STROKE DRUG: NEWLY APPROVED tPA IN LIMITED USE HERE

Researchers have made great strides in reducing the effects of strokes, but doctors say the best medicine is an educated public.

A drug that has been used for several years in the treatment of heart attacks was cleared this summer for use in reducing the debilitation caused by a stroke.

But the drug, called tissue Plasminogen Activator (tPA), must be administered within three hours of the onset of a stroke. That means the patient must be able to recognize symptoms of a stroke and understand the urgency of immediate treatment.

"The message that I'd like to see get out to the public is, if they have stroke symptoms they need to seek help immediately; they need to treat it as a medical emergency," said Chris Byrd, a clinical nurse specialist in the neurology department of St. Francis Medical Center. "Stroke symptoms are weakness, numbness and tingling usually on one side of the body."

Byrd said those are the three predominant symptoms but some people can experience slurred speech, headaches, vision problems, confusion, dizziness and loss of consciousness.

"That's why when people have these symptoms they need to be evaluated," she said. "There are a lot of other symptoms. It depends on which part of the brain is involved, and you can get some more subtle symptoms."

A stroke is caused when a blood vessel to the brain is clogged by a clot. The clot is formed from platelets and blood cells, essentially the same cells that form scabs. The drug, tPA, dissolves these clots, opening the vessel to normal blood flow.

This allows the brain tissue to regain the blood and oxygen that keeps its cells alive. The quicker this happens the more brain tissue will be saved and the less disability will result from the stroke.

The dangers of tPA stem directly from the same thing that makes it so beneficial: its ability to dissolve clots.

Both St. Francis and Southeast Missouri Hospital have strict policies regarding who can receive treatment with tPA. Anyone who has the potential of having a healing clot dissolved by the drug is excluded. This includes patients who have had surgery within three weeks of their stroke, pregnant women, patients who have a history of brain hemorrhages or strokes or patients with bleeding disorders.

Most importantly, the drug can only be administered within a three-hour period and cannot be given if it may cause more damage by initiating bleeding into the brain.

It is possible that tPA will open a clot, allowing normal blood flow to an area that has deteriorated from lengthy deprivation of oxygen. This tissue may no longer retain blood, resulting in more damage.

"The biggest obstacle to this three-hour timeframe is early recognition by the patient that the symptoms they are experiencing is a stroke," said Randy Dooley, a pharmacist at Southeast Missouri Hospital. "The rehabilitation potential is much better with this drug. But administration of this drug is not without its consequences or its risks."

Southeast has used tPA twice, both on Dec. 15, once successfully and once unsuccessfully. The patients were treated within the prescribed three-hour time limit.

One patient has responded very well to the treatment and rehabilitation. The other died from complications arising from the stroke. Dooley said death was caused by bleeding into the brain.

The neurology department of Southeast said the hospital sees more than 900 stroke victims a year. St. Francis treats more than 200, Byrd said. St. Francis has not had the opportunity to use tPA even though it has treated stroke patients since the drug was approved for use.

Byrd said St. Francis is also working with paramedics and ambulance attendants to try and identify strokes quicker in first-response situations.

"It's not that everyone who gets this drug is going to have their stroke symptoms completely disappear," Byrd said. "It's just the first treatment that we've had that can reduce the disability that occurs with a stroke. "Disability is what most people fear."