New treatment modalities for stroke in the near future

The ischemic penumbra is a functionally depressed, structurally intact but potentially salvageable region in the brain following stroke. Several pathophysiological mechanisms dominate during various intervals after stroke onset. New promising clinical treatment possibilities include hemicraniectomy in younger patients with malignant media infarction (albeit no RCT data available as today); brain cooling during the acute phase; and constraint-induced therapy and physiotherapy enhanced either by psychotomimetics (amphetamine) to improve general function or by anesthesia of the shoulder and upper arm to improve chronic paretic hand function. In a further future perspective, promising results from animal experiments should be clinically translated. Such results include newborn neurons induced in the penumbra spontaneously after stroke (endogenous neurogenesis) or exogenously administered stem cells implanted directly, or alternatively migrating to the ischemic penumbra, where differentiation to functional neurons is hoped for. Several safety aspects are however crucial, especially with regard to minimizing the risk of tumorigenesis after application of exogenous stem cells, and further detailed experimental characterization is essential before large scale clinical trials are initiated.