Toward a multimodal neuroprotective treatment of stroke.
OBJECTIVE
Stroke remains a common medical problem with importance attributable to the demographic changes in industrialized societies.


RESULTS
After years of setbacks, acute stroke therapy has finally emerged, including thrombolysis with tissue plasminogen activator (t-PA). However, t-PA treatment is limited by a narrow time window and side effects, so that only 3% of all stroke patients receive thrombolysis. Unimodal targeting of key events in stroke pathophysiology was not effective in providing long-term benefits, leading to negative results in previous clinical neuroprotective stroke trials. A successful future stroke therapy should approach multiple pathophysiological mechanisms besides revascularization at once, including reduction of t-PA-related side effects, prevention of cell death, stimulation of neuroregeneration, and plasticity.


CONCLUSIONS
Strategies targeting these processes include multiple combination therapies as well as treatment with multimodal drugs that interact with these mechanisms. Here, we review such combination approaches, and outline how this concept could be developed into future stroke treatment.
Rogalewski
Andreas
A
Department of Neurology, University of Muenster, Germany.
Schneider
Armin
A
Ringelstein
E Bernd
EB
Schäbitz
Wolf-Rüdiger
WR
D000818:Animals; D006801:Humans; D009462:Neurology / Q000639:trends; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy*
D018696:Neuroprotective Agents