STROKE AND FUNCTIONAL REHABILITATION - THE CHINESE EXPERIENCE

According to an epidemiological study of cerebrovascular disease carri ed out in China in 1986, the prevalence, incidence, and mortality rate s were 159.93/ 100,000, 115.61/100,000, and 31.33/100,000, respectivel y. These figures were high compared to available epidemiological data for the rest of the world. This highlights the fact that, as in other countries, functional rehabilitation after stroke is an important medi cal and social need in China. Clinical experience shows that within a few hours to a few months after a stroke, a large proportion of patien ts spontaneously experience partial, or on occasion, complete recovery from neurologic symptoms. However, functional rehabilitation in medic al care units is required because it assists in and accelerates the re covery of impaired function. Almitrine-raubasine has been used to impr ove functional rehabilitation after stroke for some time in China. By enriching the oxygen content of arterial blood, it brings more oxygen to the cerebral tissues and therefore promotes cerebral aerobic metabo lism during ischemia. In the acute phase of stroke, positron emission tomography showed, in man, that almitrine-raubasine helps normalize th e ischemic penumbra area, as shown by an improvement in the coupling b etween oxygenation and perfusion. Long after stroke, single photon emi ssion computed tomography showed that almitrine-raubasine restores nor mal cerebral vasodilator response to acetazolamide. With a view to fur ther documenting the clinical efficacy of almitrine-raubasine on the c onvalescent period of patients with cerebrovascular disease, a double- blind, placebo-controlled study is planned. One hundred patients with ischemic cerebrovascular disease in the territory of the carotid arter y will be included 4-6 weeks after the acute onset. Two tablets daily of almitrine-raubasine or placebo will be prescribed for 3-6 months. B efore treatment, there will be a 2-week washout period for all other d rugs, except for antihypertensive and antidiabetic drugs. In addition to complete clinical monthly examinations, neurological functional def icit scores, Barthel index, Hasagawa Dementia scales, and CT scan are scheduled. The study results should confirm those reported in the scie ntific literature: although untreated patients may show spontaneous im provement, almitrine-raubasine should accelerate patients' functional rehabilitation.