Recovery Period Of Ischemic Stroke Research Articles

The mechanisms for activation of a vascular platelet component of hemostasis in the stroke recovery period and the ways of their correction

Objective : to assess changes in the vascular platelet component of hemostasis in patients in different recovery periods of ischemic stroke (IS). Patients and methods. The investigation enrolled 73 patients with prior IS. According to the remoteness of stroke, the patients were divided into two groups: 1) 41 patients with a stroke remoteness of 1 to 6 months (an early recovery period); 2) 32 patients with that of 7 to 12 months (a late recovery period). In addition, a group of patients with recurrent stroke was identified to evaluate the efficiency of secondary prevention. A control group consisted of 30 healthy volunteers. All the patients took acetylsalicylic acid (ASA). Medical history data and laboratory and instrumental findings were analyzed. To assess the vascular platelet component of hemostasis, platelet aggregation with inductors was studied applying optical aggregometry; enzyme immunoassay was used to estimate the concentrations of the inflammatory marker myeloperoxidase and the endothelial dysfunction (ED) markers sICAM-1 and sE-selectin. Results and discussion. The patients were found to have enhanced platelet aggregation with inductors; moreover, this was more pronounced in the patients with recurrent stroke than in those with new-onset IS. This suggests that the vascular platelet component of hemostasis contributes to the progression of the disease and its unfavorable course and necessitates the monitoring of these parameters to choose optimal secondary prevention methods, such as replacement of ASA with clopidogrel or use of its combination with dipyridamol. The activity of chronic immune inflammation processes and ED was ascertained to be enhanced, which can contribute to the aggravation of cerebrovascular insufficiency and to the development of acute cerebrovascular accident. Conclusion. In the recovery period of stroke, the follow-up monitoring of hemostatic parameters and immune inflammatory and ED markers is of importance in evaluating the efficiency of secondary prevention. For the successful prevention of recurrent strokes, it is necessary to prescribe adequate antiplatelet therapy, as well as drugs that have anti-inflammatory properties, affect intercellular interaction processes (ASA, clopidogrel, and statins), and suppress oxidative stress associated with endothelial inflammation (alpha-lipoic acid and succinic acid preparations).

Pathological Changes in Microcirculation in the Early Recovery Period of Ischemic Stroke

The rates of morbidity and mortality due to stroke among people of working age have been growing in recent years and have increased by more than 30% over the past 10 years. An important place among the complications of ischemic stroke is motor disorders, accompanied by persistent muscle hypertension and disorders of peripheral microcirculation. The purpose of the study: to reveal the features of microcirculatory disorders in patients in the early recovery period of ischemic stroke. Violations of peripheral hemodynamics are very typical for patients in the early recovery period of ischemic stroke. They are more pronounced on the side of the paresis. In the early recovery period, more severe forms of microcirculation disorder were observed more often on the paretic limb, accompanied by signs of a sharp decrease in blood flow, increased vascular tone with the phenomena of blood stagnation. The revealed disorders of the microcirculatory link allow the use of disaggregants, peripheral vasodilators, venotonicks, massage, physiotherapy, reflexotherapy, and physical therapy with the involvement of the patient and healthy limbs to be recommended to patients in the early recovery period after ischemic stroke. All this should contribute to improving the effectiveness of rehabilitation of this category of patients during the early recovery phase.

Matrix metalloproteinase-9 blood level as a predictor of post-stroke cognitive impairment

Ischemic stroke is one of the leading causes of disability of the population. Among the consequences of stroke besides motor, speech disorders, the most important cause of cognitive impairments, it’s frequency is variable between 25-40%. Post-stroke cognitive disorders are pathogenetically heterogeneous conditions. The nature, modality and severity are determined by the clinical subtype of it’s development. So, cognitive impairment most often can be a consequence of a strategic infarcts, multi-infarct damage, decompensation of chronic cerebrovascular pathology against the background of an acute condition or neurodegenerative process that existed earlier and diagnosed before the appearance of any signs of stroke. In addition, the subtype of ischemic stroke also matters. In stroke, a family of zinc-binding proteolytic enzymes, in particular matrix metalloproteinase-9, plays a significant role in the development of damage of the brain tissue, which is of great importance in the reconstruction of the extracellular matrix. A high serum concentration of metalloproteinase-9 increases the severity of ischemic damage, the severity of the stroke and worsens the functional outcome of the disease. In addition, metalloproteinase-9 is also considered as a biomarker for Alzheimer’s disease, since it acts as a proteolytic enzyme, which, along with neprilizine, cleaves the amyloid protein. The results of a survey of 135 patients in the acute and early recovery period of ischemic stroke are presented. The level of metalloproteinase-9 and cognitive impairment have been studied on 1-2 and 21-22 days of the disease. It was found that a higher level of metalloproteinase-9 in blood plasma reflects a high probability of post-stroke cognitive impairment at the end of an acute period of ischemic stroke. The increase in metalloproteinase-9 did not depend on the localization of the focus of the stroke and its volume. Thus, metalloproteinase-9 investigation in the acute period of the ischemic stroke can predict the development of post-stroke cognitive decline.

Post-stroke dysphagia: novel treatment approaches

The paper presents the results of examination and treatment in patients in the early recovery period of ischemic stroke. It considers the concurrent use of drug and speech therapies to improve the rehabilitation of patients with post-stroke speech and swallowing disorders. Objective : to identify the role of speech-language therapy and neuropsychology sessions in the treatment of speech and swallowing disorders in the early recovery period of ischemic hemispheric stroke. Patients and methods . A total of 45 patients (32 (71%) men and 13 (29%) women) with a 2–3-month history of ischemic hemispheric stroke were examined. The follow-up period was 2 months. The patients were divided in two groups. Group 1 (a study group) included 30 patients who received combination therapy (drug treatment; sessions with a speech-language pathologist; and compensatory treatments for restoring swallowing function). All the patients had moderate dysphagia accompanied by speech disorders. Moderate sensorimotor aphasia was observed in 15 patients; moderate dysarthria was also seen in 15 patients. Vinpocetine (Cavinton®) and its dispersible tablets (Cavinton® Comfort) were chosen as an agent for vasoactive therapy. Group 2 (a comparison group) consisted of 15 patients with dysphagia who had only standard therapy and speech therapy sessions. There was sensorimotor aphasia in 2 (4%) patients and dysarthria in 13 (29%). A complex psychological and logopedic examination was carried out using the Mann Assessment of Swallowing Ability (MASA), dysarthria assessment, and the scale designed by L.I. Vasserman for estimating the degree of speech disorders in patients with local brain injuries. Results and discussion . Posttreatment swallowing function improved in all the 45 patients; however, more pronounced positive changes were recorded in the patients of Group 1 (p< 0.05). Survey data, possible diet modification, better patient communications, improved quality of life in the patients, and the opinions of their relatives and medical staff served as criteria for the effectiveness of the model used to recover swallowing function. A subjective improvement showed itself as an increased ability to initialize the pharyngeal phase of swallowing in 25 (56%) patients and none mild delays (up to 5 sec) in the movement of a food bolus in the oral cavity in 10 (22%) patients and in the intake of the food of different consistency in 10 (22%). After a treatment cycle in Group 1, the number of patients with mild dysphagia increased up to 30%; moderate swallowing disorders were present in 63% of patients, which required that medical and speech correction should be continued. A significant improvement in swallowing function was noted in 10% of Group 1 patients with medium-sized cortical and cortical-subcortical lesions; a moderate improvement was seen in 67% with medium and small cerebral foci at the same location. At the same time, in Group 2 there were insignificant positive changes only in 20% of patients, most of whom had dysarthria. Conclusion. The high incidence of post-stroke makes it reasonable to use speech therapy methods in a set of multidisciplinary specialized types of care. This care should be personalized; prescribing easy-to-swallow dispersible drugs plays an important role in this case. This will improve quality of life in the patient and protect him from unwanted complications.

Restoration of Speech Functions in Patients with Aphasia in the Early Rehabilitation Period of Ischemic Stroke

Objectives. To study the efficacy of complex therapy including daily speech therapy and two courses of Cellex in patients with aphasia in the early recovery period of ischemic stroke (IS). Materials and methods. Forty patients in the early recovery period of IS in the basin of the left middle cerebral artery with moderate or severe aphasia were studied. Twenty patients received complex therapy, including daily sessions with a speech therapist/aphasia specialist for 10 days using an improved method followed by self-study using educational materials and two 10-day courses of Cellex injections; the other 20 patients received only speech therapy. Treatment efficacy was evaluated using an automatic “Aphasia patient study program,” the Goodglass–Kaplan scale, and the modified Rankin scale. Results and conclusions. Patients of both groups achieved significant improvements in speech functions, communicative abilities, and functional recovery (p < 0.01); patients receiving complex therapy including two courses of Cellex injections showed significantly higher levels of rehabilitation (p < 0.05). These results allow the inclusion of Cellex into the complex restorative treatment of patients with poststroke speech impairments to be recommended.

Drug support in a complex of rehabilitation measures for patients with post-motor impairment: the role of neurocytoprotectors

The article is devoted to medical support of rehabilitation measures for post-stroke motor disorders. The approach to the selection of neurocytoprotectors from the positions of the concept of neuroplasticity and multimodal action is considered. The results of our own observation of the use of citicoline (Ceraxon ®) in the complex program of medical rehabilitation of patients after ischemic stroke are presented. The high efficiency of citicoline application in complex rehabilitation of patients in the early recovery period of ischemic stroke is shown in the form of improving walking function, increasing functional independence, daily activity and quality of life. Conclusions. The use of modern neurocytoprotectors in a complex of rehabilitation programs is an important and indispensable component for achieving the maximum possible results of rehabilitation aimed at improving the functioning and quality of life of patients.

PECULIARITIES OF MICROCIRCULATOR DISORDERS IN PATIENTS IN EARLY AND LATE RECOVERY PERIODS OF ISCHEMIC STROKE

Aim. To reveal the peculiarities of microcirculatory disorders in persons in early and late recovery periods of ischemic stroke using the method of laser Doppler flowmetry. Materials and methods. We examined 58 patients aged 43 to 75 years, diagnosed with ischemic stroke with motor deficiency. The functional state of microcirculation was studied in dynamics-in the early and late recovery periods of ischemic stroke by laser Doppler flowmetry (LDF). Results. All patients with ischemic stroke along with central hemodynamic disorder had peripheral microcirculatory disorders both on paretic and on healthy limbs correlated with the degree of paresis. Disorders of the сentral hemodynamics were revealed in the form of stenosing and non-stenosing atherosclerosis vessels of the carotid basin, hypertensive angiopathy. Violations of peripheral hemodynamics were established in all patients in both early and late recovery periods of ischemic stroke, coarser on the side of the paresis. More often, more severe forms of microcirculation disorders were observed in the paretic extremity both in the early and late recovery periods, accompanied by signs of a sharp decrease in blood flow, an increase in vascular tone with the phenomena of blood stagnation. In the presence of positive dynamics on the part of the motor sphere, patients in the late recovery period showed positive changes in the parameters of the microcirculation, both on the side of the paresis and on the healthy limbs. Conclusion. The established features of microcirculation disorders make it possible to recommend to patients with ischemic stroke both in the early and late recovery periods active use of drugs that improve arterial blood flow, remove vascular spasm, disaggregants, peripheral vasodilators, vegetative correctors, massage, physiotherapy, reflexology, physiotherapy involving Sick, and healthy limbs, which contributes to the improvement of rehabilitation potential in this category of patients At different stages of recovery.

The prognosis for post-stroke aphasia

To determine risk factors and factors of favorable prognosis for regression of post-stroke aphasia in the early recovery period of ischemic stroke (IS). A cohort study was undertaken with 40 patients with different clinical forms of aphasia. The duration of study was 3-4 months of the disease. The regression of speech and non-speech cognitive impairment was assessed by the Method of a 10-point evaluation of higher mental functions. The method involves a comprehensive assessment of all mental functions with more than 90 subtests at the beginning and at the end of rehabilitation course and the calculation of the difference in the scoring of each mental function as a measure of treatment efficacy. Using logistic regression and odds ratio estimation, significance of the influence and the prognostic relationship of symptoms related to IS, and a number of biological and social factors (sex, age, and education) were studied. An independent prognostic value for the aphasia regression on the third month of disease has the severity of neurologic symptomatology (NIHSS score) for the first day of stroke (OR 3,27 95% CI 1,02-9,77) and the third month of the disease (p=0,005, OR 4,6, 95% CI [1,39-15,11]) and the decrease in daily activity assessed by the total score of the Barthel index (p=0,004, OR 3,92, 95% CI [1,01-15,21]). A number of MRI signs (localization of post-stroke changes in the left angular gyrus, frontal-temporal region and focal volume) had a significant effect on the dynamics of non-verbal cognitive impairment. Neuropsychological examination revealed a significant improvement of speech in patients with initially severe forms of aphasias, in particular, sensory and sensorimotor. A direct relationship between age and certain clinical forms of aphasia as well as a significant positive effect of duration (β=1,91, p≤0,01) and level of education (β=1,68, p≤0,007) on aphasia regression were determined. The severity of neurologic symptoms, in particular motor and sensory deficits, both in the acute and in the recovery period of the disease is one of the pathogenetic factors worsening the processes of functional reorganization of neuronal speech networks. The positive dynamics of the recovery of speech function is associated with the initial severity and clinical form of aphasia. The level and duration of education are related to factors positively affecting post-stroke neuroplasticity.

Effects of Antioxidant Treatment on Neurotrophins and Rehabilitation Processes Following Stroke

Objectives. To study the effects of Cytoflavin during the recovery period of ischemic stroke (IS) in terms of changes in neuropsychological status and serum levels of neurotrophins. Materials and methods. A total of 52 patients were observed after fi rst IS at age 52–74 years. Patients were divided into two groups. The study group (25 patients) received basal therapy supplemented with intravenous Cytoflavin infusions of 20 ml in 400 ml of 5% glucose solution once daily for 10 days followed by two tablets twice daily half an hour before meals for one month. The reference group (27 patients) received standard treatment. The control group consisted of 12 essentially healthy subjects. Apart from standard clinical laboratory investigations, participants underwent complex neuropsychological studies with assessment of data on the NIHSS, Bartel, Beck, and Spilberger–Hanin tests, the Frontal Assessment Battery, and the Mini Mental State Examination. In addition, neurotrophic factor levels were determined: nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF). Studies were performed over time: before treatment started and two months after treatment. Results and conclusions. Patients in the recovery period following first IS showed moderate impairments to neuropsychological status and decreases in neurotrophic factor levels. Prescription of Cytoflavin increased treatment efficacy, which was apparent as a more marked improvement in neurological symptomatology as compared with the results obtained with basal therapy, along with improvements in cognitive functions and increases in BDNF levels. Efficacy and safety data indicate that Cytoflavin can be included in treatment schemes for patients in the recovery period following first carotid IS.

Mirror therapy in complex rehabilitation of the function of the upper extremity in the early recovery period of ischemic stroke

Mirror therapy in complex rehabilitation of the function of the upper extremity in the early recovery period of ischemic stroke

Cognitive trajectory of patients in the recovery period after ischemic stroke: role of neuroinflammation and structural cerebral factors

Aim. To study the role of neuroinflammation and cerebral structural factors in the development of cognitive impairment in the recovery period of ischemic stroke. &#x0D; Methods. In 55 patients with ischemic stroke the assessment of global cognitive status in acute and recovery period of ischemic stroke, evaluation of cytokine concentrations (interleukin-1β, interleukin-4, interleukin-6, interleukin-10 and tumor necrosis factor α) in cerebrospinal fluid and blood serum, as well as a number of MRI morphometric and diffusion tensor parameters were performed. &#x0D; Results. Predictors of stable cognitive status were low concentration of interleukin-6 and -10 and interleukin-1β and -10 dominance in cerebrospinal fluid, high fractional anisotropy of ipsilateral superior longitudinal fasciculus in the acute phase of stroke. Predictors of positive trend of cognitive status include low level of C-reactive protein, intermediate values of fractional anisotropy of the designated tract, high level of high-density lipoproteins in serum and interleukin-10 in cerebrospinal fluid, codominance of interleukin-1β and -6 in serum and interleukin-10 in cerebrospinal fluid, predominance of interleukin-10 over interleukin-1β in serum, as well as lesser degree of stenosis of the ipsilateral internal carotid artery. Predominance of interleukin-1β over interleukin-10 in serum, large volume of the brain ventricles, lower values of fractional anisotropy of ipsilateral superior longitudinal fasciculus, low level of high-density lipoproteins and greater degree of stenosis of the ipsilateral internal carotid artery can be considered as predictors of negative trend of cognitive status. &#x0D; Conclusion. The trajectory of cognitive status in the recovery period of ischemic stroke is determined by the profile of neuroinflammation in conjunction with microstructural integrity of the ipsilateral superior longitudinal fasciculus, as well as severity of atherosclerosis of the carotid artery on the side of stroke, level of high-density lipoproteins and ventricular dilation in the acute period of the disease.

Efficacy of cortexin in acute and recovery periodes of hemispheric ischemic stroke

To study the effectiveness and sustained effects of early appointment of a repeated course of low-dose drug cortexin neuroprotection in patients in acute and recovery period of hemispheric ischemic stroke. The study included 90 patients with hemispheric ischemic stroke. Patients of the first group received 20 mg cortexin (10+10) intramuscularly on basic therapy, the patients of the second group (n=30) was obtained cortexin 20 mg (10+10) in the two courses each for 10 days with an interval between them in 10 days, patients of the third group - only basic therapy. For objectification severity used NIH stroke scale, modified Rankin scale, the Barthel index, the Rivermead mobility index, MMSE. Appointment in acute hemispheric ischemic stroke drug cortexin repeated course leads to more complete regression of neurological deficit, compared to the comparison group and the group of patients who received one course of medication cortexin, for all acute and early recovery period of ischemic stroke from 11-13 days of illness.

Современный взгляд на проблему качества жизни больных, перенесших ишемический инсульт

In article there are described some aspects of the impact on the incidence of stroke in the general morbidity and mortality in all age groups. There are adduced characteristic features of the quality of life for patients in acute and recovery period of ischemic stroke due to hypertensive disease as the leading risk factor for disease development. We studied the problems of quantifying outcomes in patients after acute ischemic stroke as well as the possibility of correction of life quality indicators in the recovery period of this disabling disease.

Neurometabolic therapy in the recovery period of ischemic stroke: impact on quality of life and cognitive functions

Some recovery of impaired neurological functions (a stroke recovery period) is almost always observed within the first 6–24 months after ischemic stroke (IS). The paper discusses the mechanisms responsible for this process (neurogenesis, neuroplasticity, and readaptation) and possible approaches to the drug support of cerebral reparative processes. It presents data on the rate and etiology of poststroke cognitive impairments (CI) that are one of the important factors that negatively influence the outcome of rehabilitation measures. The results obtained from a recent study of the efficacy of the neurometabolic agent citicoline in the recovery period of IS are given. The use of citicoline is shown to cause a significant regression of CI and to improve quality of life in patients who have sustained IS for the first time.

ROLE OF NEUROTROPHINS IN THE RE COVERY AFTER THE IS CHEMI C STROKE UNDER THE INFLUEN CE OF NEUROPROTE CTIVE THERAPY

Objective : to study the level of neurotrophins in serum of patients in the recovery period of ischemic hemisphere stroke before and after treatment with choline alphosceratus. Materials and methods . Complex neuropsychological examination and assessment of neurotrophic factors level by ELISA were carried out in 70 patients after first ischemic stroke. Results . Patients in the recovery period after first ischemic stroke had significant decrease both of neuropsychological status outcomes and the level of nerve growth factor (Nerve Growth Factor – NGF) up to 139,77 ± 43,5 ng/ml. After 3 months of treatment with choline alphosceratus the basic objective outcomes of neurological status and daily activity improved and the level of NGF in the peripheral blood increased up to 1838,93 ± 195,26 (p<0.05). Conclusions . Emotional and cognitive impairments in patients in the recovery period of ischemic stroke are associated with decreased level of NGF in the peripheral blood serum. Choline alphosceratus treatment activates neurotrophic systems of the brain.

Тиоцетам® в лечении больных с ишемическим инсультом

Статья посвящена проблеме терапии одного из самых распространенных неврологических заболеваний — ишемического инсульта и его последствий. Приведено подробное описание оригинального клинического исследования эффективности и безопасности препаратов Тиоцетам®, раствор для инъекций, и Тиоцетам® форте, таблетки, у 160 пациентов в остром и раннем восстановительном периодах ишемического инсульта. Полученные данные свидетельствуют о том, что применение препаратов Тиоцетам® и Тиоцетам® форте позволяет достоверно ускорить восстановление нарушенных неврологических функций, в том числе устранить очаговую неврологическую симптоматику, повысить показатели повседневной жизненной активности и улучшить когнитивные функции.

Rehabilitation of patients in the recovery period after stroke in Kazakhstan

To evaluate the effectiveness of complex rehabilitation of post stroke patients in a Stroke Rehabilitation Centre. The results of rehabilitative treatment of 86 patients, aged from 50 to 68 years, in early and late recovery periods of ischemic stroke in the middle cerebral artery were analyzed. Neurological deficit was assessed with the Scandinavian Stroke Scale, the dynamics of recovery of neurological disorder with Barthel daily activity index, the degree of misbalance with the modified Rankin scale. After the rehabilitation, a decrease in neurological deficit, improvement of gait and self-service skills, decrease in disability level were observed. The average scores before and after rehabilitation were 35.9±3.9 and 42.7±4.1 on the Scandinavian Stroke Scale, 41.8±4.9 and 52.4±4.4 on Barthel index, 3.3±0.6 and 2.5±0.5 on the modified Rankin scale, respectively. The importance of complex multidisciplinary approach to rehabilitative measures is emphasized.

Динаміка нейропсихологічних функцій та показників системної запальної відповіді в пацієнтів у відновному періоді ішемічного інсульту за умов лікування препаратом Гліатилін

Мета дослідження — встановити ефективність препарату Гліатилін щодо динаміки неврологічного дефіциту, когнітивних порушень та рівня депресії, а також лабораторних показників запальної відповіді при використанні його у відновному періоді ішемічного інсульту поєднано з компонентами базисної терапії. Обстежено 40 пацієнтів у відновному періоді первинного церебрального ішемічного інсульту. Встановлено, що курсове лікування препаратом Гліатилін покращує стан когнітивних функцій у пацієнтів, які перенесли ішемічний інсульт, а також у хворих із післяінсультними депресивними розладами, порівняно зі стандартною терапією ефективно знижує рівень депресії за шкалою Гамільтона. Відновлювальний вплив препарату здійснюється не лише через стимулювання холінергічних систем центральної нервової системи, але й завдяки помірній протизапальній дії та здатності нормалізувати обмін оксиду азоту.