Alternative treatment strategies: physical approaches and nervous stimulation
Peter D Schellinger
69 slide(s) – 00:22:27– English –2010-09-27
This 25min talk will give an overview of new biophysical approaches to acute stroke treatment. In specific temperature management, near-infrared laser therapy and stimulation of he sphenopalatine ganglionwill be discussed.Management of fever as well as normothermia and hypothermia for acute stroke alone or in combination with recanalizing therapies is a promising neuroprotective approach. Different cooling techniques will be discussed. A sufficiently powered randomized trial is not yet underway although various applications for funding have been submitted. Near-infrared Lasertherapy (NIRLT) is suspected to have an effect on mitochondrial metabolism thereby increasing the availability of energy substrates such as ATP. A pilot study (NEST 1) as well as a phase 3 trial have rendered promising results with an overall effect size of 5% for the reduction of independent or dead outcomes.A large confirmatory trial (NEST-3) will start recruitment in fall 2010. Stimulation of the ipsilateral SPGcan increase blood flow to the ischemic hemisphere. This is currently put to test in the IMPACT trial.A small electrode is inserted into the sphenopalatine canal and over several days intermittently stimulation takes place. The trial is designed as paramount phase 3 trial with a clinical endpoint. Results are expected within the next 12-24 months.