The Cholinergic Profile as a Target for Rational Therapy of Central Nervous System Diseases and Injuries

Abstract

Objective. To conduct a comparative analysis of the clinical efficacy of cholinergic drugs and acetylcholinesterase inhibitors and their combinations in the complex therapy of cerebrovascular pathology and the sequelae of closed craniocerebral trauma (cCCT) using clinical, instrumented, and laboratory follow-up investigations. Materials and methods. A total of 90 patients with cerebrovascular pathology (chronic cerebral ischemia grade 2 (I67; 45 patients) and the sequelae of cCCT (T90; 45 patients) were studied. Groups were divided into three subgroups each of 15 patients. Complex treatment included basal and specific therapy: subgroup 1 received the drug Neuromidin, group 2 received Gliatilin, and group 3 received Neuromidin plus Gliatilin. Treatment duration was two months. All patients underwent complex clinical, neurophysiological, and laboratory investigations before treatment and at one and two months from treatment initiation: plasma cholinesterase activity was estimated, patients were tested on the Mini Mental State Examination (MMSE) and the Hamilton scale, and patients underwent transcranial magnetic stimulation with assessment of the central motor conduction time and evaluation of somatosensory evoked potentials with determination of the central afferent conduction time. Results. Before treatment, a strong positive correlational relationship was found between patients’ age and serum cholinesterase activity (Rs = 0.77; p = 0.0001). On the background of treatment, all study parameters showed significant (p < 0.05) improvements with the exception of the MMSE, which showed only a trend to improvement) in subgroups 1 and 3 of each group as compared with values obtained in subgroups 2 of the corresponding groups. In addition, at two months from treatment initiation, there were significant decreases in serum cholinesterase activity in patients of subgroups 1 and 2. Conclusions. Assessment of deviations in the “cholinergic profile” (blood cholinesterase activity) in patients with cerebral pathology and the strategy of using cholinergic drugs and acetylcholinesterase inhibitors and their combination to correct psychoneurological disorders is among the most important directions in optimizing the combined treatment of patients of this category.