Treating stroke sequelae early prevents long-term disability

The World Health Organization (WHO) has estimated that of the 15 million people who suffer a stroke each year, 5 million die, and another 5 million suffer permanent sequelae that affect their quality of life and autonomy. In Argentina, where a stroke occurs every 9 minutes (which is equivalent to about 126,000 per year), stroke is the leading cause of permanent disability in adults.

“In those who have suffered a stroke it is essential to work on risk factors and on lifestyle changes to avoid a second episode(the risk of recurrence at 5 years is 26.4%), but it is also key to address the early diagnosis and treatment of eventual sequelae, to avoid the functional worsening of the patient and at the same time improve his or her function as much as possible. quality of life ”, stated Dr. Verónica Silvana Matassa (Min 118772), president of the Argentine Society of Physical Medicine and Rehabilitation (SAMFyR).

As the specialist explains, stroke is the result of a sudden loss of blood flow to some area of the brain, which may be due to a blocked blood vessel (ischemic form) or its rupture (hemorrhagic form).

In both cases, the resulting lack of oxygenation of the brain tissues can cause severe injury or even death of the patient. And although the prompt re-establishment of circulation in the brain area affected by stroke is the objective of its acute treatment, in a large percentage of patients there are sequelae that can affect the quality of life and autonomy, and that requires an approach as early as possible.

“The sequelae are several and each one requires a specific treatment. Spasticity (SS) is an important motor sequela and is present in most patients who have suffered some type of stroke and have recovered. Spasticity is a motor disorder characterized by increased tonic reflexes with increased muscle tone, speed dependent on resistance to passive stretching,” warned Matassa.

Early diagnostic

Studies show that between 3 and 18 months after a stroke, brain injuries can cause a change in muscle remodeling that leads to the development of a severe form of spasticity. Without treatment, in general, at 3 months 27% of patients have developed spasticity and at 6 months this sequela already affects 58% (15% of them seriously).

However, the diagnostic tools currently available to physicians allow –as soon as 10 days after stroke – predict the development of spasticity with high sensitivity and specificity, leading to early treatment.

“Spasticity must be treated with a multidisciplinary team and, from a pharmacological point of view, it can be addressed with oral treatments that act on the whole organism or with focal treatments, which act only on the affected muscles, with botulinum toxin. There are also intrathecal infusion pumps for special cases,” explained Matassa.

The need to become aware of the importance of addressing stroke early extends to all stages of its treatment: “Most stroke patients should have access to correct treatment from the onset of symptoms, the importance of what we call the golden hour. Subsequently, rehabilitation should be worked from the acute, as happens in first world countries”, says the specialist.

After a stroke, the first thing a patient should do is receive immediate care to be able to recognize and assess the condition. In the first stage, the emergency stage in which the patient arrives at the health center is attended by the intensive care physician and the neurologist. Once stabilized, it requires a multidisciplinary team and care. Physiatrists, speech therapists, occupational therapists, physiotherapists, who work together with the neurologist, intervene here.

Professionals insist that immediate treatment is key to improving the prognosis of patients after suffering a stroke. “It is essential to be aware that early treatment of the sequelae reduces their impact, allowing the patient to have a better quality of life,” concluded Matassa.