HEALTH

CAN THE LITTLE BLUE PILL TREAT A STROKE?

ALEXANDRA SHIMO August 18 2008
HEALTH

CAN THE LITTLE BLUE PILL TREAT A STROKE?

ALEXANDRA SHIMO August 18 2008

CAN THE LITTLE BLUE PILL TREAT A STROKE?

HEALTH

Viagra’s newest uses may be nothing short of revolutionary

ALEXANDRA SHIMO

As a 46-year old

woman, René Jarinski is not your typical Viagra user. In fact, to understand why she and some other stroke victims have been prescribed the drug off-label, it’s best to go back to the summer of 2003. At 5 a.m. on July 27, just as it was getting light, Jarinski, nurse, awoke and realized that she could not move. Her legs, torso, arms and facial muscles were completely paralyzed. She could hear her husband getting ready for work at the Ford Motor Co. in Detroit, but she could not move her lips, much less call out. She had been sleeping on the white, leather couch in the living room—she had woken up in the middle of the night and hadn’t wanted to wake her husband by returning to their bedroom—and so when he came to the settee and asked if she was okay, she lay still and stared at him silently. The only conscious motor-neuron function that had not failed was her ability to blink. In reality, she was very far from well; she was not only paralyzed, she was having a major stroke. She was awake, aware, but unable to communicate: she was experiencing what’s called “locked-in syndrome.”

The condition is extremely rare: although exact numbers are unknown, it’s estimated that 500 people in the world are living with this almost complete paralysis, Of those, about 14 per cent recover some limited voluntary movement—some wiggling of their fingers or toes. Most can communicate only by blinking or through eye movements. The condition was documented beautifully in the film and book, The Diving Bell and the Butterfly, which the author, Jean-Dominique Bauby, editor-in-chief of French Elle before he had a stroke, dictated by blinking at a list of letters read out by his assistant.

On realizing that something was seriously wrong with Jarinski, her husband, Roger, called 911 and then followed the ambulance to the local hospital. For four days, he lived

by her bedside. By that time, Roger, 50, was desperate. His wife, who had four children from her previous marriage, was still completely paralyzed, and since doctors assumed she wasn’t going to get any better, they had offered to “make her comfortable,” by easing her way into death. “We are both Christian so we wouldn’t try stem cell, but I was prepared to try anything else,” he says.

On the fifth day, she was transferred to

Henry Ford Hospital in Detroit for an experimental treatment that a doctor friend of the family had heard about through word of mouth. A neurologist there, Montreal-born Brian Silver, and his colleague Michael Chopp, a neuroscientist, had been doing research, feeding sildenafil, better know by its trade name Viagra, to rodents that had had strokes. Although they had never tried the treatment on humans, they offered to give Jarinski high

doses of the drug, at three times what is prescribed for sexual dysfunction.

Since 2001, Silver and Chopp have been studying and experimenting with sildenafil. Working with mice and rats, they would induce strokes and test how quickly the animals recovered with and without the drug. The rodents were then put through a battery of functional and memory tests. Some were covered in round, orange stickers, and timed on how long it took them to pick them off; others were tested on their coordination and balance skills. In addition, the doctors probed

what was happening inside the brain: measuring blood flow with MRIs and brain activity by counting the difference in neuron production. (Neurons are necessary to store new memories and process information.)

Ten studies conducted over seven years supported

the findings: sildenafil caused the animals to produce more neurons, more synaptic connections and to regrow the nerve cells in the brain damaged by the stroke. The Viagra-fed rodents recovered more quickly from the stroke-induced brain injuries: they were smarter, more coordinated, and had better memory function than the control group. Another study put elderly rats on Viagra, and they had better motor-neuron skills than animals that hadn’t taken the drug.

Two months after being fed the first crushed

pill through her feeding tube, Jarinski started being able to move her head from side to side. About six months later, she was able to move her fingers and her arms a little. After nine months, she was able to smile, and very gently move her legs at the knees from side to side. After a year, she began to recover her speech. “It’s amazing,” Silver remarked in an interview with Maclean’s. “I’ve been treating stroke patients for 12 years, and I’ve never seen this sort of recovery before.”

Of course, given that Jarinski was the first human stroke victim to take the drug, it’s

SHE WAS AWAKE, AWARE, BUT ALMOST TOTALLY PARALYZED. SHE WAS EXPERIENCING LOCKED-IN SYNDROME.

impossible to know for certain if it was the erectile dysfunction drugs that caused her recovery, says Silver. (Jarinski was switched to Cialis after two years, which is part of the same family of medications, but works out cheaper for high dosages.) Viagra dilates blood vessels, which is why it helps erectile dysfunction and wilted flowers stand up straight. The dilating effect brings more blood to the brain, which may help the organ heal itself. The drug also encourages the brain to produce more neurons—grey matter—by pharmacologically stimulating stem cells to

become neurons, explains Silver. This could have tremendous importance in the treating of Alzheimer’s or dementia, or any other disease that affects cognitive impairment, but none of these applications have yet been tested, says Chopp. “There are no other restorative treatments for the brain,” explains Chopp. “This one is really remarkable.” Following the success of the animal trials, Silver and Chopp have now started Viagra trials on human stroke victims, which are still in the safety-testing stage. Some doctors read about Jarinski’s story—it was published in the

Canadian Journal of Neurological Sciences in 2006—and have put their own stroke patients on Viagra, off-label. They report “remarkable” improvements, says Chopp, although so far the evidence is purely anecdotal.

As the first patient to try this therapy, Jarinski has made a remarkable, if incomplete recovery. She has regained some movement in one hand—she can type, and is writing a memoir about the experience of being locked-in. She has regained limited use of her voice—she speaks slowly and softly, although she sometimes trails off over multisyllabic words. Because she is unable to get up from her wheelchair, or dress or feed herself, she lives in a nursing home, 140 km from her old home. Although she is now no longer taking the

medication, since the doses required were prohibitively expensive once her medical trial had finished, she continues to make improvements in her speech and articulation, five years after the stroke that paralyzed her.

Silver sees her every three to six months, and writes encouraging emails. “Dr. Silver has told me I will walk again by Christmas,” Jarinski says. “He always tells me that no matter what time of year it is.” It’s clear that she doesn’t quite believe him, but she’s confounded so many expectations and made so much progress, she refuses to give up hope. M