New hope that strokes need not be disabling

September 29, 1996|By Sara Engram

DR. MARIAN LAMONTE, director of the University of Maryland Medical Center's new Brain Attack Team, knows the frustration of living between the cutting edge of medical knowledge and the need to spread the word.

The calls come in from hospitals in the area, describing a person who has come in with stroke symptoms and asking whether the team can help. Too often it turns out that the call comes after those crucial hours when new therapies can make a huge difference in a patient's ability to recover -- leaving Dr. LaMonte to wonder how much better that person's quality of life would have been had help come sooner.

Strokes, interruptions of blood flow to the brain, are a common cause of death. But more frightening for many people is their capacity for leaving a person disabled, whether the damage results in slurred speech or the inability to walk.

Until now, there wasn't much anyone could do once a stroke began. For that reason, emergency-room doctors usually let these patients wait while nature took its course. There was no real need for neurologists to rush in to see the victim, since there wasn't much they could do anyway.

But now, there is something hospitals can do for stroke victims -- provided it's done within a three-hour window from the time symptoms first begin.

That good news brings a formidable challenge to the medical community, not just in changing its own approach to stroke, but in educating the public that quick treatment is just as important for stroke victims as for people having heart attacks.

Hospitals that are capable of supporting brain-attack teams need to set them up and make them available around the clock. Smaller hospitals need to have contingency plans for speeding patients to places where they can get help in time.

The ability to ease the impairment often associated with stroke is a huge step forward. According to the American Heart Association, some 500,000 Americans suffer strokes each year, and almost 150,000 died of strokes in 1993.

More frightening for many people than the death rate is the disability that often results from a stroke. About one-third of stroke survivors need help caring for themselves, and some 20 percent are impaired severely enough to need help in walking. About 70 percent are left with disabilities that affect their ability to work.

Those three golden hours in stroke treatment come courtesy of a clot-dissolving drug already used in treating heart attacks. In June, Activase, also known as tissue plasminogen activator, or t-PA, was approved by the Food and Drug Administration for use in stroke. A study of the drug's usefulness for this purpose found that patients treated with Activase were about one-third more likely to have little or no disability compared to patients who received a placebo.

Preventing disabilities

Activase is not useful for every stroke patient. But combined with surgical procedures and drugs under development, it brings major new possibilities for treating the country's leading cause of long-term disability.

Until these recent developments, stroke was a prime example of medical progress that had been far more successful in adding years to life than in adding life to the years we have. While the death rate from stroke has dropped dramatically, until now tTC physicians have been unable to do much to prevent the disabilities associated with stroke.

Now that we know something can be done, Dr. LaMonte and others are faced with the challenge of showing the medical community how to do it and educating the public that something can be done. That may be a formidable task, but it's a welcome one.

Writing in the New Yorker, Malcolm Gladwell gives a fascinating account of pioneering research that could hold the promise of dramatically extending human life span. But he notes that such progress would involve trade-offs that may be unacceptable. Longer life, he says, may come only at the cost of bypassing the exhilarating, risk-taking, unforgettable rush of youth for years and years of sober middle age.

A fair exchange? Tough question. Fortunately, the ability to improve the years we already have poses no such dilemma.

Sara Engram is deputy editorial-page editor of The Sun.

Pub Date: 9/29/96

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