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Stroke in Europe

Stroke in Europe. Prof. Didier Leys University Lille North of France Department of Neurology Stroke centre. ___________________________________ Disclosures : No stocks from pharmaceutical / device companies. No travel paid by pharmaceutical /device companies.

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Stroke in Europe

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  1. Stroke in Europe Prof. Didier Leys University Lille North of France Department of Neurology Stroke centre • ___________________________________ • Disclosures : • No stocks from pharmaceutical / device companies. • No travel paid by pharmaceutical /device companies. • Participation during the last 5 years to trials, advisory boards, or symposia sponsored by Sanofi Aventis, BMS, Astrazeneca, Boeringher-Ingelheim, Servier, Ebewe, CoLucid Pharm, Brainsgate, Photothera, Lundbeck, GSK, Bayer and Allergan(honoraria paid to Adrinord). • Served as editor of the Journal of neurology, neurosurgery and psychiatry until 2010(personal incomes).

  2. Background • Stroke: major public health issue • Frequent • Important killer • Often leave patients with residual disability • High risk of delayed complications • Most are preventable • Many are treatable • Leads to important direct and indirect costs

  3. Types of strokes

  4. Types of strokes • Ischaemic strokes • Large-vessel atherosclerosis • Cardio-embolism • Small-vessel occlusion • Other definite causes • Unknown and undetermined

  5. Types of strokes • Intra cerebral haemorrhages • Deep • Lipohyalinosis +++ • Focal lesions (tumours, AVM, cavernomas …) • Lobar • Cerebral venous thrombosis • Amyloid angiopathy • Focal lesions (tumours, AVM, cavernomas …)

  6. Burden of stroke

  7. Incidence • 2,400 new cases / 1 million inhabitants / year • Higher than that of myocardial infarction

  8. Prevalence • 12,000 prevalent cases / million inhabitants Prevalence of major diseases in the elderly (%) in Rotterdam Stroke TIA MI PAD AA AD PD 55-642.0 0.9 2.6 0.9 1.2 0.2 0.3 65-74 4.2 1.7 5.62.0 2.5 0.9 1.0 75-84 7.82.3 6.2 2.9 4.7 7.4 3.1 85 + 11.0 2.2 4.4 4.1 6.2 26.84.3

  9. Mortality

  10. Time-trends • What is expected for the next years ? • Increase in incidence • Increased survival after coronary events • Increased survival after stroke when adjusted on age • Ageing of EU population • Stability in case-fatality rates • Decreased case-fatality rate per age-category • Decreased severity (prevention) • Improvement of acute care • Changes in case-mix over time • Ageing of EU population

  11. Risk factors

  12. Risk factors • Non-modifiable • Increasing age • Male gender • Non-white ethnicity • Genetics • Migraine • Modifiable • High blood pressure • High cholesterol (LDL) • Smoking • Diabetes • Overweight • Alcohol • Oral contraceptive therapy • Hormonal replacement therapy • SAS

  13. Acute stroke therapies

  14. Acute ischaemic stroke therapies

  15. Thrombolysis N=2776 End point: mRS 0-1 1h30 3h00 4h30 6h00

  16. Decompressive surgery Volume : 259 cc

  17. Experimental therapies

  18. Acute ICH therapies • Correction of haemostatic disorders (no evidence)

  19. Acute ICH therapies • Control or blood pressure(some evidence)

  20. Acute ICH therapies • Sometimes surgery (no evidence)

  21. Stroke prevention

  22. Stroke prevention.

  23. Stroke prevention.

  24. Long-term complications

  25. Late epileptic seizures

  26. Dementia • 1/10 first-ever stroke patients is already demented • 3/10 with recurrent strokes are already demented • 1/3 patient was or will be demented after stroke • 50% of dementia after stroke are of Alzheimer type

  27. Depression • More than 50% of stroke patients will develop depressive symptoms • Depressive syndromes are rare however (< 10%)

  28. What is available in the E.U. for stroke care ?

  29. Stroke care in the E.U.

  30. Stroke care in the E.U. • Denmark (8) • Finland (8) • Norway (8) • Sweden (14) • Belgium (9) • Netherlands (20) • Luxemburg (2) • Estonia (6) • Latvia (11) • Lithuania (11) • UK (120) • Ireland (6) • Czech Republic (15) • Hungary (15) • Poland (77) • Slovakia (8) • Slovenia (3) • France (121) • Switzerland (11) • Germany (166) • Austria (12) • Spain (86) • Portugal (16) • Italy (116) • Greece (17)

  31. Stroke care in the E.U.

  32. Is Europe the appropriate level ?

  33. Is Europe the appropriate level ?

  34. Priorities for the next decade

  35. Priorities for the next decade • Cliquez pour modifier les styles du texte du masque • Deuxième niveau • Troisième niveau • Quatrième niveau • Cinquième niveau

  36. Priorities for the next decade • Aim of the synergium : • To devise and prioritise new ways of accelerating progress in reducing the risks, effects and consequences of stroke • Method : • Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. • The resulting draft document had further input from contributors outside the synergium

  37. Priorities for the next decade • Basic science, drug development and technology • There is a need to develop • New systems of working together to break down the prevalent “silo” mentality • New models of vertically integrated basic, clinical, and epidemiological disciplines • Efficient methods of identifying other relevant areas of science.

  38. Priorities for the next decade • Stroke prevention • There is a need to develop • Establish a global chronic disease prevention initiative with stroke as a major focus. • Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. • Develop, implement and evaluate a population approach for stroke prevention. • Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques.

  39. Priorities for the next decade • Acute Stroke management • There is a need to continue the establishment of • Stroke centers, • Regional systems of emergency stroke care • Telestroke networks.

  40. Priorities for the next decade • Brain recovery and rehabilitation • There is a need to: • Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. • Standardise poststroke rehabilitation based on best evidence. • Develop consensus on, then implementation of, standardized clinical and surrogate assessments. • Carry out rigorous clinical research to advance stroke recovery.

  41. Priorities for the next decade • Into the 21st century : web, technology, communication • There is a need to: • Work toward global unrestricted access to stroke-related information. • Build centralised electronic archives and registries • Foster cooperation amongst stakeholders to enhance stroke care: • large stroke organisations, nongovernmental organisations, governments, patient organisations and industry • Educate professionals, patients, public, and policy makers

  42. Priorities for the next decade • The cost of underfunding stroke care

  43. Priorities for the next decade • The cost of underfunding stroke care

  44. For more information http://www.eso-stroke.org

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