Robert J. Joynt, MD, PhD
JAMA. 1996;275(23):1826-1827. doi:10.1001/jama.1996.03530470054032.
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The pace of new information about the basis of neurological disease and new treatment possibilities continues to accelerate. I have practiced neurology for 40 years. Treatment options in the 1950s were few, and notions about causation were rudimentary. Some in our profession are jaded by the changes in medical practice, but I find that it has become more exciting and fulfilling with our expanding knowledge. In this past year there has been activity in several areas, but only a few will be highlighted.

Stroke, especially ischemic stroke, continues to be a major killer and crippler. Most of the efforts have been spent in prevention, because little can be done once the stroke occurs. Two major trials of treatment of the acute stroke with tissue-type plasminogen activator (t-PA) have been completed.1,2 Both studies were randomized, double-blind trials, and treatment with t-PA or placebo was started by 6 hours after the


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