Strokes are the leading cause of disability in the United States. There’s no technology that can reverse the damage done after one occurs — but that might be changing.
At the University of Miami’s Miller School of Medicine, one doctor is participating in a national trial where bone marrow stem cells are being tested to regenerate brain cells that die during a stroke.
Dr. Dileep R. Yavagal, associate professor of neurology and neurosurgery and the director of interventional neurology, was chosen to lead the Southeast portion of the study because of his research on stem cells in the carotid artery for the past four years.
“What’s been found is that the cells mainly have a nursing function,” Yavagal said. “When using the bone marrow stem cells, those cells don’t end up replacing dead cells by themselves, but they enhance the body’s process of repair.”
The Recover-Stroke trial began in December 2012 and has enrolled 30 patients across the nation so far, five of whom were treated in South Florida. Other states participating include Texas, California, Ohio and Georgia.
James Anderson, 58, a physical education teacher from Fryeburg, Maine, is one of Yavagal’s patients who received the stem cell implants in December.
“I started to feel tingly and unsteady and my eyes looked a little bit blank, then my wife convinced me that something was wrong,” said Anderson, who was flown to Jackson Memorial Hospital from Naples, where he planned to visit his mother-in-law for Christmas vacation.
“I was given the option to participate in something that had very little risk and potential reward,” Anderson said. “I thought it was a progressive opportunity.”
After a stroke, a range of conditions can occur: paralysis, inability to speak, loss of vision, and the body’s inability to repair itself.
For Anderson, the left side of his body was affected and he was left using a wheelchair. The doctors told him it would take a year to recover, but it’s been five months and he is walking with a quad-walker, lifting his left arm over his head, and in September will return to work using a cane.
But Anderson’s recovery is not only attributed to his stem cell implant, but also the quickness of his treatment when he had the stroke, his rehabilitation therapy and his diet.
Dr. Ralph Sacco, chairman of neurology at UM’s Miller School of Medicine, who is conducting a study with the University of Puerto Rico on stroke disparities among Hispanics and African Americans, said advancements in rehabilitation are important because only 20 to 25 percent of stroke patients go to rehab. Stroke rehabilitation includes occupational therapy, speech therapy and lifestyle modifications.
“It’s unfortunate that there’s too many people who, even though they had a stroke, won’t change their behavior,” Sacco said. “They will take their medicine, but they still won’t watch their diet.”
Yavagal agrees that even with the stem cell technology, diet and physical activity are necessary for as full a recovery as possible.
Anderson, an annual triathlon runner, has been physically active his whole life and likes to eat healthy meals with his wife.
“I’m the type of guy that would have a can of peas rather than two chocolate chip cookies,” said Anderson, whose father and uncles have also suffered strokes in their lifetimes.
Yavagal said genetics is part of the story.
But the real challenge is to educate the public on a stroke’s warning signs, said Dr. Amer Malik, medical director of the stroke program at Baptist Hospital.
Malik said the national average of stroke victims who make it to the hospital in time to receive TPA, the clot-busting medication that has become the standard for stroke care over the past 10 years, is only 3 to 4 percent.
“The main reason why so little get it [TPA] is because they are actually not recognizing the symptoms and they might shrug it off,” Malik said.
Sacco agrees and said TPA is underutilized.
“TPA can only be given to the right person at the right time, at a stroke center and up to only four and a half hours from the time the stroke started,” Sacco said.
Yavagal said it could be two to three years until the public starts to see the bone marrow stem cells as a rehabilitation option.
Meantime, Sacco said, “How do we really create the awareness and education programs that can really make a person want to change behavior? I think it’s not just the person, I think we have to focus on the whole family.”