CEREBROVASCULAR PATHOLOGY. NEUROPRECTION. CHOICE OF THERAPY (literature review)

Abstract

Introduction. In recent years, there has been an increased interest in the problem of cerebrovascular diseases (CVD), which is associated with the high incidence, disability and mortality of the population from this pathology. Chronic cerebral ischemia (CCI) is one of the leading causes of morbidity, mortality and disability in the Republic of Kazakhstan.
The diversity of the clinical picture of chronic CVD is not limited only to cognitive disorders of various origins. The main clinical syndromes in this pathology are: cognitive impairment, focal neurological deficit, asthenic conditions, sleep disorders, psychoemotional disorders (anxiety and depression), etc.
The purpose of the study. Based on the study of modern literature data on the pathogenesis and factors of the development of clinical manifestations of cerebral ischemia, the modern possibilities of neuroprotective therapy in patients with CCI are presented using the example of the drug Mexidol.
Methods. A systematic search was carried out in such electronic bibliographic databases as PubMed, MEDLINE, Google Scholar, in an electronic resource and on Russian-language, English-language sites for publicly available articles on the problem of chronic cerebral ischemia, as well as on the drug Mexidol on the official Internet pages of medical journals. Search terms: randomized controlled trials, meta-analyses, and original studies.
Results and discussion. An important place in the treatment of CCI is occupied by therapy with neuroprotectors – drugs designed to improve the function and restore the integrity of brain cells.
Nootropic drugs can increase neuronal plasticity, increase the adaptive capabilities of nerve cells and reduce their exposure to damaging factors by improving metabolic processes in neurons. Nootropic drugs have a positive effect on the higher integrative functions of the brain, facilitate learning processes, and memory consolidation.
Such drugs include Mexidol (ethylmethylhydroxypyridine succinate), an original antioxidant and antihypoxant. The main effects of Mexidol are antioxidant, antihypoxant and membrane stabilizing, as well as a decrease in glutamate excitotoxicity. Due to their combination, Mexidol has nootropic, antiamnestic, anxiolytic and other effects. The advantages of the drug are a combination of the breadth of the therapeutic effect with a high safety profile, the absence of sedative, muscle relaxant, stimulating action. The main advantage of the antioxidant and antihypoxant Mexidol is the multimodality of the effect, which contributes to its effective use.
Conclusions. Mexidol has a wide range of pharmacological effects, realized at two levels – neuronal and vascular. It has neuroprotective, antihypoxic, anti-ischemic, nootropic, vegetotropic, antistress, anxiolytic, anticonvulsant, antialcoholic, cardioprotective, antiatherogenic, geroprotective effects. The widespread use of Mexidol in clinical and outpatient practice in the treatment of acute strokes and chronic cerebral circulatory disorders has shown that it is one of the most effective drugs used in the treatment of these.
The clinical efficacy, safety of use and good tolerability of Mexidol make it possible to recommend long-term sequential therapy in the form of injections for two weeks, followed by a transition to tablets for two months, for the treatment of patients with CCI, including those with comorbidity.