Alcohol and Caffeine May Aid Stroke Victims

A couple of Irish coffees for stroke victims in the emergency room? Beyond the joke lies the real possibility that a combination of alcohol and caffeine could prove more beneficial to stroke victims than the acute care stroke drugs currently available.

At the American Neurological Association's 124th annual meeting, October 10-13 in Seattle, researchers from The University of Texas-Houston Medical School presented data from animal studies suggesting that alcohol and caffeine administered in combination just before or after a stroke can significantly reduce the resulting brain damage.

A stroke occurs when blood flow to brain tissues is disrupted, killing brain cells by robbing them of oxygen and nutrients. Patients who survive strokes are often left with some disability, such as paralysis, loss of speech or memory lapses.

If the stroke is ischemic - caused by a blocked artery - drugs that break up clots are sometimes administered. (Ischemic strokes make up approximately 85 percent of all strokes.) These drugs can prevent or reverse paralysis in some, but not all, cases if given within three hours of the stroke's onset. A post-stroke drug that works directly to protect brain cells has thus become a holy grail for pharmaceutical researchers.

It would be ironic if the most effective post-stroke measure turned out to be common substances such as alcohol and caffeine. This is just the hypothesis that a group of Texas researchers has put forward.

Dr. James C. Grotta, professor of neurology at The University of Texas-Houston Medical School, has been studying a rat model of stroke, trying out various treatments to find one that might limit the brain volume destroyed by the ischemia. Roger Strong, a research scientist, had the idea to try commonly available substances, among them were alcohol and caffeine.

The choices were not entirely random. Studies have shown that people who regularly drink modest amounts of alcohol may have a reduced risk of coronary heart disease and ischemic stroke. Researchers have wondered for years about caffeine, since it clearly has effects on the adenosine and glutamate neurotransmitter systems, which are involved in the brain's response to injuries such as stroke.

Strong found that alcohol alone aggravated the stroke damage, and caffeine alone had no effect. But the two together had a protective effect on the brain.

"Nothing is known about the potential differential effect of combination as opposed to each single substance alone," says Dr. Jarek Aronowski, assistant professor of neurology at UT-Houston Medical School and an author of the presentation. "It is absolutely intriguing to us why those two substances are active while the ingredients are not."

"The striking thing to me isn't just that it's effective but how great the effect is," says Dr. Grotta. "It is really very dramatic." In fact, the alcohol/caffeine combination was equal, or superior, to drugs developed by pharmaceutical companies that the researchers tested in the same stroke model.

Dr. Grotta notes, however, that the effect was only found when the alcohol and caffeine were given at the time of the stroke or within two hours after the stroke. "If you give too much of either the alcohol or the caffeine, then the effect is lost. Furthermore, if you give the combination chronically - for a week or so prior to the stroke - there's also no benefit. So, it's a peculiar effect," he says.

Dr. Grotta cautions that not too much should be made of the data just yet. He says that the very narrow range of doses that had an effect could mean that the combination would be hard to dose appropriately and therefore might not be clinically useful.

"We definitely need to establish the optimal dosages for both substances and after that, try to repeat this in other laboratories," says Dr. Aronowski.

"If it's corroborated, then I think it's not unreasonable to consider a small pilot study (in humans) of low doses of alcohol and caffeine, because they're fairly innocuous," says Dr. Grotta.

And pointing to a fact of drug development in the United States, Dr. Grotta suggests that even if their data is replicated, it may still be a while before there is any large scale testing of the alcohol/caffeine combination in emergency rooms. Drug studies are, for the most part, funded by pharmaceutical companies who own rights to certain chemicals. "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," he says.

According to Dr. Aronowski, the presentation made in Seattle has been accepted for publication in the journal Neuropharmacology.

- Additional reporting by Kristina Van Arsdel

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©2006 Texas Medical Center

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