You are twitching, your vision is blurred and you can't move the right side of your body. In other words, you are suffering an ischemic stroke - a blockage of an artery that normally brings blood to a portion of your brain. You could die or suffer significant brain damage as your brain cells starve for oxygen.
When they haul you into the ER, the doctor runs a few tests and sticks a needle in your arm. In the needle is an unlikely potion - the chemical equivalent of four cups of coffee and a nice glass of toasty red wine. That's right, they are shooting you up with caffeine and alcohol.
Sound implausible? Not entirely, according to a University of Texas stroke research team from the Houston Medical School. The team, led by neurologist Dr. James Grotta, found that a mellow mix of caffeine and ethanol (alcohol) cut the damage to brain cells of laboratory rats as a result of stroke by more than 70 percent in some cases.
There are enough similarities between the biochemistry of rat brains and people brains to merit serious consideration of this counterintuitive remedy. According to their research, to be published in the scientific journal Neuropharmacology, this cheap and easy mixture regularly bested damage control efforts of more expensive and more dangerous pharmaceuticals. "It was the most powerful substance we tested in our laboratory," says Dr. Jarek Aronowski, a neuroscientist who is part of the research team. "It was amazing how robust our findings were."
Should we all carry a flask and a thermos of joe just in case? That's probably premature for now, as Grotta and Aronowski themselves say. But should alcohol and caffeine turn out to be effective in humans, it could be a big deal. Here's why. According to the Centers for Disease Control and Prevention, stroke is the third leading cause of death in the U.S. -- 3.3 million Americans may suffer strokes each year and nearly 160,000 of them die. The after-effects of strokes cost tens of billions in medical care and lost wages each year and leave tens of thousands of Americans with impairments of speech, motor skills and other essential life functions. Strokes are becoming more common as more Americans age; strokes are likeliest in the elderly and people 55 years of age and greater suffer two-thirds of strokes. In other words, strokes are a major public health problem destined to grow even worse.
Despite large amounts of medical research, stroke treatment is still somewhat hit-and-miss. Often doctors have to wait for hours before they can decide on what treatment to use. In the case of ischemic strokes (when an artery is blocked; about 80 percent of all strokes are ischemic), doctors can often spot the clot with imaging equipment. Surgeons can sometimes clear the artery but this is a very risky procedure. There is an alternative, a drug called tPA that breaks up blood clots and restores blood flow. But tPA is very expensive and must be given within three hours of the stroke to be effective. Furthermore, tPA is not effective in all cases.
So doctors have continued to search for more effective anti-stroke drugs. One group of drugs they are testing is called neuroprotectors. These drugs, through mechanisms still poorly understood, insulate or safeguard brain cells during the nutrient and oxygen deficit of a stroke. This, in turn, reduces brain damage. Ideally, neuroprotectors would provide doctors a cushion of precious hours to treat the acute symptoms of the stroke without having to worry as much about immediately restoring blood flow to the brain. Neuroprotectors as a class are relatively new on the medical scene.
The caffeine and alcohol cocktail falls into the neuroprotector camp. As is common with other neuroprotectors, Grotta and his group do not understand the exact mechanisms that might be at work. "There are hundreds of (neurotransmitter) pathways that are affected by the stroke and probably all of these pathways are important to the pathology of the stroke. Even when we talk about the acute effects, there are at least 20 mechanisms that people speculate could be important but are not immediately interrelated," explains Aronowski.
However, Grotta's team did have a hunch that alcohol and caffeine might, at the very least, have an effect on strokes. For years, they had examined ischemic strokes in rats and tested various substances to see if they limited the death of brain cells. At the suggestion of his laboratory technician Roger Strong, Grotta decided to test caffeine and alcohol separately. Some studies have shown that moderate drinkers may enjoy a long-term reduced risk of ischemic stroke. So Grotta figured it might have an effect on acute stroke symptoms, as well. And caffeine interacts strongly with adenosine and glutamate neurotransmitter systems, both of which are closely tied into the brain's response to stroke.
Initial tests of caffeine on the rats found it had no effect. And tests using alcohol on the rats found that it augmented rather than alleviated brain damage. But when the two were mixed in low dosages, they somehow teamed up to save considerable chunks of gray matter. "The striking thing to me isn't just that it's effective but how great the effect is. It really is very dramatic," says Grotta. The treatment seemed most effective when applied a half-hour after the stroke. But even two hours after the stroke the combination managed to reduce brain damage in terms of volume by about 47 percent.
The prophylactic effect of the combination was somewhat ephemeral, however. The mixture did not save the brain cells of rats that had been regularly dosing on alcohol and caffeine before their induced stroke. "And if you give too much of either the alcohol or the caffeine, then the effect is lost. It's a peculiar effect," says Grotta, who cautions that another lab must replicate his results to ensure their validity.
As Grotta himself would admit, no one is suggesting that ERs start stocking wet bars with rum and cokes. And other neurologists are skeptical that buzz and booze treatment will translate. "I would not make much of this result. The rats were probably young, whereas most stroke victims are old. The rats were likely naive to alcohol and caffeine. But few adult stroke victims are. Furthermore the agents were given before or shortly after the experimental stroke. This is difficult to achieve in humans," says Dr. Louis Caplan, a neurologist at Harvard University School of Medicine.
Even if another lab is able to validate Grotta's results, getting funding for wide-scale clinical tests might be difficult. Drug companies with a vested interest in the outcome fund most of these clinical trials, which cost millions of dollars to run. But no drug company could hope to profit from a treatment using public domain substances like caffeine and alcohol. "Obviously no pharmaceutical company is going to fund a study of alcohol and caffeine since they won't be able to make money from those substances," says Grotta.
But the gatekeeper of the biz, the U.S. Food and Drug Administration, might be more inclined to approve trials for the caffeine and alcohol treatment than for most drugs due to the low and clearly non-toxic dosages involved. "I would imagine that if we would be able to successfully complete all the animal experimental work, this can be taken to clinical trials next year," says Aronowski. And that's when they can study the really big question of interaction with humans. "Even though ethanol and caffeine may be tolerated in those dosages in healthy humans, they may not be tolerable in stroke victims. That's what we have to find out," says Aronowski.