Carlos de la Cruz Cosme: "It is undeniable that stress is causing strokes in young people"

Carlos de la Cruz Cosme, head of the Neurology Service at the Virgen de la Victoria University Clinical Hospital in Málaga, discusses in this interview the main challenges of his specialty and the significant therapeutic and diagnostic advances made in recent years against diseases with such social impact as Alzheimer's or ALS, as well as the bothersome headaches, and also addresses the current proliferation of strokes among young people.

–A problem that is very much in vogue is that of strokes, which increasingly affect younger people...

–Indeed, we are seeing more strokes in young people. In Spain, it is estimated that around 120,000 strokes occur annually, and this adds to the list of people who have a stroke as a precedent. Fortunately, therapeutic approaches have changed, and disability is decreasing, especially because ischemic stroke, which occurs due to the occlusion or blockage of an artery reaching a part of the brain, now has pharmacological and mechanical treatments available to resolve this blockage in the first minutes or hours after it occurs, allowing patients to leave the hospital without or with minimal sequelae. This changes things. However, it is still very prevalent.

–Lifestyle habits have a significant impact...

–Lifestyle habits have a significant impact; society is under a lot of stress. There are studies that scientifically demonstrate that prolonged and acute stress increases the risk of having a stroke, and this, along with the consumption of toxic substances—by which I mainly mean amphetamines, cannabis, cocaine, something we frequently see in patients in their 30s or 40s admitted with strokes to our hospital—has led to an increase in prevalence among young people in recent years, which is not the case with other diseases. It is now more common to see young people having strokes due to these factors or excessive stress than in the past. And it is essentially a matter of diet and personal care: a healthy life, no toxic habits, physical activity, and basically limiting exposure to stress. This part is complicated because it depends on the individual, not on the hospital having a treatment.

–Can we then affirm that stress is causing strokes in young people?

–That is undeniable, and there are well-structured scientific studies that show it is more frequent or more likely to have a stroke if you lead a life of high, significant, and persistent stress than if you do not. It is proven.

–There is a disease that greatly diminishes the quality of life of those who suffer from it: headaches...

–Migraine is very common, especially among young people, and results in many lost workdays and a significant loss of quality of life. Until recently, we had a series of conventional drugs that continue to emerge and are effective, especially for aborting acute migraine attacks. We also have preventive drugs that we continue to use, which generally had been released with a different indication. It was observed that people taking these drugs who had migraines improved. So, different types of drugs began to be applied to migraines: for blood pressure, epilepsy, depression. Not because the patient has these diseases, but because they have an independent effect on migraines. This is the classic approach, and we continue to use it effectively. But there was a percentage of patients who did not respond to this type of medication and had a poor quality of life.

–New drugs have been released against migraines...

–Two new types of drugs have been released: one is monoclonal antibodies, injectable drugs administered periodically, which rescue many chronic migraine patients, turning them into patients without apparent migraines. Then there are the gepants, another recently emerged group of drugs for both acute and chronic migraines, which are taken orally and have also rescued other patients.

–Will there come a time when ALS is not a death sentence?

I cannot say that in this case we are close to delivering good news regarding the control of the disease. We have made progress in care, especially in the creation, as in our hospital, of multidisciplinary ALS units where we try to provide patients with all available resources in a specific space and time to facilitate care and improve their quality of life, prolong life with artificial means, with artificial nutritional support, even with mechanical respiratory support, portable mechanical ventilation. There are some clinical trials on ALS. There is already a drug marketed for specific types with a genetic basis of ALS, but even in those drugs that are already approved, the efficacy is very limited. In ALS, we are far off, but there are groups working on it, and surely in the next five or ten years, there will be something that changes the prognosis.

–Is there any significant progress against Alzheimer's that has been made in recent years?

–Well, it is a disease with a very high prevalence, not only in Málaga, in our environment. In Spain, there are currently about 800,000 patients diagnosed with Alzheimer's. There are many patients who are undiagnosed and may be at risk of having it. This disease is one of those that has evolved the most in diagnosis and will evolve in therapeutics in the coming years. As for advances, we are at a relatively sweet point because they have already been tested in Europe, they have been tested in the United States, and we expect to have them here by the end of this year or the beginning of next year, two drugs. The first will be a specific drug, Lecanemab, which already directly affects the molecular pathology of the disease, which has not happened until now, and is capable of modifying the patient's history. A history in which the patient, within five to seven years, went through all the phases until complete dependency and death. Now, we will be able to prolong it for several more years, three to five more years with good quality of life.