Kim Jun Yup, Kim Hyun Jung, Choi Hyo Seon, Park So Young, Kim Deog Young
Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Front Neurol. 2019 Aug 2;10:803. doi: 10.3389/fneur.2019.00803. eCollection 2019.
The neurotrophic drug Cerebrolysin is composed of low-molecular-weight peptides and amino acids and has been shown to have neuroprotective and neuroplastic properties. Cerebrolysin has been reported to promote the recovery of motor functions in central nervous system disorders; however, the effects on the consciousness improvements in post-stroke patients have not yet been studied extensively. Therefore, we aimed to examine the effectiveness of Cerebrolysin on improving the consciousness level of stroke patients with minimally conscious state (MCS). In this retrospective study we included ischemic and/or hemorrhagic stroke patients with MCS according to the Coma Recovery Scale-Revised (CRS-R), who were admitted to our hospital between 2014 and 2017. All patients received comprehensive rehabilitation therapy including physical and occupational therapy. We compared patients treated with Cerebrolysin against patients who did not receive Cerebrolysin. Patients were included in the verum group if they received 10 mL of Cerebrolysin IV for at least 20 days. CRS-R scores were assessed at admission and discharge. Of 1,531 patients screened, 75 were included in the study (Cerebrolysin, = 43; control, = 32). Baseline characteristics were similar between groups. At discharge, ~2 months after onset of stroke, Cerebrolysin-treated patients improved significantly in the CRS-R ( = 0.010) after adjustment for confounders using linear mixed model (LMM), especially in the Oromotor ( = 0.003) and Arousal subscales ( = 0.038). No safety issues were observed. This retrospective study suggests that Cerebrolysin may improve the level of consciousness in stroke patients with MCS, which should be further investigated in a well-designed, double-blind, placebo-controlled, randomized trial.
神经营养药物脑蛋白水解物由低分子量肽和氨基酸组成,已被证明具有神经保护和神经可塑性特性。据报道,脑蛋白水解物可促进中枢神经系统疾病中运动功能的恢复;然而,其对中风后患者意识改善的影响尚未得到广泛研究。因此,我们旨在研究脑蛋白水解物对改善最低意识状态(MCS)中风患者意识水平的有效性。在这项回顾性研究中,我们纳入了2014年至2017年间根据修订的昏迷恢复量表(CRS-R)诊断为MCS的缺血性和/或出血性中风患者。所有患者均接受了包括物理和职业治疗在内的综合康复治疗。我们将接受脑蛋白水解物治疗的患者与未接受脑蛋白水解物治疗的患者进行了比较。如果患者接受10 mL静脉注射脑蛋白水解物至少20天,则将其纳入真药组。在入院时和出院时评估CRS-R评分。在筛选的1531例患者中,75例被纳入研究(脑蛋白水解物组,n = 43;对照组,n = 32)。两组之间的基线特征相似。在中风发作约2个月后的出院时,使用线性混合模型(LMM)对混杂因素进行调整后,脑蛋白水解物治疗的患者在CRS-R上有显著改善(P = 0.010),尤其是在口部运动(P = 0.003)和觉醒子量表(P = 0.038)方面。未观察到安全问题。这项回顾性研究表明,脑蛋白水解物可能改善MCS中风患者的意识水平,这应在精心设计的双盲、安慰剂对照、随机试验中进一步研究。