Sutter Hospitals treat stroke patients with new drugs

Aphasia is a debilitating condition that deprives a person of the ability to speak or understand speech.

The case came to light with the announcement last week that confinement had forced actor Bruce Willis to retire.

Stroke is the number one cause of disorders that affect speech and lead to aphasia in a quarter to a third of cases. Traumatic brain injury, autoimmune disease, or a brain tumor may also cause aphasia.

“It limits all the things you can do,” said Dr. Manoj Mittal, director of stroke and neurocritical care at Sutter Valley Health District. The doctor said frustration and stress are common for aphasia sufferers.

The increased risk of stroke for middle-aged and younger adults was a health concern prior to the COVID-19 pandemic and has been compounded by community transmission of the virus.

Mittal said in an interview with Zoom last week that people who had minor strokes were afraid to come to hospital emergency departments for fear of contracting COVID-19. Stroke patients coming to hospitals were in serious condition.

Stroke is also a known complication of COVID-19. A heart weakened by COVID-19 could lead to a stroke or the viral illness could thicken the blood, Mittal said, causing blood vessels in the brain to block. Two types of stroke are ischemia, which limits blood flow to part of the brain, and cerebral hemorrhage.

Any loss of speech associated with a stroke may be temporary. Mittal said he saw stroke patients who suddenly lost their speech come home from the hospital and regain their speech the next day. But aphasia can also become a long-term disability.

Willis, who has starred in films including “Die Hard” and “Armageddon,” has reportedly struggled with aphasia as a gradual decline over the years, according to the Los Angeles Times. The reason has not been announced.

Mittal said that some aphasia sufferers find it difficult to understand what others are saying. Some people with this condition can understand speech but are no longer able to express themselves. Disability may vary depending on the location of the affected brain.

Mittal said patients have a better chance of recovering from aphasia once they reach the emergency room.

Doctors often use an intravenous medication to remove a blood clot in the brain that’s causing stroke symptoms. Sutter Hospitals are using a new drug that is considered more effective in the emergency treatment of stroke patients.

Does TNK work best for stroke patients?

Sutter’s representatives said that Tenecteplase, also known as TNK, is more easily given and is three times more effective at removing blood clots than previous standard medications.

Sutter said a drug called alteplase, or “rtPA,” was effective 8% of the time at breaking up clots, while TNK is successful 20% of the time.

Feeding older medication through an intravenous line is an hour-long procedure, but TNK can be given more quickly. The new medicine may start to work sooner. Sutter said patients could be transferred in a shorter time frame to the primary stroke center.

Sutter Hospital in Santa Rosa was the first facility in its network to use tenecteplase. Other Sutter hospitals include Memorial Medical Center in Modesto and Sutter Tracy Community Hospital.

Alteplase and TNK both carry a risk of cerebral hemorrhage. A study published in the New England Journal of Medicine in 2018 found no significant difference in the incidence of cerebral hemorrhage between TNK and the older drug.

Krista Deans, a spokeswoman for Physicians Medical Center, said that Modesto Hospital, which is owned by Tenet Healthcare, has also switched to Tenectiplaz for emergency stroke treatment. She noted that the clot-busting drug was the topic of discussion at this year’s International Stroke Conference.

“One advantage of our region includes the ability to administer this particular drug over a period of a few minutes versus an hour-long injection, which may reduce transfer time from external centers to us, if intervention is required,” Deans said in an email.

Physicians Medical Center recorded a nearly 20% jump in patients initially diagnosed with stroke in 2021, the second year of the COVID pandemic.

Most people have never heard of aphasia

It is estimated that up to 2 million people in the United States suffer from aphasia, although a survey showed that nearly 9 in 10 people are not familiar with the term, according to the American Stroke Association.

The risk of developing aphasia increases with age. After a person’s 60th birthday, the risk of stroke doubles every 10 years.

Speech therapy may help people with aphasia regain their language skills. According to the National Aphasia Association, symptoms that persist for more than two or three months suggest that a full recovery is unlikely, but some people improve over time.

Family support is important for people with aphasia. The American Stroke Association advises family members and caregivers to give the person extra time to communicate. The association recommends the use of communication tools such as writing, facial expressions, picture books, and phone or computer applications.

This story was originally published April 5, 2022 6:30 a.m.

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Ken Carlson covers county government and health care for The Modesto Bee. His coverage of public health, medicine, consumer health issues, and the healthcare business has appeared on The Bee for 15 years.

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