The study of the efficacy and safety of Mexidol and Mexidol Forte in patients with chronic cerebral ischemia

Voronezh State Medical University. N.N. Burdenko, Voronezh, Russia

Objective. To study the efficacy and safety of Mexidol used intravenously (500 mg 1 time per day) for 14 days, followed by the oral administration of Mexidol Forte 250 in a dose of 250 mg 3 times a day for 60 days, in patients with chronic cerebral ischemia (CCI). Material and methods. The study included 56 patients with CCI due to a combination of hypertension and atherosclerosis. The results of physical examinations (control of blood pressure, heart rate etc.), dynamics of complaints, scores on CGI, MoCa, MFI‑20, HRSD, HARS and the Tinetti test were evaluated. Results and conclusion. The high level of efficacy and safety of intravenous injections of Mexidol followed by the oral administration of Mexidol Forte 250 are demonstrated. This scheme of therapy contributes to a significant decrease in the objective and subjective symptoms of CCI, leads to improvements in the emotional, cognitive and motor spheres.
Keywords: chronic brain ischemia, atherosclerosis, arterial hypertension, motor disorders, cognitive disorders, Mexidol, Mexidol Forte 250.

Efficacy and safety of the drug mexidol FORTE 250 as part of sequential therapy in patients with chronic ischemia of the brain

Pirogov Russian National Research Medical University, Moscow, Russia

Objective. To study the efficacy and safety of mexidol dripped intravenously (500 mg once a day) in the form of infusions for 14 days, followed by oral administration of mexidol FORTE 250 at a dose of 250 mg (1 tablet) 3 times a day for 60 days, in treatment of chronic brain ischemia in patients with hypertension and atherosclerosis. Material and methods. The open observation program included 60 patients with an established diagnosis of chronic brain ischemia confirmed by neuroimaging methods. Results and conclusion. The results of the study show the high efficacy and safety of sequential therapy (injections followed by tablets of mexidol FORTE 250). The treatment improves emotional and cognitive status, decreases motor disorders and severity of subjective manifestations. High adherence of patients to the therapy is shown.
Keywords: chronic cerebrovascular disease, arterial hypertension, atherosclerosis, ethylmethylhydroxypyridine succinate, mexidol, c ognitive impairment.

The efficacy of mexidol for transient ischemic attacks in the vertebrobasilar system in elderly patients with chronic cerebral ischemia

Tver State Medical University, Tver, Russia

Objective. To evaluate the clinical efficacy, metabolic and membrane protective effects of mexidol for transient ischemic attacks (TIA) in the vertebrobasilar system in elderly patients with chronic cerebral ischemia (CCI). Material and methods. Fifty-three patients, aged from 60 to 74 years, with the first episode of TIA in the vertebrobasilar system and CCI were examined. Patients of the main group (n=33) received mexidol in the dose of 500 mg for 10 days along with standard therapy, patients of the comparison group (n=20) received only standard therapy. The clinical implications of TIA, laboratory indices of the state of oxidant and antioxidant systems and percentage absorption of lipid-phospholipid complexes in the infrared spectrum of blood serum were studied. The control group consisted of 20 healthy people. Results and сonclusion. The use of mexidol was associated with more rapid regression of the focal neurological deficit. Mexidol significantly reduced the intensity of lipid peroxidation and had a positive impact on the level of neuronal membrane phospholipids. Metabolic and membrane protective effects of mexidol and it’s positive impact on the regression of focal neurological deficit justify its inclusion into complex therapy of TIA in the vertebrobasilar system developed in patients with CCI, especially in elderly patients.

Keywords: transient ischemic attack, vertebrobasilar system, chronic cerebral ischemia, mexidol, lipid peroxidation, phospholipids.

Characteristics of anxiety in patients of older age groups with different types of mild cognitive disorder

Urals State Medical University, Ekaterinburg, Russia

Objective. To study the structure of anxiety symptom complex in patients of older age groups with amnestic, disregulatory and polymodal types of mild cognitive impairment (MCI) and determine the clinical efficacy of 2-ethyl-6-methyl-3-hydroxypyridine succinate (mexidol). Material and methods. Thirty-two patients over 55 years of age with MCI (ICD-10 item F 06.7) seeking medical help due to anxiety were included in the study. Inclusion criteria were the compensation of concomitant diseases, absence of relevant stressful events during the last year, absence of depression. Clinical-psychopathological method and psychometric scales (HAM-A, GDS, MMSE, CGI-S, CGI-I) and a stressful life events list were used. Reduction of the total score on the HАМ-А was the main criterion of the efficacy of 4-week treatment with mexidol (375 mg daily). Results and conclusion. At baseline, mean scores on the HAM-A and MMSE were 39,9+3.18 and 25.7+0.6 respectively. The study of the anxiety structure in patients with amnestic, disregulatory and polymodal types of MCI revealed the different phenomenology of anxiety symptom complex. Repeated assessment of anxiety on the HAM-A was performed on 1, 2 and 4 week of treatment with mexidol. The improvement of mental state was noted in all types of MCI but the better results were obtained in disregulatory and polymodal types. The rate of anti-anxiety effect was higher in the disregulatory type of MCI. In all patients, mexidol improved attention stability and autonomic function.

Keywords: anxiety in the elderly, mild cognitive disorder, neuropsychological types MCI, comorbidity MCI and anxiety, mexidol.

Improvement of the efficacy of treatment of hypertensive encephalohathy by using mexidol

Kuban State Medical University under the Health Care Ministry of the Russia, Krasnodar, Russia; Reserch Institute - Territorial Clinical Hospital №1 med after Professor S.V. Ochapovski under the Health Ministry of the Russia, Krasnodar, Russia.

Objective. To assess the efficacy and tolerability of mexidol used to improve cognitive impairment in patients with hypertension and clinical manifestations of chronic cerebral circulatory insufficiency. Material and methods. Forty-two patients with chronic cerebral circulatory insufficiency and cognitive impairment were examined. MMSE, МоСА and the clock drawing test were used to assess neuropsychological status. The Morisky-Green test was administered to evaluate medication adherence. Patients were stratified into two groups: patients of the first group (n=21) received standard treatment. Patients of the second group (n=21) received additionally mexidol in dose 200 mg (4 ml) in 100 ml of NaCl isotonic solution intravenously during 10 days and then in tablets (2 tablets 0,125 mg) twice a day during 8 weeks. Results. According to the 4-item Morisky Medication Adherence Scale (MMAS), 31% of respondents were not adherent to the treatment (MMAS score 0—2), 35.7% (n=15) of patients showed high adherence (MMAS score 4), 33.3% (n=14) demonstrated low adherence (MMAS score 3). The average score on the questionnaire was 2.85. In patients treated with mexidol, the absence of complaints increased by 3 times and headache regression increased by 90%. The improvement of memory, concentration and anxiety was observed in 50%, 55%, 67% of patients, respectively. Patients treated with mexidol demonstrated more significant changes during the clock drawing test. The average change in the scores increased by 0.95 compared to the control group, where the changes were 0.54 (p<0.02). The positive dynamics on MMSE and МоСА was shown in the mexidol group that indicated the positive effect of this drug on cognitive symptoms. Conclusion. The positive impact on cognitive symptoms and health in patients with chronic cerebral circulatory insufficiency allows to recommend mexidol as add-on to standard treatment of the main disease.

Keyword: mexidol, cognitive impairment, adherence.

The system stress-limiting action of mexidol in chronic cerebral ischemia

Nizhny Novgorod State Medical Academy of the Ministry of Public Health, Nizhny Novgorod; Lobachevsky Nizhny Novgorod State University, Nizhny Novgorod.

Objective. To clarify the mechanisms of the action of anti-stress antioxidant agent (mexidol) in patients with chronic cerebral ischemia. Material and methods. Sixty-seven patients with chronic cerebral ischemia (TE stage II), 48 women and 19 men, mean age 48.2 years, were examined. To assess the state of multilevel stress system, the level of anxiety and depression, degree of autonomic imbalance, adaptive reactions of the blood and functional properties of erythrocyte membranes, level of average weight molecules in the blood plasma were studied. Therapeutic complexes consisted of standard therapy (vinpocetine and piracetam) and mexidol (10 ml intravenous drip 200 ml of physiological solution once a day every day for 10 days with subsequent transition to the oral ingestion of the drug (1 tablet (125 mg) 3 times a day for three months). Results and conclusion. In group 1 treated with additional antioxidant mexidol, the more pronounced and prolonged positive effect on the clinical symptoms of TE was observed. There were the persistent decrease in the level of anxiety and reduction of autonomic imbalance in the main group. The dynamics of adaptive reactions of blood indicated the activation of the adrenal cortex. There was a decrease in the content of average weight molecules and recovery of the sorption capacity of red blood cells. The results indicate the multi-component multi-level stress-limiting effect of mexidol in patients with chronic cerebral ischemia stage II.

Keywords: mexidol, chronic cerebral ischemia, treatment, stress.

Тhе possibility of treatment of cognitive impairment in the complex therapy of patients with the consequences of cerebral infarction

Saratov State Medical University of the Russian Health Protection, Neurology Chair.

Objective. То study neuropsychological status of inpatients with the consequences of сеrеbrаl infarction treated with cortexin аnd mexidol. Material аnd methods. We carried out а neurological аnd neuropsychological examination of 62 patients with the consequences of cerebral infarction treated with cortexin in the dose of 10 mg and mexidol in the dose of 5 ml of 5% solution intravenously during 15 days. Results аnd conclusion. It has bееn shown that the use of this drug combination decreases complaints аnd neurological symptoms аnd significantly improves cognitive аnd emotional status as well. The more positive changes аrе related to attention, speed of mental reactions, anxiety аnd verbal activity. The complextherapy with cortexin аnd mexidol decreased neurological deficit аnd improve cognitive functioning and psychoemotional status thus increasing quality of life аnd rehabilitation potential of the patients.

Keywords: consequences of сеrеbral infarction, cognitive impairment, emotional status, cortexin, mexidol.

Тhе neuroprotective therapy of outpatient treatment of chronic cerebral ischemia

Kazan, Municipal health саrе «City hospital №6»; Kazan State Medical University.

Objective. То perform а differential analysis of the efficacy of combination therapy bу the drugs with different modalities (mexidol, aescusan, halidorum) in outpatients with chronic cerebral ischemia (CCI), stages I-III. Material and methods. А study included 50 patients with CCI of atherosclerotic, hypertensive and mixed genesis (stage I-20, stage II-20, stage III-10 patients). In addition to somatic therapy, patients received three courses of mexidol, halidorum and aescusan combination therapy during 6 weeks with а 3 month interval between the courses. The changes in subjective complaints and objective clinical manifestations were evaluated after each course. Results and conclusion. The therapeutic efficacy after durable complex therapy bу repeated courses of antioxidants is supported bу the results of clinical and neurological examinations. Mexidol in the combination with aescusan and halidorum contributed to the improvement of cognitive, adaptive, motor functions of the patients with CCI, stages I and II. То increase treatment efficacy in patients with CCI, stage III, we recommend to use the drugs that improve cognitive functions of the patients.

Keywords: chronic cerebral ischemia, mexidol, combination therapy.

The results of the study of the efficacy and safety of mexidol in patients with chronic cerebral ischemia

Pirogov Russian National Research Medical University, Moscow.

Objective. To analyze the efficacy and safety of mexidol and their effect on the dynamics of neurological signs of the disease, emotional status and quality of life in patients with chronic cerebral ischemia (CCI). Material and methods. We studied 45 patients with CCI who received mexidol in dose 500 mg a day during 14 days by introvenal introduction with the following peroral administration in doses 500 mg twice a day during 60 days. A comparison group included 30 patients with CCI matched for age, risk factors and severity of neurological symptoms, who did not receive mexidol. Patients of both groups received standard treatment that included medications needed for the complete correction of the risk factors. Cognitive function (MMSE), movement activity and quality of life (SF-36) were assessed. Results. To the end of the study (74th day), a decrease in the severity of movement disorders, normalization of SF-36 scores and improvement of mean values of screening-assessment of cognitive function were identified in patients of the main group compared to those of the comparison group. Conclusion. The high efficacy and safety of treatment of CCI patients with mexidol using.

Keywords: chronic cerebral ischemia, oxidative stress, movement disorders, depression, quality of life, mexidol.

Possibilities of antioxidant therapy for asthenia and cognitive deficit in elderly patients with chronic brain ischemia

Research Institute of Therapy, Siberian Branch, Russian Academy of Medical Sciences, Novosibirsk.

Aim. To evaluate the effect of the antioxidant mexidol on the oxidant-antioxidant potential of low-density lipoprotein (LDL), asthenic and anxious symptoms, and cognitive function of neurodynamic type in elderly patients with chronic brain ischemia (CBI). Subjects and methods. Thirty women (mean age 66.7 years) with grade 1-2 dyscirculatory encephalopathy (DE) were examined. Trends for asthenic, anxious, and cognitive symptoms of neurodynamic type were estimated using the standard tests (MFI-20, Hamilton Anxiety Rating Scale, Schulte Tables, Wechsler test) on days 1, 15, and 60 of mexidol treatment (for 60 days). LDLs were isolated from blood by heparin precipitation. The baseline level of lipid peroxidation products was determined and the concentrations of fat-soluble antioxidants (α-tocopherol, retinol, β-carotene, and xanthins) were examined in the isolated LDLs on days 1 and 5 of the study. Results. A 60-day mexidol therapy cycle statistically significantly caused a reduction in asthenic and anxious symptoms in elderly patients with CBI and induced positive changes in the symptoms of cognitive neurodynamics. Assessing the specific features of the pharmacodynamics of the antioxidant mexidol used in the elderly patients for 15 days revealed a statistically significant positive effect on the oxidative potential of LDLs as a decreased predisposition to their antioxidative processes in vivo. The drug’s effect in elevating the levels of α-tocopherol and β-carotene was altered insignificantly (without statistically significant changes), which reflects the pharmacodynamic features of the drug in the elderly patients. Conclusion. The 60-day cycle of therapy with the antioxidant mexidol has a positive impact on asthenic and neurotic symptoms in the elderly patients with CBI. Mexidol is well tolerated and safe when used long.

Keywords: asthenia, anxiety, cognitive defect, chronic brain ischemia, elderly age, specific features of antioxidant therapy, mexidol.