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21.09.2005:
   21.09.2005

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USE OF AMINO ACID COMPOUNDS IN THE TREATMENT OF INSULT CONSEQUENCES.

N.A. Chernova, neuropathologist; V.V. Ryazantsev, neuropathologist
1997

INTRODUCTION

Prospects of recovering working ability functions in patients who sustained a stroke remain very limited which causes clinicians to actively search for neuroprotectors capable of preventing neuron destruction both in acute ischemia and in the subsequent recovery period.

The previous studies (Ye.I. Gusev et al., 1995, and V.I Skvortsova et al., 1995) have shown the efficacy of glycine amino acid in the acute period of cerebral ischemic insult.

The objective of the present study was to examine the efficacy of amino acid compounds in the treatment of insult consequences.

MATERIAL AND STUDY METHODS

40 patients whose age ranged from 24 to 69 years (23 males and 17 females) with consequences of cerebral ischemic and hemorrhagic insult have been examined. The mean age was 57.6 years. All patients admitted for treatment were carefully examined in the acute disease phase. In 28 patients CT or magnetic resonance tomography (MRT) recordings of the brain were made; in the remaining cases we judged on the nature of the sustained stroke and its localization by excerpts from case histories and the clinical picture at the moment of admission to the Center.

Atherosclerosis as the background disease was found in 10 patients; that combined with arterial hypertension in 16 patients, including 2nd type diabetis mellitus in 4 cases. In 4 patients insult developed at the background of hypertensive disease. In 10 instances hemorrhage was due to a cerebral aneurism rupture that was confirmed angiographically. An acute cerebral circulation impairment (ACCI) developed in the left hemisphere of the brain in 13 cases (32.5%), in the right hemisphere in 24 cases (60%) and in the cerebral trunk in 3 patients (7.5%). In terms of the cerebral circulation disorder history, the patients were distributed as follows: 5 patients - up to 6 months (12.5%); 7 patients - up to 7 months (17.5%); 14 patients - up to 3 years (35%) and 14 patients over 3 years (35%).

Retrospectively, depending on the dominant neurologic syndrome at the moment of their examination at the Center, all patients can be subdivided into 4 main groups:

Spastic hemiparesis where irritation symptoms dominated: muscular hypertonicity; hyperreflexia; marked pathologic concomitant movements; pathologic foot reflexes. This syndrome sets on in compensatory involvement of cortical-subcortical links, reticular formation and intensification of the spinal gamma-system activity;

Central atonic hemiparesis with dominant symptoms of nerve-muscle prolapses: muscular hypotonicity or normotonia, restriction or absence of movements, trophic disturbances and hypersthesia. The flaccid paralysis syndrome of central origin is associated with Betz cells impairment or of their axons and is conditioned by a predominance of inhibitory effects of the cerebral trunk formation on the activity of the spinal anterocorneous apparatus; Impairment of the cerebral subcortical nodules (especially, of substantia nigra) with the most commonest rigid-kinetic syndrome. In these instances, the clinical picture was represented by 3 groups of syndromes: increased muscular tone of extrapyramidal type (muscular rigidity), general hypodynamics (amyostatic symptom complex) and hyperkineses;

Syndromes of vertebrobasilar system impairment. The principal symptoms were dizziness, static and movement coordination disturbances as well as truncal function involvement.

All the patients were treated with amino acid compounds selected according to the basic neurologic syndrome at an average dose of 2-4 g daily. A course of treatment lasted 5-6 weeks. 11 patients underwent 2 courses of treatment.

STUDY RESULTS

As a result of the treatment it has been established that there cannot be a single therapeutic scheme in treating after-stroke patients since not only various neurologic syndromes but also the dominant syndrome - central hemiparesis - call, depending on focus localization, for a differentiated approach to the drug selection.

Thus, in 20 spastic hemiparesis patients of the 1st group the optimal choice were different combinations of amino acid compounds that reduce the muscular tone: Glucaprim, Primavit and Gluconal.

In 6 patients of the 2nd group Aminovil, Glucaprim and Neurovit were used most often. In the presence of mnestic-intellectual disorders, speech disturbances (dysarthria, aphasia) and other phenomena characteristic of hemispheric insults in these groups, Vitamixt and small doses of Neoprim were ordered.

The 3rd group mainly received Aminovit, Aminocomposit, Detrem, Depark and Vitamixt.

The patients of the 4th group were treated with Neurovit, Neoprim, Glucaprim and Aminovil.

The best results were obtained in the early (up to 6 months) recovery period (12 patients). A 60-80% reduction of neurologic deficiency was recorded. A clear-cut positive dynamics as manifested by diminished spasticity or reduced spastic rigidity by more than 50% was reported in 22 subjects (55%). In the course of treatment it was found that in the residual period when the patients had already formed the flexion contracture in the elbow joint and/or in the hand which could not be dealt with as a result of 1 or 2 courses of treatment, a favorable trend in the form of a reduced algesic syndrome and trophic manifestations was recorded.

All patients reported an improvement of the general condition expressed in decreased headaches, reduced vertigo, normalized sleep and appetite, increased general activity and working efficiency.

CONCLUSION

Thus, the use of amino acid compounds in the treatment of post-insult conditions shows considerable promise.

REFERENCES (in Russian)

Skvortsova, V.I., Gusev, Ye.I., Komissarova, V.I., et al. In: Journ. of Neuropat. and Psychiatr., 1995, issue 1, pp. 11-19.

Gusev, Ye.I., Skvortsova, V.I., Kovalenko, A.V., et al. In: Clinical Messenger , 1995. April-June issue, pp. 6-8.


 
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