recovery after a stroke. Frontiers in Neurology, 15. p. 1346177. ISSN 1664-2295, DOI https://doi.org/10.3389/fneur.2024.1346177.
Full text not available from this repository.Abstract
Background: Stroke burden is largely due to long-term impairments requiring prolonged care with loss of productivity. We aimed to identify and assess studies of different registered pharmacological therapies as treatments to improve post-stroke impairments and/or disabilities. Methods: We performed a systematic-search-and-review of treatments that have been investigated as recovery-enhancing or recovery-promoting therapies in adult patients with stroke. The treatment must have received registration or market authorization in any country regardless of primary indication. Outcomes included in the review were neurological impairments and functional/disability assessments. ``The best available studies'' based on study design, study size, and/or date of publication were selected and graded for level of evidence (LOE) by consensus. Results: Our systematic search yielded 7,801 citations, and we reviewed 665 full-text papers. Fifty-eight publications were selected as ``the best studies'' across 25 pharmacological classes: 31 on ischemic stroke, 21 on ischemic or hemorrhagic stroke, 4 on intracerebral hemorrhage, and 2 on subarachnoid hemorrhage (SAH). Twenty-six were systematic reviews/meta-analyses, 29 were randomized clinical trials (RCTs), and three were cohort studies. Only nimodipine for SAH had LOE A of benefit (systematic review and network meta-analysis). Many studies, some of which showed treatment effects, were assessed as LOE C-LD, mainly due to small sample sizes or poor quality. Seven interventions had LOE B-R (systematic review/meta-analysis or RCT) of treatment effects. Conclusion: Only one commercially available treatment has LOE A for routine use in stroke. Further studies of putative neuroprotective drugs as adjunctive treatment to revascularization procedures and more confirmatory trials on recovery-promoting therapies will enhance the certainty of their benefit. The decision on their use must be guided by the clinical profile, neurological impairments, and target outcomes based on the available evidence.
| Item Type: | Article |
|---|---|
| Funders: | UNSPECIFIED |
| Uncontrolled Keywords: | stroke; recovery; neuro-restoration; review; rehabilitation; evidence |
| Subjects: | R Medicine > R Medicine (General) R Medicine > RC Internal medicine |
| Divisions: | Universiti Malaya Medical Centre (UMMC) |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 11 Nov 2024 01:52 |
| Last Modified: | 11 Nov 2024 01:52 |
| URI: | http://eprints.um.edu.my/id/eprint/45718 |
Actions (login required)
 |
View Item |
