Optimizing the treatment of motor and cognitive disorders in ischemic stroke
Keywords:ischemic stroke, motor disorders, cognitive dysfunction
The urgency of the problem of treatment for motor and cognitive function disorders is associated with high disability and mortality due to ischemic stroke . The key problems of acute ischemic stroke treatment are the following: restoration of motor functions, prevention of spasticity, adaptation of the patient in the view of the existing neurological deficiency, speech correction, swallowing, cognition and pelvic disorders. The arm function abnormalities, as well as the correlation with cognitive impairment due to stroke, are not sufficiently covered in the literature and require further study . Objective: to study the clinical efficacy and safety of the combination of Armadin® and Reneuro® medications in the early recovery period of acute ischemic stroke, the effect of this cerebroprotective combination on the lost function recovery, dysfunction of the paretic arm and cognitive impairment, and also to determine the cognitive functions condition, depending on the degree of the upper limb paresis. Materials and methods. The main group consisted of 30 patients (16 women and 14 men) aged 53 to 79 years (average age 66.0 ± 4.2 years) who were in the early recovery period of the stroke. Patients in the main group, in addition to basic treatment, received treatment with the combination of Armadin® + Reneuro® medications. The control group consisted of 28 patients in the early recovery period of ischemic stroke aged 54 to 76 years (average age 63.0 ± 3.8 years) who received standard treatment only. The severity of stroke was determined according to the NIHSS, the analysis of the duration and reversal of the neurological deficit was performed according to the Barthel scale, and the dynamics of motor neurological disorders was determined according to a 6-point scale by R. Braddom (1996). Cognitive deficit was evaluated using the
MoCA scale. Results. After treatment, there was determined a positive dynamics in both patients’ groups according
to the NIHSS, but the group receiving the combination of neuroprotective medications Armadin® + Reneuro® had a more significant improvement (p < 0.05) according to the NIHSS, in comparison to the group where the cerebroprotective combination was not prescribed. Lost function recovery in the paretic limbs within the first 14 days and patients’ daily activity level according to the Barthel scale proved to be statistically significant (p < 0.05) in most patients of the main group in comparison to the control group, especially in terms of arm and hand function recovery, allowing to judge indirectly about life quality improving in these patients. Analysis of the cognitive functions conditions according to the MoCA scale revealed the main group patients’ statistically significant (p < 0.05) improvement in cognitive functions by 0.5 points in comparison to the group where cerebroprotectors were not prescribed. The correlation between average force (r = 0.57) was determined: reduction of the upper limb force was accompanied by a decrease in cognitive functions according to the MoCA scale (p < 0.05). At the same time, there was not statistically determined any significant dependency of the arm force or cognitive functions reduction on the degree of the cerebrovascular accident. The combination of Armadin® and Reneuro® medications has shown itself as a safe therapy for the patients’ treatment after the acute ischemic stroke. The combination of medications did not cause significant side effects. Conclusions. As a result of the received treatment with the combination of Armadin® and Reneuro® medications, there was found out a statistically significant (p < 0.05) faster recovery of motor and cognitive functions in patients who suffered from acute ischemic stroke, improving the arm functions and memory, first of all, in comparison to the group where the combination of medications was not used. Thus, taking into account the positive effect of the combination of Armadin® and Reneuro® medications, we can consider it rather positive and recommend for using in the comprehensive treatment of ischemic stroke.
Ведение больных с ишемическим инсультом и транзиторными ишемическими атаками (Рекомендации Исполнительного комитета Европейской организации по проблемам инсульта (ESO) и Авторского комитета ESO, 2008 год) // Мистецтво лікування. — 2008. — № 10(56). — С. 23-32.
Гуляев Д.В. Политика здравоохранения в борьбе с инсультом: из опыта развитых стран [Электронный ресурс] / Д.В. Гуляев // Therapia. — Режим доступа: http://therapia.ua/therapia/2007/01/politika-zdravookhraneniya-v-borbe-s-insultom-iz-opyta-razvitykh-stran
Никонов В.В. Старые и новые идеи в церебропротекции ишемического инсульта (предварительное сообщение) / В.В. Никонов, И.В. Савицкая // Медицина неотложных состояний. — 2007. — № 6(13). — С. 53-57.
Алгоритмы терапии острого инсульта [Электронный ресурс] / С.А. Румянцева, А.И. Федин, В.В. Афанасьев [и др.]. —
Режим доступа: http://www.mif-ua.com/archive/article/12845
Чуприна С.Е. Реабилитация постинсультного пациента: роль врача общей практики (врача-терапевта) / С.Е. Чуприна, О.В. Небогина // РМЖ. — 2017. — № 9. — С. 579-584.
Калинина С.Я. Нарушение функции руки в клинической картине инсульта [Электронный ресурс] / С.Я. Калинина, Т.Н. Семенова, В.Г. Григорьева. — Режим доступа: http://pmarchive.ru/narushenie-funkcii-ruki-v-klinicheskoj-kartine-insulta/
Meyer S., Karttunen A.H., Thijs V. et al. How do somatosensory deficits in the arm and hand relate to upper limb impairment, activity, and participation problems after stroke? A systematic review / Meyer S., Karttunen A.H., Thijs V. еt al. // Phys. Ther. — 2014. — № 94(9). — Р. 1220-1231.
Coupar F. Simultaneous bilateral training for improving arm function after stroke / Coupar F., Pollock A., van Wijck F., Morris J. еt al. // The Cochrane Collaboration. — 2010 — № 14(4). — Р. 1-64.
Carey L.M. Sensory loss in stroke patients: effective training of tactile and proprioceptive discrimination / Carey L.M., Matyas T.A., Oke L.E. // Arch. Phys. Med. Rehabil — 1993 — № 74(6). —
Hsiu-Yun H. Clinical application of computerized evaluation and re-education biofeedback prototype for sensorimotor control of the hand in stroke patients / Hsiu-Yun H., Cheng-Feng L., Fong-Chin S. еt al. // Journal of NeuroEngineering and Rehabilitation. — 2012. — № 9(26). — Р. 1-9.
Deluca C. Hemi- and monoataxia in cerebellar hemispheres and peduncles stroke lesions: topographical correlations / Deluca C.,
Moretto G., DiMatteo A., Cappellari M. et al. // Cerebellum. — 2012 — № 11(4). — Р. 917-924.
Arboix A. Clinical study of 227 patients with lacunar infarcts / Arboix A., Martí-Vilalta J.L., García J.H. // Stroke. — 1990. — № 21(6). — Р. 842-847.
Гусев Е.И., Скворцова В.И. Ишемия головного мозга. — M.: Медицина, 2001. — 328 с.
Ушкалова Е.А. Применение холина альфосцерата и его комбинации с этилметилгидроксипиридина сукцинатом в терапии соматических больных когнитивными расстройствами [Электронный ресурс] / Е.А. Ушкалова, А.В. Ушкалова. — Режим доступа: https://lib.medvestnik.ru/articles/Primenenie-holina-alfoscerata-i-ego-kombinacii-s-etilmetilgidroksipiridina-sukcinatom-v-terapii-somaticheskih-bolnyh-s-kognitivnymi-rasstroistvami.html
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