Role of citicoline in improvement of cognition, memory and post stroke disability in stroke patients

Authors

  • Mahendrapal Singh Department of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
  • Mohd. Imran Khan Department of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
  • Richa Giri Department of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
  • Lalit Kumar Department of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20191154

Keywords:

Citicoline, Neuroprotection, Post-stroke disability

Abstract

Background: Citicoline has emerged as a potential neuroprotectant in experimental models in stroke patients. Citicoline has shown some beneficial effects in human ischaemic stroke and with an excellent safety profile while in haemorrhagic stroke data is limited. Authors conducted this study to test role of citicoline in stroke patients in terms of cognition, memory and post stroke disability.

Methods: In this prospective study, patients had to be previously independent, aged >18 years of age, presented within 24 hours of onset of symptoms of stroke diagnosed by neuroimaging (CT or MRI). Patients received either a placebo or 500 mg/12 h citicoline for 12 weeks (orally or intravenously). The primary aim was to evaluate improvement in cognition, memory and post stroke disability after 12 weeks. The efficacy endpoint was the percentage of subjects with MMSE and DRS at 12 weeks.

Results: Total 75 stroke patients were enrolled, 40 in control group and 35 in citicoline group were allotted randomly. Patients in citicoline group were given intravenous citicoline 500 mg/12 hour during hospital stay and orally 500 mg/12 hour after discharge for up to 12 weeks. Control Group was given Placebo. cognition, memory and post stroke disability show positive improvement in citicoline group.

Conclusions: Citicoline shows beneficial effects in stroke in terms of cognition, memory and post stroke disability.

References

Fisher M, Albers GW. Applications of diffusion–perfusion magnetic resonance imaging in acute ischemic stroke. Neurol. 1999 Jun 1;52(9):1750.

Kase CS. Intracerebral haemorrhage. Bailliere's Clin Neurol. 1995 Aug;4(2):247-78.

Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005 Jan 29;365(9457):387-97.

Gong C, Boulis N, Qian J, Turner DE, Hoff JT, Keep RF. Intracerebral hemorrhage-induced neuronal death. Neurosurg. 2001 Apr 1;48(4):875-83.

Leira RM, Davalos AM, Silva Y, Gil-Peralta AM, Tejada JM, Garcia MM, et al. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurol. 2004 Aug 10;63(3):461-7.

DeGraba TJ, Pettigrew LC. Why do neuroprotective drugs work in animals but not humans?. Neurol Clin. 2000 May 1;18(2):475-93.

Secades JJ. CDP-choline: update and review of its pharmacology and clinical use. Methods Find Exp Clin Pharmacol. 2002; 24(suppl B):1-53.

Saver JL, Wilterdink J: Choline precursors in acute and subacute human stroke: a meta-analysis. Stroke 2002;33(1):353.

Dávalos A, Castillo J, Álvarez-Sabín J, Secades JJ, Mercadal J, López S, et al. Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Stroke. 2002 Dec 1;33(12):2850-7.

Warach S, Harnett K. Dose dependent reduction in infarct growth with citicoline treatment: evidence of neuroprotection in human stroke? Stroke. 2002;33(1): 354.

Kase M, Ono J, Yoshimasu N, Hiyamuta E, Sugiura K. Effect of CDP-choline in experimental cerebral hemorrhage. Curr Therapeut Res Clin Experiment. 1974 May;16(5):483-502.

Clark W, Gunion-Rinker L, Lessov N, Hazel K. Citicoline treatment for experimental intracerebral hemorrhage in mice. Stroke. 1998 Oct 1;29:2136-9.

World Health Organization-WHO. International Classification of Functioning, Disability and Health-ICF. Geneva: WHO;2001. Available at: https://www.who.int/classifications/icf/en/

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974 Jul 13;304(7872):81-.

Scranton J, Fogel ML, Erdman 2nd WJ. Evaluation of functional levels of patients during and following rehabilitation. Arch Physical Med Rehab. 1970 Jan;51(1):1.

Bhattacharya S, Saha SP, Basu A, Das SK. A 5 years prospective study of incidence, morbidity and mortality profile of stroke in a rural community of eastern India. J Indian Med Assoc. 2005 Dec;103(12):655-9.

Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction: the Northern Manhattan Stroke Study. Stroke. 1995 Jan;26(1):14-20.

Banerjee TK, Das SK. Epidemiology of stroke in India. Neurol Asia. 2006 Jun;11:1-4.

Gong C, Boulis N, Qian J, Turner DE, Hoff JT, Keep RF. Intracerebral hemorrhage-induced neuronal death. Neurosurgry. 2001 Apr 1;48(4):875-83.

Andaluz N, Zuccarello M, Wagner KR. Experimental animal models of intracerebral hemorrhage. Neurosurg Clin North Am. 2002 Jul;13(3):385-93.

Belayev L, Saul I, Curbelo K, Busto R, Belayev A, Zhang Y, et al. Experimental intracerebral hemorrhage in the mouse: histological, behavioral, and hemodynamic characterization of a double-injection model. Stroke. 2003 Sep 1;34(9):2221-7.

Castillo J, Davalos A, Álvarez–Sabín J, Pumar JM, Leira R, Silva Y, Montaner J, Kase CS. Molecular signatures of brain injury after intracerebral hemorrhage. Neurol. 2002 Feb 26;58(4):624-9.

Fatar M, Stroick M, Griebe M, Hennerici MG. Matrix metalloproteinases in cerebrovascular diseases. Cerebrovasc Dis. 2005;20(3):141-51.

Wahlgren NG, Diez-Tejedor E, Teitelbaum J, Arboix A, Leys D, Ashwood T, et al. Results in 95 hemorrhagic stroke patients included in CLASS, a controlled trial of clomethiazole versus placebo in acute stroke patients. Stroke. 2000 Jan;31(1):82-5.

Lyden P, Shuaib A, Ng K, Levin K, Atkinson RP, Rajput A, Wechsler L, Ashwood T, Claesson L, Odergren T, Salazar-Grueso E. Clomethiazole acute stroke study in ischemic stroke (CLASS-I). Stroke. 2002;33(1):122-9.

Haley Jr EC, Thompson JL, Levin B, Davis S, Lees KR, Pittman JG, DeRosa JT, et al. Gavestinel does not improve outcome after acute intracerebral hemorrhage: an analysis from the GAIN International and GAIN Americas studies. Stroke. 2005 May 1;36(5):1006-10.

Lees KR, Asplund K, Carolei A, Davis SM, Diener HC, Kaste M, et al. Glycine antagonist (gavestinel) in neuroprotection (GAIN International) in patients with acute stroke: a randomised controlled trial. Lancet. 2000 Jun 3;355(9219):1949-54.

Sacco RL, DeRosa JT, Haley Jr EC, Levin B, Ordronneau P, Phillips SJ, et al. Glycine antagonist in neuroprotection for patients with acute stroke: GAIN Americas: a randomized controlled trial. JAMA. 2001 Apr 4;285(13):1719-28.

Dávalos A, Castillo J, Álvarez-Sabín J, Secades JJ, Mercadal J, López S, Cobo E, et al. Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Stroke. 2002 Dec 1;33(12):2850-7.

Gutiérrez-Fernández M, Leciñana MA, Rodríguez-Frutos B, Ramos-Cejudo J, Roda JM, Díez-Tejedor E. CDP-choline at high doses is as effective as iv thrombolysis in experimental animal stroke. Neurological research. 2012 Sep 1;34(7):649-56.

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Published

2019-03-25

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Original Research Articles