Modern strategies of protection of hypoxic-ischemic brain damage
Author:
S.N. YANISHEVSKY, N.V. TSYGAN, S.YU. GOLOKHVASTOV, R.V. ANDREEV, I.V. LITVINENKO, O.S. KARPOVA, V.A. YAKOVLEVA.
Kirov Military Medical Academy, St. Petersburg, Russia.
Summary:
Nowadays, there are two complementary approaches to treatment of patients with ischemic stroke: reperfusion and neuroprotection. The main purpose of neuroprotection is to intervene ischemic cascade at every stage of the pathological process and thus avoid the death of nerve cells and expand the therapeutic window for reperfusion therapy. The use of drugs with neurotrophic, antioxidant and neuroregenerative effects is pathogenically explained at all stages of post stroke rehabilitation. Ethylmethylhydroxypyridine succinate (mexidol) is a derivative of succinic acid with antihypoxic, membrane protective, nootropic, anticonvulsant and sedative action. The majority of researchers confirmed the positive effect of mexidol expressed as the marked regression of neurological deficit and wider opportunities for further early rehabilitation. The results of the randomized double blind multicenter placebo-controlled, parallel-group trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA) were published in 2017. The results of the study showed the best positive dynamics of neurological function recovery in case of timely treatment with mexidol with the following two month therapy. The safety of the long-term use of mexidol was confirmed.
Keywords: stroke, acute period, neuroprotection, succinate, efficacy of treatment, safety of therapy.
Тhе neuroprotective therapy of outpatient treatment of chronic cerebral ischemia
Author:
S.V. BEREZHNAYA, E.Z. YAKUPOV.
Kazan, Municipal health саrе «City hospital №6»; Kazan State Medical University.
Summary:
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.
Results of a randomized double blind multicenter placebo-controlled, in parallel groups trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA)
Author:
L.V. STAKHOVSKAYA, N.A. SHAMALOV, D.R. KHASANOVA, E.V. MELNIKOVA, A.S. AGAFIINA, K.V. GOLIKOV, E.I. BOGDANOV, A.A. YAKUPOVA, L.V. ROSHKOVSKAYA, L.V. LUKINYKH, T.M. LOKSHTANOVA, I.E. POVERENNOVA, L.A. SHEPANKEVICH.
Pirogov Russian National Research Medical University, Moscow, Russia; Research Institute of Cerebrovascular Pathology and Stroke of Pirogov Russian National Research Medical University, Moscow, Russia; Interregional Clinical-Diagnostic Center, Kazan, Russia; City Hospital №26, St. Petersburg, Russia; City Hospital №40, St. Petersburg, Russia; City General Hospital №2, St. Petersburg, Russia; Kazan State Medical University, Kazan, Russia; Nikolaev Hospital, St. Petersburg, Russia; Vsevolga Clinical Interregional Hospital, Leningrad Region, Russia; Pirogov City Clinical Hospital №1, Samara, Russia; Seredavin Samara Regional Clinical Hospital, Samara, Russia; Research Institute Experimental and Clinical Medicine, Novosibirsk, Russia.
Summary:
Aim. To evaluate the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (IS). Material and methods. A randomized double blind multicenter placebo-controlled, in parallel groups trial included 151 patients (62 men and 89 women) with hemispheric IS. Using a method of simple randomization, 150 patients (62 men and 88 women), aged 40-79 years, were randomized into two groups. Patients of Group I were treated with mexidol: 500 mg/day IV infusion for 10 days, followed by 125 mg tid (375 mg/day) PO for 8 weeks. Patients of Group II received the placebo according to the same scheme. The total duration of patients’ participation in trial ranged from 67 to 71 days. Results. By the end of treatment, the mean score on the modified Rankin scale (mRS) was lower in Group I compared to Group II (p=0.04). In Group I, the decrease in mRS mean score (Visit 1-5) was more prominent (p=0.023), percentage of patients with 0-2 scores by mRS scale (Visit 5) was higher (p=0.039), mean NIHSS score lower (p=0.035) in Visit 5 compared to group II. By the end of treatment, the decrease in mean NIHSS score in patients with diabetes mellitus was more prominent in Group I in comparison with Group II (p=0.038). In Group I, the dynamic of improvement of quality of life was more prominent and started from Visit 2 in general population and subpopulation of patients with diabetes mellitus. The share of patients with no problems with movement in space was higher in Group I (p=0.022). There were no statistically significant differences in frequency of side effects in patients of both groups. Conclusion. It is recommended to include mexidol in therapy of patients with IS in the acute and early rehabilitation stages.
Keywords: acute disturbances of cerebral circulation, mexidol, ethylmethylhydroxypyridine succinate, efficacy and safety, ischemic stroke, acute period, acute rehabilitation period, EPICA.
The results of the study of the efficacy and safety of mexidol in patients with chronic cerebral ischemia
Author:
E.I. CHUKANOVA, A.S. CHUKANOVA, KH.I. MAMAYEVA.
Pirogov Russian National Research Medical University, Moscow.
Summary:
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.
Contemporary paradigm of rational stroke treatment
Author:
S.A. ZHIVOLUPOV, YU.S. BUTAKOVA, I.N. SAMARTSEV.
Department of nervous diseases of the Military Medical Academy; primary vascular compartment Novodvinsk City Hospital, Saint Petersburg, Russia.
Summary:
Stroke was and remains one of the world’s leading medical and social problems. Nowadays we are watching permanent sometimes cardinal changes in view about etiology, pathogenetic mechanisms and therapy of patients with stroke. In this work there have been elucidated contemporary theoretical and practical aspects of stroke treatment and prophylaxis based on the results of multicenter clinical trials and experience of leading foreign and native specialists. Much attention is devoted to the pharmacotherapy of patients with stroke. It is showed that application of neuroprotective drugs is of great importance, among which antihypoxants with pleiotropic action play a crucial role (mexidol).
Keywords: stroke, therapy, prophylaxis, neuroprotection, antihypoxants, mexidol.
Possibilities of antioxidant therapy for asthenia and cognitive deficit in elderly patients with chronic brain ischemia
Author:
S.N. DUMA.
Research Institute of Therapy, Siberian Branch, Russian Academy of Medical Sciences, Novosibirsk.
Summary:
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.
Optimization of hypolipidemic therapy in patients with ischemic stroke and diabetes mellitus
Author:
L.A. SHCHEPANKEVICH, YU.A. NIKOLAEV, N.A. DOLGOVA.
Research Institute of Experimental and Clinical Medicine, Novosibirsk.
Summary:
Objectives. Evaluation of effectiveness of Mexidol in optimization of hypolipidemic therapy in ischemic stroke and diabetes mellitus patients. Material and methods. Authors analyzed the indicators of lipid status: total cholesterol, low-density lipoproteins, high density lipoproteins, triglycerides and concentration of platelet factor-4, β-tromboglobulin, von Willebrand factor in 68 patients with acute ischemic stroke and diabetes mellitus. Authors investigate the dynamics of these parameters (1st, 21st, 3-d and 6th month after onset stroke) depending on timing and dose of Mexidol. Results. Long time therapy of Mexidol may optimize of hypolipidemic therapy in ischemic stroke and diabetes mellitus patients.
Keywords: ischemic stroke, diabetes mellitus, comorbidity, lipids, hemostasis, mexidol.
Chronic cerebrovascular diseases associated with metabolic syndrome: new treatment approaches
Author:
M.M. TANASHYAN, O.V LAGODA, K.V. ANTONOVA.
Nevrology Research Center Russian Academy of Medical Sciences, Moscow.
Summary:
Metabolic syndrome is a risk factor for acute and chronic cerebrovascular diseases. The development of oxidative stress promotes the progression of cerebral ischemia and treatment of the biochemical disturbances is needed. Use of antioxidants in patients with cerebrovascular diseases and metabolic syndrome reduce such symptoms as insulin resistance, hyperglyceridemia, hyperglycemia. The authors present results of a clinical study of mexidol in 40 patients, aged from 50 to 70 years, with chronic cerebrovascular pathology. Perspectives of using this group of drugs as universal neuroprotectors are discussed.
Keywords: ischemic cerebrovascular diseases, antioxidant treatment, metabolic syndrome, mexidol.
Neurometabolic therapy in secondary prevention of stroke
Author:
V.V. KOVALCHUCK.
Semashko City Hospital №38, St. Petersburg.
Summary:
Objective. To study the efficacy of mexidol in secondary prevention of stroke. Material and methods: We analyzed 3400 patients with stroke which were stratified into 7 groups: patients with cryptogenic ischemic stroke (II), arterial hypertension, atrial fibrillation, metabolic syndrome, syndrome of sleep-induced obstructive apnea/hypnea, diabetes mellitus, vasculitis. The assessment of efficacy was based on the absence of repeated II within 5 years of therapy. Results. Mexidol reduced the frequency of repeated II both in patients without concomitant diseases and in those with arterial hypertension, syndrome of sleep-induced obstructive apnea/hypnea, vasculitis, diabetes mellitus, atrial fibrillation and metabolic syndrome. Conclusion. The reliable efficacy of mexidol in secondary prevention of stroke was found out.
Keywords: stroke, secondary prevention, mexidol.
Adaptogenic effects of mexidol in chronic cerebral ischemia
Author:
E.A. ANTIPENKO.
Summary:
The data on the effect of the succinate-containing antioxidant mexidol on the adaptation abilities of patients with chronic brain ischemia are presented. We studied 98 patients with discirculatory encephalopathy of I, II and III stages. A set of indices for psychoemotional status, functional state of the brain, autonomic status, nonspecific stability to hypoxia, adaptive reactions of the blood system and status of antioxidant defense have been used to evaluate adaptive abilities of the body. It has been shown that the introduction of the antioxidant in the treatment set strengthens the effects of basic treatment by increasing adaptive reserves of the body in stages I and II of disease that is related with the realization of reactions of urgent adaptation. The introduction of mexidol in the treatment set increases the frequency of favorable outcomes after one year of follow-up.
Keywords: brain ischemia, discirculatory encephalopathy, adaptation, adaptogenic effect, stress.