Cellular and Molecular Targets for Non-Invasive, Non-Pharmacological Therapeutic/Rehabilitative Interventions in Acute Ischemic Stroke.

Gelu Onose,Aurelian Anghelescu,Florentina Firan,Vlad Ciobanu,Mihaela Oprea,Constantin Munteanu,Anca Ionescu,Cristina Daia,Ștefan Busnatu,Cristina Popescu,Aura Spinu,Dan Blendea

doi:10.3390/ijms23020907

Abstract

BACKGROUND: Cerebral circulation delivers the blood flow to the brain through a dedicated network of sanguine vessels. A healthy human brain can regulate cerebral blood flow (CBF) according to any physiological or pathological challenges. The brain is protected by its self-regulatory mechanisms, which are dependent on neuronal and support cellular populations, including endothelial ones, as well as metabolic, and even myogenic factors. OBJECTIVES: Accumulating data suggest that “non-pharmacological” approaches might provide new opportunities for stroke therapy, such as electro-/acupuncture, hyperbaric oxygen therapy, hypothermia/cooling, photobiomodulation, therapeutic gases, transcranial direct current stimulations, or transcranial magnetic stimulations. We reviewed the recent data on the mechanisms and clinical implications of these non-pharmaceutical treatments. METHODS: To present the state-of-the-art for currently available non-invasive, non-pharmacological-related interventions in acute ischemic stroke, we accomplished this synthetic and systematic literature review based on the Preferred Reporting Items for Systematic Principles Reviews and Meta-Analyses (PRISMA). RESULTS: The initial number of obtained articles was 313. After fulfilling the five steps in the filtering/selection methodology, 54 fully eligible papers were selected for synthetic review. We enhanced our documentation with other bibliographic resources connected to our subject, identified in the literature within a non-standardized search, to fill the knowledge gaps. Fifteen clinical trials were also identified. DISCUSSION: Non-invasive, non-pharmacological therapeutic/rehabilitative interventions for acute ischemic stroke are mainly holistic therapies. Therefore, most of them are not yet routinely used in clinical practice, despite some possible beneficial effects, which have yet to be supplementarily proven in more related studies. Moreover, few of the identified clinical trials are already completed and most do not have final results. CONCLUSIONS: This review synthesizes the current findings on acute ischemic stroke therapeutic/rehabilitative interventions, described as non-invasive and non-pharmacological.

Highlights

Stroke is a significant cause of death or long-term disability, with a severe negative impact on the affected individuals, their kin, and society, and a global incidence of one in every six people
We have interrogated, employing specific keyword combinations, five international medical databases: Elsevier, National Center for Biotechnology Information (NCBI)/PubMed, NCBI/PubMed Central (PMC), Physiotherapy Evidence Database (PEDro), and—to verify whether the works found are published in ISI-indexed journals—the renowned ISI Web of Science database
We enhanced our documentation with other bibliographic resources with an overall connection to our subject, identified in the literature with a non-standardized search, to fill the knowledge gaps

Summary

Introduction

Stroke is a significant cause of death or long-term disability, with a severe negative impact on the affected individuals, their kin, and society, and a global incidence of one in every six people. The ischemic stroke is a transient or permanent interruption of the blood supply into/through the cerebral vasculature. Acute stroke patients subject to reperfusion intervention with recombinant tissue plasminogen activator (rtPA) are at greater risk of developing seizures than non-treated patients [8]. METHODS: To present the state-of-the-art for currently available non-invasive, nonpharmacological-related interventions in acute ischemic stroke, we accomplished this synthetic and systematic literature review based on the Preferred Reporting Items for Systematic Principles Reviews and Meta-Analyses (PRISMA). DISCUSSION: Non-invasive, non-pharmacological therapeutic/rehabilitative interventions for acute ischemic stroke are mainly holistic therapies. Few of the identified clinical trials are already completed and most do not have final results. CONCLUSIONS: This review synthesizes the current findings on acute ischemic stroke therapeutic/rehabilitative interventions, described as non-invasive and non-pharmacological

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