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Stroke and functional rehabilitation: the Chinese experience
1Department of Neurology, Peking Union Medical College Hospital, Beijing, People's Republic of China.
Insights
Almitrine-raubasine may accelerate functional rehabilitation in stroke patients by improving cerebral oxygenation. This study aims to confirm its efficacy in the convalescent period, enhancing recovery beyond spontaneous improvements.
Area of Science:
- Neurology
- Pharmacology
- Rehabilitation Medicine
Background:
- Cerebrovascular disease presents high prevalence, incidence, and mortality rates in China.
- Functional rehabilitation post-stroke is a critical medical and social need.
- Almitrine-raubasine is utilized in China to enhance stroke recovery.
Purpose of the Study:
- To document the clinical efficacy of almitrine-raubasine in the convalescent period of cerebrovascular disease patients.
- To evaluate if almitrine-raubasine accelerates functional rehabilitation compared to placebo.
Main Methods:
- A double-blind, placebo-controlled study involving 100 patients with ischemic cerebrovascular disease.
- Treatment with almitrine-raubasine or placebo for 3-6 months, with a 2-week drug washout period.
- Monthly clinical examinations, neurological deficit scores, Barthel index, Hasagawa Dementia scales, and CT scans.
Main Results:
- Almitrine-raubasine enhances arterial oxygen content, promoting cerebral aerobic metabolism during ischemia.
- Positron emission tomography indicates normalization of the ischemic penumbra area in the acute phase.
- Single photon emission computed tomography shows restoration of normal cerebral vasodilator response in the long term.
Conclusions:
- Almitrine-raubasine demonstrates potential in improving cerebral oxygenation and metabolism post-stroke.
- The drug may accelerate functional rehabilitation in patients recovering from cerebrovascular disease.
- Further clinical studies are planned to confirm the therapeutic benefits of almitrine-raubasine.
Abstract:
According to an epidemiological study of cerebrovascular disease carried out in China in 1986, the prevalence, incidence, and mortality rates were 159.93/100,000, 115.61/100,000, and 31.33/100,000, respectively. These figures were high compared to available epidemiological data for the rest of the world. This highlights the fact that, as in other countries, functional rehabilitation after stroke is an important medical and social need in China. Clinical experience shows that within a few hours to a few months after a stroke, a large proportion of patients spontaneously experience partial, or on occasion, complete recovery from neurologic symptoms. However, functional rehabilitation in medical care units is required because it assists in and accelerates the recovery of impaired function. Almitrine-raubasine has been used to improve functional rehabilitation after stroke for some time in China. By enriching the oxygen content of arterial blood, it brings more oxygen to the cerebral tissues and therefore promotes cerebral aerobic metabolism during ischemia. In the acute phase of stroke, positron emission tomography showed, in man, that almitrine-raubasine helps normalize the ischemic penumbra area, as shown by an improvement in the coupling between oxygenation and perfusion. Long after stroke, single photon emission computed tomography showed that almitrine-raubasine restores normal cerebral vasodilator response to acetazolamide. With a view to further documenting the clinical efficacy of almitrine-raubasine on the convalescent period of patients with cerebrovascular disease, a double-blind, placebo-controlled study is planned. One hundred patients with ischemic cerebrovascular disease in the territory of the carotid artery will be included 4-6 weeks after the acute onset. Two tablets daily of almitrine-raubasine or placebo will be prescribed for 3-6 months. Before treatment, there will be a 2-week washout period for all other drugs, except for antihypertensive and antidiabetic drugs. In addition to complete clinical monthly examinations, neurological functional deficit scores, Barthel index, Hasagawa Dementia scales, and CT scan are scheduled. The study results should confirm those reported in the scientific literature: although untreated patients may show spontaneous improvement, almitrine-raubasine should accelerate patients' functional rehabilitation.