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Health hazard: if a stroke threatens during sleep


Stroke during sleep: new therapy option for patients

Every year, more than a quarter of a million Germans suffer a stroke. Timely emergency treatment is often vital for those affected. But some people suffer from a brain attack while they sleep. Researchers have now discovered that a certain treatment option - contrary to what was previously thought - could also help hours after the stroke.

Numerous deaths could be avoided

Health experts say that more than a quarter of a million Germans have a stroke each year. Brain infarction is one of the most common causes of death in Germany. According to experts, many deaths could be avoided if stroke symptoms were quickly identified and those affected were given immediate care. However, some people suffer a brain attack while they sleep. Researchers may report that there may be new treatment options for these patients.

Save lives by acting quickly

Stroke is the second leading cause of death and the most common cause of permanent adult disability in the western world.

The cause of a stroke is usually the occlusion of a blood vessel in the brain (ischemia) by a blood clot (thrombus). As a result, the brain tissue supplied by the closed vessel dies.

Fast action is therefore vital.

The blood clot can be medicated by thrombolysis treatment. If this happens in time, permanent neurological symptoms or a disability can be prevented.

According to doctors, intravenous thrombolysis with the active ingredient Alteplase is an effective and safe acute treatment for ischemic stroke if the therapy is started within the first 4.5 hours after the onset of symptoms.

The exact time of onset of symptoms is often unknown

"In around 20 percent of all patients with an acute stroke, however, the exact time of the onset of symptoms is unknown, for example because the symptoms only become apparent when they wake up in the morning or because patients experience a stroke unobserved and cannot provide information about the onset of symptoms due to speech disorders," explains Prof. Dr. Götz Thomalla from the University Medical Center Hamburg-Eppendorf (UKE) in a message.

This large group of patients has so far not been considered due to the lack of knowledge about the time window for thrombolysis.

However, a study led by scientists at the UKE (“WAKE-UP”) has now shown for the first time that even patients who suffer a stroke while sleeping and only experience symptoms after waking up the next morning can benefit from thrombolysis.

As stated in the communication, the WAKE-UP study has now for the first time been able to use MRI diagnostics to select suitable patients for thrombolysis, even without knowing the time of the stroke.

They had less neurological symptoms or disabilities than other patients.

The study results were recently presented at the European Stroke Organization Conference in Gothenburg and published in the specialist magazine "New England Journal of Medicine".

Further improve the treatment of stroke patients

"The positive result of the WAKE-UP study is a big step towards further improving the treatment of stroke patients, as the study opens up the possibility of treating a large number of patients with thrombolysis who were previously excluded from it," said Thomalla , First author of the study and senior consultant in the UKE Clinic for Neurology.

"Treatment based on MRI imaging without knowing when the symptoms started is a paradigm shift for thrombolysis in stroke."

Prof. Christian Gerloff, Director of the Clinic for Neurology and Deputy Medical Director of the UKE, also appreciates the importance of the study:

“The results of WAKE-UP will have a direct effect on the clinical practice of stroke treatment. Based on the study results, we will be able to avert a permanent disability in many stroke patients in the future. "

Identify suitable patients for thrombolysis with MRI

The WAKE-UP study included patients with acute ischemic stroke and unknown date of onset of symptoms between the ages of 18 and 80 years. Patients were selected for treatment using magnetic resonance imaging (MRI).

A total of 503 of the patients were treated - either with the active ingredient Alteplase or with a dummy drug (placebo).

"After 90 days, the clinical outcome in the group treated with Alteplase was significantly better than in the placebo group," said study leader Thomalla.

53.3 percent of the patients treated with thrombolysis achieved a very good clinical result, whereas this was only the case for 41.8 percent of the patients in the placebo group.

Prof. Thomalla: "This corresponds to an absolute increase of 11.5 percent in patients who survived the stroke without a disability."

Patients in the old plasma group had a 62 percent higher chance of having fewer neurological symptoms or disabilities than the placebo group three months after the stroke.

The patients in the old-age group also benefited significantly from their self-assessment of their state of health and quality of life after three months. (ad)

Author and source information

Video: Sleeping after stroke (August 2020).