With one person suffering a stroke every ten minutes the effects of this disease has an impact on all of us.
Restoring physical and mental well-being to stroke patients is the focus of the Stroke Treatment Trial at the Menzies Health Institute Queensland. For National Stroke Week, 31 August – 6 September, Associate Professor Stephen Ralph, Griffith University, and Associate Professor Coralie Graham, University of Southern Queensland, talk about the trial and their research.
What is a stroke?
A stroke is a sudden interruption in the blood supply of the brain. Most strokes are caused by an abrupt blockage of arteries leading to the brain. Other strokes are caused when a blood vessel breaks and bleeding occurs into an area of the brain.
Every stroke is different. The symptoms and effects vary according to the type of stroke, the part of the brain affected and the size of the damaged area. For some people, the symptoms are severe, for others they are mild.
Australian stroke statistics
According to the Brain Foundation, stroke is the third most common cause of death in Australia and a leading cause of disability. About 55,000 Australians have strokes annually, 73% of these being first-ever strokes. Of all the neurological disorders stroke is the largest single cause of adult disability.
Q&A with Associate Professors Stephen Ralph and Coralie Graham
What sparked your passion for stroke research?
Coralie: I have been a Registered Nurse for the last 40 years and my interest in neurological injury led to me completing a degree in psychology. As a student I had an amazing teacher, a neurosurgeon who knew I was interested in neurology so included me in his cases.
But primarily my psychology degree and passion for stroke research was driven by my middle son who suffered a brain injury when he was three years old. The injury affected him on a cell level much like stroke. Then 60 minutes did a feature story on stroke and a new treatment in the US using the drug Etanercept (Enbrel). Used for many years as a therapy to treat inflammatory diseases, such as rheumatoid arthritis, a doctor in the US had begun using the drug to treat strokes. After much research, I took my son to the US for treatment using Etanercept and it dramatically changed the quality of his life for the better. I contacted many scientists and that is how I met Steve and ended up collaborating with Griffith as lead on their second stroke treatment trial.
Steve: Similar to Coralie, my awareness of stroke treatments came about due to one of my friends developing dementia. I also watched a 60 minutes story about this amazing new treatment using Etanercept that had been tested in the US and approved by the US Federal Drug Administration. So I called the doctor/ inventor in the States who was great but who confirmed that no clinical trials using the drug to treat strokes had been undertaken.
What were the outcomes from the initial Stroke Trial in 2019?
Our results were startling. We recorded a significant decrease in pain levels and a significant improvement in mobility. Traditionally injections or medication with a large molecular size have not been able to bypass the blood-brain barrier so injections must go through the spinal cord which is far riskier. With the peri spinal route of delivery, Etanercept bypasses the blood-brain barrier and we saw changes in behaviour and mobility within 15 to 30 minutes.
It is amazing to see patients go back to a more normal life and to re-engage socially.
What is the focus of the current Stroke Treatment Trial?
Whilst the first trial at Griffith focussed on post stroke pain, the second trial will focus on a broader range of strokes, and with a focus on post stroke fatigue. Fatigue is a major problem as it prevents stroke suffers from returning to work, engaging socially and leading an active life.
Currently we are recruiting for stroke patients and we plan to complete the trial by the end of February 2021. In conjunction with scientists and doctors in the US who are working in this area, we are writing a Perispinal Etanercept Treatment Practice Advisory which will outline the criteria to be applied to any clinical trial investigating this treatment.
Does your research have broad impact?
Neurological suffering is one of the worse sufferings. We see our research as having broader application for other neurological and psychological conditions where neurological inflammation is part of the pathology, not being restricted to stroke. Our research also has huge potential in the area of repeated post-concussion injury, most evident in boxers and football players.
Our research builds medical insight into our understanding of brain function and the molecules regulating it. Etanercept is used by millions for rheumatoid arthritis – we just need to take the leap.
Also working with the trial team from the University of Southern Queensland is Professor Odette Best, an Aboriginal Registered Nurse of 31 years and a recognised leader for her research and passion for Indigenous health. In general, the rate of stroke is one in six but for the Indigenous peoples this rate is two to three times higher – and they have less access to culturally safe care. This research will work towards Closing-the-Gap in Indigenous populations.
How can people become involved?
Currently we are recruiting stroke patients for the second clinical trial. If you are interested in participating and have not previously had the treatment, please send an email with your details to: [email protected]
We are looking for funding support and encourage people to donate (tax-deductable $2 and over) to stroke research at Griffith University by:
- choosing Stroke Research from the dropdown menu at https://app.secure.griffith.edu.au/donations/info.php
- making a tax-deductable donation ($2 and over) to the Stroke Recovery Trial Fund LTD
Ultimately it is important to create general awareness and to advocate for our research into the treatment of stroke. Please share this blog, have conversations with your family and friends, and advocate for action.
Trial research outcomes
The stroke trial’s outcomes and findings along with further stroke research is available through our open access research on Griffith Research Online:
- Phase I/II parallel double-blind randomized controlled clinical trial of perispinal etanercept for chronic stroke: improved mobility and pain alleviation
- Phase I/II parallel double-blind randomized controlled clinical trial of perispinal etanercept for chronic stroke (research data)
- Undetected and underserved: The untold story of patients who had a minor stroke: Equity of access is particularly concerning for minor stroke
- Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation
- Evaluation of adult stroke presentations at an Emergency Department in Queensland Australia
- Meeting unmet needs following minor stroke: the SUN randomised controlled trial protocol
- The utility of the brain trauma evidence to inform paramedic rapid sequence intubation in out-of-hospital stroke
- Clarifying the Nature and Extent of Prospective Memory Impairment after Stroke
- Adjusting to Life after Stroke: A Theoretical Model Based on Survivor Experience
Access Griffith Research Online for more research on stroke.