Cerebrovascular disorders in the working-age population have become common in high-income countries. “In part, this is probably due to changes in lifestyles. People get less everyday exercise, they sit more and live an increasingly stressful life,” said Docent Jukka Putaala, President of the Nordic Stroke Society, in a media event of the XXII Nordic Stroke Society Congress in Kuopio.
Cerebrovascular disorders refer to cerebral infarction caused by clotting, or to cerebral haemorrhage caused by a vascular rupture. The clot may also be temporary, in which case the term transient ischaemic attack, TIA, is used. They are the third most common cause of death in Finland.
Society, too, should play a role in improving brain health
The majority of cerebrovascular disorders could be prevented through healthy lifestyles, non-smoking and appropriate management of risk factors, such as high blood pressure, abnormal blood lipids, atrial fibrillation, diabetes and obesity. “People should take responsibility for their health, but more effective prevention of cerebrovascular disorders also requires societal measures, ranging from promoting cycling to limiting air pollution and the salt content of foodstuffs,” said Professor Hanne Christensen of the University of Copenhagen.
According to Christensen, a key objective of the ongoing Stroke Action Plan for Europe is, by 2030, for every European country to have a national plan to improve the prevention and treatment of cerebrovascular disorders throughout society and the chain of care. “At least 90% of patients should be treated in units specialising in cerebrovascular disorders – including older and fragile patients. In addition, a national treatment register is needed to monitor the outcomes of treatment.”
The extensive action plan already includes 49 countries whose progress will also be monitored. “Most countries are already in the process of preparing their national action plans.”
“In the Nordic countries, access to care is good and acute care is of high quality. However, monitoring of patients with cerebrovascular disorders remains inadequate, both here and elsewhere.”
Aiming at recovery-promoting drugs
“We don’t have drugs that would help the brain to recover from a cerebrovascular disorder yet, despite a large number of patients needing such drugs,” Professor Mikko Airavaara of the University of Helsinki said.
His research has focused on whether various nerve growth factors could help. “Right now, an interesting protein is MANF, which plays a role in cellular stress. We have observed in animals that it promotes neural cell regeneration and mitigates inflammation in the brain after a cerebrovascular disorder – although it doesn’t affect the damage caused. However, plenty of more research is needed before we know whether it’s worth studying in humans.”
“Another challenge is how to measure recovery from a cerebrovascular disorder, and the effectiveness of the drug used. We don’t have clearly identified biomarkers for measuring recovery.”
According to Airavaara, the discovery of new drugs also requires input from clinician-researchers who understand both patient care and pre-clinical research into cerebrovascular disorders in animal models. “During their studies, medical students should be encouraged to engage in pre-clinical research, despite its current struggles with low popularity and funding. Hopefully, we’ll see an increase in basic funding for research.”
“In the past, research into diseases of the brain may have been too focused on a single cell type, i.e., neurons, and other brain cells, such as microglia and astrocytes, have been slightly neglected. The next breakthrough will probably be related to these other brain cell types, the significance of which we are only just beginning to understand,” Airavaara added.
Seamless and rapid care
Organised by the University of Eastern Finland, Kuopio University Hospital and the Nordic Stroke Society, the XXII Nordic Stroke Society Congress 2023 on 21–23 August provided participants with latest research findings on the prevention, acute treatment and rehabilitation of cerebrovascular disorders. The high level of expertise found in Kuopio was well visible in the in the programme sections related to rehabilitation and neurosurgery. “In recent years, surgical treatment of brain intracerebral haemorrhage has developed tremendously through progress in microsurgery, and Kuopio has been a frontrunner in Finland in its development,” said Chair of the Organising Committee, Professor of Neurology Pekka Jäkälä of the University of Eastern Finland.
According to Chief Physician Timo Koivisto who leads the KUH Neurocenter, the treatment outcomes of neurosurgery have also been improved by more advanced imaging, which helps in surgery targeting, and by advances in neuro-intensive care. “The KUH Neurocenter is an overall asset for Kuopio, as it provides experts from different neurological fields with a platform for seamless collaboration in patient care.”
In cerebrovascular disorders, rapid access to treatment is critical. Acute Neurologist Anne-Mari Kantanen focused in her presentation on ways to reduce delays in patient transport and treatment initiation even in sparsely populated regions where lakes are abundant and pose their own challenges to the road network, such as in the catchment area of Kuopio University Hospital. “Each region needs a model that fits its needs.”
Long and difficult journeys to access treatment are a challenge shared by the Nordic countries. “Another thing we have in common is unique health care services, robust health registers and reputation as excellent partners in pharmaceutical research. This is also a good foundation for within our own organisation, the Nordic Stroke Society, which has been in operation for over 40 years. The Baltic states have also been involved since 2005,” Putaala said.
Website of the Nordic Stroke Society Congress: https://www.nscongress2023.com/
