After strike one

CHINA - Better education is needed in China so the symptoms of a stroke are recognised. Otherwise, many patients miss out prevention and treatment because vital signs are missed that could save their lives. Wang Hongyi speaks to experts in Shanghai.

The incidences of strokes in Western countries are relatively well controlled, thanks to informed efforts by government, medical and social organisations, according to Yang Guoyuan, a professor from Med-X Research Institute of Shanghai Jiao Tong University. But not so in China. The Chinese are still vague about what stroke really is, and they often fail to recognise the early signs due to a lack of awareness and the absence of proper public education.

"In China, many people still have no idea what a stroke is, and don't recognise the early signs. Consequently, they delay treatment," Yang says.

Strokes happen when the blood supply to the brain is blocked or when a blood vessel in the brain ruptures. Loss of blood supply to the brain leads to a loss of oxygen and brains cells become damaged and die.

As a result, parts of the brain can no longer function and may leave the victim with a permanent disability, such as loss of vision or speech, paralysis and confusion.

Worldwide, stroke is the second leading cause of death among those aged 60 or over. It is one of the most common causes of disability. Each year, around 15 million people suffer strokes, and more than 5 million will die and another 5 million are left permanently disabled, according to the World Health Organisation.

Over the last decades, China has become increasingly prosperous, lengthening life expectancies. This, and an aging population, means the incidences of stroke are rising.

"Increasingly unhealthy lifestyles, high pressure at work and hypertension are the important risk factors for stroke. We are seeing a shift in the disease profile that is getting much more similar to that in developed countries. The number of stroke victims is also on the rise," Yang says.

About 2 million people suffer strokes every year in China in reported cases. Statistics show that there is a stroke patient every five minutes. At present, the country has more than 7 million patients living with varying degrees of disability, which had resulted from a stroke.

"In fact, strokes can be treated if detection and treatment happen quickly," says Wang Yongjun, vice-president of Beijing Tiantan Hospital, noting the condition needs to be treated within three hours after symptoms start appearing.

The most effective therapy for ischemic stroke, the most common kind, is clot-busting drugs that break up the blockage and allow blood and oxygen to flow back to the affected parts of brain. Such drugs must be administered within three hours after the stroke.

But, there are many patients who do not get this immediate help, so only about 5 per cent of stroke victims are benefiting from this therapy at present.

"Because there is poor awareness and because the emergency systems outside of hospitals are not adequate, early prevention and treatment for strokes are still lagging," says Gao Ying, a professor with the Beijing Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine.

While the average response time for stroke treatment in developed countries in 2003 was about 5.6 hours, in China, the response time was about four times longer at 20.1 hours in 2006, according to Gao.

"The longer the patient waits for treatment, the greater the dangers he faces. More often than not, the patient and his family do not know what to do when a stroke occurs," Wang says.

"There must be more public education," Yang says. "Medical bodies and communities should organise more such initiatives."

In China, disability caused by strokes is much more frequent than that from other diseases such as diabetes, heart failure, asthma and cancer. The mortality rate is four to five times that of Europe and the United States, 3.5 times that of Japan, and even worse than other developing countries such as India and Thailand.

The mortality rate is growing by 8.7 per cent each year.

Scientists have been looking for more effective treatment for strokes and experts believe that the key is to transform lab research results into clinical practice.

According to Yang, basic clinical research has not been well grounded, despite a large number of papers published over the years.

"Lots of research has been done, but experiments on animals rarely prove workable on human beings."

Yang also notes that very little of lab research findings have been put to use in real clinical treatments.

Other scientists share his concern, and this became a focus point at the International Symposium on Cerebral Blood Flow, Metabolism and Function and the International Conference on Quantification of Brain Function with PET, which was held last week in Shanghai.

One of the answers may be a change in the research methodology, according to Yang.

"Interdisciplinary studies may help sort out the problem. And related research has to be refined into various aspects including neural protection after stroke, regeneration of nerves and blood vessels, and new technology to assist rehabilitation.

"Most importantly, we have to make sure that research findings find a place in real treatments," he says.

What you need to know

Stroke is the rapid loss of brain functions when there is an interruption of the blood supply to the brain. It can be due to ischemia caused by blockage, or a hemorrhage. Ischemic stroke currently accounts for 80 per cent of all strokes.

It is important for people to recognise the early signs of stroke and seek immediate treatment without delay.

All strokes happen fast, and symptoms appear suddenly. It's common for people to get more than one symptom at the same time, though not everyone gets all of the signs.

These are the signs to watch out for:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

• Sudden confusion, trouble speaking or understanding.

• Sudden trouble seeing in one or both eyes.

• Sudden trouble walking, dizziness, loss of balance or coordination.

• Sudden severe headache with no known cause.