scholarly journals Effect of Propentofylline on Regional Cerebral Glucose Metabolism in Acute Ischemic Stroke

1993 ◽  
Vol 13 (3) ◽  
pp. 526-530 ◽  
Author(s):  
M. Huber ◽  
B. Kittner ◽  
C. Hojer ◽  
G. R. Fink ◽  
M. Neveling ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glucose Metabolism ◽  
Acute Ischemic Stroke ◽  
Statistical Significance ◽  
Brain Regions ◽  
Controlled Study ◽  
Control Group ◽  
Double Blind ◽  
Positron Emission ◽  
Regional Cerebral Glucose Metabolism

In a randomized double-blind placebo-controlled study in 30 patients with acute ischemic stroke, the effect of the adenosine uptake blocker propentofylline on regional brain glucose metabolism (rCMRglu) was investigated using repeated positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-d-glucose (FDG). Treatment was initiated within 48 h after onset of symptoms. The clinical course was followed for 3 months. In the propentofylline group, after 14 days rCMRglu was increased in the infarct by 37.3% and was practically unchanged in other brain regions, whereas in the control group glucose metabolism had decreased in all regions (1.4–13.4%). These differences were significant between the two groups [Analysis of variance (ANOVA) p = 0.005]. Although there was a trend toward greater clinical improvement in the propentofylline-treated patients, this did not reach statistical significance. The results correspond to experimental data showing that propentofylline improves energy metabolism in cerebral ischemia. A clinical trial is needed to determine whether this new therapeutic principle can be successfully used in acute human stroke.

Effect of Nimodipine on Regional Cerebral Glucose Metabolism in Patients with Acute Ischemic Stroke as Measured by Positron Emission Tomography

1990 ◽  
Vol 10 (1) ◽  
pp. 127-132 ◽  
Author(s):  
W. -D. Heiss ◽  
V. Holthoff ◽  
G. Pawlik ◽  
M. Neveling
Keyword(s):  
Positron Emission Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Focal Ischemia ◽  
Emission Tomography ◽  
Control Group ◽  
Double Blind ◽  
Positron Emission ◽  
Median Change

In a randomized double-blind placebocontrolled study of 27 patients with acute ischemic stroke, the effect on regional CMRglc (rCMRglc) of the calcium channel blocking agent nimodipine administered in addition to routine treatment was investigated. Following computed tomography-supported diagnosis of focal ischemia in the middle cerebral artery territory, positron emission tomography (PET) of 2-[18F]fluoro-2-deoxy-d-glucose (FDG) was performed, and the patients were entered into the study within 48 h after onset of symptoms, randomly receiving either nimodipine (2 mg/h constant i.v. infusion for 5 days, 120 mg/day orally for another 16 days) or carrier/placebo. FDG PET was repeated after completion of therapy. The clinical course was followed during the treatment period and for 6 months after the stroke, using the Mathew Score for early and the Barthel Index for late assessment. During that observation period, five patients died in the nimodipine group and four in the control group. Subsequently, the code was broken, and the clinical and PET data were analyzed in relation to treatment assignment, with the nimodipine group comprising 11 and the control group 12 eligible cases. The two groups were similar with respect to age and sex distribution, initial clinical deficit, and infarct size and location. While the infarct rCMRglc showed comparable slight increases over time in both groups, the metabolic changes in the other evaluated regions (contralateral infarct mirror region, ipsi- and contralateral cerebral gray matter, contra- and ipsilateral cerebellar hemispheres) differed significantly between treatment groups (side x region x treatment interaction p < 0.025). In the control group, major improvement was found only in contralateral cerebrum (7.4%), whereas the nimodipine group had bilaterally increased rCMRglc of morphologically intact cerebral (14.6 and 17.1%, respectively) and, to a lesser degree, cerebellar (6.9 and 10.0%, respectively) structures. Likewise, progress of (postacute) rehabilitation was significantly (p1 < 0.05) better in the nimodipine treated patients (median change of Barthel Index = 40 vs. 2.5), although their clinical improvement during the first 3 weeks did not differ from the controls' (median change of Mathew Score = 12 and 11.5, respectively). These results lend further support to the notion that nimodipine treatment is of benefit in acute ischemic stroke. Since action on the infarct proper is unlikely when the drug is given many hours after the ischemic attack, it may be concluded that nimodipine exerts its beneficial effect by ameliorating the functional impairment of morphologically intact tissue surrounding the focal ischemia and by improving the metabolic deactivation of remote brain structures.

scholarly journals Efficacy and safety of cinepazide maleate injection in patients with acute ischemic stroke: A multicenter, randomized, double-blind, placebo-controlled trial

2020 ◽  
Author(s):  
Jun Ni ◽  
Huisheng Chen ◽  
Guofang Chen ◽  
Yong Ji ◽  
Fei Yi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Controlled Trial ◽  
Survival Rates ◽  
Control Group ◽  
Efficacy And Safety ◽  
Clinical Trial Registry ◽  
Double Blind

Abstract Background: Ischemic stroke is a leading cause of morbidity and mortality. Thrombolytic therapy improves disability and survival rates; however, to be effective, it must be given within 4.5 hours of onset. Moreover, thrombolytic therapy is frequently contraindicated. Therefore, alternative therapeutic options are required. In China, cinepazide maleate injection has been shown to improve the cerebral collateral circulation and further reduce disability in stroke patients; however, very few studies investigating this therapy have been conducted to date. Therefore, this study aimed to further confirm the efficacy and safety of cinepazide maleate injection in patients with acute ischemic stroke.Methods: Patients with acute ischemic stroke were administered an intravenous infusion of 320 mg cinepazide maleate or placebo once daily for 14 days. All patients were also administered basic therapy (citicoline sodium). The primary efficacy endpoint was the proportion of patients with a modified Rankin scale (mRS) ≤2 on day 90. Secondary efficacy endpoints included Barthel Index ≥95. Safety was evaluated by recording all adverse events (AEs), monitoring laboratory parameters and vital signs, and electrocardiogram.Results: In total, 937 patients with an acute ischemic stroke were included, with a mean (standard deviation, SD) National Institutes of Health Stroke Scale score of 8.8 (2.4) and a mean (SD) stroke onset of 30.9 (11.4) hours prior. Following treatment for 90 days, the proportion of patients with an mRS score ≤2 was significantly higher in the cinepazide maleate group than in the control group (60.9% vs. 50.1%; p=0.0004). Moreover, the proportion of patients with a Barthel Index of ≥95 on day 90 was also significantly higher in the cinepazide maleate group than in the control group (53.4% vs. 46.7%; p=0.0230). There were no statistically significant differences in safety parameters between the cinepazide maleate and control groups.Conclusions: The results of this study show that cinepazide maleate injection is superior to placebo in improving neurological function and activities of daily living, reducing disability, and promoting functional recovery in patients with acute ischemic stroke. Cinepazide maleate injection was safe and well tolerated with no unexpected AEs reported.Trial registration: Chinese Clinical Trial Registry CTR20160292 and ChiCTR1900023827. Retrospectively registered June 13, 2019.

Nimodipine in acute ischemic stroke: a double-blind controlled study

1989 ◽  
Vol 80 (4) ◽  
pp. 282-286 ◽  
Author(s):  
A. Paci ◽  
P. Ottaviano ◽  
A. Trenta ◽  
G. Lannone ◽  
L. Santis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Controlled Study ◽  
Double Blind

scholarly journals Stroke outcomes in Thai elderly patients treated with and without intravenous thrombolysis

2013 ◽  
Vol 5 (3) ◽  
pp. 15 ◽  
Author(s):  
Pornpatr A. Dharmasaroja ◽  
Sombat Muengtaweepongsa ◽  
Junya Pattaraarchachai ◽  
Permphan Dharmasaroja
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Retrospective Review ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Controlled Study ◽  
Control Group ◽  
Base Line ◽  
Old Patients ◽  
Stroke Outcomes

Higher mortality was found in very old patients with acute ischemic stroke treated with intravenous recombinant tissue-plasminogen activator (rtPA) as compared to younger patients. The benefit of thrombolytic treatment in this particular subgroup is still a subject of debate. The purpose of this study was to compare stroke outcomes in Thai patients aged over 70 years treated with and without intravenous rtPA. This was a retrospective review of sequential cases and was not a randomized controlled study. One-hundred and five patients with acute ischemic stroke aged over 70 years who were treated with intravenous rtPA and 105 patients without rtPA treatment (control group) were included in the study. Patients’ base-line characteristics and study outcomes of interest were compared. There were significant differences in the base-line characteristics of the two groups. However, for the subgroup of patients aged over 80 years, these characteristics were similar. Those who were treated with intravenous rtPA had a higher rate of favorable outcomes (40% <em>vs</em> 16%; P=0.137) and a lower rate of mortality (22% <em>vs</em> 44%; P=0.128) than patients who did not receive rtPA treatment. In well-matched subgroups of patients aged over 80 years, our retrospective review revealed there was a trend of a higher rate of favorable outcome and lower mortality in patients receiving rtPA treatment. More study is needed to further confirm the suggested benefit of thrombolysis in Asian octogenarian acute stroke patients.

scholarly journals Regional Cerebral Glucose Metabolism is Normal in Young Adults with down Syndrome

1990 ◽  
Vol 10 (2) ◽  
pp. 199-206 ◽  
Author(s):  
Mark B. Schapiro ◽  
Cheryl L. Grady ◽  
Anand Kumar ◽  
Peter Herscovitch ◽  
James V. Haxby ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Glucose Metabolism ◽  
Control Group ◽  
Vocabulary Test ◽  
Peabody Picture Vocabulary ◽  
Mental Age ◽  
Positron Emission ◽  
Darkened Room ◽  
Regional Cerebral Glucose Metabolism ◽  
Global Brain

Regional CMRglc (rCMRglc) values were measured with [18F]2-fluoro-2-deoxy-d-glucose (18FDG) and positron emission tomography (PET), using a Scanditronix PC-1024-7B scanner, in 14 healthy, noninstitutionalized subjects with trisomy 21 (Down syndrome; DS) (mean age 30.0 years, range 25–38 years) and in 13 sex-matched, healthy volunteers (mean age 29.5 years, range 22–38 years). In the DS group, mean mental age on the Peabody Picture Vocabulary Test was 7.8 years and dementia was not present. Resting rCMRglc was determined with eyes covered and ears occluded in a quiet, darkened room. Global gray CMRglc equaled 8.76 ± 0.76 mg/100 g/min (mean ± SD) in the DS group as compared with 8.74 ± 1.19 mg/100 g/min in the control group (p > 0.05). Gray matter regional measurements also did not differ between groups. The ratio of rCMRglc to global CMRglc, calculated to reduce the variance associated with absolute rCMRglc, and right/left ratios did not show any consistent differences. These results show that healthy young DS adults do not have alterations in regional or global brain glucose metabolism, as measured with 18FDG and PET, prior to an age at which the neuropathological changes in Alzheimer disease are reported to occur.

scholarly journals Efficacy and safety of cinepazide maleate injection in patients with acute ischemic stroke: A multicenter, randomized, double-blind, placebo-controlled trial

2020 ◽  
Author(s):  
Jun Ni ◽  
Huisheng Chen ◽  
Guofang Chen ◽  
Yong Ji ◽  
Fei Yi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Controlled Trial ◽  
Survival Rates ◽  
Vital Signs ◽  
Control Group ◽  
Efficacy And Safety ◽  
Double Blind

Abstract Background: Ischemic stroke is a leading cause of morbidity and mortality. Thrombolytic therapy improves disability and survival rates; however, to be effective, it must be given within 4.5 hours of onset. Moreover, thrombolytic therapy is frequently contraindicated. Therefore, alternative therapeutic options are required. In China, cinepazide maleate injection has been shown to improve the cerebral collateral circulation and further reduce disability in stroke patients; however, very few studies investigating this therapy have been conducted to date. Therefore, this study aimed to further confirm the efficacy and safety of cinepazide maleate injection in patients with acute ischemic stroke. Methods: Patients with acute ischemic stroke were administered an intravenous infusion of 320 mg cinepazide maleate or placebo once daily for 14 days. All patients were also administered basic therapy (citicoline sodium). The primary efficacy endpoint was the proportion of patients with a modified Rankin scale (mRS) ≤2 on day 90. Secondary efficacy endpoints included Barthel Index ≥95. Safety was evaluated by recording all adverse events (AEs), monitoring laboratory parameters and vital signs, and electrocardiogram. Results: In total, 937 patients with an acute ischemic stroke were included, with a mean (standard deviation, SD) National Institutes of Health Stroke Scale score of 8.8 (2.4) and a mean (SD) stroke onset of 30.9 (11.4) hours prior. Following treatment for 90 days, the proportion of patients with an mRS score ≤2 was significantly higher in the cinepazide maleate group than in the control group (60.9% vs. 50.1%; p=0.0004). Moreover, the proportion of patients with a Barthel Index of ≥95 on day 90 was also significantly higher in the cinepazide maleate group than in the control group (53.4% vs. 46.7%; p=0.0230). There were no statistically significant differences in safety parameters between the cinepazide maleate and control groups. Conclusions: The results of this study show that cinepazide maleate injection is superior to placebo in improving neurological function and activities of daily living, reducing disability, and promoting functional recovery in patients with acute ischemic stroke. Cinepazide maleate injection was safe and well tolerated with no unexpected AEs reported.

scholarly journals PENGARUH EKSTRAK CHANNA STRIATUS TERHADAP KADAR DHA SERUM DAN NIHSS PASIEN STROKE ISKEMIK AKUT

2020 ◽  
Vol 35 (4) ◽  
Author(s):  
Kundha Deyanningtyas ◽  
Retnaningsih Retnaningsih ◽  
Amin Husni
Keyword(s):  
Ischemic Stroke ◽  
Docosahexaenoic Acid ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Serum Levels ◽  
Control Group ◽  
Double Blind Study ◽  
Docosahexanoic Acid ◽  
Double Blind ◽  
Channa Striatus

  THE EFFECT OF CHANNA STRIATUS EXTRACT ON DHA SERUM LEVELS AND NIHSS IN ACUTE ISCHEMIC STROKE PATIENTSABSTRACTIntroduction: The level of docosahexanoic acid (DHA) is associated with clinical outcome in acute ischemic stroke (AIS). Channa striatus/snakehead fish has a neuroprotective function due to its DHA content.Aims: Investigate the effect of Channa Striatus extract (EIG) administration which contains DHA on DHA serum levels and neurological clinical output of AIS patients.Methods: This was a randomized pre-posttest control group design with double-blind study. Patients were divided into two groups: treatment, with additional 15 grams EIG administered for 7 days, and control, without additional EIG. DHA serum levels and NIHSS scores were measured before and after treatment. Other factors that may affected the out- come were also analyzed by multivariate statistic.Result: A total of 42 subjects were allocated randomly as treatment or control. The difference of elevated DHA se- rum levels in treatment group was significantly greater than control group. There was a negative correlation between DHA serum levels changes and NIHSS changes. Multivariate analysis showed that NIHSS improvement was affected by EIG (Odds ratio/OD:0.25) gender (OR:5.64).Discussions: There was a significant relationship between EIG supplementation with NIHSS changes. EIG may im- prove neurologic clinical outcome a one-fourth times greater than placebo, thus can be considered as supportive treatment in the recovery of acute ischemic stroke patients.Keywords: Channa Striatus, docosahexaenoic acid (DHA), ischemic stroke, NIHSSABSTRAKPendahuluan: Kadar docosahexanoic acid (DHA) berkaitan dengan luaran klinis stroke iskemik akut (SIA). Channa Striatus/ikan gabus mempunyai fungsi neuroprotektif karena memiliki kandungan DHA.Tujuan: Mengetahui pengaruh pemberian ekstrak ikan gabus (EIG) yang mengandung DHA terhadap kadar DHA serum serta luaran klinis pasien stroke iskemik akut.Metode: Penelitian dengan desain randomized pre-posttest control group secara tersamar ganda. Pasien dibagi menjadi 2 kelompok; kelompok perlakuan mendapatkan  EIG 15gr selama 7 hari dan kelompok kontrol tanpa perlakuan tambahan. Kadar DHA serum dan skor NIHSS diukur sebelum dan sesudah perlakuan. Faktor-faktor lain yang berpengaruh pada luaran klinis juga dianalisis secara multivariat.Hasil: Sebanyak 42 subjek dilakukan random alokasi sebagai kelompok perlakuan atau kontrol. Didapatkan adanya selisih peningkatan kadar DHA serum pada kelompok perlakuan yang lebih besar secara bermakna dibanding kelompok kontrol. Terdapat korelasi negatif antara perubahan kadar DHA serum dengan perubahan skor NIHSS. Analisis multivariat tampak bahwa EIG berpengaruh pada penurunan skor NIHSS (rasio Odds/RO:0,25) dan variabel jenis kelamin (RO:5,64).Diskusi: Terdapat hubungan yang bermakna antara pemberian EIG dengan perubahan skor NIHSS pasien stroke iskemik akut. Pemberian EIG dapat memperbaiki luaran klinis neurologis seperempat kali lebih besar dibanding plasebo, sehingga dapat dipertimbangkan untuk penunjang pemulihan pasien stroke iskemik akut.Kata kunci: Channa Striatus, docosahexaenoic acid (DHA), NIHSS, stroke iskemik

Clinical Study of Qingpeng Ointment Treatment of Shoulder-Hand Syndrome After Cerebral Hemorrhage During the Rehabilitation Period

2020 ◽  
Vol 23 ◽  
Author(s):  
Ruihuan Pan ◽  
Shanshan Ling ◽  
Haodong Yang ◽  
Yan Huang ◽  
Lechang Zhan ◽  
...  
Keyword(s):  
Treatment Group ◽  
Cerebral Hemorrhage ◽  
Clinical Medicine ◽  
External Rotation ◽  
Statistical Significance ◽  
Hand Function ◽  
Tibetan Medicine ◽  
Controlled Study ◽  
Control Group ◽  
The Difference

Background: Shoulder-hand syndrome (SHS) refers to a syndrome causing sudden edema, shoulder pain and limited hand function. Qingpeng ointment, a kind of Tibetan medicine, can reduce swelling, relieve pain, tonify stagnation and clear the meridians, which is consistent with the pathological mechanism of SHS after stroke. Therefore, if clinical trials can be used to explore the effectiveness of Qingpeng ointment for treatment of poststroke SHS and promote its application in clinical medicine, this is of specific significance for the treatment of poststroke SHS. Objective: To investigate the clinical efficacy and safety of Qingpeng ointment in the treatment of poststroke SHS. To provide an objective basis for a better therapeutic treatment for poststroke SHS． Method: A prospective, randomized, controlled study was conducted. This study recruited 120 patients with poststroke SHS who met the inclusion criteria. They were randomized into the treatment group and the control group, with 60 patients allocated to each group. The treatment group received routine medical treatment and rehabilitative care after using the Qingpeng ointment, while the patients in the control group received only routine treatment without the ointment. All patients received clinical assessment with the Visual Analogue Scale (VAS), measurement of the range of motion (ROM) of the upper-limb joints, the Fugl-Meyer Assessment of Upper Extremity (FMA-U) and the Modified Barthel Index Score (MBI) before and after the whole treatment. Results: After 4 weeks of treatment, the VAS scores of both groups were decreased significantly (P＜0.05), and the difference between the two groups was statistically significant (P < 0.05). There is no statistical significance for the difference between the treatment group and control group in terms of the FMA-U and MBI scores and the forward bend, backward, outstretch, external rotation and pronation angles after treatment. The increases in the values of VAS, FMA-M and MBI in the treatment group were greater than those in the control group, and the difference was statistically significant (P < 0.05). The increases in the values of the forward bend, outreach and external rotation angles in the treatment group were greater than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion: The treatment group showed better results than the control group in terms of the relief of pain symptoms, the improvement of motor function and the improvement of the activities of daily living for patients with shoulder-hand syndrome after cerebral hemorrhage. Qingpeng ointment is effective and safe in treating poststroke SHS.

scholarly journals Selective intra-carotid blood cooling in acute ischemic stroke: A safety and feasibility study in an ovine stroke model

2021 ◽  
pp. 0271678X2110249
Author(s):  
Giorgio FM Cattaneo ◽  
Andrea M Herrmann ◽  
Sebastian A Eiden ◽  
Manuela Wieser ◽  
Elias Kellner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Neurological Outcome ◽  
Artery Occlusion ◽  
Control Group ◽  
Stroke Model ◽  
Primary Endpoints ◽  
Neuroprotective Strategy ◽  
Vessel Patency

Selective therapeutic hypothermia (TH) showed promising preclinical results as a neuroprotective strategy in acute ischemic stroke. We aimed to assess safety and feasibility of an intracarotid cooling catheter conceived for fast and selective brain cooling during endovascular thrombectomy in an ovine stroke model. Transient middle cerebral artery occlusion (MCAO, 3 h) was performed in 20 sheep. In the hypothermia group (n = 10), selective TH was initiated 20 minutes before recanalization, and was maintained for another 3 h. In the normothermia control group (n = 10), a standard 8 French catheter was used instead. Primary endpoints were intranasal cooling performance (feasibility) plus vessel patency assessed by digital subtraction angiography and carotid artery wall integrity (histopathology, both safety). Secondary endpoints were neurological outcome and infarct volumes. Computed tomography perfusion demonstrated MCA territory hypoperfusion during MCAO in both groups. Intranasal temperature decreased by 1.1 °C/3.1 °C after 10/60 minutes in the TH group and 0.3 °C/0.4 °C in the normothermia group (p < 0.001). Carotid artery and branching vessel patency as well as carotid wall integrity was indifferent between groups. Infarct volumes (p = 0.74) and neurological outcome (p = 0.82) were similar in both groups. Selective TH was feasible and safe. However, a larger number of subjects might be required to demonstrate efficacy.

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