Effectiveness and safety of transcranial laser therapy for acute ischemic stroke
Department of Neurology
Acute Disease; Adult; Aged; Aged, 80 and over; Brain Ischemia; Female; Humans; Infrared Rays; Laser Therapy, Low-Level; Male; Middle Aged; Severity of Illness Index; Stroke; Treatment Outcome
Neurology | Neuroscience and Neurobiology
BACKGROUND AND PURPOSE: We hypothesized that transcranial laser therapy (TLT) can use near-infrared laser technology to treat acute ischemic stroke. The NeuroThera Effectiveness and Safety Trial-2 (NEST-2) tested the safety and efficacy of TLT in acute ischemic stroke.
METHODS: This double-blind, randomized study compared TLT treatment to sham control. Patients receiving tissue plasminogen activator and patients with evidence of hemorrhagic infarct were excluded. The primary efficacy end point was a favorable 90-day score of 0 to 2 assessed by the modified Rankin Scale. Other 90-day end points included the overall shift in modified Rankin Scale and assessments of change in the National Institutes of Health Stroke Scale score.
RESULTS: We randomized 660 patients: 331 received TLT and 327 received sham; 120 (36.3%) in the TLT group achieved favorable outcome versus 101 (30.9%), in the sham group (P=0.094), odds ratio 1.38 (95% CI, 0.95 to 2.00). Comparable results were seen for the other outcome measures. Although no prespecified test achieved significance, a post hoc analysis of patients with a baseline National Institutes of Health Stroke Scale score of <16 showed a favorable outcome at 90 days on the primary end point (P<0.044). Mortality rates and serious adverse events did not differ between groups with 17.5% and 17.4% mortality, 37.8% and 41.8% serious adverse events for TLT and sham, respectively.
CONCLUSIONS: TLT within 24 hours from stroke onset demonstrated safety but did not meet formal statistical significance for efficacy. However, all predefined analyses showed a favorable trend, consistent with the previous clinical trial (NEST-1). Both studies indicate that mortality and adverse event rates were not adversely affected by TLT. A definitive trial with refined baseline National Institutes of Health Stroke Scale exclusion criteria is planned.
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Citation: Stroke. 2009 Apr;40(4):1359-64. Epub 2009 Feb 20. Link to article on publisher's site
Zivin, Justin A.; Albers, Gregory W.; Bornstein, Natan; Chippendale, Thomas; Dahlof, Bjorn; Devlin, Thomas; Fisher, Marc; Hacke, Werner; Holt, William; Ilic, Sanja; Kasner, Scott; Lew, Robert; Nash, Marshall; Perez, Julio; Rymer, Marilyn; Schellinger, Peter; Schneider, Dietmar; Schwab, Stefan; Veltkamp, Roland; Walker, Michael; and Streeter, Jackson, "Effectiveness and safety of transcranial laser therapy for acute ischemic stroke" (2009). Neurology Publications and Presentations. Paper 374.