- Combined neuroprotection in the complex rehabilitation in diabetic patients with acute stroke
Combined neuroprotection in the complex rehabilitation in diabetic patients with acute stroke
INTERNATIONAL JOURNAL REHABLITATION AND PALLIATIVE MEDICINE.2017.1-2(5-6):53-58; doi 10.15574/IJRPM.2017.5-6.53
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
In the complex of rehabilitation measures after an acute stroke (AS) is widely used neuroprotectors of different groups, but there are no clear recommendations for their use in patients with AS on the background of concomitant diabetes mellitus (DM).
Objective. To investigate the efficacy of the combination of citicoline and magnesium sulfate as neuroprotection methods in the rehabilitation complex in diabetic patients with acute stroke.
Material and methods. A comprehensive clinical-neurological and laboratory examination of 346 patients (171 women and 175 men) with the acute ischemic stroke was performed. These patients were administered citicoline 1000 mg 1 time per day and magnesium sulfate solution 25% 10 ml 3 times a day. The control group (36 patients – 16 women and 20 men) were administered various drugs with declared neuroprotective activity (except citicoline and magnesium sulfate).
Results. In the citicoline and magnesium sulfate groups, starting from the 5th day the level of consciousness recovered faster than in the conventional treatment group. According to the FOUR scale, the difference between the 1 and 2 groups and the control up to 10th day of treatment measured up a confidence level (p<0.05). On the 3rd day of treatment in all groups of patients, the level of neuron-specific enolase (NSE) exceeded the normal findings, and the highest one was observed in the control group, whose NSE level increased 10-fold (from 9.2 to 96.4 ng/ml). Then there was the rapid NSE level decrease, which in the treatment groups reached normal levels up to the 10th day of treatment. In the control group, the dynamics of NSE decline was not so pronounced and until the 10th day of treatment the NSE level did not reach reference values.
Conclusions. The citicoline and magnesium sulfate combination efficacy was significantly-valid in the treatment of diabetic patients with AS and is one of the promising components of the rehabilitation complex of these patients.
Key words: acute ischemic stroke, diabetes mellitus, rehabilitation, neuroprotection, citicoline, magnesium sulfate.
1. Gelfand B.R. (2009). Intensivnaya terapIya. Natsionalnoe rukovodstvo. V 2-h t. Pod red. A.I. Saltanova. Moskva: GEOTAR-Media. T.I: 960.
2. Sokolova L.I., Dovbonos T.A., Shandiuk V.Yu. (2015). Zastosuvannia sulfatu mahniiu pry ishemichnomu insulti. Ukr. nevrolohich. zhurn. 4(37): 91–97.
3. Stadnik S.M. (2017). Suchasni pidkhody do preventyvno-terapevtychnoi korektsii postinsultnykh kohnityvnykh rozladiv. Hostri ta nevidkladni stany v praktytsi likaria. 1(64): 32–38.
4. Suchasni pryntsypy diahnostyky ta likuvannia khvorykh iz hostrym ishemichnym insultom ta TIA (Adaptovana klinichna nastanova). (2012). Kyiv: Vydavets D.V. Huliaiev: 144.
5. Titov I.I. (2017). Effektivnost, bezopasnost i perenosimost kombinatsii elektrolitov i tsitikolina (Neyrotsitin®) u patsientov s ostryim ishemicheskim insultom: pervyie rezultatyi issledovaniya. MIzhnar. nevrolog. zhurn. 1(87): 64–72.
6. Hobzey N.K., Mischenko T.S., Golik V.A., Ipatov A.V. (2010). Epidemiologiya insulta, klinicheskie i ekspertnyie aspektyi v Ukraine. SudinnI zahvoryuvannya golovnogo mozku. 4: 2–6.
7. Afshari D., Moradian N., Rezaei M. (2013). Evaluation of the intravenous magnesium sulfate effect in clinical improvement of patients with acute ischemic stroke. Clin Neurol Neurosurg. 115(4): 400-4. https://doi.org/10.1016/j.clineuro.2012.06.001.
8. Alvarez-Sabín J., Román G.C. (2013). The role of citicoline in neuroprotection and neurorepair in ischemic stroke. Brain Sci. 3(3): 1395–414. https://doi.org/10.3390/brainsci3031395.
9. Nomani F., Kamal A.K. (2013). Citicoline in the treatment of acute ischaemic stroke: an international, randomized, multicentre, placebocontrolled study (ICTUS trial) is the use of Citicoline is beneficial for acute ischaemic stroke? J Pak Med Assoc. 63(11): 1445. PMid:24392540.
10. Overgaard K. (2014). The effects of citicoline on acute ischemic stroke: a review. J Stroke Cerebrovasc Dis. 23(7): 1764–9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.020.
11. Singh H, Jalodia S, Gupta MS et al. (2012). Role of magnesium sulfate in neuroprotection in acute ischemic stroke. Ann Indian Acad. Neurol. 15(3): 177–80. https://doi.org/10.4103/0972-2327.99705.