As every year with the approach of World Stroke Day, the French Neurovascular Society (SFNV) is mobilizing to raise public awareness of good reflexes. First post: “Every minute counts”. “Early management is decisive, for the survival of the patient and for the future”, insists its vice-president, Professor Sonia Alamowitch. Hence the need to know the characteristic signs: deformation of the mouth, weakness on one side of the body, speech disorders appearing suddenly…
Another message, more difficult to convey: “We can be affected at all ages. » Head of neurovascular emergencies at Saint-Antoine and Pitié-Salpêtrière hospitals in Paris, Sonia Alamowitch regrets that “this diagnosis is rarely mentioned before the age of 70, whereas one in four accidents occurs before the age of 65”. And while most victims have a risk profile, some are young adults with no particular history. Even children. “But the cases are rare, a hundred a year”reassures the neurologist.
Brain plasticity decreases with age
In France, the development of neurovascular units (UNV) in the 1990s improved the vital prognosis of patients thanks to multi-professional management. Today there are 135, spread over the whole territory. If the National Academy of Medicine recently warned of access difficulties in certain areas, “the cover is pretty good”says Jean Paysant, professor of physical medicine and rehabilitation and director of the Nancy Regional Rehabilitation Institute.
Still, the ability to recover varies greatly from one person to another. “When you’re young and healthy, stroke is obviously a big shock because it’s very unexpected. But the underlying ground being often good, we recover more easily”, explains Jean Paysant. This is due to what is called brain plasticity. “In people under 50, the brain has a greater capacity for recovery. Despite the fact that an area is destroyed, he manages to reorganize his connections, and compensate for the deficit »describes Sonia Alamowitch.
Older people generally have more difficulty recovering because their plasticity is less good and their “health plan” less favorable. Above all, they cannot benefit from recent treatment techniques, such as intravenous thrombolysis. This consists of injecting, in the very first hours after the stroke, a substance that dissolves the clot blocking the artery of the brain. “Immense progress has been made in the last twenty years to regulate the treble, but these are aggressive acts which are contraindicated for the elderly”, says Professor Paysant.
“Some people manage to return to their activity”
If the good recovery depends directly on the quality of the treatment, the involvement of the patient at the time of rehabilitation is decisive for the future. “We rehabilitation doctors only accompany the patients, but they are the ones who do all the work”, insists Professor Paysant, who relies on the therapeutic education of patients, thanks to small exercises to be done at home, in a more motivating setting than that of a rehabilitation center.
“A few years ago, when I was an intern, it was extremely rare to see a patient find a professional activity. Today, some people, especially the youngest, manage to return to their previous activity or an adapted activity, but in an ordinary environment.he welcomes.
He regrets, however, that in many “inner stigmata”, invisible but tough. According to Sonia Alamowitch, about 30% of stroke survivors have mood disorders or depressive symptoms. Others struggle with post-traumatic stress. “Even when you recover well, this event is a source of great vulnerability, insists the doctor. Psychological support must therefore also be up to par. »