A modern view of approaches of neuroprotective therapy in patients with ischemic stroke. Review

Abstract

Timely use of neuroprotectors for treatment of ischemic stroke should prevent or inhibit the pathogenetic mechanisms that lead to apoptosis of brain cells, both in the nucleus of the infarct and in the ischemic penumbra. The concept of neuroprotection has a sufficient scientific basis, but the questions of its effectiveness, safety and optimal points of application remain controversial, taking into account the available results of clinical trials. Currently, two pharmacological agents are most commonly used as neuroprotective agents in ischemic stroke (IS) — Cerebrolysin and Edaravon (in the Ukrainian pharmaceuзtical market — Xavron). They have the broadest evidence base and are favored by practitioners to provide the potential for recovery in the post­stroke period. Objective — to investigate the available evidence base of results of admission and effectiveness of neuroprotective agents — Cerebrolysin and Edaravon in treatment of IS: the impact to the outcome of treatment during hospita period and in the medium term. A search was conducted for studies and metaanilysis for the Key words «schemic stroke», «neuroprotection», «edaravon», «cerebrolysin» in the PubMed database and the Cochrane Library, published between 2010 and 2022.The selection criteria for publications were the availability of a full text or a detailed summary in English. Given the results of research, the clinical effects of neuroprotective therapy are significant. However, there are reports of questionable results, the probable causes of which may be: failure to take into account the level of neurological deficit at the time of hospitalization, as well as the therapeutic window for the appointment of the drug and the dosage regimen. The outcome on the 90th day of treatment could be influenced by factors such as comorbid pathology, complications of the hospital period, as well as different approaches to rehabilitation measures. Large clinical trials with more sophisticated patient selection criteria are needed to determine the importance of neuroprotective agents in the complex intensive care of patients with IS.