Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SATURDAY, February 11, 1995                   TAG: 9502130031
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A1   EDITION: METRO 
SOURCE: ASSOCIATED PRESS
DATELINE: CHARLESTON, S.C.                                LENGTH: Medium

STROKES MAY BE TREATABLE

But experts aren't ready to recommend it for widespread use, because the treatment involves a perilous balance between risks and benefits.

The medicine is tissue plasminogen activator - TPA - a genetically engineered protein that is already a mainstay of heart attack therapy.

About 500,000 Americans suffer strokes annually. They are the leading source of adult disability and the No. 3 cause of death after heart disease and cancer. Until now, there has been no proven treatment to limit the damage in the first hours after they occur.

A European team reported Friday that TPA significantly reduces the amount of brain injury resulting from strokes if given quickly after the onset of symptoms - but only when reserved for a carefully selected group of patients, probably half to three-quarters of all stroke victims.

The difficulty of deciding precisely who these patients are is likely to curtail its widespread use, at least until experts sort out better guidelines for emergency-room doctors.

The dilemma for doctors is simple: If given to the right patients, TPA can prevent a lifetime of paralysis and other crippling disabilities. If given to the wrong ones, it can trigger bleeding in the brain that makes the strokes even worse.

``The patients who we really want to treat benefit a lot. Treating those who we don't want to can be a disaster,'' said Dr. Werner Hacke of the University of Heidelberg in Germany, the study's director.

The study was conducted on 620 stroke patients who were given TPA within six hours of the start of their symptoms. The results were released at a stroke conference sponsored by the American Heart Association.