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Table of Contents
Vol. 21, Suppl. 2, 2006
Issue release date: May 2006
Cerebrovasc Dis 2006;21:127–130
(DOI:10.1159/000091712)

Other Neuroprotective Therapies on Trial in Acute Stroke

Ferro J.M. · Dávalos A.
aDepartment of Neurosciences and Mental Health, Hospital de Santa Maria, Lisboa, Portugal, and bDepartment of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

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Abstract

New neuroprotective agents on trial may potentially offer benefit to stroke patients without the associated hemorrhagic risk of thrombolytic therapy. Clinical investigation of these drugs has been designed to obtain the highest probability of success, or concentrates on the salvageable ischemic brain and use infarct growth on MRI as a surrogate end-point. Nine substances in 10 trials are currently being tested in three therapeutical strategies in patients with acute ischemic stroke. These strategies focus on: (1) the optimal management of serum glucose with the infusion of glucose, insulin and potassium to induce and maintain euglycemia; (2) the modulation of the inflammatory response with recombinant human interferon-β1a, and (3) interfering with the ischemic cascade using magnesium, albumin, the metal iron chelator DP-b99, the AMPA receptor antagonist zonampanel, the serotonin agonists repinotan and piclozotan, the free radical scavenger cerovive, and the membrane modulator citicoline. Future directions should develop neuroprotective compounds that are safe and well tolerated, are effective in a broad range of patients and can be used with or without rt-PA.



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References

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    External Resources

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  5. US National Institutes of Health. www.clinicaltrials.gov
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  7. European Stroke Initiative Executive Committee and the EUSI Writing Committee: European Stroke Initiative recommendations for stroke management – update 2003. Cerebrovasc Dis 2003;16:311–337.
  8. Scott JF, Robinson GM, French JM, O’Connell JE, Alberti KG, Gray CS: Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST). Stroke 1999;30:793–799.
  9. Muir KW, Lees KR, Ford I, Davis S, Intravenous Magnesium Efficacy in Stroke (IMAGES) Study Investigators: Magnesium for acute stroke (Intravenous Magnesium Efficacy in Stroke Trial): randomised controlled trial. Lancet 2004;363:439–445.
  10. Teal P, Silver FL, Simard D: The BRAINS study: safety, tolerability, and dose-finding of repinotan in acute stroke. Can J Neurol Sci 2005;32:61–67.
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  12. Lees KR, Zivin JA, Ashwood T, Davalos A, Davis SM, Diener HC, Grotta J, Lyden P, Shuaib A, Hardemark HG, Wasiewski W for the SAINT I Investigators: NXY-059 for Acute Ischaemic Stroke: the SAINT I Trial. N Engl J Med 2006;354:588–600.
  13. Dávalos A, Castillo J, Ðlvarez-Sabín J, Secades JJ, Mercadal J, López S, Cobo E, Warach S, Sherman D, Clark WC, Lozano R: Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Stroke 2002;33:2850–2857.


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