[Diagnosis and treatment of neurogenic dysphagia after acute ischemic stroke]. / Diagnostika i lechenie neirogennoi disfagii u bol'nykh, perenesshikh ostryi karotidnyi ishemicheskii insul't.

AIM: To determine the efficacy of post-stroke dysphagia treatment by choline alfoscerate (ChA), succinate combination (SC), and their combination with sip, larynx, and swallowing exercises. MATERIAL AND METHODS: Four groups of primary ischemic stroke (IS) patients (n=80; 62±0.2 y.o., verified by MRI), including controls, admitted to Stroke Unit 24 h after stroke in the area of RAM (29.5%), and LAM (70.5%), were studied. Basic therapy was provided according to National Stroke Treatment Recommendations, treated groups received ChA 14 mg/kg (2st gr.), SC 0.5 mg/kg (3nd gr.), combination of two compounds (3d gr.). Controls (4th gr.) received placebo. Pharmacological treatment was provided for 10 days with continuation by oral administration. Dysphagia was measured semi-quantitively by MASA scale, three scale determinants were measured on admission, on 5 and 13 days of stay in the hospital. RESULTS AND CONCLUSION: The differences were significant and observed on the 5th day of treatment. ChA mostly improved sip control, and larynx movements (38% above controls; p<0.01), while SC improved the closure of vocal cords (55% above controls; p<0.01). This may reflect the differences in synaptic control of these functions. Combined treatment was more effective than monotherapy: 15% above ChA, and 21% above SC for swallowing function (p=0.01); 33 and 22% for vocal closure, 37% (p=0.05) and 76% (p=0.01) for larynx movement, which may be due to synergism between two medications. Therefore, sip, larynx, and swallowing exercises with pharmacological support of ChA and SC ameliorated dysphagia after IS.

[Results of a randomized double blind multicenter placebo-controlled, in parallel groups trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA)]. / Rezul'taty randomizirovannogo dvoinogo slepogo mul'titsentrovogo platsebo-kontroliruemogo v parallel'nykh gruppakh issledovaniia éffektivnosti i bezopasnosti meksidola pri dlitel'noi posledovatel'noi terapii u patsientov v ostrom i rannem vosstanovitel'nom periodakh polusharnogo ishemicheskogo insul'ta (ÉPIKA).

AIM: To evaluate the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (IS). MATERIAL AND METHODS: A randomized double blind multicenter placebo-controlled, in parallel groups trial included 151 patients (62 men and 89 women) with hemispheric IS. Using a method of simple randomization, 150 patients (62 men and 88 women), aged 40-79 years, were randomized into two groups. Patients of Group I were treated with mexidol: 500 mg/day IV infusion for 10 days, followed by 125 mg tid (375 mg/day) PO for 8 weeks. Patients of Group II received the placebo according to the same scheme. The total duration of patients' participation in trial ranged from 67 to 71 days. RESULTS: By the end of treatment, the mean score on the modified Rankin scale (mRS) was lower in Group I compared to Group II (p=0.04). In Group I, the decrease in mRS mean score (Visit 1-5) was more prominent (p=0.023), percentage of patients with 0-2 scores by mRS scale (Visit 5) was higher (p=0.039), mean NIHSS score lower (p=0.035) in Visit 5 compared to group II. By the end of treatment, the decrease in mean NIHSS score in patients with diabetes mellitus was more prominent in Group I in comparison with Group II (p=0.038). In Group I, the dynamic of improvement of quality of life was more prominent and started from Visit 2 in general population and subpopulation of patients with diabetes mellitus. The share of patients with no problems with movement in space was higher in Group I (p=0.022). There were no statistically significant differences in frequency of side effects in patients of both groups. CONCLUSION: It is recommended to include mexidol in therapy of patients with IS in the acute and early rehabilitation stages.

[Clinical and morphologic efficacy of a complex antioxidant and energy correction therapy of different duration in brain infarction: results of a multicenter randomized trial].

AIM: To compare clinical and morphological results of treatment of ischemic stroke in three groups of patients which differed by the forms and duration of an antioxidant therapy. MATERIAL AND METHODS: A randomized clinical trial was performed in 8 vascular centers of the Russian Federation in 2010-2014. It included 373 patients with ischemic stroke in the carotid territory. Patients were randomized into 3 groups to receive different regimens of antioxidant therapy as an adjunct to standard therapy: control group (ascorbic acid; 132 patients); cytoflavin (20 ml per day for 10 days; 133 patients); cytoflavin (the dose was decreased to 10 ml per day from 11th to 20th day) (108 patients). Patient's condition was assessed in 1, 10 and 21 day by a complex of clinical, laboratory and instrumental methods. RESULTS AND CONCLUSION: The analysis of CT in 1th and 21th day revealed a significant 1,5-1,7- fold decrease in the cerebral ischemic lesion in both groups treated with cytoflavin with no significant morphologic changes in the ascorbic acid group. The percentage of patients with ischemic lesion, increased during days 1-21, was 2-fold higher in the ascorbic acid group compared to cytoflavin groups. Morphologic changes were correlated with clinical variables and outcome. In patients with ≥14 points on NIH scale on admission, prolonged 20 day cytoflavin therapy was associated with a more prominent improvement of neurologic, functional and cognitive status compared to 10-day cytoflavin infusion. No differences in clinical variables were observed in patients with mild symptoms (<14 points on NIH scale on admission) receiving cytoflavin for 10 and 20 days.

[The comparative information value of radiodiagnostic methods in the detection of stenosing lesions of the major arteries of the head]. / Sravnitel'naia informativnost' metodov luchevoi diagnostiki v vyiavlenii stenoziruiushchikh porazhenii magistral'nykh arterii golovy.

To define the comparative informative value of different radiation diagnostic techniques, such as transcranial Doppler study (TCDS), duplex scanning (DS) of the great arteries of the head, magnetic resonance angiography (MRA) of vessels of the vessels of Willis and great arteries of the head, digital subtraction angiography (DSA), the authors analyze the results of examination of 15 patients with stenotic lesions of common carotid bifurcations and upper segments of inferior carotids. A full agreement of DSA and MRA findings was revealed in 6 patients; of them 5 and 1 patients had inferior carotid occlusion and subocclusion, respectively. There was mainly a discordance of data on lesion re-evaluation in < 90-99% (MRA revealed a complete lack of blood flow) and < 70% stenosis (changes were estimated as physiological turbulence in the bulb of the inferior carotid while analyzing MR images). A combination of MRA and DS of the great arteries of the head for diagnosis the presence and extent of stenosis and TCDS for evaluation of the activation of collateral circulatory pathways and a cerebrovascular reserve may virtually replace DSA which must probably be used only when the data obtained by different methods.