Brain Attack

Globally more people are falling to strokes than ever before and the numbers are only rising making them the leading cause of disability and an important contributor to health care burden and costs. Two hundred / lakh population suffer from strokes resulting in death or, worse, crippling disability. Every year, the number of new cases are swelling by 790,000 in the US alone and one out of every 20 deaths is due to Stroke . In India, owing to lack of reliable data, it is difficult even to estimate the scale of its prevalence. The study published by S K Das from Kolkata has shown the incidence of 123 per 1,00,000 per year. However, it is known that a considerable number of stroke victims in India continue to opt for untested alternative therapies over modern medicine despite the path-breaking progress made by neuroscience highlighting the gap between scientific care and its accessibility to the masses: only some of the advances in neuroscience, in effect, pass through to the masses.

One reason is that a majority of people including members of the medical fraternity are unaware of treatment options, particularly in rural areas. In other words, only some of the scientific progress translate into real benefits, which imperils the progress ofmedicine itself as it is not possible to validate the time, money and effort spent on medical innovations without proper data

This is sad, particularly in the context of the exciting progress made in recent times across the medical spectrum, from innovative clinical trialsto effective therapeutic options like medication, thrombolysis and interventions. The guidelines from all this work have underscored the role of endarterectomy and provided clear indications for endovascular interventions. Recent ESCAPE trial spotlights the benefit of endovascular thrombectomy in fresh MCA occlusions. However, such valuable information doesn’t reach end users despite the all-pervasive growth of IT and is a sign of collective failure of the entire medical fraternity.

The implications are far-reaching as a majority of people are deprived of the benefits of the latest trends and innovations even as alternative therapies continue to thrive, feeding on ignorance. The so called “golden hour” interventions are at the mercy of logistic logjams and are, therefore, inconsistent and ineffective.

There is no doubt that all of us are hamstrung by shortage of man-power, training, infrastructure and affordable access to state-of-the-art care methodologies. But so are other medical streams, notably cardiology, which has fared dramatically better in creating mass-level awareness. Patients and doctors are far more aware of heart attacks and they respond much better to them than say to a stroke. Off course the fear of death could be the main reason for such a response but driving force; but it is also owing to consistent efforts of specialists over a long period of time.

Although the risk factors associated with a brain stroke and a heart attack are very similar, the responses are entirely different. Even more than in the case of the heart, timely intervention in a brain incident can yield higher long-term benefits when it comes to quality of life and costs. Hence responses to brain strokes must at least match cardiac standards. This is clearly the need of the hour. Awareness regarding early cerebral angiography and timely interventions needs to grow manifold across general populations and medical fraternities.

Brain attack as a concept needs to be uniformly adopted and relentlessly promoted. We can ride on such a wave of rising awareness and reap rich social benefits. Creation of awareness among medical and paramedical professionals, resolution of logistic hurdles, constant upgradation of skills, effective implementation and cost effective solutions are the priorities.

The expression Brain Attack must connote to all forms of stroke: ischemic, hemorrhagic (brain hemorrhage), subarachnoid haemorrhage and cerebral venous thrombosis to ensure a comprehensive approach, optimize resources and avoid duplication of efforts. Measures like creation of awareness and designated centres, early diagnosis, rapid reach and timely intervention will vastly improve clinical outcomes. Both brain and heart attacks are primarily diseases of the vessels and, therefore, are characterized by similar risk factors and require similar prevention and treatment options. Medical and public response systems should, therefore, be complimentary rather than contradictory. Treating a heart attack in a CCU is considered a gold standard, and it’s time that every stroke patient too gets similar care in a dedicated Stroke ICU. Creating awareness, establishing protocols that suit local needs and execution should be the mandate for the future. The need and demand are huge and ever growing calling for a robust and comprehensive system designed to offer end-to-end solutions. Integrated team work among neuro-physicians, neuro-surgeons, neuro-sonologists interventionists and neuro radiologists is the way forward. Other areas like prevention programmes and diet, rehabilitation would have to play a complimentary role. Currently existing facilities and programmes in the country are quite dismal. The magnitude of the problem warrants a comprehensive national programme dedicated to “brain attack.” The need for planning, training, data management, participation, validation of therapies and constant improvisation cannot be over-emphasised.

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