Limits...
The role of citicoline in neuroprotection and neurorepair in ischemic stroke.

Alvarez-Sabín J, Román GC - Brain Sci (2013)

Bottom Line: Advances in acute stroke therapy resulting from thrombolytic treatment, endovascular procedures, and stroke units have improved significantly stroke survival and prognosis; however, for the large majority of patients lacking access to advanced therapies stroke mortality and residual morbidity remain high and many patients become incapacitated by motor and cognitive deficits, with loss of independence in activities of daily living.Citicoline has therapeutic effects at several stages of the ischemic cascade in acute ischemic stroke and has demonstrated efficiency in a multiplicity of animal models of acute stroke.Long-term treatment with citicoline is safe and effective, improving post-stroke cognitive decline and enhancing patients' functional recovery.

View Article: PubMed Central - PubMed

Affiliation: Neurovascular Unit, Department of Neurology, Universitat Autónoma de Barcelona, 119-129 Passeig de la Vall d'Hebron, Barcelona 08035, Spain. josalvarez@vhebron.net.

ABSTRACT
Advances in acute stroke therapy resulting from thrombolytic treatment, endovascular procedures, and stroke units have improved significantly stroke survival and prognosis; however, for the large majority of patients lacking access to advanced therapies stroke mortality and residual morbidity remain high and many patients become incapacitated by motor and cognitive deficits, with loss of independence in activities of daily living. Therefore, over the past several years, research has been directed to limit the brain lesions produced by acute ischemia (neuroprotection) and to increase the recovery, plasticity and neuroregenerative processes that complement rehabilitation and enhance the possibility of recovery and return to normal functions (neurorepair). Citicoline has therapeutic effects at several stages of the ischemic cascade in acute ischemic stroke and has demonstrated efficiency in a multiplicity of animal models of acute stroke. Long-term treatment with citicoline is safe and effective, improving post-stroke cognitive decline and enhancing patients' functional recovery. Prolonged citicoline administration at optimal doses has been demonstrated to be remarkably well tolerated and to enhance endogenous mechanisms of neurogenesis and neurorepair contributing to physical therapy and rehabilitation.

No MeSH data available.


Related in: MedlinePlus

Functional status during six month follow-up: Subjects treated with citicoline had improvement on all cognitive domains; however, improvement was statistically significant only for attention/executive function and temporal orientation. Modified from Álvarez-Sabín et al. [91].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4061873&req=5

brainsci-03-01395-f005: Functional status during six month follow-up: Subjects treated with citicoline had improvement on all cognitive domains; however, improvement was statistically significant only for attention/executive function and temporal orientation. Modified from Álvarez-Sabín et al. [91].

Mentions: Most end-points used in clinical trials address issues relevant to motor function, activities of daily living and quality of life; in fact, many patients with cognitive or behavioral problems are excluded from clinical trials. Therefore, there is a need to identify cognitive and behavioral problems occurring as a result of stroke or “silent” small-vessel vascular disease. For the above reasons, International Guidelines recommend routine cognitive and behavioral evaluation of stroke patients [88]. In reality, these aspects are rarely evaluated in stroke patients [89]. Along the same lines, few pharmacological products have been evaluated for prevention or treatment of cognitive problems in the stroke patient. A Cochrane meta-analysis of citicoline in 942 patients with vascular cognitive impairment studied in 12 placebo-controlled, double-blind, randomized studies showed modest evidence of improvement in memory and behavior, and a significant impression of improvement on the global impression of change on the part of caregivers [90]. Based on these data and on abundant evidence on the neuroprotective and neurorepair effects of citicoline, we evaluated the safety and efficacy of citicoline on the cognitive manifestations of patients with acute ischemic stroke. This study was an open-label, randomized, parallel study of citicoline (1 g/day) for 12 months vs. usual treatment in patients with first-ever ischemic stroke [91]. Citicoline-treated patients showed better outcome at follow-up in attention-executive functions and temporal orientation at six months and 12 months (Figure 4). Moreover, although differences are not statistically different, patients treated with citicoline showed a trend towards having a better functional outcome, measured with mRS at 6 and 12 months (Figure 5).


The role of citicoline in neuroprotection and neurorepair in ischemic stroke.

Alvarez-Sabín J, Román GC - Brain Sci (2013)

Functional status during six month follow-up: Subjects treated with citicoline had improvement on all cognitive domains; however, improvement was statistically significant only for attention/executive function and temporal orientation. Modified from Álvarez-Sabín et al. [91].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061873&req=5

brainsci-03-01395-f005: Functional status during six month follow-up: Subjects treated with citicoline had improvement on all cognitive domains; however, improvement was statistically significant only for attention/executive function and temporal orientation. Modified from Álvarez-Sabín et al. [91].
Mentions: Most end-points used in clinical trials address issues relevant to motor function, activities of daily living and quality of life; in fact, many patients with cognitive or behavioral problems are excluded from clinical trials. Therefore, there is a need to identify cognitive and behavioral problems occurring as a result of stroke or “silent” small-vessel vascular disease. For the above reasons, International Guidelines recommend routine cognitive and behavioral evaluation of stroke patients [88]. In reality, these aspects are rarely evaluated in stroke patients [89]. Along the same lines, few pharmacological products have been evaluated for prevention or treatment of cognitive problems in the stroke patient. A Cochrane meta-analysis of citicoline in 942 patients with vascular cognitive impairment studied in 12 placebo-controlled, double-blind, randomized studies showed modest evidence of improvement in memory and behavior, and a significant impression of improvement on the global impression of change on the part of caregivers [90]. Based on these data and on abundant evidence on the neuroprotective and neurorepair effects of citicoline, we evaluated the safety and efficacy of citicoline on the cognitive manifestations of patients with acute ischemic stroke. This study was an open-label, randomized, parallel study of citicoline (1 g/day) for 12 months vs. usual treatment in patients with first-ever ischemic stroke [91]. Citicoline-treated patients showed better outcome at follow-up in attention-executive functions and temporal orientation at six months and 12 months (Figure 4). Moreover, although differences are not statistically different, patients treated with citicoline showed a trend towards having a better functional outcome, measured with mRS at 6 and 12 months (Figure 5).

Bottom Line: Advances in acute stroke therapy resulting from thrombolytic treatment, endovascular procedures, and stroke units have improved significantly stroke survival and prognosis; however, for the large majority of patients lacking access to advanced therapies stroke mortality and residual morbidity remain high and many patients become incapacitated by motor and cognitive deficits, with loss of independence in activities of daily living.Citicoline has therapeutic effects at several stages of the ischemic cascade in acute ischemic stroke and has demonstrated efficiency in a multiplicity of animal models of acute stroke.Long-term treatment with citicoline is safe and effective, improving post-stroke cognitive decline and enhancing patients' functional recovery.

View Article: PubMed Central - PubMed

Affiliation: Neurovascular Unit, Department of Neurology, Universitat Autónoma de Barcelona, 119-129 Passeig de la Vall d'Hebron, Barcelona 08035, Spain. josalvarez@vhebron.net.

ABSTRACT
Advances in acute stroke therapy resulting from thrombolytic treatment, endovascular procedures, and stroke units have improved significantly stroke survival and prognosis; however, for the large majority of patients lacking access to advanced therapies stroke mortality and residual morbidity remain high and many patients become incapacitated by motor and cognitive deficits, with loss of independence in activities of daily living. Therefore, over the past several years, research has been directed to limit the brain lesions produced by acute ischemia (neuroprotection) and to increase the recovery, plasticity and neuroregenerative processes that complement rehabilitation and enhance the possibility of recovery and return to normal functions (neurorepair). Citicoline has therapeutic effects at several stages of the ischemic cascade in acute ischemic stroke and has demonstrated efficiency in a multiplicity of animal models of acute stroke. Long-term treatment with citicoline is safe and effective, improving post-stroke cognitive decline and enhancing patients' functional recovery. Prolonged citicoline administration at optimal doses has been demonstrated to be remarkably well tolerated and to enhance endogenous mechanisms of neurogenesis and neurorepair contributing to physical therapy and rehabilitation.

No MeSH data available.


Related in: MedlinePlus