Health hazard If a stroke threatens during sleep

Stroke in sleep: New therapy option for patients

Every year, more than a quarter of a million Germans suffer a stroke. A timely emergency treatment is often vital for those affected. But some people hit the cerebral infarction in their sleep. Researchers have now discovered that a certain treatment option - unlike previously thought - even hours after the stroke could help.

Numerous deaths could be avoided

According to health experts, more than a quarter of a million Germans suffer a stroke each year. Cerebral infarction is one of the most common causes of death in this country. According to experts, many deaths would be preventable if stroke symptoms are recognized quickly and those affected are treated promptly. But some people suffer the cerebral infarction in their sleep. For these patients, there could be new treatment options, as researchers report.

In a stroke, quick action can save lives. But some people do not even notice their cerebral infarction, perhaps because they suffer it while they sleep. However, a specific treatment can also take place much later than previously thought, as researchers have now found out. (Image: psdesign1 / fotolia.com)

Save lives by acting fast

Stroke is the second leading cause of death and the leading cause of adult disability in the Western world.

The cause of a stroke is usually the occlusion of a blood vessel in the brain (ischemia) by a blood clot (thrombus). As a result, the brain tissue supplied by the closed vessel dies.

Fast action is therefore vital.

The blood clot can be dissolving medically by the treatment with thrombolysis. If this happens in time, permanent neurological symptoms or disability can be prevented.

According to medical experts, intravenous thrombolysis with alteplase is an effective and safe acute treatment for ischemic stroke if therapy is initiated within the first 4.5 hours after onset of symptoms.

Exact time of symptom onset often unknown

"In about 20 percent of all patients with acute stroke, the exact time of symptom onset, however, is unknown, for example, because the symptoms are not noticed until the morning awakening or because patients unobserved stroke suffer and because of speech disorders can give no information about the onset of symptoms," explains Prof. Dr. Götz Thomalla from the University Medical Center Hamburg-Eppendorf (UKE) in a statement.

So far, this large group of patients was out of the question due to the lack of knowledge about the time window for thrombolysis alone.

However, a study led by UKE scientists ("WAKE-UP") has now shown for the first time that patients who suffer a stroke while asleep and notice the symptoms only after waking up the next morning can benefit from so-called thrombolysis.

According to the statement, in the WAKE-UP study, it was possible for the first time to use MRI diagnostics to select suitable patients for thrombolysis, even without knowing the time of the stroke.

They had lower neurological symptoms or disabilities than other patients.

The study results were recently presented at the European Stroke Organization Conference in Gothenburg and published in the journal "New England Journal of Medicine".

Further improvement of the treatment of stroke patients

"The positive outcome of the WAKE-UP study is a major step in further improving the treatment of stroke patients as the study opens the possibility of treating a large number of patients with thrombolysis that were previously excluded," said Thomalla , First author of the study and chief physician at the Department of Neurology of the UKE.

"Treatment based on MRI imaging without knowing the timing of symptom onset represents a paradigm shift for stroke thrombolysis."

Also Prof. Dr. Christian Gerloff, Director of the Department of Neurology and Deputy Medical Director of the UKE, estimates the importance of the study is extremely high:

"The results of WAKE-UP will have a direct effect on the clinical practice of stroke treatment. Based on the study results, we will be able to avert a lasting disability for many stroke patients in the future. "

MRI-eligible patients for thrombolysis

The WAKE-UP study included patients with acute ischemic stroke and unknown symptom onset at the age of 18 to 80 years. The selection of patients for treatment was performed by magnetic resonance imaging (MRI).

A total of 503 of the patients were treated with either alteplase or a dummy drug (placebo).

"At 90 days, the clinical outcome was significantly better in the alteplase-treated group than in the placebo group," said study leader Thomalla.

For example, 53.3 percent of patients treated with thrombolysis achieved a very good clinical outcome, compared to only 41.8 percent of patients in the placebo group.

Prof. Thomalla: "This corresponds to an absolute increase of 11.5 percent of patients who have survived the stroke without disability."

Patients in the AGP group had a 62 percent higher chance of having fewer neurological symptoms or disabilities three months after stroke than patients in the placebo group.

Also in the self-assessment regarding health status and quality of life after three months, the patients in the Alteplasegruppe had benefited significantly. (Ad)