For years, stroke was a disease with few treatment
options. This changed in the mid 1990s with the
approval of thrombolytic therapy. Despite this revolutionary change in acute stroke management, only a
limited number of patients reach the hospital in time
to benefit from such interventions; many who are so
treated none the less have significant long-term disability. A need exists for therapies that are accessible
and efficacious for a majority of patients beyond the
current narrow treatment window.
Recent years have seen the dawning of a new field
of clinical therapeutics based on the neuroscience of
brain repair. With this approach, the aim is not to
rescue threatened tissue, but to rewire, restore, repair,
and rehabilitate. The current volume examines brain
repair after stroke, from the latest basic science experiments performed in animal models of stroke recovery
(Section I) to the process of spontaneous recovery
in human stroke survivors, including results of modern neuroimaging studies (Section II) to treatment
strategies in humans largely based on brain repair
principles (Section III).
In the first section (Chapters 1–8), preclinical studies pave the way for evidence-based hypothesis testing
in humans. Molecular data, derived from species ranging from rodents to primates, provide a mechanistic
foundation. An important chapter focuses on MR
imaging of stroke recovery in animals, with results
relating directly to the human findings that are presented in the second section. Effects of environment,
therapy, and behavior are also considered, topics particularly relevant to translational efforts.
In the second section (Chapters 9–15), the science
of spontaneous stroke recovery in humans is reviewed.
The relationship to core aspects of the field of stroke,
such as acute stroke therapy and epidemiology,
is examined. Several brain systems are considered,
including motor, language, attention, and affect, with
many areas of overlap among the findings. These data
provide a baseline against which interventional therapies will be compared, and also suggest key brain
events whose measurement might help optimize prescription of repair-based therapies after stroke. In the third section (Chapters 16–24), a range of
emerging therapies is examined. Approaches include
drugs, robotics, stimulation, physical therapies, cognitive approaches, growth factors, and cells. The progress and potential for each approach is considered. A
separate chapter considers issues of clinical trial methodology that might be of particular importance to
brain repair approaches.
The field of brain repair after stroke is young.
However, already, animal and human sciences are
converging on core principles. The literature is witnessing a blossoming of reports focused on this area of
research. The current volume brings together international experts to review the current state of brain
repair after stroke. We expect that the future will see
increasingly successful efforts to reduce disability after
stroke based on this approach.
This book will serve as a valuable reference for
clinicians wanting to gain a better understanding of
emerging brain repair therapies, for scientists and
students wanting to gain increased knowledge of
human stroke recovery and its underlying principles,
and for basic scientists working with animal models
to provide a comprehensive volume that covers the
spectrum of stroke research from laboratory to clinic.
