[ExI] Rapid improvement -- TEN MINUTES!!! -- of chronic stroke deficits

[Jeff Davis]

Friends,

Here's a Newtonmas present I think you'll appreciate.

Forwarded from the New Cryonet:

--- On Mon, 12/12/11, Doug Skrecky <oberon at vcn.bc.ca> wrote:

    Wow!

    Snip>

    "Onset of clinical response was evident within 10 minutes of
perispinal injection in all patients"

    CNS Drugs. 2011 Feb 1;25(2):145-55. doi: 10.2165/11588400-000000000-00000.
    Rapid improvement of chronic stroke deficits after perispinal
etanercept: three consecutive cases.
    Tobinick E.
    Source
    Institute for Neurological Research, a private medical group,
inc., Los Angeles, California, USA. etmd at ucla.edu
    Abstract
    BACKGROUND:
    Thrombolytic therapy reduces stroke size and disability by
reperfusion and salvage of ischaemic penumbra. Emerging evidence
suggests that retrieved penumbra may be the site of ongoing
inflammatory pathology that includes extensive microglial activation.
Microglial activation may be associated with excessive levels of
tumour necrosis factor (TNF) and resultant neurotoxicity. Etanercept,
a potent biologic TNF antagonist, reduces microglial activation in
experimental models and has been therapeutically effective in models
of brain and neuronal injury. Perispinal administration of etanercept,
previously reported to be beneficial for the treatment of Alzheimer's
disease, may facilitate delivery of etanercept into the brain.
    OBJECTIVE:
    The objective of this report is to document the initial clinical
response to perispinal etanercept in the first chronic stroke cohort
so treated.
    METHODS:
    Three consecutive patients with stable and persistent chronic
neurological deficits due to strokes that had failed to resolve
despite previous treatment and rehabilitation were evaluated at an
outpatient clinic. They were treated off-label with perispinal
etanercept as part of the clinic's practice of medicine.
    RESULTS:
    All three patients had chronic hemiparesis, in addition to other
stroke deficits. Their stroke distributions were right middle cerebral
artery (MCA), brainstem (medulla) and left MCA. The two patients with
MCA strokes had both received acute thrombolytic therapy. Each of the
three patients was treated with an initial dose of perispinal
etanercept 13, 35 and 36 months following their acute stroke,
respectively. Significant clinical improvement following perispinal
etanercept administration was observed in all patients. Onset of
clinical response was evident within 10 minutes of perispinal
injection in all patients. Improvements in hemiparesis, gait, hand
function, hemi-sensory deficits, spatial perception, speech, cognition
and behaviour were noted among the patients treated. Each patient
received a second perispinal etanercept dose at 22-26 days after the
first dose that was followed by additional clinical improvement.
    CONCLUSIONS:
    Open-label administration of perispinal etanercept resulted in
rapid neurological improvement in three consecutive patients with
chronic neurological dysfunction due to strokes occurring 13-36 months
earlier. These results suggest that stroke may result in chronic
TNF-mediated pathophysiology that may be amenable to therapeutic
intervention long after the acute event. Randomized clinical trials of
perispinal etanercept for selected patients with chronic neurological
dysfunction following stroke are indicated.
    PMID: 21254790


**********************************************

Best, Jeff Davis

               "Everything's hard till you know how to do it."
                                            Ray Charles