Abstract
SUMMARY Stroke is a major cause of mortality, morbidity, and resource consumption. To reduce this burden, enormous efforts have focused on the development of drugs to limit brain damage. However, a breakthrough has not yet materialised, and data suggest that even if future drug trials do demonstrate a benefit, the overall impact of such drugs will be relatively limited. The pathophysiology of stroke is too complex to be markedly influenced by interruption of one or two components of the ischaemic cascade; intervention needs to be very soon post‐stroke; and multiple pre‐existing diseases and disabilities in elderly patients diminish their scope for recovery. In contrast, wider application of primary prevention, secondary prevention, and better organisation of services (eg setting up stroke units), could have a far greater effect on public health. Despite considerable enthusiasm for drug therapy in acute stroke, it is likely that the overall potential of such therapy will be disappointing.
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