IU Stroke Program Seeks Prevention, Better Treatments and Improved Outcomes

INDIANAPOLIS - Prevention and early treatment to reduce brain damage are just some of the clinical research efforts under way at the Indiana University Stroke Program.

Specialists in the program are faculty with the IU School of Medicine Department of Neurology, who work closely with IU neurosurgeons, vascular surgeons, radiologists and cardiologists. The IU Department of Physical Medicine and Rehabilitation also offers patients options for recovery programs.

The recent stroke-related death of Indiana Gov. Frank O’Bannon has generated more interest among people, who are more cognizant of stroke-related complications and are seeking information about treatment options before stroke becomes a reality in their lives.

Researchers in the program have long been on the cutting edge of treatments to improve the quality of life for patients at risk of stroke and for those who have had strokes. Early trials with tissue plasminogen activator (TPA), now an accepted treatment administered within hours to non-hemorrhaging stroke patients to reduce long-term damage, were conducted at IU School of Medicine.

Askiel Bruno, M.D., associate professor of neurology and director of the IU Stroke Program, is the principal investigator of a National Institutes of Health grant to determine if stroke patients with higher glucose levels are more at risk for permanent damage or death. An early study on existing data from the Regenstrief Medical Record System at IU School of Medicine indicated patients with high blood sugar at the time of admission to the hospital for treatment of stroke are at higher risk of death than stroke patients with normal blood sugar.

Effectiveness of treatment for depression after stroke is the focus of another NIH-funded study. Linda Williams, M.D., assistant professor of neurology, is the principal investigator of the study that focuses on a serious and common side effect of stroke. Dr. Williams said about 30 percent of stroke patients develop depression, in part because serotonin levels in the brain decrease. Behavioral and social issues also play a part, although the level of disability after a stroke does not play a crucial role in the development of depression.

Dr. Williams and her colleagues are looking at medications to best treat stroke patients suffering from depression. Following stroke, the brain is recovering from injury and another aspect of the study is to determine if depression affects the brain’s ability to recover.

Depression, Dr. Williams says, can play a significant role in the lives of patients after stroke, but it also can be important indicator before stroke. Depression is a risk factor for both stroke and heart attack, she said.

IU has conducted many studies including several stroke prevention trials involving aspirin and other anti-clotting drugs, effects of controlling blood pressure and lipids, drugs for protection of the brain during a stroke, and ways to protect stroke patients who are at higher risk for additional strokes within the first two years of their initial attack. Another clinical trial seeks to determine if angioplasty, which is less invasive, is as effective as surgery to treat blockage in the carotid artery.

Allison Brashear, M.D., associate professor of neurology, is one of the leading authorities on the effectiveness of Botox®, a block for muscle contraction, to reduce spasticity after a stroke.

Rehabilitation after stroke is an essential component of treatment. IUSM physiatrist Angela Carbone, M.D., assistant professor of physical medicine and rehabilitation, treats recent stroke patients and long-term stroke patients who, because of disabilities, are overcompensating and causing additional physical problems.

Dr. Carbone said the Indiana University Acute Rehabilitation Center at Wishard Memorial Hospital employs various physical therapy techniques to prevent additional complications and promote early mobility among stroke patients. Maximizing function is the goal.

The IU Stroke Program physicians are the only physicians in Indiana with special fellowship training in stroke management. Stroke patients are seen by IU Stroke Program specialists at Indiana University Hospital and Riley Hospital for Children at Clarian Health, Wishard Memorial Hospital and the Roudebush VA Medical Center.

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CONTACT: Mary Hardin
317-274-7722
mhardin@iupui.edu

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