Having a stroke is a frightening and potentially life-threatening experience. A stroke occurs when the blood supply to part of the brain is interrupted, causing brain cells to die. This can lead to permanent disabilities or even death. Understandably, those who survive a stroke are eager to know if there are any medical interventions that can reverse the damage. In this article, we will examine the latest research on pills and medications that may help reverse the effects of stroke.
How do strokes happen?
There are two main types of stroke:
- Ischemic stroke – This is the most common type of stroke, accounting for around 87% of cases. It occurs when a blood clot blocks an artery leading to the brain.
- Hemorrhagic stroke – This accounts for around 13% of strokes and happens when a blood vessel in the brain leaks or ruptures.
In either case, the disruption of blood flow starves brain cells of oxygen and nutrients. This causes the cells to die within minutes. The effects of a stroke depend on the part of the brain impacted and the amount of damage done. Smaller strokes may only cause minor impairments, while larger strokes can paralyze one side of the body, affect speech and vision, impact cognition and memory, and more.
The urgent need for treatment
When a stroke occurs, it is imperative to restore blood flow to the affected part of the brain as quickly as possible. According to the American Stroke Association, the saying “time is brain” stresses the importance of fast treatment. The sooner blood flow is restored, the better the chances of surviving and reversing damage from a stroke.
Ischemic strokes can sometimes be reversed with a medication called tissue plasminogen activator (tPA) if it is given within 3-4.5 hours of stroke onset. This “clot-buster” works by dissolving the blood clot obstructing the artery. However, not all patients arrive at the emergency room and receive treatment within this narrow window of time. Other treatment options are needed for patients who do not receive tPA or who suffer a hemorrhagic stroke.
The search for a neuroprotective pill
Because immediate treatment is so critical for stroke outcomes but not always possible, researchers have been searching for a neuroprotective agent – a pill that could be given to protect and preserve brain cells even when given hours after stroke onset. Unlike clot-busting drugs that aim to restore blood supply, neuroprotective medications would directly prevent brain cell death.
Ideally, a neuroprotective pill to reverse stroke damage could be taken by someone who experiences a stroke before arriving at the hospital. This could mitigate neurological impairments and disabilities. It could even be used alongside tPA for added protective benefits.
Key challenges in developing a neuroprotective pill
While an effective neuroprotective stroke pill would be groundbreaking, creating one has posed significant challenges:
- The complex nature of strokes – Strokes affect people in different ways based on location, severity, age, and other variables. Finding a single pill to counteract neurological damage across all these factors is difficult.
- The blood-brain barrier – This semi-permeable barrier protects the brain from toxins but also makes it hard for medicines to cross from the bloodstream into the brain.
- Potential side effects – Medications potent enough to penetrate into the brain and prevent cell death may also have risks like brain swelling, hemorrhage, or seizures.
Progress has been made despite these roadblocks. Some of the most promising neuroprotective agents researched so far include…
Key candidates for a neuroprotective stroke pill
Nerinetide
Nerinetide is a synthesized version of a natural brain protein called activity-dependent neuroprotective protein (ADNP). Studies in mice have shown that administering nerinetide up to 4 hours after an induced stroke reduced brain cell death and neurological deficits. When given immediately after a stroke, it helped mice recover mobility. Human trials are underway to evaluate safety and effectiveness.
NA-1
NA-1 is a peptide derived from a venom used by the Israeli deathstalker scorpion. In rodent studies, NA-1 helped reduce stroke damage when administered up to 4 hours after onset. A small human study in 2020 indicated that NA-1 was safe when given alongside tPA. Larger clinical trials are planned.
Tat-NR2B9c
This neuroprotective peptide is derived from a section of the NR2B subunit of NMDA receptors involved in cell signaling. Rodent research showed it reduced brain damage and neurological deficits when given up to 3 hours after stroke. Phase 2 human trials examining safety are underway.
Anakinra
Already approved to treat rheumatoid arthritis, anakinra is an anti-inflammatory medication being investigated for additional uses like stroke. A small human pilot study in 2020 indicated that giving anakinra 3-4 days after a severe ischemic stroke was safe. It also found hints that it might limit the proportion of tissue that progressed to infarction. Further research is needed.
Other promising approaches
In addition to pills taken after a stroke, researchers are exploring other innovative approaches that could help reverse stroke damage, including:
- Cell-based therapies – Introducing stem cells or other cell types to repair damaged brain tissue
- Gene therapies – Delivering therapeutic genes to protect vulnerable cells
- Electrical stimulation – Using electric current to activate and rewire undamaged parts of the brain to take over functions lost to stroke
Current guidelines on treating stroke
While we await future pills specifically able to reverse stroke damage, current treatment guidelines focus on restoring blood flow and preventing recurrent stroke. The American Heart Association/American Stroke Association guidelines recommend:
- Giving tPA to eligible patients having an ischemic stroke as soon as possible within 4.5 hours of onset
- Endovascular thrombectomy to remove blood clots in larger ischemic strokes
- Preventing edema and managing blood pressure
- Beginning rehabilitation therapies early
- Taking medications like aspirin and statins long-term to prevent another stroke
Rehabilitation
Starting rehabilitation as soon as possible can help patients regain function after a stroke. Common therapies include:
| Type of Therapy | Purpose |
|---|---|
| Physical therapy | Improve mobility, balance, and coordination |
| Occupational therapy | Relearn everyday activities like eating, dressing, and using the bathroom |
| Speech therapy | Work on communication skills, swallowing, and cognition |
Rehabilitation taps into neuroplasticity – the brain’s natural ability to make new connections and learn new skills through repetition and practice. While rehabilitation therapies cannot directly repair dead brain tissue, they can help the brain rewire itself to regain lost abilities to the extent possible.
Conclusion
In conclusion, there is currently no pill that can directly reverse brain damage and impairments from a stroke. However, promising research is underway investigating several neuroprotective agents that may be able to limit stroke damage when administered hours after onset. This could allow an effective treatment window beyond what is currently possible with clot-busting drugs like tPA.
Other cutting-edge approaches like cell therapies, gene therapies, and electrical stimulation may one day also help undo stroke damage. For now, rapid treatment to restore blood flow and early rehabilitation remain the best ways to optimize recovery after stroke. Anyone who experiences sudden onset of stroke symptoms like weakness, numbness, vision loss, or confusion should immediately seek emergency medical treatment.