Journal of Medicine Vol 2 - Amrita Institute of Medical Sciences and ...

Amrita Journal of Medicine
LITERATURE SCAN
Cases, Evidence and Verdicts
T. Roy, T. Rony, A.N. Babu
The sixth installment of this series
reviews three recent articles
related to neuroprotection in cerebrovascular
disease considering either
primary or secondary prevention
agents.
Y. Lampl MD, M. Boaz, PhD , R.
Gilad MD , M. Lorberboym MD , R.
Dabby,MD , A. Rapoport MD, M.
Anca-Hershkowitz MD, M. Sadeh,
MD :Minocycline treatment in acute
stroke An open-label, evaluatorblinded
study. Neurology 2007;
69:1404–1410
BACKGROUND
Ischemic animal model studies
have shown a neuroprotective effect
of minocycline.
OBJECTIVE
To analyze the effect of
minocycline treatment in human
acute ischemic stroke.
METHODS
An open-label, evaluator-blinded
study was performed. Minocycline at
a dosage of 200 mg was administered
orally for 5 days. The therapeutic window
of time was 6 to 24 hours after
onset of stroke. Data from NIH Stroke
Scale (NIHSS), modified Rankin Scale
(mRS), and Barthel Index (BI) were
evaluated. The primary objective was
to compare changes from baseline to
day 90 in NIHSS in the minocycline
group vs. placebo.
RESULTS
One hundred fifty-two patients
were included in the study. Seventy-
Dept. of Digital Health, AIMS, Kochi.
four patients received minocycline
treatment, and 77 received placebo.
NIHSS and mRS were significantly
lower and BI scores were significantly
higher in minocycline-treated patients.
This pattern was already
apparent on day 7 and day 30 of follow-up.
Deaths, myocardial
infarctions, recurrent strokes, and
hemorrhagic transformations during
follow-up did not differ by treatment
group.
CONCLUSIONS
Patients with acute stroke had significantly
better outcome with
minocycline treatment compared
with placebo. The findings suggest a
potential benefit of minocycline in
acute ischemic stroke.
Somchai Laowattana, MD, PhD;
and Stephen M. Oppenheimer, MD,
PhD
Protective effects of beta-blockers
in cerebrovascular disease. Neurology
2007;68:509–514
OBJECTIVE
Because activated sympathetic
tone is associated with poorer outcome
after stroke, we investigated
whether beta-blocker treatment was
associated with lesser stroke severity
and improved outcome.
METHOD
This study prospectively evaluated
111 patients with stroke. Stroke severity
on presentation gauged by
Canadian Neurologic Scale (CanNS)
and medication use verified from
medical records. Power spectral
analysis of heart rate variability estimated
cardiac sympathovagal tone.
Coagulation and inflammatory activity
were assessed.
RESULTS
On multiple linear regression,
betablocker use was the sole independent
predictor of less severe stroke on
presentation (95% CI: 0.12 to 1.86:
p =0.03). When CanNS was dichotomized,
multiple logistic regression
revealed that beta-blocker use (odds
ratio [OR] 3.70, 95% CI: 1.24 to
11.01, p= 0.02) and female gender
(OR 2.96, 95% CI: 1.14 to 7.69, p=
0.03) were independent predictors of
CanNS score >8.5. There was no
difference in blood pressure and blood
glucose between these two groups.
Beta-blocker treatment was associated
with lower sympathovagal tone
(p = 0.001), thrombin (p = 0.009),
hemoglobin A1C levels (p =0.02),
and erythrocyte sedimentation rate (p
= 0.003).
CONCLUSION
Beta-blocker use is associated with
less severe stroke on presentation and
may be cerebroprotective due to a
sympatholytic effect associated with
decreased thrombin, inflammation,
and hemoglobin A1C.
Xiaobin Wang, Xianhui Qin,
Hakan Demirtas, Jianping Li,
Guangyun Mao, Yong Huo, Ningling
Sun, Lisheng Liu, Xiping Xu
Efficacy of folic acid supplementation
in stroke prevention: a
meta-analysis.
Lancet Vol 369 June 2, 2007
42