Department of Neurology, Kawakita General Hospital, Tokyo, Japan.
Clin Drug Investig. 2010;30(3):143-55. doi: 10.2165/11535500-000000000-00000.
Edaravone is a free-radical scavenger that has been widely used for acute ischaemic stroke in Japan. However, the optimal total dosage of edaravone has not been established.
To clarify the relationship between the gain in functional recovery (rehabilitation gain) and the total amount of edaravone used for acute-phase therapy for cerebral infarction at a convalescent rehabilitation hospital. We also sought to determine if there were differences in outcome between stroke subtypes.
Medical records were retrospectively surveyed to identify patients who had received edaravone treatment for acute-phase cerebral infarction at Kawakita General Hospital, Tokyo, Japan, followed by recovery rehabilitation at Kawakita Rehabilitation Hospital, Tokyo, Japan, for > or = 30 days. Edaravone was initiated within 24 hours of stroke onset, and was administered as a 30 mg (1 ampoule) continuous intravenous infusion twice daily for up to 14 days. Patients were stratified into tertiles based on the total amount of edaravone used (measured in ampoules) during the acute phase (i.e. administration duration). Rehabilitation gain was defined as the change (increase) from convalescent rehabilitation hospital admission to discharge in the Functional Independence Measure-Motor (DeltaFIM-M) or Barthel Index (DeltaBI) score.
Of the 72 enrolled patients, 21 belonged to the lower (short-term) tertile (0-14 ampoules), 27 to the middle (medium-term) tertile (15-23 ampoules) and 24 to the upper (long-term) tertile (24-33 ampoules) groups. There was no correlation between the total amount of edaravone used and the length of stay at an acute-phase hospital. However, a significant correlation was seen between the total amount of edaravone used and DeltaFIM-M (adjusted regression coefficient 0.81; p = 0.003) and DeltaBI (0.88; p = 0.005) score in patients with cardioembolic stroke; no significant correlation was seen in other stroke subtypes. Cardioembolic stroke patients also showed improvements in both FIM-M and BI score as the total amount of edaravone used increased. The difference between the short- and long-term group was 10.1 (95% CI 2.3, 17.8) for DeltaFIM-M score, and 12.0 (95% CI 2.8, 21.2) for DeltaBI score. Patients with atherothrombotic stroke showed a similar tendency with respect to DeltaBI score.
Edaravone dose-dependently increases rehabilitation gain according to DeltaFIM-M and DeltaBI scores in patients with cardioembolic stroke, and a similar trend was also observed with respect to DeltaBI score in patients with atherothrombotic stroke. This suggests that the total amount of edaravone used is associated with its efficacy for rehabilitation gain.
依达拉奉是一种自由基清除剂，已在日本广泛用于治疗急性缺血性脑卒中。然而，依达拉奉的最佳总剂量尚未确定。
在康复医院明确急性脑梗死急性期依达拉奉总用量与功能恢复（康复增益）之间的关系。我们还试图确定不同脑卒中亚型之间的结局是否存在差异。
回顾性调查了在日本东京川口综合医院接受依达拉奉治疗的急性脑梗死患者的病历，随后在东京川口康复医院接受了＞30 天的康复治疗。依达拉奉在脑卒中发病后 24 小时内开始使用，每天两次静脉滴注 30 mg（1 安瓿），持续 14 天。根据急性期（即使用时间）依达拉奉的总用量（以安瓿数计），患者被分为三分位组。康复增益定义为从康复医院入院到出院时的功能独立性测量-运动（DeltaFIM-M）或巴氏指数（DeltaBI）评分的变化（增加）。
在纳入的 72 例患者中，21 例属于低（短期）三分位组（0-14 安瓿），27 例属于中（中期）三分位组（15-23 安瓿），24 例属于高（长期）三分位组（24-33 安瓿）。依达拉奉总用量与急性期医院住院时间之间无相关性。然而，依达拉奉总用量与心源性栓塞性脑卒中患者的 DeltaFIM-M（校正回归系数 0.81；p=0.003）和 DeltaBI（0.88；p=0.005）评分呈显著相关；在其他脑卒中亚型中则无显著相关性。心源性栓塞性脑卒中患者随着依达拉奉总用量的增加，FIM-M 和 BI 评分均有改善。短期组和长期组之间的差异在 DeltaFIM-M 评分上为 10.1（95%CI 2.3，17.8），在 DeltaBI 评分上为 12.0（95%CI 2.8，21.2）。动脉粥样硬化血栓性脑卒中患者在 DeltaBI 评分上也表现出类似的趋势。
依达拉奉的剂量与心源性栓塞性脑卒中患者的 DeltaFIM-M 和 DeltaBI 评分呈正相关，且在动脉粥样硬化血栓性脑卒中患者的 DeltaBI 评分上也呈类似趋势。这表明依达拉奉的总用量与其康复增益疗效有关。
