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  • Dr Ashleigh Bhanjan

Shining a Light on Stroke

Stroke is a clinically defined syndrome of acute, focal neurological deficit attributed to vascular injury of the central nervous system.


It is the 2nd leading cause of death and disability worldwide

In this blog, we will explore the causes, clinical presentation, current treatment modalities, complications, prevention, and the emerging use of photobiomodulation therapy (aka low level laser therapy, or LLLT) in stroke management.


 

Causes of Stroke


Stroke can be caused by a wide range of risk factors, disease processes, and mechanisms


The most important modifiable risk factor for stroke is hypertension.

Other risk factors include:

  1. Atrial fibrillation

  2. Diabetes

  3. High cholesterol

  4. Smoking

  5. Obesity

  6. Sedentary lifestyle

  7. Family history of stroke


 

Clinical Presentation of Stroke


The clinical presentation of stroke can vary depending on the location and extent of the vascular injury.





Common symptoms and signs of stroke include :

  • Sudden weakness or numbness on one side of the body

  • Difficulty speaking or understanding speech

  • Sudden severe headache

  • Loss of balance or coordination

  • Vision changes

  • Confusion or altered mental status


MRI brain images demonstrating acute right middle cerebral artery infarct (white)

 

MRI brain images demonstrating acute left middle cerebral artery infarct (white)

 

Current Treatment Modalities for Stroke


The treatment of stroke aims to restore blood flow to the affected area of the brain and prevent further damage.



Time is BRAIN !

The phrase "time is brain" emphasizes that human nervous tissue is rapidly lost as stroke progresses and emergent evaluation and therapy are required.





Reperfusion strategies


1. Thrombolytic Therapy: Intravenous administration of tissue plasminogen activator (tPA) to dissolve blood clots and restore blood flow.


When administered quickly after stroke onset (within 3 hours, as approved by the FDA), tPA helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment.

2. Mechanical Thrombectomy: Minimally invasive procedure to remove blood clots using a catheter-based device.


Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) caused by large vessel occlusion of the anterior circulation within 6 hours of symptoms onset and can be performed with an extended window up to 24 hours in selected patients.

Secondary Prevention


Antiplatelet and Anticoagulant Medications : Medications to prevent blood clot formation and reduce the risk of recurrent stroke.


Rehabilitation


Physical, occupational, psychotherapy, and speech therapy to regain lost functions and improve quality of life, referral to a rehabilitation unit



 

Complications of Stroke


Stroke can lead to various complications, including :

  1. Paralysis or weakness on one side of the body

  2. Difficulty speaking or understanding speech

  3. Cognitive impairment

  4. Emotional and behavioral changes

  5. Swallowing difficulties

  6. Chronic pain

  7. Depression and anxiety

  8. Increased risk of recurrent stroke

  9. Seizures

 

Prevention of Stroke


Prevention is always better than CURE !


Prevention plays a crucial role in reducing the incidence of stroke. Strategies for stroke prevention include :

  1. Controlling hypertension, diabetes, and high cholesterol through lifestyle modifications and medications.

  2. Quitting smoking and avoiding second hand smoke.

  3. Maintaining a healthy weight through regular exercise and a balanced diet.

  4. Limiting alcohol consumption.

  5. Managing stress levels.

  6. Taking medications as prescribed for underlying medical conditions.


 

Photobiomodulation Therapy in Stroke Management


Photobiomodulation therapy (PBM) is an emerging treatment modality that involves the use of low-level light therapy to stimulate cellular function and promote tissue healing.


Recent studies have explored the potential benefits of PBM in stroke management.




Research indicates that PBM therapy applied within 24 hours from stroke onset can reduce neurological damage, final infarct volume, and mortality rate

PBM therapy has shown promising results in animal models of ischemic stroke, indicating its potential as a neuroprotective intervention.





 

Photobiomodulation therapy (PBM) : Biological effects, in Stroke


Neuroprotection: PBM therapy may help protect brain cells from further damage after a stroke. Animal models of ischemic stroke have shown that PBM therapy applied within 24 hours from stroke onset reduces neurological damage, final infarct volume, and mortality rate. PBM therapy may also promote the survival of neurons and glial cells by increasing the production of neurotrophic factors


Anti-inflammatory effects : PBM therapy may have anti-inflammatory effects that can reduce the inflammatory response associated with stroke. Inflammation plays a crucial role in the pathogenesis of stroke, and reducing inflammation can help prevent further damage to brain tissue. PBM therapy has been shown to reduce the expression of pro-inflammatory cytokines and increase the expression of anti-inflammatory cytokines.


Improved blood flow: PBM therapy may improve blood flow to the affected area of the brain, which can help promote tissue healing and recovery. PBM therapy has been shown to increase the production of nitric oxide, which can dilate blood vessels and improve blood flow.


Enhanced cellular metabolism: PBM therapy may enhance cellular metabolism, which can promote tissue healing and recovery. PBM therapy has been shown to increase the production of ATP, which is the primary energy source for cellular metabolism.


Promotion of neurogenesis : PBM therapy may promote neurogenesis in stroke patients. Studies have shown that PBM therapy promotes neurogenesis by improving the post-stroke local microenvironment and stimulating neuroprogenitor cells





 

Why Consider Photobiomodulation Therapy?


  • Supported by Research : Multiple studies have demonstrated the positive effects of PBMT on stroke-related outcomes, including motor function improvement, reduced neurological deficits, and enhanced recovery rates.


  • Non-Invasive and Safe : PBMT is non-invasive and well-tolerated, making it a favorable option for patients who may have contraindications to other treatments.


  • Complementary Approach : PBMT can be used alongside conventional stroke treatments to potentially enhance their efficacy and accelerate recovery.


  • Minimal Side Effects : Unlike some medications or interventions, PBMT is associated with minimal side effects, further increasing its appeal as an adjunctive therapy.


  • Neuroprotection : PBM therapy may help protect brain cells from further damage after a stroke.


  • Neuroplasticity : It is well established that rehabilitation after a stroke depends strongly on the stimulation of neuroplasticity within the injured brain.



The brain has the capacity to rearrange or “rewire” itself to develop new neural pathways that can take over the function of lost pathways caused by brain damage after a stroke
Once a stroke has occured, there are minimal neuroprotective therapies available, hence one should consider PBMT early in stroke management.




It is important to note that PBM therapy should be used as an adjunct to standard stroke treatments and under the guidance of healthcare professionals.

Further research and clinical trials are necessary to fully understand the potential of PBM therapy in stroke management.


 

How many photobiomodulation treatments are required for stroke ?


The number of photobiomodulation treatments required for stroke varies depending on the protocol implemented, individual patient neuroplasticity, extent of stroke etc.

Animal models of ischemic stroke have shown that PBM therapy applied within 24 hours from stroke onset reduces neurological damage, final infarct volume, and mortality rate.


In a case series study, chronic stroke patients were treated with a high power, FDA-approved superpulsed laser system applied to the head for 12 weeks.





However, further research and clinical trials are necessary to establish the optimal protocols and number of treatments required for PBM therapy in stroke management


 

Are there any risks or side effects associated with photobiomodulation therapy for stroke ?


Based on the available research, PBM therapy appears to be a safe and well-tolerated treatment modality for stroke.


In fact, the almost complete lack of any adverse side-effects of PBM is one of its advantages, coupled with growing disillusion with pharmaceutical drugs that affect brain function.
 

Conclusion : Embracing Innovation in Stroke Care


Stroke remains a significant global health concern, but advancements in stroke care continue to improve outcomes for patients.


Beyond conventional therapies, the emerging role of photobiomodulation therapy offers new hope by harnessing the power of light to facilitate brain healing and recovery.

While further research is needed, the evidence thus far underscores the potential of PBMT as an adjunctive therapy in stroke management.





As medical science progresses, the integration of innovative approaches like PBMT holds the promise of brighter futures for stroke survivors.

 

References

  1. Iglesias-Rey R, Castillo J (2020) New strategies for ischemic stroke: internal photobiomodulation therapy. PMC. Link

  2. Stroke: causes and clinical features. PubMed. Link

  3. Clinical Presentation and Diagnosis of Cerebrovascular Disease. Thoracic Key. Link

  4. What Can A Chronic Stroke Patients Study Reveal? Vielight Inc. Link

  5. Most recent papers in the journal Current Treatment Options in Neurology. Link

  6. Hamblin M. (2021) Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophysics

  7. Light-Emitting Diode Photobiomodulation After Cerebral Ischemia - Frontiers

  8. New strategies for ischemic stroke: internal photobiomodulat... : Neural Regeneration Research

  9. Photobiomodulation with Super-Pulsed Laser Shows Efficacy for Stroke and Aphasia: Case Studies - Scientific Research Publishing

  10. Photobiomodulation for Traumatic Brain Injury and Stroke - PMC - NCBI



 

Contact us to setup a consultation with Dr. Ashleigh Bhanjan, at the Durban Neuro laser Clinic...



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