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Focus on stroke: Making advances

4 May, 2012

Stroke stamp Ten leading clinicians, researchers and other professionals working on stroke answer the question: 

What do you think has been the most significant advance or turning point in the field during your career so far?

Lalit Kalra, Professor of Stroke Medicine at King’s College London: “The most important advances in the last 20 years have been the introduction of medical and surgical treatments to prevent stroke, interventions that reduce damage from stroke once it has happened, and finally the emphasis on organised stroke unit care that has significantly reduced disability in stroke patients.” 

 Nick Ward, Reader in Clinical Neurology at the Institute of Neurology, University College London: “Stroke units, because of the fact that if you’re admitted to a stroke unit you’ll do better. That has changed the way stroke services are organised up and down the country. If you’re admitted to a unit where the staff know about stroke and are used to dealing with it and talking about it, you’ll do better than if you’re not. That, far and away, has got to be the most important thing that has happened – not the sexiest, but that is the most important thing.” 

Hugh Markus, academic clinical neurologist, Professor of Neurology, Head of Stroke and Dementia Research Centre at St George’s, University of London: “We now thrombolyse [give clot-busting drugs to] patients, which has had a huge impact – not just because some patients get dramatically better, but because it’s as much of a change in the whole service delivery. Now, acute stroke care has suddenly become more urgent and better organised so all the other patients, even those who are not thrombolysed, benefit from rapid, structured care. In about 2003 (before thrombolysis came in), we reorganised stroke services here at St George’s Hospital. We put everyone on a stroke unit, gave them very good care, and the mortality halved. It was really dramatic: falling from around 16 or 17 per cent to around 9 per cent.”

Professor Alun H Davies, vascular surgeon: “When we first started [about 25 years ago], we wouldn’t dream of operating on somebody within six weeks of having a stroke. Now we would operate within 24 hours.” 

Sophie Scott, Professor of Cognitive Neuroscience, Institute of Cognitive Neuroscience, University College London: “I think one thing in a lot of hospitals is that patients aren’t getting speech and language therapy at all. That’s been desperate – we’re not only not providing help, but we’re taking help away. I would say it’s been extremely interesting to see how functional imaging is being used as a technique to address what’s happening in stroke, both to understand the relationship between a lesion and the sorts of problems people have and also to see where there are differences in the brain. Actually being able to identify how the brain is dealing with the changes and to visualise that is extraordinary.”

Anthony Strong, Emeritus Professor of Neurosurgery, King’s College London: “The recognition by governments, including the UK government, that early diagnosis and treatment carries significant benefits, coupled with the investment that has been made.”

Anthony Rudd, Consultant Stroke Physician at St Thomas’ Hospital, London: “The National Audit Office report of 2005 highlighted how poor stroke care was in the UK, and pointing out what we needed to do. It wasn’t until the NAO made it very high profile, and the Department of Health took it up, leading to the Stroke Strategy of 2007, that it was recognised that stroke was an important disease that we need to do something about.”

Eileen Gambrell, Service Manager at the stroke patient group Different Strokes: “The 2007 Stroke Strategy, because it laid out what should be done and allowed people to go back and see what progress had been made. It set out a lot of challenges and kick-started a lot of improvement. There is still a long way to go but it was certainly a good starting point.”

Fatemeh Geranmayeh, a Wellcome Trust Clinical Research Fellow in the Computational, Cognitive and Clinical Neuroimaging Laboratory at Imperial College London: “I think what’s made the most impact on patients has been the introduction of the stroke units. Taking someone to a stroke unit has been shown to be the single most effective measure in improving outcome following stroke. Even if the patients are not thrombolysed, they will be looked after more vigorously by people who know what they’re doing. They will have more intensive care and better prevention of complications such as DVTs and bed sores.”

Damian Jenkinson, Interim National Clinical Director for Stroke, Department of Health: “The turning-point was the sequence of events starting with the National Audit Office report of 2005 saying ‘this is terrible’, and the Stroke Strategy response to it. The greatest improvement in service has been in last five years. The whole stroke care pathway has improved immeasurably since the Stroke Strategy was published in 2007.”

Masud Husain, Professor of Clinical Neurology at the Institute of Neurology, University College London: “We’ve been able to develop a new way of looking at short-term or working memory. This has been important not only in terms of trying to understand cognitive deficits in patients, but also given us fundamental insights into how memory operates within the healthy brain. We’ve been able to show that in stroke patients with inattention, working memory is extremely limited. So part of what seems to be inattention is actually a problem with memory. A patient may actually have attended to an object but lose it within seconds – a kind of ultra-rapid forgetting. That inattention isn’t just about perception but can also be about memory has been a really important insight for me. It’s led to an entirely new strategy for devising treatments for inattention after stroke.”

  • Reporting by Moheb Costandi and Nic Fleming.

Image credit: Wellcome Library, London

This article is part of the Wellcome Trust’s Focus on stroke, a series of articles, interviews and videos running throughout May 2012, which is the Stroke Association’s Action on Stroke Month.

For more information on stroke, visit the Stroke Association’s site or call its helpline on 0303 303 3100. If you or someone with you is suspected of having a stroke, call the emergency services immediately.

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