17 - Neuropharmacology in stroke recovery  pp. 183-194

Neuropharmacology in stroke recovery

By Isabelle Loubinoux and François Chollet

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Introduction

Clinicians have long recognized that most stroke survivors recover over time, albeit to varying degrees. Until now, rTPA thrombolysis within the first hours of the stroke is recognized as the only validated treatment able to improve the spontaneous – and most of the time incomplete – recovery of neurological functions after stroke. However, we have learnt from research over the last decade, in part based on the considerable improvement of neuroimaging techniques, that spontaneous recovery of neurological functions was associated with a large intracerebral reorganization of the damaged human brain (see Chapters 9–13). Recruitment of remote functional areas, overactivation of primary cortices, and changes in cortical maps are now considered as the physiological substratum of clinical recovery. Moreover, it has now been demonstrated that brain post-stroke plasticity can be modulated in order to reduce the residual neurological deficit and the subsequent disability. Rehabilitation, rTMS, peripheral stimulations, local anesthetic blocks, drugs, and other interventions have demonstrated in certain conditions a capacity to induce an intracerebral reorganization after focal lesion (see also Chapters 18–24). All are potential therapeutic agents for recovery. They rely on induced functional changes in a damaged intracerebral network. Each of these therapeutic interventions requires extensive validation. We review in this chapter the data concerning drug and other neuropharmacological aspects of the issue. We also address the clinical questions concerning the repair of damaged neuronal networks and potential future therapy using external cellular material.

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