Modern methods of rehabilitation for poststroke patients
Author:
I.V. SIDYAKINA, M.V. VORONOVA, P.S. SNOPKOV, T.V. SHAPOVALENKO, K.V. LYADOV
Medical Rehabilotation Center, Moscow
Summary:
The article reviews the problem of complex post stroke rehabilitation. Special attention is drawn to neurorehabilitation aspect of patient’s state, restorative treatment in the acute stage of stroke, peculiarities of working up individualized rehabilitation programs, innovations and medicament support of rehabilitation process.
Keywords: stroke, rehabilitation, technical means of rehabilitation, medication support of rehabilitation process.
Side effects of psychopharmacotherapy in patients with the syndrome of dementia and the ways of its correction
Author:
S.N. DUMA
Summary:
The purpose of the study. Analysis of side effects of treatment with neuroleptics in patients with the syndrome of dementia of Alzheimer’s type. Evaluation of the effectiveness of the correction of side effects of treatment with neuroleptics with the additional use in the treatment of ethylmethylhydroxypiridine succinate (Mexidol®). Materials and methods. The study included 150 patients with Alzheimer’s disease with behavioral and psychotic disorders. The average duration of disease was 4.8 years. The average age of patients was 79,8±3,2 years. All patients received basic anti-dementia therapy for 2,6±1,4 years. Additionally patients were getting neuroleptic therapy within 4,2 ±1,2. The analysis of the character and intensity of the newly appeared side effects was based on the complaints of the relatives who were taking care e of patients and results of neurological examination. The comparative analysis of effectiveness of dose=reduction correction of side effects of neuroleptics was performed in two groups of patients. In the main group (n=76) the therapy included of Mexidol® 5,0–10,0 ml (250–500 mg), by parenteral route, No. 10–15. In the control group (n=74) the medicine was not administered. Evaluation of the effectiveness of treatment was based on a scale of Global Clinical Impression (CGI-I) after treatment. The results and conclusion. Side effects associated with neuroleptic therapy included the following most frequent and early appearing: reversible extrapyramidal disturbances such as akathisia and parkinsonism. They disappeared with a dose reduction of the antipsychotic medicine. While choosing pharmacotherapy it’s necessary to give preference to low doses of atypical neuroleptics. Additional parenteral therapy with ethylmethylhydroxypiridine succinate (Mexidol®) 5,0–10,0 ml (250–500 mg) No. 10–15 effectively (p<0,05) provides a more rapid reduction of side effects from neuroleptic therapy.
Keywords: Alzheimer’s Disease, dementia, psychotic symptoms, antipsychotics, Mexidol®.
The efficacy of mexidol in carotid endarterectomy procedure in patients with cerebral atherosclerotic stenosis
Author:
V.I. GOLOVKIN, A.V. SVETLIKOV, A.S. SHAPOVALOV, L.O. POPOVA
North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg
Summary:
Objective - to determine the antihypoxic efficacy of mexidol in carotid endarterectomy (CE) procedure in patients with cerebral atherosclerotic stenosis using cerebral oximetry. Material and methods. Clinical/psycho/neurological monitoring was performed in 109 patients with internal carotid artery stenosis of 69±7.0% and neurological symptoms of cerebral ischemia, 2-3 degree, in pre- and postoperative periods. Cerebral oximetry was carried out perioperatively. Fifty-four patients were treated with mexidol in a dose of 1000 mg/day for 14-15 days and 55 patients did not received mexidol. Results and conclusion. The difference in initial brain oxygenation (rSO2) between the main and comparison groups was shown (60.8±5.0 and 47.29±5.5%, respectively). During operation, the degree of blood oxygenation in these groups decreased by 57% and 41%, respectively. On day 7, significant differences in the Schulte test in two groups of patients with similar neurological status were found considering efficiency of work and mental stability before and after operation. No differences were found in the comparison group. Mexidol used for antihypoxic brain protection in carotid endarterectomy of patients with cerebral atherosclerotic stenosis significantly reduces the degree of cerebral hypoxia, decreases the duration of surgery, improves neurological status of patients and performance of psychological tests in postoperative period.
Keywords: cerebral stenosis, cerebral ischemia, carotid endarterectomy, cerebral oximetry, mexidol.
Efficiency mexidol in patients with endocrine polyneuropathy
Author:
E.B. KUZNETSOVA, I.I. SHOLOMOV, S.V. GERASIMOV, E.A. SALINA
Razumovsky Saratov State Medical University, Saratov; Clinical Hospital, Saratov
Summary:
Objective. To evaluate the efficacy of mexidol and necessity of using it in patients with endocrine polyneuropathies caused by primary hypothyroidism (PPHT). Materials and methods. We have examined 51 patients with confirmed diagnosis of PPHT and assessed their neurological status and indicators of metabolic homeostasis before and after treatment. Electroneuromyography (ENMG) was performed to assess the status of the peripheral nervous system. Results. The results indicate the presence of endocrine disorders of obligate metabolic homeostasis in patients with polyneuropathies. Antioxidants, in particular, mexidol, in a complex with other drugs can be used in the treatment of these disorders. Worsening of ENMG-parameters, demonstrating a trend towards the normalization in response to treatment antioxidants, are characteristics of this pathology. Conclusion. The efficacy of mexidol in patients with PPHT has been confirmed.
Keywords: endocrine polyneuropathies, metabolic homeostasis, mexidol, electroneuromyography.
Diagnosis and treatment of asthenic syndrome in elderly people after acute respiratory viral infection
Author:
I.E. POVERENNOVA, I.A. ZOLOTOVSKAYA, E.V. BEZGINA
Samara State Medical University, Samara; Samara City Policlinic, Samara; Medical X-Ray Center, Samara
Summary:
Objective: To study the characteristics of asthenic syndrome in elderly people after acute respiratory viral infection. Material and methods: We examined 87 patients with chronic cerebral ischemia and other comorbid disorders, aged from 63 to 78 years. Patients were randomized to two groups. Patients of the main group received mexidol (1 tablet (125 mg) 3 times a day during 3 weeks) along with standard treatment. Patients of the control group received standard treatment only. All patients underwent neuropsychological testing for the assessment of symptoms of asthenic syndrome. Results and Conclusion: A comparative analysis of the patient’s condition in both groups has demonstrated a reduction in symptoms of asthenia, autonomic lability and cognitive deficit in patients treated with mexidol.
Keywords: old age, asthenic syndrome, acute respiratory viral infection, treatment, mexidol.
Improvement of the efficacy of treatment of hypertensive encephalohathy by using mexidol
Author:
E.V. BOLOTOVA, N.YU. LUSHPAY, I.V. KOVRIGINA.
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.
Summary:
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.
Assessment of the efficacy of mexidol in the combination with hyperbaric oxygen in acute ischemic stroke
Author:
N.S. KULAI, E.YU. KOVALCHUK.
Saint-Petersburg I.I. Dzhanelidze research institute of emergency medicine, Saint-Petersburg, Russia.
Summary:
Objective. To study the efficacy of mexidol in the combination with hyperbaric oxygenation (HBO) in comparison with the standard HBO sessions in patients with acute ischemic stroke. Material and methods. One hundred and twelve patients were examined. In the main group, 48 patients underwent HBO and received treatment with mexidol. The control group consisted of 64 people who underwent the standard HBO sessions only. Results and conclusion. The use of combination therapy (HBO+mexidol) leads to the significantly more rapid normalization of acute phase indices which are correlated with neurological deficit reduction.
Keywords: ischemic stroke, hyperbaric oxygen therapy, mexidol.
The system stress-limiting action of mexidol in chronic cerebral ischemia
Author:
E.A. ANTIPENKO, A.V. DERUGINA, A.V. GUSTOV.
Nizhny Novgorod State Medical Academy of the Ministry of Public Health, Nizhny Novgorod; Lobachevsky Nizhny Novgorod State University, Nizhny Novgorod.
Summary:
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.
An influence of submaximal (submineximal) doses of mexidol on oxidant stress and inflammation in the acute period of ischemic stroke
Author:
A.R. GODUNOVA, A.A. RAKHIMOVA, O.I. LEONTYEVA, I.G. TALIPOVA, R.M. YAKHIN, SH.G. MUSIN.
Emergency Hospital, Naberezhnye Chelny, Russia.
Summary:
Objective. To study an effect of submaximal doses of mexidol on the dynamics of biochemical markers of inflammation and damage to brain tissue in the acute period of ischemic stroke. Material and methods. A total of 60 patients admitted in the first 6h after disease onset with a verified ischemic stroke (7-9 points on the ASPECT scale) were enrolled in the study. Thirty patients in the study group received submaximal doses of mexidol: 750 mg infusion dropwise in 250 ml of 0.9% NaCl solution for 6 days. Thirty patients of the control group received standard therapy. Biomarkers and neurological status were evaluated within 60 minutes from the time of admission to the hospital and after 6 days. Results and conclusion. In both groups, the changes in CRP, IL-6, and fibrinogen did not contribute to the efficacy of mexidol. The brain natriuretic peptide (BNP) biomarker, plasma-A-associated pregnancy (PAPP-A) biomarker, average NIHSS score and mean cerebroasthenia score on the MFI-20 scale in the study group were significantly reduced compared to the control group. This study indicates a decrease in oxidative stress and signs of inflammation, a reduction of the severity of neurological deficit and an increase in physical activity of patients treated with submaximal doses of mexidol. Given the activation time of the damaged antioxidant system of the body, the recommended period of treatment is 3 months.
Keywords: antioxidant stress, inflammation, acute period, ischemic stroke, mexidol.
Тhе possibility of treatment of cognitive impairment in the complex therapy of patients with the consequences of cerebral infarction
Author:
Е.В. KUZNETSOVA, Е.А. SALINA, I.I. SHOLOMOV.
Saratov State Medical University of the Russian Health Protection, Neurology Chair.
Summary:
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.