Research-Evidence-Practice Gaps in Post-stroke Neuro-recovery Pharmacological Therapies in Asia

Our recently-published systematic-search-and-review identified eight registered treatments with level A or B-R evidence of improving neuro-recovery after a stroke. In this study, we aimed to assess their availability, usage, and recommendation in national guidelines in different Asian countries or regions.

We conducted a survey on availability, estimated usage in stroke patients, inclusion in local stroke guidelines, and if they believed more clinical trials were necessary for nimodipine, edaravone, cinepazide, clomethiazole, selective-serotonin reuptake inhibitors (SSRIs), MLC601/MLC901, cerebrolysin and panax notoginseng among leading neurologists from 21 countries or regions in Asia.

Nimodipine and SSRIs are the most widely available across countries or regions in Asia. National stroke guidelines uniformly recommend nimodipine for SAH, while SSRIs are indicated and used for post-stroke depression. Edaravone, MLC601/ MLC901, cerebrolysin and panax notoginseng are available in about a third to half of the countries or regions surveyed, while cinepazide and clomethiazole are generally unavailable. Even when available, usage is low particularly when not in the national guidelines. Further clinical trials are often desired on treatments that are not widely available or in the guidelines.

We found research-evidence-practice gaps in several post-stroke treatments for neuro-recovery, particularly in terms of availability and inclusion in clinical guidelines. Bridging the gap between research and practice will be crucial to improve patient outcome.