[The use of succinates for the correction of metabolic disorders in the penumbra in patients with stroke].

The aim of the study was to determine the quantitative content and correlation between metabolites in the core ischemic zone, the ischemic penumbra and the intact tissue of the opposite hemisphere in the acute stage of ischemic stroke using MR-spectroscopy. We studied 72 patients, including 37 patients (the main group) treated with the antioxidant mexidol (2-ethyl-6-methyl-3-hydroxypiridine succinate) in addition to standard therapy and 35 patients who received standard therapy only. The severity of stroke was assessed using the NIHSS. The Barthel index and Rankin scale were used to evaluate functional outcome in the 30th day, hydrogen MR-spectroscopy was used twice: in the first 24 h from disease onset and in the 5th day. Mexidol used in dose 500 mg intravenously during 14 days reduced significantly the content of lactate (p=0.002) and inositol (p=0.005) in the cells compared to the control group that enhanced the restoration of the balance between aerobic and anaerobic mechanisms of oxidation and positively influenced on the rehabilitation of patients. Positive correlations between the content of lactate in the ischemic penumbra and NIHSS scores (r=0.5786; p=0.049) and the negative correlation between the content of lactate in the ischemic penumbra and the degree of functional restoration assessed by the Barthel index (r= -0.6305; p=0.028) were found. These findings support the evidence for the interaction between the disturbance of glucose metabolism in conditions of hypoxia and the degree of nervous tissue damage.

[Efficacy of cytoflavin in patients in the acute ischemic stroke].

We present the results of a multicenter study on efficacy of cytoflavin in the treatment of patients with acute ischemic stroke. Seventy patients (41 of the main group and 29 of the control group) were enrolled in the study. All patients received basic therapy aimed at improving systemic hemodynamics, rheological blood properties and at the prevention of stroke complications. Patients of the main group were treated with cytoflavin as follows: days 1-10 - 20 ml (in 400 ml of the 0,9% NaCl solution) twice a day intravenously in drops; days 11-35 - 850 mg twice a day. We assessed the dynamics of restoration of lost functions (NIHSS, the Rankin scale, the Barthel index) and volumes of ischemic lesion (MRI T1-, T2-, diffusion-weighted images). Results of the study on patients of the control group were supplemented with literature data about 306 patients studied using clinical scales and 40 patients studied with MRI. We revealed a trend towards an effect of cytoflavin on the preservation of brain matter in the acute phase of stroke. Cytoflavin reduced the neurological deficit and improved activities of daily living in patients that may be explained by the less brain damage.

[Changes in the focus of experimental ischemic stroke under the influence of neuroprotective drugs].

The purpose of this study was to compare the morphological changes in the focus of ischemic stroke under the influence of the drugs of neurotrophic group (alpha-GPC, cerebrolysin), drugs possessing the nootropic properties (piracetam) and those with combined effect (vinpocetin). The experiments were performed in 18 rats. Temporary disturbance of cerebral circulation (acute ischemia) in right cerebral hemisphere was induced by clipping the trunk of innominate artery for 40 minutes. Areas of cerebral cortex, brainstem and cerebellar cortex were studied using light and electron microscopy. Treatment with alpha-GPC or cerebrolysin resulted in an increased tolerance of neurons to ischemic damage and in delayed realization of the program of cell death. Some intracellular changes were detected that could be regarded as the signs of adaptation and repair (indentation of nuclear envelope, increased number of ribosomes, hypertrophy of endoplasmic reticulum and Golgi complex). These drugs preserved the structure of the membranes in the nucleus and major organelles. In animals treated with piracetam and vinpocetin, all morphological signs were indicative of insufficient supply of energy-consuming processes of repair in the acute phase of ischemic stroke. This was accompanied by morphological features of functional stress of the neurons of the cerebral cortex, different stages of gliocyte apoptosis, phenomenon of incomplete separation of gliocytes during their proliferation, myelin and unmyelinated nerve fiber pathology, as well as by changes in synapse structure.