Joint statement of the WSO, ESO, EAN and WFN on stroke on the occasion of the 68th WHO-Europe meeting 2018, Rome

What a fucking pile of lazy shit. NOTHING to address these many problems in stroke. 
And these are our stroke 'leaders'? They all need to be keelhauled.  Awareness, knowledge and 'care'  are useless to stroke survivors. Have you ever talked to a survivor? They all want to get back to their old life, 100% recovery. Get the fuck out of the way and let survivors run things.

1. Only 10% of patients get to full recovery.
2. tPA only fully works to reverse the stroke 12% of the time. Known since 1996.
3. No protocols to prevent your 33% dementia chance post-stroke from an Australian study.
4. Nothing to alleviate your fatigue.
5. Nothing that will cure your spasticity.
6. Nothing on cognitive training unless you find this yourself.
7. No published stroke protocols.
8. No way to compare your stroke hospital results vs. other stroke hospitals.

https://www.wfneurology.org/2018-09-16-WHO-joint-statement-on-stroke#.W59I1bT4IXU.twitter

This statement was jointly prepared by the World and European Stroke Organizations (WSO and ESO), the World Federation and the European Academy of Neurology (WFN and EAN) all of which are specialty societies for neurology and brain health.

Statement

NCDs continue to increase worldwide. Cardiovascular diseases, stroke and dementia are a major concern. Stroke is now ranked the 2nd greatest cause of both disability and death worldwide. Stroke threatens everyone. Stroke causes paralysis of limbs, impairs vision, gait, language and cognition. It contributes to dementia. Of particular concern is the increasing stroke burden in young adults and its effect on keeping employment, as more than 40% of working age adults with stroke fail to return to work.
The burden of stroke disproportionately affects people living in countries with limited resources, also in Europe. Most stroke survivors carry lifelong physical, cognitive, mental, and socio-economic burdens. A significant proportion of European and Global NCD burden can be attributed to stroke and stroke-related dementia. This issue of NCDs, including stroke and dementia, is highlighted at this month's UN High-Level Meeting in New York.
The importance of stroke is acknowledged by the WHO in ICD 11 where stroke is now included as a disease of the nervous system. This most important change will have dramatic impact on the promotion of brain health and the distribution of resources.
For stroke prevention, it is important to know that 90 % of strokes are linked to 10 modifiable risk factors including hypertension, smoking, obesity, physical inactivity, and unhealthy diet. The same factors apply to ischemic heart disease, the other main cause of global disability and death. The occurrence of an acute stroke has to be considered a major emergency which needs a seamless chain of interventions until recovery. Quality care needs to be provided timely by competent personnel and teams across the whole pathway in an organized and audited manner. This kind of access to adequate stroke expertise should be independent of region, time of day and socio-economic status. These stroke facts were highlighted during last year's WFN World Brain Day.
Dementia on the other hand is growing globally with ageing populations, and stroke contributes with other NCDs such as hypertension, heart disease, chronic kidney disease and diabetes mellitus to the development of dementia. Rates of dementia may be reduced by modifying these risk factors and both stroke and dementia may be prevented through coordinated action.
Developments in vascular neurology has made stroke and dementia preventable, treatable and increasingly reversible, thus reducing the burden on patients, families and societies. To ensure these developments are more evenly distributed, we will require national, regional and global efforts to increase awareness, make available quality acute stroke treatment, primary and secondary prevention and rehabilitation.
ESO and the patient organization SAFE (Stroke Action for Europe - https://www.safestroke.eu) have just finalized the Action Plan for Stroke in Europe 2018-2030, which is aligned with the UN's Sustainable Development Goals. The plan has four overarching goals:

1. to reduce the absolute number of strokes in Europe by 10%
2. to treat 90 % or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care
3. to have national plans for stroke encompassing the entire chain of care, and
4. to fully implement national strategies for multisector public health interventions

In this context WSO, ESO, EAN and WFN call upon the WHO European Regional Committee to support its member states to increase their efforts based on these three domains:

1. Awareness: WHO-Europe should help to strengthen programs that increase awareness of stroke, as risk factors, therapy and rehabilitation.
   
2. Access: We will support WHO-Europe with its efforts to remove financial barriers for patients for prevention, detection and treatment of NCDs, including European wide health coverage.
   
3. Action: The neurology specialist societies will support WHO-Europe in the development of regional and national strategies, to develop the health-related Sustainable Development Goals, with the goal to reduce premature deaths caused by NCD by one-third by 2030.
   

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About the World Stroke Organization (WSO)

The WSO promotes stroke awareness and knowledge through its annual World Stroke Day, the World Stroke Campaign, and educational programs like the World Stroke Academy. Professionals and searchers benefit from clinical exchange programs, the biannual World Stroke Congress, and the International Journal of Stroke. WSO supports patients with post-stroke checklists, its Roadmap for Quality Stroke Care, and through stroke support organizations. WSO is in official relation with the World Health Organization (WHO).
WSO website: www.world-stroke.org
Contact: mgrupper@world-stroke.org

About the European Stroke Organization (ESO)

The ESO aims to improve stroke care in Europe by promoting awareness, prevention and treatment of all aspects of stroke. Through the annual ESO conference, best practice approaches, the European Stroke Journal, teaching and research, the ESO strives to support and harmonize stroke management by professionals and the lay public. ESO works as the voice of stroke in Europe to develop and promote public policies to reduce stroke's individual and societal burden.
ESO website: www.eso-stroke.org
Contact: esoinfo@eso-stroke.org

About the World Federation of Neurology (WFN)

The World Federation of Neurology (www.wfneurology.org) is a UK charity, devoted to the interest of neurology worldwide. It has presently 120 members, and is regionally represented in the Americas, Asia-Oceania, Arab countries, Africa and Europe. The aim is to "Foster quality neurology and brain health worldwide ". The regional organization in Europe is the European Academy of Neurology (EAN). The WFN has a long tradition of good relations and close cooperation with the WHO, including projects such as WHO Atlas of Neurology, participation in ICD development, and change of stroke classification in ICD 11. At the last WHO meeting in Europe the WFN made a statement on environment and neurology (to be accessed here), and the yearly WFN World Brain Day of 2018 was devoted to environment and pollution. WFN is a non-state actor in official relations with the World Health Organization (WHO).
WFN Websit:e: www.wfneurology.org
Contact: jade@wfneurology.org

About the European Academy of Neurology (EAN) and this statement

The European Academy of Neurology (EAN) was founded to promote "Excellence in Neurology in Europe" and represents 47 European national neurological societies with about 45.000 neurologists. One of the missions of EAN is to increase the availability and standards of neurological services across Europe. Along these lines EAN full heartedly underscores this statement as a) stroke is in the lead of neurologic diseases which cause disability and death and b) inequalities of stroke incidence and care do not only exist in resource poor countries but also across Europe. This has just been recently demonstrated in a pan European survey conducted among others by ESO and EAN (D. Aguiar de Sousa et al., European Stroke Journal 2018). It is important to stress, however, that also several other neurologic diseases such as dementia, movement disorders and epilepsy are on the rise due to the aging of our population and poor recognition and management of vascular risk factors and that this development needs immediate attention because of associated disability, death and socioeconomic consequences.
EAN website: www.ean.org
Contact: Eveline Sipido: sipido@ean.org

 

Experts discuss new therapy options for stroke treatment at EAN Congress

Our fucking failures of stroke associations will not put these out there for public comment by stroke survivors so we can influence which ones are most important. And for sure your doctor and hospital will not do anything innovative with these options. They keep talking about 'care'. Survivors don't fucking care about care, they want results you godamned idiots.
Every time you see articles discussing 'happy talk' about stroke, put this in a reply. We need to change the attitude towards stroke, that it is a complete failure and needs complete rebooting.
My measured response to this article: I was good, no swearing:
This would be much more likely to impress survivors if every time 'care' was used it was replaced with 'results'. I still see no strategy to solve all the problems in stroke, and there are many.
88% failure rate of tPA for full recovery.
Only 10% of patients almost fully recover.
Nothing to cure spasticity.
Nothing to cure fatigue.
Nothing on preventing the likely chance of getting dementia.
No publicly available stroke rehab protocols with efficacy percentages.
No fast and accurate way to diagnose stroke, young persons are badly diagnosed.
http://www.news-medical.net/news/20160530/Experts-discuss-new-therapy-options-for-stroke-treatment-at-EAN-Congress.aspx

There are more well-founded therapy options for the treatment of strokes than ever before(Really?). Care has to be reorganised before these innovations are actually used on patients. At the Congress of the European Academy of Neurology in Copenhagen, experts are discussing just how to do that successfully - from guidelines for the use of thrombectomy procedures all the way to the structure and expansion of stroke care units. Oftentimes, it is precisely the small organisational changes that make the big difference.
Major advances are being made in stroke therapy. Experts at the Second Congress of the European Academy of Neurology (EAN) in Copenhagen are discussing whether or not these innovations are actually used on patients. EAN Vice-President Franz Fazekas, professor at the University Clinic in Graz, Austria: "The only way to make full use of the potential of these new options is to adjust the structures and processes of stroke care to fit the latest findings. This reorganisation must cover the entire chain of care - from the ambulance ride to the precisely defined use of the thrombectomies."
Thrombectomy: new guidelines for application and organisation of care
An increasing number of study results provide evidence of the high degree of effectiveness of thrombectomy, the mechanical removal of blood clots (thrombi) after a stroke. This procedure leads to good results particularly with very long blood clots and large cerebral artery occlusions. More than 60 per cent of patients survive a stroke thanks to this procedure without or with only slight impairment. The relevant European organisations of medical specialists just recently issued a joint therapy recommendation. The consensus paper serves, among other things, as orientation regarding the conditions under which the method should be used and on what types of patients. It defines the ideal window of time and clarifies when intravenous thrombolysis and mechanical thrombectomies should be combined.
Preparations are now underway on further international recommendations. They are supposed to indicate how stroke care has to be organised for thrombectomies to be successfully carried out. Prof Fazekas: "The new paper is supposed to define, for instance, the organisational and personnel requirements that a neurological centre has to meet and how much experience the treating physicians have to bring to the task. The paper is also supposed to describe in great detail how the thrombectomy itself should be performed, from the selection of the suitable instruments to the blood pressure of the patients during the procedure and beyond to post-operative care. Open issues are also supposed to be indicated and efforts made to clarify them through corresponding scientific studies." The guidelines incorporate the collective expertise of six relevant societies, namely the European Academy of Neurology (EAN), the European Association of Neurosurgical Societies (EANS), the European Society of Emergency Medicine (EuSEM), the  European Society of Minimally Invasive Neurological Therapy (ESMINT), the European Society of Neuroradiology (ESNR) and the European Stroke Organisation (ESO).

Prof Fazekas: "We hope that health care managers throughout Europe will greet the guidelines with open ears. Their implementation and the set-up of specialised centres can prevent serious impairments after strokes and save many lives." Every year, 600,000 strokes are reported in Europe and that number is on the rise.
Specialised centres reduce mortality after strokes
A current study being presented at the EAN Congress confirms that optimised care in specialised centres is the right approach to take. Data from more than 9,500 patients from the Danish Stroke Registry shows that the reorganisation of stroke care in Central Region Denmark (CRD) has paid off. Since 2012, patients with typical stroke symptoms have no longer been taken to one of five hospitals but rather to one of two specialised stroke units. Prof Fazekas summarises the main results of the study as follows: "Since this changeover, a larger percentage of patients have received an intravenous thrombolysis within the desired window of time of one hour after contact with the hospital and the percentage of early procedures to eliminate stenosis in the carotid artery have risen. Mortality within 30 days after the stroke was able to be reduced from 10.4 to 8.2 per cent."
MRI examination as an optimum way to support therapy
Which diagnostic procedure yields the biggest benefit? That too is a question being explored at the EAN Congress. Two Danish studies covering 444 stroke patients show, for example, that an MRI examination is an essential aid for the treating physicians in helping them to take the right decision regarding therapy. This examination to determine a stroke takes an average of 7.5 minutes longer than a computer tomography, however. Prof Fazekas comments on the findings of his Danish colleagues as follows: "The ultimate principle is to minimize door-to-needle time, i.e. the time between arrival at the hospital and the beginning of thrombolysis. That said, the findings presented show that the better imaging diagnostic method with a precisely fitting therapy decision apparently pays off." At the same time, the researchers also point out ways to make up for the lost time, namely by eliminating other organisational factors that cause delays; for instance, having only experienced physicians indicate the examination and improving organisational procedures.
An Italian study presented in Copenhagen on the reorganisation of stroke care in Lombardy shows, in addition, that patients with stroke symptoms end up undergoing a thrombolysis if they are delivered by ambulance right away and classified as an emergency with the highest priority. Prof Fazekas: "This is another adjusting screw we can turn to make optimum use of the new therapy options."

Source:

European Academy of Neurology