Lubeluzole Treatment of Acute Ischemic Stroke
Stroke 28:2338-2346, 1997
A multicentric double-blind, placebo-controlled study on the use of Lubeluzole in 723 patients with acute stroke was undertaken to study its effects on neurological recovery, functional status and level of disability. Randomization was to Lubeluzole [7.5 mg over 1 hour, then a continuous daily infusion of 10 mg for upto 5 days] or placebo. The primary efficacy end point was mortality at 12 weeks. Safety assessments were scheduled regularly during drug administration and follow-up.
The two groups were similar in baseline characteristics and in interval between stroke onset and initiation of therapy [ average 4.7 hours]. All but 21 of the randomized patients had confirmed ischemic strokes and 50% had severe strokes. Overall mortality at 12 weeks did not show significant difference [Lubeluzole 20.7% against placebo 25.2% ]. Neurological recovery at 12 weeks, after controlling for relevant covariates favoured lubeluzole; this group also had significantly greater improvements in functional status and overall disability.
Treatment with lubeluzole within 6 hours of the onset of ischemic stroke was associated with a trend towards lower mortality and statistically significant improvement in neurological recovery, functional status and global disability 3 months after stroke. With its favorable safety profile, lubeluzole could be expected to improve long term outcomes in many stroke patients.
Shin C Kinsky MP, Thomas JA et al [ Yousea Univ Seoul Korea]
Effect of Cutaneous Burn Injury and Resuscitation on Cerebral Circulation in an ovine model
Burns 24 : 39-45, 1998
Altered consciousness, delirium, hallucinations, or seizures can occur in adults or children with major or minor burns.
A 70% to the body surface scald injury was induced in 8 anesthetized sleep. Animals received 30 minutes of resuscitation with Ringer’s Lactate, titrated to restore and maintain baseline oxygen delivery practices.
During resuscitation, Intracranial pressure increased gradually and cerebral perfusion pressure fell.
This ovine model showed reduced cerebral perfusion pressure immediately after major cutaneous burn, and again after 6 hours of resuscitation. Blood flow to brain is maintained by cerebral autoregulation in the early phase after injury,, blood flow fails after development of brain edema and elevated intracranial pressure.
A number of burn patients develop encephalopathy even though they have no evidence of head injury. Decreased cerebral blood flow may be contributing to the postburn CNS syndromes.