The importance of treatment algorithms in post-stroke rehabilitation

The global epidemiological burden of stroke leads to very high levels of disability adjusted life years (DALY) in low- and middle-income countries that contribute to a further increase of the socio-economic burden. In order to reduce these burdens, internationally recognised algorithms have been developed in almost all areas of stroke, leading to improvements in the standard of care – with one noteworthy exception – post-stroke rehabilitation. In this field of stroke care such algorithms have either not yet been developed or been implemented or are still too heterogenous.

Even if quality indicators have been identified they have not been standardized in the same way as in acute stroke care. The following requirements still need to be widely implemented:

1. Rehabilitation needs to be organized more centrally and equally across different centers
2. Rehabilitation needs indicators to monitor the quality of care with regular benchmarking
3. Stroke rehabilitation needs detailed and practical guidelines for each type of treatment, including pharmacological support

In this context the EAN & EFNR Guideline on Pharmacological Support in Early Motor Rehabilitation of 2021 and other new guidelines on motor recovery will be briefly discussed.

At the end of this presentation a short excursion will be made into the orphan drug indication CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) for which Cerebrolysin received an FDA orphan drug designation several years ago. At our centre in Prague we started the clinical development in this indication and will introduce briefly the trial protocol and the hypothesis why Cerebrolysin may be beneficial for CADASIL patients.