Modesto hospitals use a new drug to save stroke patients, as COVID increased the risk

Charles Sykes/Charles Sykes/Invision/AP

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

The condition was thrust into the spotlight with the announcement last week that aphasia has forced actor Bruce Willis to retire.

Stroke is the No. 1 cause of disorders affecting speech and results in aphasia in a quarter to a third of cases. Traumatic brain injury, auto-immune disease or a brain tumor also may cause aphasia.

“It limits all the things you can do,” said Dr. Manoj Mittal, director of stroke and neurocritical care for the Sutter Health Valley Area. Frustration and stress is common for people with aphasia, the physician said.

An increase in stroke risk for adults who are middle age and younger was a health concern before the COVID-19 pandemic and was compounded by community transmission of the coronavirus.

Mittal said in a Zoom interview last week that people who suffered minor strokes were afraid to come to hospital emergency departments out of fear of catching COVID-19. The stroke patients who came to hospitals tended to be in serious condition.

Stroke is also one of the known complications of COVID-19 disease. Mittal said a heart weakened by COVID-19 may lead to a stroke or the viral illness may thicken the blood, causing a blocked blood vessel in the brain. The two types of stroke are ischemic, which limits blood flow to part of the brain, and cerebral hemorrhage.

Any stroke-related loss of speech may be temporary. Mittal said he has seen stroke patients who suddenly lost their speech return home from the hospital and recover their speech the next day. But aphasia may also become a long-term disability.

Willis, who starred in movies including the “Die Hard” series and “Armageddon,” reportedly experienced aphasia as a gradual decline over years, according to the Los Angeles Times. The cause has not been made public.

Mittal said some people with aphasia find it difficult to understand what others are saying. Some who suffer the condition can understand speech but can no longer express themselves. The disability may differ depending on the location of the brain affected.

Mittal said patients have better chances of recovering from aphasia the sooner they arrive in the emergency room.

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

Does ‘TNK’ work better for stroke patients?

Tenecteplase, also known as TNK, is more easily administered and is about three times more effective in clearing a blood clot compared to the previous standard medication, Sutter representatives said.

A drug called alteplase, or “rtPA,” has been effective 8% of the time in breaking up clots, while TNK is successful 20% of the time, Sutter said.

Feeding the older drug through an IV line is an hourlong procedure, but TNK can be administered more quickly. The new drug may start working sooner. And patients can be transferred in a shorter time frame to a primary stroke center, Sutter said.

Sutter’s 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 occurrence of cerebral hemorrhage between TNK and the older drug.

Krista Deans, a spokeswoman for Doctors Medical Center, said the Modesto hospital owned by Tenet Healthcare also has made the switch to tenecteplase for emergency treatment of stroke. The clot-busting drug was the topic of discussion at this year’s International Stroke Conference, she noted.

“One benefit specific to our region includes the ability to give this particular drug over a few minutes versus an hourlong infusion, which can reduce transfer time from outside centers to us, if intervention is needed,” Deans said in an email.

Doctors Medical Center recorded an almost 20% jump in patients with a primary diagnosis of stroke in 2021, the second year of the COVID pandemic.

Most people have never heard of aphasia

It’s estimated up to 2 million people in the United States struggle with aphasia, though a survey revealed that almost 9 in 10 people are not familiar with the term, according to the American Stroke Association.

The risk of 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 recover their language skills. According to the National Asphasia Association, symptoms lasting for more than two or three months suggest that complete recovery is unlikely, but some people improve over time.

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