Experts to Discuss Central Issues in Stroke Care at Future of Neurology Congress

Fred Rincon, MD, MSc, MB.Ethics

This Fall, top neurology professionals will convene in New York City for the 1st annual International Congress on the Future of Neurology, held September 27-28, 2019 at the InterContinental New York Times Square.

The 2-day Congress will feature a rigorous agenda of presentations, question and answer sessions, and lightning rounds highlighting topics across the breadth of neurology, including the latest in stroke medicine, multiple sclerosis, dementia, movement disorders, and epilepsy.

Congress Chair Stephen D. Silberstein, MD, professor of neurology and director of the Jefferson Headache Center in Philadelphia, will be joined by dozens of faculty from top institutions who will offer their expertise on various topics, sharing the latest data and best practices to better inform clinical decision-making.

Fred Rincon, MD, MSc, MB.Ethics, FACP, FCCP, FCCM, division head of cerebrovascular disease at the Vicki and Jack Farber Institute for Neuroscience and associate professor of neurology and neurological surgery at Thomas Jefferson University, will moderate the session on stroke, titled "Novel Interventions in Stroke Care," where experts in the field will discuss current limitations to pharmacologic and surgical interventions, extending the ischemic stroke treatment window, and up-and-coming therapeutic approaches for hemorrhagic stroke.

In an interview with NeurologyLive, Rincon discussed some of the central issues currently at play in stroke care.

Neurology Live: Given that stroke care is a race against the clock, what are some of the persisting barriers to reducing door-to-treatment times?

Fred Rincon, MD, MSc, MB.Ethics: The main barrier to improving stroke treatment time is primarily recognition of stroke symptoms by patients, family, bystanders, and medical providers. Stroke is particularly difficult, as the nature of the disease is silent, so better educating the public and emergency health personnel would help to improve recognition of signs of stroke, which can help get a patient the appropriate care that they need faster. In addition, the lack of recognition or acceptance of thrombolysis as an effective therapy is preventing patients from accessing evidence-based, quality treatment that can significantly reduce poststroke disability and improve overall outcomes.

What are some of the new therapeutic options being explored to help address those patients who don’t fit within current stroke treatment parameters?

Given that time to treatment is the essential issue in stroke care, we now have evidence that IV tPA guided by CT or MR perfusion techniques can be safe and effective up to 9 hours from symptom onset in patients with ischemic stroke and those with wake-up stroke. Results of the WAKE-UP and EXTEND clinical trials^1,2 really opened the door for this therapy to be utilized in many more patients.

We are also investing much more time and research into the use of mobile stroke technology to help recognize stroke patients who may be eligible for intervention prior to their arrival to the emergency department. Being able to properly triage patients to an appropriate treatment center or even administering IV tPA in the field can have a significant impact on functional outcomes.

Where does telemedicine fit into the evolving stroke treatment equation?

Much like mobile stroke units, telemedicine technology can assist in the recognition, stratification, and assessment of stroke patients. Telemedicine increases the chances of receiving thrombolysis and also helps to rule out other diagnoses, namely stroke mimics. Ultimately, telemedicine is another way of expanding access to stroke care, which may help improve outcomes.

What do you feel are the top priorities in poststroke care?

I consider the main priorities to be recognition of poststroke complications, which can include hemorrhagic transformation and cerebral edema, both of which require care in the intensive care unit. Other complications, such as depression, need to be recognized as well as this has an impact on stroke recovery.

In addition, access to poststroke rehabilitation is a major priority in poststroke care, as regaining good functional motor control and ambulatory independence are key to improving long-term outcomes.

For more information and to register, click here. Receive 25% off registration fees with code Neuro19SI.

REFERENCES

1. Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med. 2018;379(7):611-622.

2. Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med. 2019;380(19):1795-1803.