Tuesday, 9 December 2014

Brain Stroke Related Disability can be Treated and Managed

Brain stroke is one of the world’s leading causes of death leading to disability due to post stroke spasticity. However, with effective medical intervention and use of drugs like Botox, lives of the affected patients can be improved

New Delhi, November 2014: Brain stoke is one of the leading causes of death and disability worldwide. In fact, it is estimated that as many as 5 million persons are left permanently disabled because of stroke each year. Among the common complications associated with brain stroke are redual paralysis and post stroke spasticity. Due to lack of awareness above disability management, thousands of people lead difficult lives, with each day a struggle.
A stroke is caused by the interruption of the blood supply to the brain: Either by rupture of blood vessels leading to brain hemorrhage or due to blockage of blood vessels. This cuts off the supply of oxygen and nutrients, causes damage to the brain tissue. The effect of a stroke depends on which part of the brain is injured and how severely it is affected. A very severe stroke can cause sudden death. In other cases, a stroke may cause severe disability by paralyzing a part of the body.

A number of people are left paralyzed on one side after being hit by a brain stroke. Yet, fortunate others are able to emerge unscathed by the incident, mostly because they get timely medical intervention. Others have to undergo months of physiotherapy and other medical treatment options.

One important treatable complication of stroke is post-stroke spasticity. This can be effectively treated by injections of Onabotulinum toxin type A, popularly known as Botox, to manage the effects of loss of muscle function.

“Our brain, an intricate network or nerves and cells which drives our bodies, is the single largest consumer of oxygen in our bodies. The brain cells need oxygen laden blood supply all the time to survive. What happens if this crucial oxygen supply is disrupted due to some reason? The brain cells deprived of oxygen will begin to die very fast, damaging that part of the brain. This is what happens in a brain stroke,” says Prof. Vinay Goyal from AIIMS, New Delhi. . 

According to estimates by the World Health Organization, 80% of the stroke cases in the world would occur in low and middle income countries like India by 2050.

“Despite being a relatively younger country, India is witnessing a rise in incidence of stroke cases. But, not many people are equipped to sight the symptoms of a stroke; nor are they aware that it is possible to reverse its impact if the victim gets medical help if they reach hospital within 4 hours ( by drug populazied as CLOT BURSTER). Due to this lack of awareness a lot of stroke victims who can be treated, die or are left paralyzed for life. At the same time, a large number of those affected lead extremely difficult lives with even simple tasks of activity of life becoming a major struggle,” says Prof. Vinay Goyal from AIIMS, New Delhi.


The most common symptom of a stroke is sudden weakness or numbness of the face, arm or leg. The affected person might feel unable to move one side of his or her body. The victim may also experience difficultly in speaking coherently or seeing clearly. Loss of balance or coordination is also felt by some people; others may faint or feel dizzy. A severe headache may also present in some people.

FAST is easy to remember eponym which suggests:  Face paralysis, Arm drop, Speech abnormality and Time is brain (so act fast).
In case a person is experiencing such symptoms, he or she should be immediately rushed to hospital for emergency treatment.

  • If the patient is lucky enough to reach the emergency immediately after suffering a stroke, the affects can be reversed. Clot-busting drugs (CLOT BUSTER) like tPA can be used to reverse a stroke. For patients to reach within the first 4 ½ hour from onset of paralysis, for the use of tPA therapy. It is very important that awareness about recognizing a brain stroke is high among the masses. This unfortunately is not the case in India where most people reach a doctor much after the damage has been done.
  • Once the affects of the stroke have pressed in, it becomes very difficult to treat them completely. In most cases, such patients are left partially paralyzed and would need months of physiotherapy and accompanying treatment for their condition to improve. How much the patient recovers varies from person to person. The younger the patient, the better are the chances of recovery. Physiotherapy is primarily concerned with promotion of mobility, functional ability, quality of life and movement potential and is very useful for patients who are dealing with post stroke spasticity. 
Botulinum toxin (Botox) is important treatment of Post Stroke 

Spasticity: Spasticity (stiffness of limbs) is a disturbing medical condition that afflicts some stroke survivors. Spasticity happens when the affected muscles fail to receive a message from the brain telling them to relax.  This loss or damage disrupts important signals between the nervous system and muscles, creating an imbalance that increases muscle activity or spasms. The treatment for this condition involves medication, the use of Botox, a neuromuscular blocker, as a way to relax the strained muscles and physiotherapy. Injections of Onabotulinum toxin type A (popularly known as Botox), can help manage this condition. The impact of one injection remains for approximately 4 to 6 months, and comes as a great relief to the suffering person. Depending upon the severity of the spasticity, a doctor will advise multiple treatment options to the patient including physical exercise and stretching; braces to hold a muscle in a normal position to keep it from contracting; oral medication; Intrathecal baclofen therapy (ITB) to reduce the side effects that often accompany oral medications; and Botox injections.

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