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Goel D, Shangari S, Mittal M, Bhat A. Endogenous defense mechanism-based neuroprotection in large-vessel acute ischemic stroke: A hope for future. Brain Circ 2024; 10:51-59. [PMID: 38655439 PMCID: PMC11034449 DOI: 10.4103/bc.bc_56_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality worldwide and a leading cause of disability. None of the neuroprotective agents have been approved internationally except edaravone in Japanese guidelines in acute ischemic stroke. We here discuss that there are two types of endogenous defense mechanisms (EDMs) after acute stroke for neuromodulation and neuroregeneration, and if both can be activated simultaneously, then we can have better recovery in stroke. AIMS AND OBJECTIVES We aimed to study the effect of combination of neuroprotection therapies acting on the two wings of EDM in acute large-vessel middle cerebral artery (LMCA) ischemic stroke. METHODS Sixty patients of LMCA stroke were enrolled and randomized within 72 h into two groups of 30 patients each. The control group received standard medical care without any neuroprotective agents while the intervention group received standard medical care combined with oral citicoline with vinpocetine for 3 months with initial 1 week intravenous and edaravone and cerebrolysin injection, started within 72 h of onset of stroke. Patients were assessed on the basis of the National Institutes of Health Stroke Scale, Fugl-Meyer Assessment Score, Glasgow Coma Scale, and Mini-Mental Status Examination at admission, discharge, and after 90 days. RESULTS The intervention group showed significant and early improvements in motor as well as cognitive recovery. CONCLUSION Combination therapy for neuroprotection which is acting on two pathways of EDM can be useful in functional recovery after acute ischemic stroke.
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Affiliation(s)
- Deepak Goel
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sushant Shangari
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Manish Mittal
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Ashwani Bhat
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Yang B, Li Y, Guo W, Zhang Q, Pan L, Duan K, Zhang P, Ren L, Zhang W, Wang Q, Kong D. Optimized approach for active peptides identification in Cerebrolysin by nanoLC-MS. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1225:123755. [PMID: 37220681 DOI: 10.1016/j.jchromb.2023.123755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
Cerebrolysin (CBL) is a peptide-rich preparation made by hydrolysis and purified extraction of porcine brain. CBL contains various neuroprotective peptides, such as neurotrophic factor, nerve growth factor and ciliary neurotrophic factor, which can be used to treat neurodegenerative diseases. However, the active peptides in CBL had not been studied in depth. In this study, the following was carried out in order to investigate the active peptides in CBL. First, CBL samples were treated using organic reagents (acetonitrile and acetone) to precipitate the proteins and different solid phase extraction methods (MCX mixed-mode cartridges, C18 SPE cartridge columns and HILIC sorbent). Then the samples were analyzed using nanoLC-MS, followed by the identification of peptides using different sequence analysis software (PEAKS, pNovo and novor). Finally, bioinformatics analysis was performed to predict peptides with potential neuroprotective functions in CBL, such as anti-inflammatory and antioxidant peptides. Results showed that the number of peptides obtained by the MCX method coupled with PEAKS was the highest and the method was the most stable. Bioinformatic analysis of the detected peptides showed that two anti-inflammatory peptides (LLNLQPPPR and LSPSLRLP) and an antioxidant peptide (WPFPR) might be neuroprotective peptides in CBL. In addition, this study found that some peptides in CBL were present in myelin basic protein and tubulin beta chain. The results of this study for the detection of active peptides in CBL laid the foundation for the subsequent study of its active ingredients.
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Affiliation(s)
- Bingkun Yang
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China; School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017 China
| | - Yahui Li
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
| | - Wenyan Guo
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
| | - Qingning Zhang
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
| | - Liangyu Pan
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
| | - Kunfeng Duan
- Department of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Panpan Zhang
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
| | - Leiming Ren
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
| | - Wei Zhang
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China.
| | - Qiao Wang
- School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017 China.
| | - Dezhi Kong
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China.
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Mitrović SZ, Konstantinović LM, Miler Jerković V, Dedijer-Dujović S, Djordjević OC. Extended Poststroke Rehabilitation Combined with Cerebrolysin Promotes Upper Limb Motor Recovery in Early Subacute Phase of Rehabilitation: A Randomized Clinical Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020291. [PMID: 36837492 PMCID: PMC9958781 DOI: 10.3390/medicina59020291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
Background and Objectives: The recovery of stroke patients with severe impairment is usually poor and limited and, unfortunately, under-investigated in clinical studies. In order to support neuroplasticity and modulate motor recovery, Cerebrolysin combined with rehabilitation treatment has proven effective in the acute stroke phase in moderate to severe motor impairment. The aim of this study was to determine the efficacy of extended poststroke rehabilitation combined with Cerebrolysin on upper limb motor recovery in subacute stroke patients with severe upper limb motor impairment. Materials and Methods: A randomized, double-blind, placebo-controlled study was conducted. Sixty patients at the early stage of severe sub-acute stroke who fulfilled all eligibility criteria were randomly assigned to the Cerebrolysin group or placebo group (𝑛 = 30 each). Both groups, after conducting three weeks of conventional rehabilitation treatment five days per week, continued to perform conventional rehabilitation treatment three times per week until 90 days of rehabilitation treatment. The primary outcome measure was the Action Research Arm Test (ARAT), and the secondary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, Barthel index (BI), and the National Institutes of Health Stroke Scale (NIHSS). The outcome data were evaluated before, after three weeks of treatment, and on the 90th day of rehabilitation treatment, and compared within groups and between the two groups. There were no adverse events. Results: Both groups showed a significant improvement (p < 0.001) over time in BI, FMA-UE, ARAT, and NIHSS scores. Patients receiving Cerebrolysin showed more significant improvement in post-stroke upper limb motor impairment and functioning compared to the placebo group after only three weeks, and the trend was maintained after 90 days of follow up. Conclusion: Cerebrolysin delivered in the early subacute post-stroke phase added to extended conventional rehabilitation treatment is beneficial and improves motor functional recovery in patients with severe motor impairment, especially on the paretic upper extremity.
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Affiliation(s)
- Sindi Z. Mitrović
- Clinic for Rehabilitation “Dr. Miroslav Zotović”, Faculty of Medicine, University of Belgrade, Sokobanjska 13, 11000 Belgrade, Serbia
- Correspondence: (S.Z.M.); (L.M.K.)
| | - Ljubica M. Konstantinović
- Clinic for Rehabilitation “Dr. Miroslav Zotović”, Faculty of Medicine, University of Belgrade, Sokobanjska 13, 11000 Belgrade, Serbia
- Correspondence: (S.Z.M.); (L.M.K.)
| | - Vera Miler Jerković
- Innovation Center, School of Electrical Engineering, University of Belgrade, Bulevar Kralja Aleksandra 73, 11120 Belgrade, Serbia
| | - Suzana Dedijer-Dujović
- Clinic for Rehabilitation “Dr. Miroslav Zotović”, Faculty of Medicine, University of Belgrade, Sokobanjska 13, 11000 Belgrade, Serbia
| | - Olivera C. Djordjević
- Clinic for Rehabilitation “Dr. Miroslav Zotović”, Faculty of Medicine, University of Belgrade, Sokobanjska 13, 11000 Belgrade, Serbia
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Stockbridge MD, Bunker LD, Hillis AE. Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke. Curr Neurol Neurosci Rep 2022; 22:745-755. [PMID: 36181577 PMCID: PMC9525934 DOI: 10.1007/s11910-022-01231-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Stroke is a common cause of disability in aging adults. A given individual's needs after stroke vary as a function of the stroke extent and location. The purpose of this review was to discuss recent clinical investigations addressing rehabilitation of an array of overlapping functional domains. RECENT FINDINGS Research is ongoing in the domains of movement, cognition, attention, speech, language, swallowing, and mental health. To best assist patients' recovery, innovative research has sought to develop and evaluate behavioral approaches, identify and refine synergistic approaches that augment the response to behavioral therapy, and integrate technology where appropriate, particularly to introduce and titrate real-world complexity and improve the overall experience of therapy. Recent and ongoing trials have increasingly adopted a multidisciplinary nature - augmenting refined behavioral therapy approaches with methods for increasing their potency, such as pharmaceutical or electrical interventions. The integration of virtual reality, robotics, and other technological advancements has generated immense excitement, but has not resulted in consistent improvements over more universally accessible, lower technology therapy.
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Affiliation(s)
- Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA.
| | - Lisa D Bunker
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA
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5
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Zhi JF, Liao QH, He YB, Xu WW, Zhu DW, Shao LH. Superior treatment efficacy of neuromodulation rehabilitation for upper limb recovery after stroke: a meta-analysis. Expert Rev Neurother 2022; 22:875-888. [PMID: 36242781 DOI: 10.1080/14737175.2022.2137405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aims to explore the treatment efficacy of different motor rehabilitation interventions for upper limb impairment recovery. RESEARCH DESIGN & METHODS Publications were searched in PubMed and Embase. 4 grouped motor rehabilitation treatments (training, technological intervention, pharmacological intervention, and neuromodulation) were compared. The change of the Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) was applied to assess upper limb function after stroke. RESULTS 56 studies including 5292 patients were identified. A significant difference was found among the 4 groups (P = 0.02). Neuromodulation interventions had the best treatment efficacy among the 4 types of interventions (P < 0.01). Among neuromodulation interventions, acupuncture, electric, or magnetic intervention all had therapeutic efficacy for stroke upper limb recovery, without significant subgroup difference (P = 0.34). Stroke patients with mild upper limb impairment might not benefit from motor rehabilitation (P = 0.14). CONCLUSION Neuromodulation interventions might have the best therapeutic efficacy among motor rehabilitation treatments for upper limb impairment after stroke. It is a potential treatment direction for upper limb recovery among stroke patients. However, since a large proportion of the original studies are low to very low-quality evidence, large-scale RCTs should be conducted in the future to validate current findings and assess treatment effects based on patient characteristics.
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Affiliation(s)
- Jian-Feng Zhi
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Qing-Hong Liao
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Yu-Bo He
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Wen-Wen Xu
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Dan-Wei Zhu
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Lin-Hong Shao
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
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6
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Staszewski J, Stȩpień A, Piusińska-Macoch R, Dȩbiec A, Gniadek-Olejniczak K, Frankowska E, Maliborski A, Chadaide Z, Balo D, Król B, Namias R, Harston G, Mróz J, Piasecki P. Efficacy of Cerebrolysin Treatment as an Add-On Therapy to Mechanical Thrombectomy in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion: Study Protocol for a Prospective, Open Label, Single-Center Study With 12 Months of Follow-Up. Front Neurol 2022; 13:910697. [PMID: 35860483 PMCID: PMC9289167 DOI: 10.3389/fneur.2022.910697] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 12/18/2022] Open
Abstract
This study is designed to determine the efficacy of Cerebrolysin treatment as an add-on therapy to mechanical thrombectomy (MT) in reducing global disability in subjects with acute ischemic stroke (AIS). We have planned a single center, prospective, open-label, single-arm study with a 12-month follow-up of 50 patients with moderate to severe AIS, with a small established infarct core and with good collateral circulation who achieve significant reperfusion following MT and who receive additional Cerebrolysin within 8 h of stroke onset compared to 50 historical controls treated with MT alone, matched for age, clinical severity, occlusion location, baseline perfusion lesion volume, onset to reperfusion time, and use of iv thrombolytic therapy. The primary outcome measure will be the overall proportion of subjects receiving Cerebrolysin compared to the control group experiencing a favorable functional outcome (by modified Rankin Scale 0-2) at 90 days, following stroke onset. The secondary objectives are to determine the efficacy of Cerebrolysin as compared to the control group in reducing the risk of symptomatic secondary hemorrhagic transformation, improving neurological outcomes (NIHSS 0-2 at day 7, day 30, and 90), reducing mortality rates (over the 90-day and 12 months study period), and improving: activities of daily living (by Barthel Index), health-related quality of life (EQ-5D-5L) assessed at day 30, 90, and at 12 months. The other measures of efficacy in the Cerebrolysin group will include: assessment of final stroke volume and penumbral salvage (measured by CT/CTP at 30 days) and its change compared to baseline volume, changes over time in language function (by the 15-item Boston Naming Test), hemispatial neglect (by line bisection test), global cognitive function (by The Montreal Cognitive Assessment), and depression (by Hamilton Depression Rating Scale) between day 30 and day 90 assessments). The patients will receive 30 ml of Cerebrolysin within 8 h of AIS stroke onset and continue treatment once daily until day 21 (first cycle) and they will receive a second cycle of treatment (30 ml/d for 21 days given in the Outpatient Department or Neurorehabilitation Clinic) from day 69 to 90.
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Affiliation(s)
- Jacek Staszewski
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland
| | - Adam Stȩpień
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland
| | | | | | | | - Emilia Frankowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Artur Maliborski
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Zoltan Chadaide
- Brainomix Ltd., and Oxford University Hospitals NHSFT, Oxford, United Kingdom
| | - David Balo
- Brainomix Ltd., and Oxford University Hospitals NHSFT, Oxford, United Kingdom
| | - Beata Król
- Brainomix Ltd., and Oxford University Hospitals NHSFT, Oxford, United Kingdom
| | - Rafael Namias
- Brainomix Ltd., and Oxford University Hospitals NHSFT, Oxford, United Kingdom
| | - George Harston
- Brainomix Ltd., and Oxford University Hospitals NHSFT, Oxford, United Kingdom
| | - Józef Mróz
- Neurorehabilitation Clinic, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Piasecki
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
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Personalized Approaches to Stroke: One Step Forward for Functional Recovery of Stroke Patients. J Pers Med 2022; 12:jpm12050822. [PMID: 35629244 PMCID: PMC9148160 DOI: 10.3390/jpm12050822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Recent advances in diagnoses, management, and rehabilitation have had a significant impact to reduce mortality and functional recovery in stroke patients. In spite of these medical advances, many stroke survivors still suffer from significant disabilities. Stroke is a complex disease caused by a combination of multiple risk factors. Therefore, personalized medicine is more important than any other field to overcome the limitations of current stroke management and rehabilitation. It is necessary to apply accurate evaluation for functions and a personalized approach in consideration of various characteristics of each stroke patient to improve function. The objective of this Special Issue is to inform the recent scientific knowledge, current limitations, and challenges for an individually tailored strategy in the areas of diagnosis, treatment, and rehabilitation of stroke. A multidisciplinary approach and research will be strongly encouraged for personalized medicine in the field of stroke treatment and rehabilitation.
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Role and Impact of Cerebrolysin for Ischemic Stroke Care. J Clin Med 2022; 11:jcm11051273. [PMID: 35268364 PMCID: PMC8911124 DOI: 10.3390/jcm11051273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 01/01/2023] Open
Abstract
Stroke is still a significant health problem that affects millions of people worldwide, as it is the second-leading cause of death and the third-leading cause of disability. Many changes have occurred in the treatment of acute ischemic stroke. Although the innovative concepts of neuroprotection and neurorecovery have been vigorously investigated in a substantial number of clinical studies in the past, only a few trials managed to increase the number of promising outcomes with regard to the multidimensional construct of brain protection and rehabilitation. In terms of pharmacological therapies with proven benefits in the post-ischemic process, drugs with neurorestorative properties are thought to be effective in both the acute and chronic phases of stroke. One significant example is Cerebrolysin, a combination of amino acids and peptides that mimic the biological functions of neurotrophic factors, which has been shown to improve outcomes after ischemic stroke, while preserving a promising safety profile. The purpose of this paper is to offer an overview on the role and impact of Cerebrolysin for ischemic stroke care, by touching on various aspects, from its complex, multimodal and pleiotropic mechanism of action, to its efficacy and safety, as well as cost effectiveness.
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Yanishevskiy SN, Khatkova SE. [A progressive view on the treatment and rehabilitation of acute ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:50-54. [PMID: 36582161 DOI: 10.17116/jnevro202212212250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The review discusses the data on efficacy and safety of reperfusion therapy and neuroprotective therapy in ischemic stroke (IS) and during the rehabilitation. The authors recommend using an individual approach to the treatment of patients with acute IS and identify patients in whom neurotrophic therapy will bring the greatest effect. In addition, it is concluded that pharmacological support is an integral part of the rehabilitation of patients after a stroke, along with the correct assessment of neurological deficits, the timely start of rehabilitation measures, the complexity and continuity at all stages.
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Affiliation(s)
- S N Yanishevskiy
- Almazov National Medical Research Centre, St. Petersburg, Russia.,Kirov Military Medical Academy, St. Petersburg, Russia
| | - S E Khatkova
- National Medical Research Center - Medical Rehabilitation Center, Moscow, Russia
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Fiani B, Chacon D, Jarrah R, Barthelmass M, Covarrubias C. Neuroprotective strategies of cerebrolysin for the treatment of infants with neonatal hypoxic-ischemic encephalopathy. Acta Neurol Belg 2021; 121:1401-1406. [PMID: 34494216 DOI: 10.1007/s13760-021-01795-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Perinatal asphyxia (PA) is a devastating neonatal condition characterized by a lack of oxygen supporting the organ systems. PA can lead to hypoxic-ischemic encephalopathy (HIE), a brain dysfunction due to oxygen deprivation with a complex neurological sequela. The pathophysiology of HIE and PA is not entirely understood, with therapeutic hypothermia being the standard treatment with only limited value. However, alternative neuroprotective therapies can be a potential treatment modality. METHODS In this review, we will characterize the biochemical mechanisms of PA and HIE, while also giving insight into cerebrolysin, a neuroprotective treatment used for HIE and PA. RESULTS We found that cerebrolysin has up to 6-month treatment window post-ischemic insult. Cerebrolysin injections of 0.1 ml/kg of body weight twice per week were found to provide gross motor and speech deficit improvement. CONCLUSION Our literature search emphasizes the positive effects of cerebrolysin for general improvement outcomes. Nevertheless, biomarker establishment is warranted to improve patient outcomes.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA, 92262, USA.
| | - Daniel Chacon
- School of Medicine, Ross University, Bridgetown, Barbados
| | - Ryan Jarrah
- Department of Neuro-Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michaela Barthelmass
- School of Medicine, California University of Sciences and Medicine, Colton, CA, USA
| | - Claudia Covarrubias
- School of Medicine, Universidad Anáhuac Querétaro, Santiago de Querétaro, México
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