A QUICK FIX FOR STROKES

By Christine Gorman

Of all the medical catastrophes that can befall a person, suffering a stroke is one of the most terrifying. Suddenly, your arm goes numb. You can't speak. Half your body becomes useless. Until recently, doctors could do little more than watch as their stroke patients either recovered on their own or became permanently paralyzed. Then researchers determined that a drug called tissue plasminogen activator, or TPA, which has been used for years to treat heart attacks, can also alter the course of a stroke. But many physicians wouldn't try the new treatment because there is also a chance that it can make a stroke patient's condition worse. That reluctance may begin to fade now. The American Heart Association, having reviewed the data, last week issued new guidelines that should help doctors use the drug safely and effectively.

Half a million Americans suffer strokes each year. Four times out of five, the cause is a wayward clot that blocks an artery and robs the brain of oxygen-rich blood. Nerve cells start to die, depriving key parts of the body of the cerebral instructions they need to function. TPA can change all that by dissolving the clot and restoring blood flow before any damage is done to the brain. "It's the first bright sign that we've had that something we're doing actually works," says Dr. Cathy Helgason, a professor of neurology at the University of Illinois who helped to write the A.H.A. guidelines. "Our research is paying off."

As the guidelines make clear, the key to successful treatment is two-fold. Doctors must first determine, by performing a cat scan, that the stroke is indeed being caused by a clot and not by a leaky artery. (In such cases, called hemorrhagic stroke, clotting is actually beneficial because it stops the loss of blood.) Then the physicians must ensure that less than three hours have elapsed since the stroke's onset. Otherwise the risk of bleeding into the brain is too great.

Even if patients can't be given TPA, it's important for them to get to the hospital--and, if possible, to a specialized stroke-treatment center--as fast as they can. Neurologists have developed several other treatments to minimize stroke damage. For example, many patients become dehydrated, which slows down blood flow to the brain. By giving these patients intravenous liquids, doctors can correct the balance in the blood and prevent further damage.

For stroke victims who are treated quickly enough, however, TPA can literally give them back their life. Four weeks ago, Dr. Virendra Bisla, 49, was in a hospital outside Chicago, making rounds, when he suddenly found himself leaning against the wall. "The nurses kept asking me if I was all right," the cardiologist recalls. But even though Bisla could understand everything they said, he couldn't respond. They wheeled him to the emergency room, where doctors determined that he was suffering a stroke. Soon after, they transferred him to the specialized stroke center at the University of Illinois, where he was given TPA. "Just three hours after receiving the medication, I was able to talk again," Bisla marvels. His walk is almost normal now, and he's seeing his own patients part time. "It feels so good to be able to smile and talk." he says. "Truly, this is a miracle drug."

--By Christine Gorman