Published Online
on March 9, 2006

A more recent version of this article appeared on April 1, 2006

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Submitted on October 29, 2005
Revised on January 11, 2006
Accepted on January 20, 2006

Toward a Multimodal Neuroprotective Treatment of Stroke

Andreas Rogalewski MD; Armin Schneider MD; E. Bernd Ringelstein MD; and Wolf-Rüdiger Schäbitz MD^*

From the Department of Neurology (A.R., E.B.R., W.-R.S.), University of Muenster, Germany; and Axaron Bioscience (A.S.), Heidelberg, Germany.

^* To whom correspondence should be addressed. E-mail: schabitz{at}uni-muenster.de.

Background and Purpose--Stroke remains a common medical problem with importance attributable to the demographic changes in industrialized societies.

Summary of Review--After years of setbacks, acute stroke therapy has finally emerged, including thrombolysis with tissue plasminogen activator (t-PA). However, t-PA treatment is limited by a narrow time window and side effects, so that only 3% of all stroke patients receive thrombolysis. Unimodal targeting of key events in stroke pathophysiology was not effective in providing long-term benefits, leading to negative results in previous clinical neuroprotective stroke trials. A successful future stroke therapy should approach multiple pathophysiological mechanisms besides revascularization at once, including reduction of t-PA-related side effects, prevention of cell death, stimulation of neuroregeneration, and plasticity.

Conclusions--Strategies targeting these processes include multiple combination therapies as well as treatment with multimodal drugs that interact with these mechanisms. Here, we review such combination approaches, and outline how this concept could be developed into future stroke treatment.

Key words: apoptosis • clinical trials • excitotoxicity • growth factors • inflammation • neuroprotection • stroke

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