Priority 4 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY: What are the benefits and risks of new therapies for stroke (e.g. stem cell therapy) and those that work to protect the brain from damage (i.e. neuroprotection)? (JLA PSP Priority 4)
Overall ranking	4
JLA question ID	0106/4a
Explanatory note	Stroke is a leading cause of morbidity and mortality worldwide, with very large health and social care costs, and a strong demand for alternative therapeutic approaches (from Cochrane Review 2019, see Evidence. A 2019 Cochrane review concluded that "Overall, in participants with ischemic stroke, stem cell transplantation was associated with a reduced neurological impairment, but not with a better functional outcome. No obvious safety concerns were raised. However, these conclusions came mostly from small RCTs with high risk of bias, and the certainty of the evidence ranged from low to very low. More well‐designed trials are needed." There are few up to date reviews of neuroprotective therapies (see Evidence) and these show moderate quality evidence or unknown value of use. Evidence is needed on these therapies to understand the merits of their development and use in stroke care.
Evidence	https://doi.org/10.1002/14651858.CD007231.pub3 https://doi.org/10.1002/14651858.CD009280.pub3 https://doi.org/10.1002/14651858.CD007026.pub6 https://doi.org/10.1002/14651858.CD009622.pub5
Health Research Classification System category	Stroke

Extra information provided by this PSP
Original uncertainty examples	Have seen beginnings of work on treatments aimed at enhancing brain recovery, stem cell, TMS, medication; how are these progressing? ~ Are there any new treatments to repair my brain? ~ I would like to see research about brain repair after stroke. If the damaged part be repaired. ~ Developing more new and more effective therapies to reduce impairments once a stroke has happened. ~ Why isn't there more research into stem cells in this country when it's such a debilitating state to be in. ~ What is the efficacy and safety of Stem cell transplantation for ischemic stroke? ~ I would like to see Stem cell Research.
Submitted by	Health/Social care professional x 3, Stroke Survivor x 6, Carer x 6, Research recommendation x 1

Extra information provided by this PSP

Original uncertainty examples

Have seen beginnings of work on treatments aimed at enhancing brain recovery, stem cell, TMS, medication; how are these progressing? ~ Are there any new treatments to repair my brain? ~ I would like to see research about brain repair after stroke. If the damaged part be repaired. ~ Developing more new and more effective therapies to reduce impairments once a stroke has happened. ~ Why isn't there more research into stem cells in this country when it's such a debilitating state to be in. ~ What is the efficacy and safety of Stem cell transplantation for ischemic stroke? ~ I would like to see Stem cell Research.

Submitted by

Health/Social care professional x 3, Stroke Survivor x 6, Carer x 6, Research recommendation x 1

PSP information
PSP unique ID	0106
PSP name	Stroke prevention, diagnosis, pre-hospital and hospital care
Total number of uncertainties identified by this PSP.	93 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	30th April 2021