Main Article Content

Abstract

Treatment strategy of ischemic stroke is to reduce the extent of the damage and rescue neurons from death in the early days of ischemic events. Recombinant Tissue-Plasminogen Activator (r-TPA) is the only recommended therapy, but their use is very limited. Citicoline is a neuroprotectant with a therapeutic effect on several stages of the ischemic cascade. However, its use is still being debated. The purpose of this study was to analyze the use of supplementation citicoline injection in patients with acute ischemic stroke in relations to differences in changes in the level of interference (impairment), rate limitation (disability) and the level of obstruction (handicap) between the group receiving supplementation of citicoline injection 2x500 mg iv and the group without supplementation during acute phase treatment. This study was a prospective cohort study using experimental design in patients with acute ischemic stroke who met the inclusion and exclusion criteria with or without supplementation citicoline between January - April 2015 in the National Stroke Hospital, Bukittinggi. Rate of interference was assessed with NIHSS, level of limitations with Barthel Index, and level of obstruction with modified Rankin Scale. Assessment was done 2 times, before and after the treatment. Statistical methods used in this study were Wilcoxon signed rank test, paired T-test and Mann-Whitney test. This study was conducted on 50 subjects divided into 2 groups, a control group without supplementation and group treated with injected citicoline of 2x500 mg iv. Demographic and baseline characteristics did not differ between groups. There were differences in level of interference changes. Mean decrease in control group was 0.96 ± 1.74 NIHSS, while that in treatment group was 2.84 ± 1.46 NIHSS (p <0.05). There were differences in changes in the level of limitations. Mean increase of Barthel Index in control group 9.60 ± 11.17 and in treatment group 20.40 ± 13.99 (p <0.05). However, changes in the level obstacle showed no difference. In conclusion, citicoline injection supplementation in patients with ischemic stroke during acute phase treatment showed improvement differences in changes in the level of distraction (impairment) and the rate limitations (disability), but showed no difference in changes in the level of obstruction (handycaps).

Keywords

citicoline injected citicoline neuroprotection acute phase therapy acute ischemic stroke

Article Details

How to Cite
Wahyudi, R., Hasmono, D., Fitrina, R., & Armal, K. (2016). INJECTED CITICOLINE IMPROVES IMPAIRMENT AND DISABILITY DURING ACUTE PHASE TREATMENT IN ISCHEMIC STROKE PATIENTS. Folia Medica Indonesiana, 51(4), 245–251. https://doi.org/10.20473/fmi.v51i4.2854

References

  1. Adams HP, del Zoppo GJ, von Kummer R (2006). Management of Stroke: A Practical Guide for the Prevention, Evaluation, and Treatment of Acute Stroke, 3th ed, New York, Professional Communi-cations Inc
  2. Adibhatla RM, Hatcher JF, Dempsey RJ (2001). Effects of citicoline on phospholipid and glutathione levels in transient cerebral ischemia. Stroke 32, 2376-2381
  3. Adibhatla RM, Hatcher JF, Larsen EC, Chen X, Sun D, Tsao FH (2006). CDP-choline significantly restores phosphatidylcholine levels by differentially affecting phospholipase A2 and CTP: phosphocholine cytidylyltransferase after stroke. J Biol Chem 281, 6718-6725
  4. Castellanos M, Sobrino T, Castillo J (2006). Evolving paradigms for neuroprotection: molecular identificat-ion of ischemic penumbra. Cerebrovasc Dis 21 Suppl, 71-79
  5. Conant R and Schauss AG (2004). Therapeutic applications of citicoline for stroke and cognitive dysfunction in the elderly: a review of the literature. Altern Med Rev 9, 17-31
  6. Dávalos A, Alvarez-Sabí­n J, Castillo J, Dí­ez-Tejedor E, Ferro J, Martí­nez-Vila E, Serena J, Segura T, Cruz VT, Masjuan J, Cobo E, Secades JJ; International Citicoline Trial on acUte Stroke (ICTUS) trial investigators (2012). Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet 380, 349-357
  7. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM (2011). Pharmacotherapy: A Pathophysio-logic Approach, 8th ed, New York, McGraw-Hill Education
  8. Dirnagl U, Iadecola C, Moskowitz MA (1999). Pathobiology of ischaemic stroke: an integrated view. Trends Neurosci 22, 391-397
  9. Farooqui AA, Horrocks LA, Farooqui T (2000). Glycerophospholipids in brain: their metabolism, incorporation into membranes, functions, and involvement in neurological disorders. Chem Phys Lipids 106, 1-29
  10. Heart and Stroke Foundation (2005). Let's Talk About Stroke: An Information Guide for Survivors and Their Families. Available from http://www.heartandstroke. com/atf/cf/%7B99452D8B-E7F1-4BD6-A57D-B136 CE6C95BF%7D/Lets-talk-about-stroke-en.pdf. Accessed May 5, 2014
  11. Hurtado O, Moro MA, Cárdenas A, Sánchez V, Fernández-Tomé P, Leza JC, Lorenzo P, Secades JJ, Lozano R, Dávalos A, Castillo J, Lizasoain I (2005). Neuroprotection afforded by prior citicoline administration in experimental brain ischemia: effects on glutamate transport. Neurobiol Dis 18, 336-345
  12. Krupinski J, Ferrer I, Barrachina M, Secades JJ, Mercadal J, Lozano R (2002). CDP-choline reduces pro-caspase and cleaved caspase-3 expression, nuclear DNA fragmentation, and specific PARP-cleaved products of caspase activation following middle cerebral artery occlusion in the rat. Neuropharmaco-logy 42, 846-854
  13. Lo EH, Dalkara T, Moskowitz MA (2003). Mechanisms, challenges and opportunities in stroke. Nat Rev Neurosci 4, 399-415
  14. Martinet M, Fonlupt P, Pacheco H (1979). Effects of cytidine-5' diphosphocholine on norepinephrine, dopamine and serotonin synthesis in various regions of the rat brain. Arch Int Pharmacodyn Ther 239, 52-61
  15. Martynov MY, Boiko AN, Kamchatnov PR, Kabanov AA, Yasamanova AN, Shchukin IA, Kolesnikova TI, Chubykin VI, Glukhareva AP, Gusev EI (2013). Neuroprotective therapy with citicoline (ceraxon) in patients with ischemic stroke. Neuroscience and Behavioral Physiology 43, 706-711
  16. Ministry of Health, Republic of Indonesia (2007). Riset Kesehatan Dasar, Jakarta, Health Department, Republic of Indonesia
  17. Overgaard K (2014). The effects of citicoline on acute ischemic stroke: a review. J Stroke Cerebrovasc Dis 23, 1764-1769
  18. Purba JM (2011). Biomolekuler stroke. In: Misbach J, Soertidewi L and Jannis J (eds). Stroke Aspek Diagnostik, Patofisiologi, Manajemen, Jakarta, Gramedia Pustaka Utama, p 41-56
  19. Sahota P and Savitz SI (2011). Investigational therapies for ischemic stroke: neuroprotection and neuro-recovery. Neurotherapeutics 8, 434-451.
  20. Secades JJ and Lorenzo JL (2006). Citicoline: pharmacological and clinical review, 2006 update. Methods Find Exp Clin Pharmacol 28 Suppl B, 1-56
  21. Warach S, Pettigrew LC, Dashe JF, Pullicino P, Lefkowitz DM, Sabounjian L, Harnett K, Schwiderski U, Gammans R (2000). Effect of citicoline on ischemic lesions as measured by diffusion-weighted magnetic resonance imaging. Citicoline 010 Invest-igators. Ann Neurol 48, 713-722
  22. WHO (2007). Neurological Disorders: Public health challenges. Geneva: WHO Press. Available from http://www.who.int/mental_health/neurology/neurodiso/en/. Accessed May 5, 2014

Most read articles by the same author(s)