Abstract: Journal of Critical Care Research and Emergency Medicine

Abstract:
Background: Stroke is a leading cause of morbidity and mortality worldwide. A small number of patients have access to timely acute stroke interventions like thrombolysis or thrombectomy which may halt or reverse the injury. The remaining patient use to have a protracted and incomplete recovery of motor and cognitive functions. Neuroprotective therapies usually been evaluated and administered singularly have not been found successful so far in ameliorating post stroke disability. Hence currently none of the neuroprotective agent approved American, European, and Indian stroke guidelines. Our hypothesis is that combining neuroprotective agents with different mechanisms can be useful.

Aims and Objectives: To study the effect of combination of neuroprotection therapies in acute Large Vessel Middle Cerebral Artery [LMCA] ischemic stroke. Methods: A randomized controlled trial, comprising 60 patients of acute Middle Cerebral Artery [MCA] infarction who presented to the hospital within 72 hours and were randomly distributed into two groups of 30 patients each. The control group received Standard Medical Care while the intervention group received Standard Medical Care combined with Cerebrolysin , Edaravone, Vinpocetine, Levetiracetam and Citicoline, started within 72 hours of onset of stroke .Patient were assessed on basis of NIHSS, Fugl Meyer Assessment score, Glasgow Coma Scale , MMSE at admission , discharge and after 90 days.

Results: The intervention group showed significant improvements in motor recovery as measured by the Fugl-Meyer scores, better Modified Rankin Scale scores and better cognitive recovery as observed by MMSE scores.

Conclusion: Combination therapy for neuroprotection with multimodal actions may provide improvements in motor and cognitive recovery when initiated within 72 hours of ischemic stroke onset. However, large scale studies are warranted to solidify these findings.