Peculiarities of neuroprotective therapy in women with acute ischemic stroke

Abstract

There are significant differences between the course of acute ischemic stroke (AIS) in men and women. On average, women with AIS have a more pronounced degree of neurological disorders, higher mortality and disability. However, carotid procedures and thrombolytic therapy are performed less frequently in women than in men, requiring the search for alternative therapies for the treatment of AIS in women (neuroprotection). Aim. To investigate the effectiveness of a combination therapy with edaravone as a neuroprotector in women with AIS. Materials and methods. A prospective study enrolled 48 women with AIS, divided into two groups. The first group patients (n = 36) were treated with edaravone 30 mg twice daily, intravenously. Neuroprotectors were not used in the control group (n = 12). Clinical-instrumental and neurological examinations (Glasgow Coma Scale (GCS), FOUR, NIHSS, neurospecific enolase (NSE) levels) were performed in all the patients. Results. An analysis of GCS scores showed a positive trend in most patients of both groups, with no difference between the groups. Thus, the mean GCS score in the main group increased from 11.84 ± 2.62 to 13.87 ± 0.94 points against 11.69 ± 3.15 to 13.31 ±1.78 in the control group (P > 0.05). The FOUR score showed that in group 1, the level of consciousness recovered more rapidly from the 5th day and up to 9–10 days of treatment it was: in the edaravone group – 15.47 ± 0.85 points, in the control group – 13.62 ± 1.19 points (P < 0.05). The level of NSE was higher than normal in all the women, with the highest level in patients of the control group, in whom it increased 10-fold (from 9.2 to 96.4 ng/ml, P < 0.01). Later on, there was a rapid decrease in NSE level in group 1, while the level of NSE did not reach the reference values (P < 0.05) until day 10 of treatment in the control group. Conclusions. The administration of edaravone in women with AIS resulted in favorable outcomes even in the acute period of the disease. The use of edaravone was significantly effective on the FOUR scale and by the dynamics of NSE levels. Further studies are needed to clarify the role and place of edaravone in the ischemic stroke intensive care setting.