Acute Stroke Treatment

Efficacy of citicoline as an acute stroke treatment.
Expert Opin Pharmacother 2009 Apr; 10(5):839-46.
Clark WM

Citicoline (cytidine-5'-diphosphocholine or CDP-choline) is a
precursor essential for the synthesis of phosphatidylcholine,
one of the cell membrane components that is degraded during
cerebral ischemia to free fatty acids and free radicals.
Animal studies suggest that citicoline may protect cell membranes
by accelerating resynthesis of phospholipids and suppressing the
release of free fatty acids, stabilizing cell membranes, and reducing
free radical generation.
Numerous experimental stroke studies with citicoline have shown
improved outcome and reduced infarct size in both ischemic and
hemorrhagic stroke models.
Citicoline has been studied worldwide in both ischemic and
hemorrhagic
clinical stroke with excellent safety and possibly efficacy found in
several
trials.
A meta-analysis of four randomized US clinical citicoline trials
concluded
that treatment with oral citicoline within the first 24 h after a
moderate to
severe stroke is safe and increases the probability of complete
recovery
at 3 months.
Citicoline clinical efficacy trials are now continuing outside of the
US in
both ischemic and hemorrhagic stroke.
A citicoline supplement is now available from several sources on the
internet.

Expert opinion on pharmacotherapy [Expert Opin Pharmacother]

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"The mechanism may be that soybean lecithin lowers
the decrease of brain phospholipid content in brain ischemia"

Curative effect of soybean lecithin on cerebral infarction
Shi F, Zhou J, Meng D
Zhonghua Yi Xue Za Zhi. 2001 Nov 10; 81(21): 1301-3

OBJECTIVE:
To investigate the clinical curative effect of soybean lecithin on
cerebral infarction.
METHODS:
542 patients with cerebral infarction within 48 h after the onset
with the nervous fuction defect scores of 31-35 were divided into
3 groups: basic treatment group, 60 cases, with conventional
treatment; citicoline group, 122 patients, with conventional
treatment and citicoline; and soybean lecithin group, 360 patients,
with conventional treatment and soybean lecithin 10 g tid.
For all patients, treatment began sometime within 48 hours after
the onset.
The treatment course lasted 28 days.
RESULTS:
When the course was over, the infarct volumes in basic group
citicoline group, and soybean lecithin group, were 7.6 cm3 +/- 2.9
cm3,
7.3 cm3 +/- 3.1 cm3, and 6.4 cm3 +/- 2.7 cm3 respectively
(F = 7.371, P = 0.0007).
The basic group and citicoline group being compared with the soybean
group by Dunnett test, t = 4.387 and 3.969 respectively, P < 0.01.
The nervous function defect integral in the 3 groups decreased 14.2
+/-
10.93, 15.0 +/- 9.0, and 18.5 +/- 10.9 respectively.
Two-way analysis of variance of drug kind and beginning time of
treatment
showed the value of F in drugs as 6.250, P = 0.0021, and value of F in
times
as 0.9417, P = 0.4201. In the order of death,deterioration,
nonimprovement,
improvement, significant improvement, and recovery, the Ridit values
for the
comprehensive curative effect in the 3 groups were 0.4003, 0.4118,
and
0.54 5 respectively; chi2 = 27.89, P < 0.001.
CONCLUSION:
Soybean lecithin is effective in treatment of acute cerebral
infarction.
The mechanism may be that soybean lecithin lowers the decrease of
brain
phospholipid content in brain ischemia.

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Tom