We have had a longstanding and controversial discussion about thrombolysis and definitive management of stroke, however, there is a unified front in trying to find a neuroprotective agent, that somehow shields the cells from damage. Over 70 different such agents have been tried in the past, with no success. One of the main criticisms relating to previous studies has been that the median time that they were given, was over 7 hours. Studies in rodent and primate models , found benefit, when the delivery of these agents occurs within 2 hours of the insult.(J Stroke Cerebrovas Dis 2004;17:109-112.) This means prehospital delivery.
We need to know about these, as we will be hearing more about them in the future.
A study published this week in the NEJM by Saver J.L., et al., Prehospital Use of Magnesium Sulfate as Neuroprotection in Acute Stroke. 372:6 Feb 5 2015, had delivery of Magnesium Sulfate( one such potential neuroprotective agent), by pre-hospital staff, within 2 hours.
This was a multi centred, randomised, double blind, placebo controlled trial. There were 1700 patients in total and they received drug or placebo in a 1:1 ratio. The patients were between 40 and 95 years old. The dosage they received was 4g over 15 minutes and then 16g over the next 24 hours. The endpoint was disability outcomes at 90 days, using a modified Rankin Scale.
The conclusion: NO significant difference in disability outcomes.
Back to the drawing board. More about this at EMCORE