Chinese Herbal Medicines for Neuroprotection in Ischemic Stroke: Promise and Reality
Worldwide, stroke is the third leading cause of death and the leading cause of long-term disability. To date, intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA, Alteplase®) is the only effective treatment for ischemic stroke. U
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Chinese Herbal Medicines for Neuroprotection in Ischemic Stroke: Promise and Reality Nikolaus J. Sucher and Maria C. Carles
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Introduction
Stroke is not only the third leading cause of death worldwide responsible for almost 10 % of all deaths but also the leading cause of long-term disability among adults. According to data collected by the World Health Organization (WHO), more than 15 million people experience a stroke each year of which 5 million die and as many remain permanently disabled (Wolfe and Rudd 2007). Both individual suffering and the economic burden associated with stroke are immense (Di Carlo 2009). The WHO predicts that by 2020 up to 51 million disability-adjusted life years (DALYs) will be lost to stroke, up from 38 million presently (one DALY corresponds the loss of 1 year of full health). In addition, the costs of caring for stroke victims consume as much as 2–4 % of total healthcare expenditure in developed countries and total and indirect stroke-related healthcare costs in 2006 alone have been estimated at approximately €25 billion in Europe and US$57.9 billion in the USA. Like heart disease, with which it shares most of the risk factors, stroke is rare during the first five decades of life but increasingly common in older people. Overall, the lifetime risk of stroke in men is 25 % and 20 % for women. Thus globally, with more individuals reaching their sixth decade and beyond, it is likely that the incidence of stroke will increase significantly in the near future. At the same time, however, only one effective treatment is available: intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA, Alteplase®). This has been proven effective in improving the clinical outcome when tested rigorously in a randomized controlled N.J. Sucher (*) Department of Science, Technology, Engineering & Math (S.T.E.M.) Roxbury Community College, Roxbury Crossing, MA, USA e-mail: [email protected] M.C. Carles Department of Natural Sciences, Northern Essex Community College Haverhill, Haverhill, MA, USA e-mail: [email protected] H. Wagner and G. Ulrich-Merzenich (eds.), Evidence and Rational Based Research on Chinese Drugs, DOI 10.1007/978-3-7091-0442-2_9, # Springer-Verlag Wien 2013
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trial (The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group 1995), the often cited “gold standard” of evidence in medicine. Unfortunately, rt-PA only benefits patients when it is administered within 4.5 h (Davis and Donnan 2009) whereas most stroke victims (between 70 % and 98 % depending on location) do not reach the hospital within this very narrow time frame. Nonetheless, the rt-PA trial proved transformative, as it demonstrated for the first time that acute stroke was treatable and hence provided the stimulus for intense research activity directed at developing additional stroke treatments (Beresford et al. 2003). The search for new treatments for stroke has been underpinned by unprecedented progress in basic molecular neuroscience
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