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Therapeutic hypothermia in acute ischemic stroke
Heleen den Hertog1, Bart van der Worp, Maarten van Gemert
1Deparment of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. m.denhertog@erasmusmc.nl
Expert Review of Neurotherapeutics
|February 9, 2007
Summary
Fever after stroke is common and linked to worse outcomes. While cooling methods show promise in animal studies, clinical trials are needed to confirm their safety and effectiveness in humans.
Area of Science:
- Neurology
- Critical Care Medicine
- Therapeutics
Background:
- Elevated body temperature is frequently observed during the acute phase of stroke and is associated with poorer patient outcomes.
- Experimental studies in focal cerebral ischemia demonstrate that early hypothermia significantly reduces infarct volume, suggesting a neuroprotective effect.
- Current clinical evidence regarding the safety and feasibility of physical cooling methods in acute stroke patients remains uncertain.
Purpose of the Study:
- To evaluate the current evidence on physical and pharmacological methods for reducing body temperature in acute stroke patients.
- To assess the established safety and feasibility of these cooling interventions.
- To identify the need for further research, particularly large randomized clinical trials.
Main Methods:
- Review of experimental and clinical studies on body temperature management in acute stroke.
- Analysis of findings from Phase II clinical trials investigating physical cooling methods.
- Examination of current treatment guidelines regarding antipyretics for fever reduction in stroke.
Main Results:
- Animal studies consistently show reduced infarct volume with early hypothermia in focal cerebral ischemia.
- Several Phase II clinical trials have explored physical cooling methods, but their feasibility and safety are not yet definitively established.
- Antipyretics are generally recommended for fever in stroke treatment, but their impact on functional outcomes is unknown, and evidence from randomized trials for routine cooling is lacking.
Conclusions:
- There is currently insufficient evidence from randomized trials to support the routine use of physical or pharmacological cooling for improving functional outcomes in acute stroke.
- Further large-scale randomized clinical trials are essential to determine the efficacy and safety of both physical and medical cooling strategies in stroke patients.
- Investigating the precise impact of fever reduction on functional recovery after stroke is a critical area for future research.
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