AN IMPORTANT ASPECT OF MULTIMODAL TREATMENT OF NEUROLOGICAL DISORDERS IN CHRONIC BRAIN ISCHEMIA (literature review)
Keywords:
chronic cerebral ischemia, mexidol, mechanism of action, antioxidant, pathogenetic factors.Abstract
Introduction. Chronic cerebral ischemia (CCI) is a disease with progressive multifocal diffuse brain damage, which is manifested by neurological disorders of varying degrees. At the same time, there is a decrease in cerebral blood flow, often complicated by transient ischemic attacks or strokes. A literature review of the results of a study of modern methods of treating neurological disorders in patients with CCI, as well as risk factors, was carried out.
Aim. The study of literature data on the pathogenesis of development of CCI, mechanisms of action of the medicine Mexidol on various links of pathogenesis in neurological disorders in patients with CCI.
Material and 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 sites for articles published in the public domain on the problem of CCI (etiology, pathogenesis, diagnostic criteria), as well as on the medicine Mexidol and on medical journal websites. Articles published in the period from 2013 to 2022 are analyzed. Key words: chronic cerebral ischemia, mexidol, mechanism of action, antioxidant, pathogenic factors. 243 articles were found. The literature review included 41 studies involving patients with confirmed cerebrovascular accident (CCI), who were treated with antioxidants, antihypoxants.
Search terms: randomized controlled trials, meta-analyses and original studies. Exclusion criteria were studies with a low level of certainty, retrospective studies, scientific reviews, systematic reports and clinical cases.
Results. It has been proven that the choice of a medicine with a multimodal mechanism of action is a priority in the treatment of patients with CCI, a disease that has a multifactorial etiology and a complex multi-link pathogenesis of development. It was found that the use of the medicine mexidol in the early stages of CCI contributes to the most effective treatment of neurological manifestations of the disease and the prevention of further progression of chronic cerebrovascular insufficiency.
Discussion. Numerous studies of the mechanisms of influence of the medicine mexidol have shown that the main links in this process indicate that the action of mexidol is built on three main mechanisms –
antioxidant, which affects the enzymatic and non-enzymatic processes of lipid peroxidation (LPO), membrane-protective, limiting the harmful effects of LPO products and enhancing the stabilization of cell membranes, and antihypoxic action, contributing to the activation of the energy balance of mitochondria. In the pathogenesis of CCI, due to the reduction of cerebral blood flow, oxidative stress develops, depolarization of cell membranes, and a lack of energy resources; at the same time, mexidol has an effect on all of the above mechanisms for the occurrence of CCI and, being a pathogenetic medicine, prevents further progression of the disease.
Conclusions. The properties of antioxidant medicines lead to an improvement in cognitive function, improve physical activity, reduce fatigue, improve the quality of life in patients with CCI in the early stages, thereby helping to prevent the development of severe forms of chronic cerebrovascular insufficiency and the transition from stage 1-2 of CCI to stage 3.
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