Moderator of 1 Session
Presenter of 2 Presentations
Vagal Nerve Stimulation for Motor Recovery
Abstract
Abstract Body
This talk will cover the preclinical and clinical evidence for use of vagus nerve stimulation paired with intensive rehabilitation for upper limb motor recovery after ischemic stroke. The main focus will be on review of the latest clinical data but also consideration of next steps, both for research and for clinical implementation.
The therapy protocols used in the clinical studies will be described along with the experiences of a home exercise programme repaired with vagus nerve stimulation.
XANTHINE OXIDASE INHIBITION FOR IMPROVEMENT OF LONG-TERM OUTCOMES FOLLOWING ISCHAEMIC STROKE AND TRANSIENT ISCHAEMIC ATTACK (XILO-FIST)
Abstract
Background and Aims
People who suffer an ischaemic stroke are at risk of recurrent vascular events. We assessed whether allopurinol, a xanthine oxidase inhibitor, reduced white matter hyperintensity progression (WMH) and systolic blood pressure (SBP) following ischaemic stroke.
Methods
In this multicenter, prospective, randomised, blinded, controlled trial we assigned participants within 30-days of ischaemic stroke or TIA to receive allopurinol 300mg twice daily or placebo for 104 weeks (registration number NCT02122718). All participants had brain MRI performed at baseline and week 104 and ambulatory blood pressure monitoring at baseline, week 4 and week 104. The primary outcome was the WMH Rotterdam Progression Score (RPS). Secondary outcomes included change in day-time SBP. Analyses were by intention to treat.
Results
We randomised 464 participants (232 per group). A total of 372 (189 with placebo and 183 with allopurinol) attended for week 104 MRI and were included in analysis of the primary outcome. The RPS was 1.33 (SD 1.79) with allopurinol and 1.51 (SD 1.89) with placebo, between group difference -0.17, 95% CI -0.52 to 0.17, p=0.33. The change in day-time SBP at week 4 was -2.3 mmHg (SD 12.92) with allopurinol and 0.8 (SD 10.74) with placebo, between group difference -3.33, 95% CI -5.55 to -1.11, p=0.0034. At week 104, the between group difference in day-time SBP was -2.95 mmHg, 95% CI -6.00 to 0.10, p=0.058.
Conclusions
Allopurinol use did not reduce WMH progression in people with recent ischaemic stroke or TIA but did lower SBP. Further research should explore whether this blood pressure change is clinically important.