Special Issue "Advances and Challenges in Stroke Therapy: A Regenerative Prospective"

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Neurology".

Deadline for manuscript submissions: 31 July 2023 | Viewed by 1714

Special Issue Editors

Prof. Dr. Dejan Nikolić
E-Mail Website
Guest Editor
1. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University Belgrade, 11000 Belgrade, Serbia
2. University Children's Hospital, 11000 Belgrade, Serbia
Interests: electrodiagnostics; rehabilitation; population genetics; physical activity
Special Issues, Collections and Topics in MDPI journals
Dr. Milena Janković
E-Mail Website
Guest Editor
Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
Interests: neurogenetics; neurodegenerative disorders; stroke; movement disorders; mitochondrial disorders; pharmacogenetics

Special Issue Information

Dear Colleagues,

The multifactorial stroke etiology is creating the need for permanent development of novel and more specific therapies and treatments for pediatric and adult stroke patients. Decades of extensive research in the field of stroke accumulated a significant amount of evidence about inflammation influence in neuronal loss in stroke patients. On the contrary, the association between inflammation and repair processes in ischemic stroke is documented as well. Another important aspect in the recovery of patients after the stroke is genetic determinants that may have a role in complex stroke processes and genetic-dependent immunomodulation in stroke treatment.

In this Special Issue, we would like to highlight the connection between genetic factors, inflammation, and challenges in the development of next-generation therapeutics in stroke and how genetic prediction may advance the application of thrombolytic, antithrombotic, and neuroprotective interventions. Additionally, we would like to focus on therapies for balancing immune reaction and shifting activity from pro-inflammatory to anti-inflammatory, and from neurotoxic to neuroprotective.

The preferred type of manuscripts would be: Reviews, Systematic Reviews, Meta-analyses, Original articles, Evidence-based papers, Guidelines, Recommendations, and Case studies.

Prof. Dr. Dejan Nikolić
Dr. Milena Janković
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • stroke
  • next generation therapeutics
  • neuroprotection
  • neuroregeneration
  • immunomodulation
  • genetic predisposition
  • inflammation

Published Papers (3 papers)

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Research

Article
Extended Poststroke Rehabilitation Combined with Cerebrolysin Promotes Upper Limb Motor Recovery in Early Subacute Phase of Rehabilitation: A Randomized Clinical Study
Medicina 2023, 59(2), 291; https://doi.org/10.3390/medicina59020291 (registering DOI) - 03 Feb 2023
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Abstract
Background and Objectives: The recovery of stroke patients with severe impairment is usually poor and limited and, unfortunately, under-investigated in clinical studies. In order to support neuroplasticity and modulate motor recovery, Cerebrolysin combined with rehabilitation treatment has proven effective in the acute [...] Read more.
Background and Objectives: The recovery of stroke patients with severe impairment is usually poor and limited and, unfortunately, under-investigated in clinical studies. In order to support neuroplasticity and modulate motor recovery, Cerebrolysin combined with rehabilitation treatment has proven effective in the acute stroke phase in moderate to severe motor impairment. The aim of this study was to determine the efficacy of extended poststroke rehabilitation combined with Cerebrolysin on upper limb motor recovery in subacute stroke patients with severe upper limb motor impairment. Materials and Methods: A randomized, double-blind, placebo-controlled study was conducted. Sixty patients at the early stage of severe sub-acute stroke who fulfilled all eligibility criteria were randomly assigned to the Cerebrolysin group or placebo group (𝑛 = 30 each). Both groups, after conducting three weeks of conventional rehabilitation treatment five days per week, continued to perform conventional rehabilitation treatment three times per week until 90 days of rehabilitation treatment. The primary outcome measure was the Action Research Arm Test (ARAT), and the secondary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, Barthel index (BI), and the National Institutes of Health Stroke Scale (NIHSS). The outcome data were evaluated before, after three weeks of treatment, and on the 90th day of rehabilitation treatment, and compared within groups and between the two groups. There were no adverse events. Results: Both groups showed a significant improvement (p < 0.001) over time in BI, FMA-UE, ARAT, and NIHSS scores. Patients receiving Cerebrolysin showed more significant improvement in post-stroke upper limb motor impairment and functioning compared to the placebo group after only three weeks, and the trend was maintained after 90 days of follow up. Conclusion: Cerebrolysin delivered in the early subacute post-stroke phase added to extended conventional rehabilitation treatment is beneficial and improves motor functional recovery in patients with severe motor impairment, especially on the paretic upper extremity. Full article
(This article belongs to the Special Issue Advances and Challenges in Stroke Therapy: A Regenerative Prospective)
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Article
Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results?
Medicina 2023, 59(1), 96; https://doi.org/10.3390/medicina59010096 - 31 Dec 2022
Viewed by 473
Abstract
Background and Objectives: Current guidelines lack specific endovascular treatment (EVT) recommendations for posterior circulation stroke (PCS). The results of earlier studies are controversial. We aimed to compare early hospital outcomes of stroke caused by large-vessel occlusion (LVO) treated with EVT or bridging [...] Read more.
Background and Objectives: Current guidelines lack specific endovascular treatment (EVT) recommendations for posterior circulation stroke (PCS). The results of earlier studies are controversial. We aimed to compare early hospital outcomes of stroke caused by large-vessel occlusion (LVO) treated with EVT or bridging therapy (BT) in anterior circulation stroke (ACS) versus PCS (middle cerebral artery occlusion (MCAO) and basilar artery occlusion (BAO), and establish the risk factors for poor outcome. Materials and Methods: we analyzed the data of 279 subjects treated with EVT due to LVO-caused stroke in a comprehensive stroke centre in 2015–2021. The primary outcome was hospital mortality, secondary outcomes were National Institutes of Health Stroke Scale (NIHSS) after 24 h, early neurological deterioration, futile recanalization (FR), the ambulatory outcome at discharge, and complications. Results: BAO presented with higher baseline NIHSS scores (19 vs. 14, p < 0.001), and longer door-to-puncture time (93 vs. 82 min, p = 0.034), compared to MCAO. Hospital mortality and the percentage of FR were the same in BAO and almost two times higher than in MCAO (20.0% vs. 10.3%, p = 0.048), other outcomes did not differ. In BAO, unsuccessful recanalization was the only significant predictor of the lethal outcome, though there were trends for PAD and RF predicting lethal outcome. A trend for higher risk of symptomatic intracranial hemorrhage (sICH) was observed in the BAO group when BT was applied. Nevertheless, neither BT nor sICH predicted lethal outcomes in the BAO group. Conclusions: Compared to the modern gold standard of EVT in the ACS, early outcomes in BAO remain poor, there is a substantial amount of FR. Nevertheless, unsuccessful recanalization remains the strongest predictor of lethal outcomes. BT in PCS might pose a higher risk for sICH, but not the lethal outcome, although this finding requires further investigation in larger trials. Full article
(This article belongs to the Special Issue Advances and Challenges in Stroke Therapy: A Regenerative Prospective)
Article
Postacute Rehabilitation Impact on Functional Recovery Outcome and Quality of Life in Stroke Survivors: Six Month Follow-Up
Medicina 2022, 58(9), 1185; https://doi.org/10.3390/medicina58091185 - 30 Aug 2022
Viewed by 803
Abstract
Background and Objectives: This study aimed to examine the impact of postacute rehabilitation duration on the outcome of the functional recovery and patients’ quality of life after the stroke. Materials and Methods: One hundred patients (52 females, 48 males, mean age: [...] Read more.
Background and Objectives: This study aimed to examine the impact of postacute rehabilitation duration on the outcome of the functional recovery and patients’ quality of life after the stroke. Materials and Methods: One hundred patients (52 females, 48 males, mean age: 66.5 ± 7.3; range 53 to 79 years) who experienced a stroke (50 with ischemic stroke (IS) and 50 with intracranial hemorrhage (ICH)) took part in the study. Patients (treated with postacute rehabilitation measures for six months) were examined after one, three, and six months of postacute rehabilitation. Functional independence was measured using the functional independence measure (FIM) test, while the EQ-5D-3L questionnaire was used to assess the quality of life. Results: Patients with ICH had a slightly lower FIM score (FIM motor = 29.8 ± 11.8; FIM cognitive = 14.4 ± 4.6) on admission compared to patients with IS (FIM motor = 41.8 ± 18.8; FIM cognitive = 18.7 ± 6.3), but, after six months of postacute rehabilitation, patients with ICH reached an approximate level of functional independence (FIM motor = 53.8 ± 14.4; FIM cognitive = 25.8 ± 4.7), as did patients with IS (FIM motor = 67.6 ± 16.4; FIM cognitive = 29.2 ± 4.0). The motor and cognitive FIM, as well as quality of life, was statistically significantly increased at all four measurement points (p < 0.001). Furthermore, there is a statistically significant connection between functional independence and quality of life at all tested times. Conclusion: Patients achieved the highest degree of functional independence after six months. Furthermore, our findings point out that inpatient rehabilitation as well as outpatient rehabilitation are effective in functionality and quality of life improvement after a stroke; thus, both should be emphasized and regularly implemented. Full article
(This article belongs to the Special Issue Advances and Challenges in Stroke Therapy: A Regenerative Prospective)
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