scholarly journals Enhancing Recovery after Stroke with Noradrenergic Pharmacotherapy: A New Frontier?

2000 ◽  
Vol 27 (2) ◽  
pp. 97-105 ◽  
Author(s):  
David J. Gladstone ◽  
Sandra E. Black
Keyword(s):  
Animal Studies ◽  
Recovery Of Function ◽  
Recovery Process ◽  
Stroke Recovery ◽  
Therapeutic Interventions ◽  
New Frontier ◽  
Focal Brain Injury ◽  
Completed Stroke ◽  
Scientific Attention ◽  
Irreversible Injury

ABSTRACT:Despite much progress in stroke prevention and acute intervention, recovery and rehabilitation have traditionally received relatively little scientific attention. There is now increasing interest in the development of stroke recovery drugs and innovative rehabilitation techniques to promote functional recovery after completed stroke. Experimental work over the past two decades indicates that pharmacologic intervention to enhance recovery may be possible in the subacute stage, days to weeks poststroke, after irreversible injury has occurred. This paper discusses the concept of “rehabilitation pharmacology” and reviews the growing literature from animal studies and pilot clinical trials on noradrenergic pharmacotherapy, a new experimental strategy in stroke rehabilitation. Amphetamine, a monoamine agonist that increases brain norepinephrine levels, is the most extensively studied drug shown to promote recovery of function in animal models of focal brain injury. Further research is needed to investigate the mechanisms and clinical efficacy of amphetamine and other novel therapeutic interventions on the recovery process.

scholarly journals Basic and Clinical Studies of Pharmacologic Effects on Recovery from Brain Injury

1993 ◽  
Vol 4 (3) ◽  
pp. 175-192 ◽  
Author(s):  
Larry B. Goldstein
Keyword(s):  
Brain Injury ◽  
Clinical Studies ◽  
Recovery Of Function ◽  
Recovery Process ◽  
Laboratory Animals ◽  
Medical Problems ◽  
Focal Brain Injury ◽  
Pharmacologic Agents ◽  
The Impact ◽  
Selection Of

Investigations in laboratory animals indicate that certain drugs that influence specific neurotransmitters can have profound effects on the recovery process. Even small doses of some drugs given after brain injury facilitate recovery while others are harmful. Preliminary clinical studies suggest that the same drugs that enhance recovery in laboratory animals (e.g., amphetamine) may have similar effects in humans after stroke. In addition, some of the drugs that impair recovery of function after focal brain injury in laboratory animals (e.g. haloperidol, benzodiazepines, clonidine, prazosin, phenytoin) are commonly given to stroke patients for coincident medical problems and may interfere with functional recovery in humans. Until the impact of pharmacologic agents on the recovering brain is better understood, the available data suggest that care should be exercised in the selection of drugs used in the treatment of the recovering stroke patient. Pharmacologic enhancement of recovery after focal brain injury may be possible in humans.

scholarly journals Chromatin Remodeler CHD8 in Autism and Brain Development

2021 ◽  
Vol 10 (2) ◽  
pp. 366
Author(s):  
Anke Hoffmann ◽  
Dietmar Spengler
Keyword(s):  
Animal Studies ◽  
Mental Disease ◽  
Transgenic Animal ◽  
Autism Spectrum ◽  
Homeostatic Plasticity ◽  
Therapeutic Interventions ◽  
Model Organisms ◽  
Facial Dysmorphism ◽  
Transcriptional Level ◽  
Level Function

Chromodomain Helicase DNA-binding 8 (CHD8) is a high confidence risk factor for autism spectrum disorders (ASDs) and the genetic cause of a distinct neurodevelopmental syndrome with the core symptoms of autism, macrocephaly, and facial dysmorphism. The role of CHD8 is well-characterized at the structural, biochemical, and transcriptional level. By contrast, much less is understood regarding how mutations in CHD8 underpin altered brain function and mental disease. Studies on various model organisms have been proven critical to tackle this challenge. Here, we scrutinize recent advances in this field with a focus on phenotypes in transgenic animal models and highlight key findings on neurodevelopment, neuronal connectivity, neurotransmission, synaptic and homeostatic plasticity, and habituation. Against this backdrop, we further discuss how to improve future animal studies, both in terms of technical issues and with respect to the sex-specific effects of Chd8 mutations for neuronal and higher-systems level function. We also consider outstanding questions in the field including ‘humanized’ mice models, therapeutic interventions, and how the use of pluripotent stem cell-derived cerebral organoids might help to address differences in neurodevelopment trajectories between model organisms and humans.

The importance of peer support in the recovery process of persons with mental disorders

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Stimac Grbic ◽  
I Pavic Simetin ◽  
A Istvanovic
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Peer Support ◽  
Community Intervention ◽  
Recovery Process ◽  
Therapeutic Interventions ◽  
Hospital Treatment ◽  
Personal Recovery

Abstract Issue Care for people with severe mental disorders requires approach that is focused on a person's strengths, not his weaknesses, and is a shift from a deficit model that is often associated with mental illness. Care users and their family members play an important role in this approach. Description of the Problem Mental disorders are the leading group of diseases in Croatia, according to the number of days of hospital treatment. The number of hospitalizations is high, and the rate of hospitalization for depression has tripled in the last twenty years. Such indicators highlight the need for reorientation of mental health care, from hospital-based to community-based, by organizing mobile community intervention teams. Results In Croatia, psychosocial peer teams were established by the NGO Ludruga, financed by local government, to provide peer support to persons with mental disorders. The main activities are: development of a personal recovery plan, home visits and providing psychological support to persons with mental disorders, organizing support groups and education of peer workers. The teams consist of a peer worker, social worker, psychologist, and operate under the supervision of a psychiatrist. The teams have been operating for five years, have had over a hundred users so far and are a significant help to the healthcare system in preventing rehospitalizations. Lessons The goal of therapeutic interventions in mental health care should be recovery. Recovery involves empowering a person to take responsibility for themselves and their health. Peer workers play an important role in the recovery process, providing hope for recovery. Their role must also be recognized by the health system. Key messages People with mental disorders and their families should be co-creators of care and recovery-oriented interventions. Only by comprehensive interventions, tackling all determinants of health, therapeutic goal can be achieved.

First-stroke recovery process: The role of family social support

2000 ◽  
Vol 81 (7) ◽  
pp. 881-887 ◽  
Author(s):  
Evie Tsouna-Hadjis ◽  
Kostas N. Vemmos ◽  
Nikolaos Zakopoulos ◽  
Stamatis Stamatelopoulos
Keyword(s):  
Social Support ◽  
Recovery Process ◽  
Stroke Recovery ◽  
Family Social Support

Abstract P446: African American Women Have Lower Functional Performance During Acute Inpatient Rehabilitation After Intracerebral Hemorrhagic Strokes

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sana Somani ◽  
Hely Nanavati ◽  
Xiaohua Zhou ◽  
Chen Lin
Keyword(s):  
African American ◽  
African American Women ◽  
Functional Performance ◽  
Recovery Of Function ◽  
Tertiary Care ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Stroke Recovery ◽  
American Women ◽  
Ich Score

Introduction: Intracerebral hemorrhage (ICH), a subtype of stroke, leads to significant long-term disability. Research in stroke recovery and rehabilitation has focused on ischemic strokes. Identifying factors that impact the recovery of function for patients at an inpatient rehabilitation facility (IRF) following an ICH is necessary. Our purpose is to identify factors, including racial and gender disparities, associated with inpatient rehabilitation after ICH. Methods: We performed a retrospective analysis of a tertiary care academic hospital in the Stroke Belt of the US, the University of Alabama at Birmingham, and subsequently, admitted to an IRF from December 2016 through December 2019. Functional performance was measured using the Functional Independence Measure (FIM), an 18-item scale measuring the level of disability in terms of burden of care. Baseline clinical characteristics, demographics, admission and discharge FIM scores, and ICH characteristics including ICH scores and volumes were collected. FIM efficiency was calculated for all patients by dividing the difference in FIM scores at admission and discharge from the total number of days spent at rehab. The differences in FIM efficiency by gender and race were measured using multiple linear regression. Results: We evaluated 65 patients (54.4 ± 14.1 years, 61% males, 46% African American) with a median (interquartile range) ICH score of 1.0 (0.0, 2.0), median ICH volume of 13.4 (4.2, 33.0), and FIM efficiency of 1.6 (1.1, 2.4). In multiple regression, being male was positively associated with FIM efficiency (β=1.02, p = 0.0063) when adjusting for race and ICH score. The FIM efficiency was lower in African Americans (β =-0.95, p = 0.0092) when adjusting for gender and ICH volume. No significant differences were noted in ICH volumes and scores with respect to discharge FIM scores. Conclusions: FIM efficiency, is a good measure of improvement in motor function and ADLs over the rehab period. Our results indicate that African American women could potentially benefit from longer periods of rehabilitation intervention.

scholarly journals Biomarker Application for Precision Medicine in Stroke

2019 ◽  
Vol 11 (4) ◽  
pp. 615-627 ◽  
Author(s):  
Alexis N. Simpkins ◽  
Miroslaw Janowski ◽  
Helieh S. Oz ◽  
Jill Roberts ◽  
Gregory Bix ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Hemorrhagic Stroke ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Stroke Survivor ◽  
Lifestyle Factors ◽  
Stroke Recovery ◽  
Therapeutic Interventions ◽  
Disease Course ◽  
Comprehensive Review

AbstractStroke remains one of the leading causes of long-term disability and mortality despite recent advances in acute thrombolytic therapies. In fact, the global lifetime risk of stroke in adults over the age of 25 is approximately 25%, with 24.9 million cases of ischemic stroke and 18.7 million cases of hemorrhagic stroke reported in 2015. One of the main challenges in developing effective new acute therapeutics and enhanced long-term interventions for stroke recovery is the heterogeneity of stroke, including etiology, comorbidities, and lifestyle factors that uniquely affect each individual stroke survivor. In this comprehensive review, we propose that future biomarker studies can be designed to support precision medicine therapeutic interventions after stroke. The current challenges in defining ideal biomarkers for stroke are highlighted, including consideration of disease course, age, lifestyle factors, and subtypes of stroke. This overview of current clinical trials includes biomarker collection, and concludes with an example of biomarker design for aneurysmal subarachnoid hemorrhage. With the advent of “-omics” studies, neuroimaging, big data, and precision medicine, well-designed stroke biomarker trials will greatly advance the treatment of a disease that affects millions globally every year.

scholarly journals Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable

2017 ◽  
Vol 31 (10-11) ◽  
pp. 864-876 ◽  
Author(s):  
Lara A. Boyd ◽  
Kathryn S. Hayward ◽  
Nick S. Ward ◽  
Cathy M. Stinear ◽  
Charlotte Rosso ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Recovery Process ◽  
Stroke Recovery ◽  
Design Studies ◽  
Current State ◽  
Brain Structure And Function ◽  
Clinical Questions ◽  
And Function ◽  
Patient Subgroups ◽  
Rehabilitation Strategy

The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and “What is the best rehabilitation strategy for this person, given her/his clinical profile?” Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.

scholarly journals The link between chronic pain and Alzheimer’s disease

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Song Cao ◽  
Daniel W. Fisher ◽  
Tain Yu ◽  
Hongxin Dong
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Chronic Pain ◽  
Animal Studies ◽  
Microglial Activation ◽  
The Elderly ◽  
Therapeutic Interventions ◽  
Affective Component ◽  
Inflammatory Activation ◽  
Improve Patient

Abstract Chronic pain often occurs in the elderly, particularly in the patients with neurodegenerative disorders such as Alzheimer’s disease (AD). Although studies indicate that chronic pain correlates with cognitive decline, it is unclear whether chronic pain accelerates AD pathogenesis. In this review, we provide evidence that supports a link between chronic pain and AD and discuss potential mechanisms underlying this connection based on currently available literature from human and animal studies. Specifically, we describe two intertwined processes, locus coeruleus noradrenergic system dysfunction and neuroinflammation resulting from microglial pro-inflammatory activation in brain areas mediating the affective component of pain and cognition that have been found to influence both chronic pain and AD. These represent a pathological overlap that likely leads chronic pain to accelerate AD pathogenesis. Further, we discuss potential therapeutic interventions targeting noradrenergic dysfunction and microglial activation that may improve patient outcomes for those with chronic pain and AD.

scholarly journals Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

2017 ◽  
Vol 12 (5) ◽  
pp. 480-493 ◽  
Author(s):  
Lara A Boyd ◽  
Kathryn S Hayward ◽  
Nick S Ward ◽  
Cathy M Stinear ◽  
Charlotte Rosso ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Recovery Process ◽  
Stroke Recovery ◽  
Design Studies ◽  
Current State ◽  
Brain Structure And Function ◽  
Clinical Questions ◽  
And Function ◽  
Patient Subgroups ◽  
Rehabilitation Strategy

The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and “What is the best rehabilitation strategy for this person, given her/his clinical profile?” Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.

scholarly journals Plasticity after cortical stroke involves potentiating responses of pre-existing circuits but not functional remapping to new circuits

2020 ◽  
Author(s):  
William A Zeiger ◽  
Máté Marosi ◽  
Satvir Saggi ◽  
Natalie Noble ◽  
Isa Samad ◽  
...  
Keyword(s):  
Animal Studies ◽  
Structural Changes ◽  
Recovery Of Function ◽  
Definitive Evidence ◽  
Before And After ◽  
Maladaptive Plasticity ◽  
Adaptive Circuit ◽  
Evoked Activity ◽  
Sensory Evoked

AbstractFunctional recovery after stroke is thought to be mediated by adaptive circuit plasticity, whereby surviving neurons assume the roles of those that died. This “remapping” hypothesis is based on human brain mapping studies showing apparent reorganization of cortical sensorimotor maps and animal studies documenting molecular and structural changes that could support circuit rewiring. However, definitive evidence of remapping is lacking, and other studies have suggested that maladaptive plasticity mechanisms, such as enhanced inhibition in peri-infarct cortex, might actually limit plasticity after stroke. Here we sought to directly test whether neurons can change their response selectivity after a stroke that destroys a single barrel (C1) within mouse primary somatosensory cortex. Using multimodal in vivo imaging approaches, including two-photon calcium imaging to longitudinally record sensory-evoked activity in peri-infarct cortex before and after stroke, we found no evidence to support the remapping hypothesis. In an attempt to promote plasticity via rehabilitation, we also tested the effects of forced use therapy by plucking all whiskers except the C1 whisker. Again, we failed to detect an increase in the number of C1 whisker-responsive neurons in surrounding barrels even 2 months after stroke. Instead, we found that forced use therapy potentiated sensory-evoked responses in a pool of surviving neurons that were already C1 whisker responsive by significantly increasing the reliability of their responses. Together, our results argue against the long-held theory of functional remapping after stroke, but support a plausible circuit-based mechanism for how rehabilitation may improve recovery of function.

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