Hyperbaric oxygen should be used far more often in stroke survivors than it is. Hyperbaric oxygen is safe-the patient is only exposed to oxygen for crying out loud! Hyperbaric oxygen therapy for stroke may not reach the level of proof of efficacy to satisfy government bureaucrats or academic know-it-alls, but these two groups are rarely motivated by logic. The threshold for treating strokes with hyperbaric oxygen should be low, because the risks are low and the potential benefits are high. A real problem, however, is that in the earliest stage of a stroke, hyperbaric oxygen is not practical because it is not generally available. Good ways to reduce stroke damage in the earliest stage would be welcome. TPA is the only drug we have at the moment.
An interesting study came out recently showing that minocycline is very promising for early intervention in ischemic stroke. Minocycline is highly neuroprotective in animal models and there is even some preliminary evidence in stroke patients. Patients were responsive to low doses of minocycline up to 24 hours after the onset of stroke, providing a much longer treatment-opportunity window than TPA.
Because minocycline has been around for so many years and is so cheap, don’t expect the pharmaceutical industry to pay for the extraordinarily costly research that the government would demand before granting an indication for treatment of stroke. And, of course, don’t expect your typical academic neurologist to treat stroke patients with minocycline-unless they happen to be involved in minocycline research. No, the typical academic will tut-tut about the data and intone that a large, double-blind prospective study must be done first.
I hope I don’t have a stroke any time soon, but if I do, I will make sure I’m given IV minocycline.