脳卒中における最先端医療とその将来

Abstract

In the begining of this century, a dramatic increase of stroke patients is expected in concomitant with continuous increase of older-age population in the developed countries. There are three major phases for stroke management: primary prevention, treatment at acute and chronic phases of stroke. First, we focused on the importance of effective population approach for reducing the mean level of causative risk factors. Selfrating stroke risk scoring system should be developed and prevailed by using modern information technology. Among people at particularly high risk of stroke, genome-based tailor-made prevention strategy should be established. Through the basic research on 'ischemic tolerance', vaccination against stroke should also be developed in the future. Second, we focust on effective treatment of brain attack by establishing primary stroke centers, where other than thrombolytic therapy neuroprotective approaches such as mild hypothermia and gene theapies would become possible. Finally, we focused on the importance of secondary prevention based on pathophysiological mechanism of each patient and well-organized comprehensive rehabilitation based on the promotion of understanding of molecular mechanism of neuronal prasticity. Regenerative medicine such as stem cell seeding and promotion of neurogenesis in the damaged brain should be developed for chronic phase of patients in the near future.