RU2286772C2 - Method for treating and preventing chronic cerebral ischemia - Google Patents

Abstract

FIELD: medicine, neurology.

SUBSTANCE: the present innovation deals with treating chronic cerebral ischemia and preventing its complications. It has been suggested to apply aplegin (10%-D,L-carnitine chloride solution) as a preparation for monotherapy for treating and preventing the progress of chronic cerebral ischemia. Monotherapy with aplegin provides rapid, complete and stable improvement of patient's state due to normalization of thrombocytic aggregation, erythrocytic deformability and their functional properties along with neuroprotective effect.

EFFECT: higher efficiency of therapy.

3 ex, 3 tbl

Description

The present invention relates to neurology, in particular to angioneurology, and can be used for the treatment and prevention of chronic cerebral ischemia.

Methods of complex treatment and prevention of chronic cerebral ischemia are already known, including the simultaneous course administration of a whole group of drugs with a specific effect that affect various mechanisms of the pathogenesis of the disease. These drugs include means for correcting arterial hypertension (angiotensin-converting enzyme inhibitors, B-blockers, calcium channel blockers, vasoactive drugs, diuretics), platelet aggregation and, in part, erythrocytes (acetylsalicylic, nicotinic acid, trental, flexiflinent, p, flexilentin p, , curantyl, clopidogrel, ticlopedin derivatives, reopoliglukin, (reomacrodex), cinnarizine, stugeron, cavinton, vinpocetine, obzidan and others), lipid-normalizing drugs metabolism, cerebral vasodilators, neuroprotectors and cerebral metabolic agents - nootropics, glycine, gliatilin, semax, cerebrolysin, methindole, encephabol, cytomac, instenon, actovegin, etc. ("Comprehensive therapy of chronic brain ischemia." / Edited by Professor V. Ya. . Neretina, M., 2001., p. 8-31).

A similar tactic for the treatment and prevention of chronic cerebral ischemia is adhered to by many other researchers and neurologists (see: V.V. Shprakh "Discirculatory Encephalopathy", Irkutsk, 1997, p.100-119).

The therapeutic and prophylactic effect in chronic ischemia of drugs with a multimodal effect was studied, for example, Mexidol (Z. A. Suslina, I. N. Smirnova, M. M. Tanashyan et al., “Mexidol in chronic forms of cerebrovascular diseases”, - Treatment nervous diseases, 2002, No. 2 (8), p.30,31,32). In patients with arterial hypertension, especially during a crisis, mexidol either did not affect or increased platelet aggregation, which was accompanied by an exacerbation of the main symptoms of vascular disease. This required the appointment of Mexidol in combination with antiplatelet drugs.

The aim of the invention is the treatment and prevention of chronic cerebral ischemia.

This goal is achieved in that as a therapeutic and prophylactic agent in patients with the first and second stages of chronic brain ischemia, the drug DL-carnitine chloride - aplegin (10% solution) is used.

The effectiveness of the drug is illustrated by specific examples of its implementation.

Example 1

Patient A., 38 years old, complained of headaches, dizziness, tinnitus, and staggering when walking. Blood pressure rises to 160-170 / 90-95 mm RT. Art. The patient is worried about irritability, anxiety, poor sleep, fatigue, decreased performance, both mental and physical. The total diagnostic coefficient for complaints amounted to 26.8 points. From the anamnesis it is known that periodic rises in blood pressure have been noted since the age of 15, about which, with a diagnosis of autonomic-vascular dystonia of the hypertonic type, the patient was treated and was observed on an outpatient basis.

In neurological status, inconsistent horizontal nystagmus was detected when looking from both sides, hearing loss in both ears, more on the right, flattening of the right nasolabial fold. Tendon and periosteal reflexes are high with an expanded zone, uniform on both sides. Symptom Jacobson-Lyaska on his hands on both sides. Symptom Marinescu-Rodovici on both sides. In the Romberg staggering position, coordinator tests are performed clearly on both sides, but with a slight intention. Muscle tone in the limbs is low. Vegetative disorders in the form of hyperhidrosis of the palms, feet, persistent red dermographism. When testing cognitive functions and the state of psychoemotional status, a decrease in memory to 9 points was established (the norm is 12-13 points on the Luria scale), due to the difficulty of inclusion, increased exhaustion and inhibitory traces. Spilberger personal and reactive anxiety were increased to 49 and 53 points, respectively (normal to 30 points, over 46 points - a high degree of anxiety).

Moderate degree of depression (22 points on the Beck scale; absence of depression - less than 19 points). The volume and switching of attention according to Schulte tests are normal. The total diagnostic coefficient for neurological status was 10.34 points. Additional examination methods:

- Optometrist: retinal angiopathy.

Otoneurologist: mixed-right and left-sensorineural hearing loss.

- MRT of the brain: moderate expansion of the lateral ventricles (S> D) and subarachnoid spaces.

- EEG: dysfunction of mesodiencephalic structures.

Biochemical analysis of blood: total protein 73 g / l, urea 4.8 mmol / l, cholesterol 5.2 mmol / l, glucose 5.1 mmol / l.

Platelet aggregation of 80% OD (norm 48-52% OD), aggregate size 6.5 mm (norm 3-5 mm), aggregation rate ∠α 71 ° (norm 45-55 °). RBC aggregation 17% OD (norm 12-14% OD), aggregate size 1.5 mm (norm 0.8 mm), aggregation rate ∠α 16 ° (norm 12-14 °), fibrinogen content 492.8 mg% ( norm 350-450 mg%), the filtration coefficient of erythrocytes of capillary blood 15% (norm 25-35%). Computer morphodenostometry of erythrocytes determined a change in the red blood cell in the form of a decrease in the number of discocytes to 62% (norm 75-80%), an increase in the number of leptocytes by a factor of 2.6, echinocytes by a factor of 1.5, and spiculocytes by a factor of 2.8. The spicularity index was 0.3 (normal to 0.1), the local curvature of the erythrocyte membrane was 33.9, with a norm of 4.0 ± 1.3; the erythrocyte surface area increased to 30.1 (at a rate of 24, 35).

On the R-gram of the cervical spine, pronounced osteochondrosis was determined.

USDG of the main arteries of the neck and head revealed moderate hemodynamically significant changes in the left vertebral artery.

The total individual diagnostic coefficient was 101.54 points, which made it possible to diagnose chronic stage II cerebral ischemia in a patient against arterial hypertension.

The patient was prescribed a course of treatment with antiplatelet drugs (reopoliglukin 400.0 ml iv drip for 3 days, cinnarizine 25 mg 3 times a day for a month and a half with gradual withdrawal, thromboass 50 mg once a day), antihypertensive drugs , angioprotector (aktovigin one tablet three times a day, 2 courses) Essentiale forte one capsule 3 times daily for 2 months soft sedatives (rudotel in _^1/2 tablets 3 times a day), tincture of hawthorn 20 drops 3 times a day 30 minutes before meals for 3-4 months.

The patient's condition began to improve by the end of 3 weeks of treatment. Blood pressure stabilized at the patient’s normal numbers - 125-130 / 80-85 mm Hg; headaches, tinnitus decreased, dizziness stopped, staggering when walking was almost gone, irritability, anxiety, astheno-neurotic, depressive symptoms decreased, sleep improved, performance increased, memory improved (Luria test score increased to 11 points). In neurological status, nystagmus regressed, asymmetry of the nasolabial folds, hyperreflexia, muscle tone normalized, became more stable in the Romberg position, vegetative disturbances decreased, however, the Marinescu-Radovici symptom was still determined on both sides. The total individual diagnostic coefficient for neurological status decreased to 6.1 points. Indicators of aggregation properties of platelets and red blood cells, the filtration coefficient of red blood cells after 3-3.5 weeks of treatment reached normal.

However, according to computer morphodensitometry of erythrocytes, changes remained, albeit to a lesser extent (the number of discocytes increased to 69.2%, the number of lepto-, echino-, spiculocytes exceeded the norm by 1.2-1.3 times, the spicularity index decreased to 0, 19, the surface area of the red blood cell up to 28.84, the indicator of local curvature of the membrane up to 27.3). Arterial spasm phenomena have decreased on the fundus, and clinical manifestations of cervical osteochondrosis have become less pronounced.

The total total individual diagnostic coefficient decreased to 81.3 points.

3 months after the end of the 2-month course of treatment, the condition worsened again. Headaches intensified, dizziness, staggering when walking, tinnitus and head reappeared. Sleep, memory worsened, previous psycho-emotional disorders increased, and working capacity decreased. Neurological status revealed horizontal nystagmus when viewed from both sides, asymmetry of the nasolabial folds, high tendon and periosteal reflexes on both sides, uniform, Jacobson-Lyask symptom on the hands, instability in the Romberg position, intention when performing coordinating tests, Marinescu-Radovici symptom from two parties.

Blood pressure fluctuations reappeared with rises up to 170/100 mm Hg. The total individual diagnostic coefficient for neurological status increased to 9.96 points. The study of the rheological properties of blood revealed an increase in platelet aggregation to 87% OD, erythrocytes to 19.5% OD, a decrease in the filtering coefficient of red blood cells to 14%, and the number of discocytes to 59.8%. At the same time, the number of pathological forms of red blood cells increased, the spicularity index increased to 0.3, the surface area of red blood cells increased to 30.2, and the local curvature of the red blood cell membrane reached 34.0. The indicator of the total total individual coefficient increased to 104.3 points.

Due to the short term of the positive effect of the complex treatment and the lack of normalization of erythrocyte morphodensitometry indicators after it, the patient was treated with 10% DL-carnitine chloride solution - aplegin in a dose of 10.0 ml of the drug, diluted in 400.0 ml of physiological saline intravenously . The course of treatment was 10 infusions. After the third administration of aplegin, there was a decrease in headaches, dizziness, noise in the head and ears, and swaying when walking. By 6-7 infusion, all complaints of the patient regressed, sleep, performance, memory, general health improved. Increased anxiety, irritability, depression disappeared. Hearing improved. Neurological symptoms regressed significantly (a weakly expressed unilateral symptom of Marinescu-Radovichi remained). The total score for neurological status decreased to 2.2 points. After 5 infusions, platelet and erythrocyte aggregation indicators normalized, erythrocyte filtration coefficient (29%), erythrocytogram (discocyte count reached 78%, pathological forms of erythrocytes disappeared), spicularity index 0.1, local membrane curvature 4.0 and erythrocyte surface area 24 , 36. EEG, UZDG improved, arterial spasm regressed and the width of the veins in the fundus normalized. Blood pressure stabilized (120-125 / 80). The indicator of the total total individual diagnostic coefficient decreased to 58.7 points.

The positive effect of aplegin was observed within 6 months after the end of the course of treatment.

For prophylactic purposes, the patient was given oral courses of aplegin at a dose of 5.0 ml once a day for 5 days every 6 months (2 times a year). The patient's condition, neurological status, data from paraclinical studies over the next 4 years of observation remained stable. She successfully coped with her professional and domestic duties, fully preserving a good quality of life.

Thus, there was a high efficiency of aplegin monotherapy in a patient of the second stage of chronic cerebral ischemia. The drug had a pronounced, relatively quick and longer therapeutic and prophylactic effect.

It should be noted that a good effect was achieved by using one drug, with no side and allergic effects, instead of a complex of drugs, many of which can cause complications, allergic reactions.

The total cost of a course of treatment with aplegin is immeasurably lower than the cost of a course of treatment with previously used drugs, which is also significant for the patient.

Example 2

Patient P., 45 years old, complained of headaches, dizziness, staggering when walking, fatigue after mental and physical exertion, general weakness, lethargy, apathy, combined with increased irritability, decreased performance, and a feeling of tiredness after a night's sleep.

From the anamnesis it is known that the patient suffers from arterial hypotension - normal blood pressure in the range of 90 / 60-105 / 65 mm Hg.

A year ago, there were two episodes of severe dizziness with nausea, sharp staggering when walking, which were regarded as discirculation in the vertebral-basilar system. Does not smoke, does not abuse alcohol.

The present and two previous deterioration are associated with overwork and stress at work.

In neurological status - horizontal inconstant nystagmus when viewed from both sides, weak convergence on the left. Tendon and periosteal reflexes are uniform, low. Muscle hypotension. In the Romberg staggering position, the rest of the coordinating tests are performed clearly. Hyperhidrosis of the palms and feet. Inconsistent symptom of Marinescu-Radovici on the left. There is a slight decrease in memory according to Luria to 10 points (normal 12-13 points) due to the difficulty of inclusion, rapid exhaustion. Spilberger personal anxiety is high (47 points, with a norm of up to 30 points), reactive anxiety is moderately increased to 38 points. Depression, decrease in volume and switching of attention are not present. The total individual diagnostic coefficient for complaints was 23.5 points, for the neurological status of 9.8 points. An examination of the fundus revealed an unsharp narrowing of the arteries and a marked expansion and plethora of veins. USDG of the main arteries of the head established a hemodynamically significant decrease in blood flow in both vertebral arteries, especially on the left. Biochemical analysis of blood: total protein 80.0 g / l, urea 6.5 mmol / l, bilirubin 18.3-0-18.3 mmol / l, cholesterol 5.2 mmol / l, glucose 5.4 mmol / l . A study of blood rheology found a moderate increase in platelet aggregation to 60% OD, with normal sizes and aggregation rates, increased red blood cell aggregation (18%, normal 12-14%), aggregate sizes (1.2 mm, normal 0.3-0.8 mm), aggregation rate (∠α 16 °, norm 12-14 °).

The erythrocyte morphodensitometry showed a decrease in the percentage of discocytes to 60.3%, an increase in the number of leptocytes by 2.6 times, echinocytes by 1.9 times, ellipocytes by 2.7 times, spiculocytes by 1.5 times; an increase in the spicularity index to 0.16 (norm 0.1), the indicator of local curvature of the erythrocyte membrane to 12.3 (norm 4.0 ± 1.3), the index of the surface area of the red blood cell to 26.53 (norm 24.35).

The fibrinogen content was increased to 492.8 mg% (normal 350-450 mg%).

On the EEG - diffuse changes in the bioelectrical activity of the brain with signs of dysfunction of the stem-mesodiencephalic structures. On the R-gram of the cervical spine - pronounced phenomena of osteochondrosis, straightening of the cervical lordosis. The erythrocyte filtration coefficient was 8%.

The average score for all survey methods was 61.3 points. The indicator of the total total diagnostic coefficient was 93.6 points, which corresponded to the first stage of chronic cerebral ischemia against arterial hypertension, with a progressive crisis course.

The patient was prescribed treatment with the drug aplegin at 7 mg / kg of body weight intravenously in saline. On a course of 10 infusions.

After 3 injections of the drug, the patient's well-being improved: headaches significantly decreased, dizziness, staggering when walking stopped, lethargy, apathy, irritability decreased, sleep improved. Blood pressure increased to 110/70 mm Hg. By the end of the course of treatment, the patient's complaints regressed; tests of cognitive functions and the psycho-emotional sphere showed improvement in memory (12 points - normal), a significant decrease in personality to 33 points, normalization of reactive anxiety (27 points).

In the neurological status, positive dynamics was noted in the form of the disappearance of nystagmus, convergence disorders. Tendon, periosteal reflexes, muscle tone normalized. In the Romberg position is stable, vegetative disturbances regressed to a large extent. There was an inconsistent symptom of Marinescu-Radovici on the left, but it was called less often. The total score for neurological status decreased to 2 points, and for complaints to 5.2 points. On the fundus marked normalization of the caliber of arteries and veins. In the study of the rheological properties of blood, platelet and erythrocyte aggregation reached normal values, the fibrinogen content was 448.0 mg%, the erythrocyte filtration coefficient increased to 26%, the discocyticity index increased to 76%, the erythrocyte subpopulation was restored, and the spicularity index decreased to 0.1 (normal ), the linear curvature of the erythrocyte membrane is up to 4.0, and the erythrocyte surface area is up to 24.4. Decreased changes in hemodynamics in the vertebral arteries by USDG. The total total individual diagnostic coefficient decreased to 56.8 points.

A positive effect of the drug was detected during follow-up examination after 2, 4 and 6 months. However, taking into account the initial tendency toward disease progression, the patient was prescribed maintenance courses of oral administration of 5.0 ml every six months once a day for 5 days.

Over the next 3 years of dynamic observation of the patient’s state of deterioration, violations of the rheological properties of the blood, erythrocyte filtration coefficient, their morphodensitometric characteristics, and focal neurological symptoms did not increase. The total score for neurological status decreased to 1.7 points.

The patient worked a lot and successfully. Blood pressure stabilized at 110-115 - 70-75 mm Hg. Art.

Since 2002, the patient was transferred to a new, more responsible position, copes well with large and complex workloads. Leads an active full-fledged lifestyle.

Example 3

Patient T., 37 years old. She complained of severe headaches in the parieto-occipital region, aggravated in the morning, sometimes accompanied by nausea, dizziness, staggering when walking, poor memory, attention, increased irritability, daytime sleepiness and anxious sleep at night, decreased performance.

History of recurring headache from youth, sometimes with dizziness. Meteolabile. Blood pressure with a tendency to hypotension.

In neurological status, inconsistent horizontal nystagmus is detected when looking to the left. Tendon and periosteal reflexes are high with mild anisoreflexion s> d. Clonusoid stop. Reflex Jacobson - Lyaska on hand. Muscle tone is low. Symptom Orshansky positive on both sides. Symptom Marinescu-Rodovic left. In the Romberg staggering position. Hyperhidrosis of the palms of the feet. Blood pressure 95/65 mm Hg Soreness of the occipital and paravertebral points C5-C7 on both sides.

The total score for neurological status is 8.9 points.

Additional research methods:

Fundus: full-blooded, dilated veins.

Blood biochemistry: total protein 72.0 g / l, urea 4.6 mmol / l, bilirubin 12.7-0-12.7 mmol / l, cholesterol 5.8 mmol / l, AlT17ed, AcT 16 units, glucose 5 5 mmol / L.

Rheological properties of blood: platelet aggregation 70% OD, aggregate size 5 mm, aggregation rate ∠α-68 °; erythrocyte aggregation 16%, aggregate size 1.4 mm, aggregation rate ∠α - 15 °. The platelet count is 242 thousand / mm ³ , fibrinogen is 448.0 mg%. Magnetic resonance angiography revealed a decrease in the left vertebral artery along its entire length compared to the right.

EEG: diffuse change in the bioelectric activity of the brain with dysfunction of the stem-mesodiencephalic structures.

Computer morphodensitometry of erythrocytes: percentage of discocytes 60%, increase in leptocytes 2.4 times, spherocytes 2.1 times, echinodiscocytes 2.2 times, spiculocytes 1.4 times. The spicularity index was 0.14, the local curvature of the erythrocyte membrane was 11.9, and the erythrocyte surface area was 26.2. The erythrocyte filtration rate of 14%. The indicator of the total total diagnostic coefficient was 92.6 points.

The patient was diagnosed with chronic cerebral ischemia of the first stage against the background of arterial hypotension with a tendency to progressive course. Hypoplasia of the left vertebral artery (according to MR angiography).

Reopoliglucin was treated with 250.0 ml intravenously 3 drops, cinnarizine 25 mg 2 times a day for 3 weeks with gradual cancellation. Thromboass 50 mg once a day, I took 1/2 dose 2 times a day for 2 weeks, tincture of hawthorn 20 drops 3 times a day, morning and afternoon in combination with tincture of Eleutherococcus 20 drops 30 minutes before meals 2 months , vitamins of group B. Therapeutic exercise for the cervical spine.

After 3 weeks, the condition improved; headaches, dizziness, staggering when walking, nausea decreased. Sleep improved, irritability, fatigue, daytime sleepiness decreased slightly. Blood pressure increased to 105-110 / 65-70 mm Hg. Noted improved performance. In neurological status, nystagmus regressed, tendon and periosteal reflexes decreased, muscle tone increased, became more stable in the Romberg position, vegetative disorders decreased. However, anisoreflexion s> d, a symptom of Marinescu-Radovici on the left, remained. The total score for neurological status decreased to 4.8. The indicators of aggregation of red blood cells and platelets returned to normal, and the erythrocyte filtration coefficient increased to 20%. Morphodensitometry determined an increase in the percentage of discocytes to 70.3%, a decrease in the number of pathological forms of erythrocytes, almost to the norm, an index of spicularity to 0.11, an indicator of local curvature of the erythrocyte membrane to 5.2, an indicator of the surface area of an erythrocyte to 24.8. The indicator of the total total individual diagnostic coefficient decreased to 64.7 points.

4 months after the surge at work, the patient's condition worsened again. Headaches, dizziness intensified and became more frequent, staggering when walking appeared. Irritability, anxiety grew, memory, attention worsened, working capacity decreased, meteorological dependence intensified. Blood pressure was in the range of 95-100 / 60-65 mm Hg.

The previous neurological symptoms returned. In the study of memory according to Luria, its decrease to 9.8 points was revealed due to the difficulty of inclusion, rapid exhaustion. The increase in personality (up to 42 points) and reactive anxiety (up to 39 points) was determined according to Spielberger. Depression, volume decline, and Schulte attention switching were within normal limits. The total score for neurological status is 9.1 points.

In the study of the rheological properties of blood, an increase in platelet aggregation up to 69%, aggregate size up to 6 mm, aggregation rate ∠α - up to 65 ° was found.

An increase in red blood cell aggregation up to 17%, aggregate size up to 1.6 mm, aggregation rate ∠α ± - up to 16 °.

The erythrocyte filtration coefficient decreased to 9%, the fibrinogen level was 470.4 mg%.

When morphodenostometric study of red blood cells was determined, the percentage of discocytes decreased to 60.2%, leptocytes increased by 2.5 times, spherocytes by 2.3 times, echinodiscocytes by 2.3 times, spiculocytes by 1.2 times, and spicularity index to 0.15 , the indicator of local curvature of the erythrocyte membrane to 12.2; erythrocyte surface area index up to 26.8.

Due to the deterioration of the condition and the increase in the total individual diagnostic coefficient to 97.7 points, the patient underwent a course of 7 intravenous infusions of aplegin at the rate of 10 mg per kg of weight.

After 3 infusions, the patient noted an improvement in the form of disappearance of dizziness, swaying when walking, reduction of headaches, irritability, anxiety, daytime sleepiness. Sleep improved, performance increased.

After the course of treatment with aplegin, almost all of the patient’s complaints regressed, blood pressure stabilized at 110-115 / 65-70 mm Hg. In neurological status, only the inconsistent symptom of Marinescu-Radovici on the left remained. Fundus pattern almost normalized. Remained the same changes on MR-angiography. The erythrocyte filtration coefficient reached the norm (25%), the parameters of aggregation of blood cells and the level of fibrinogen returned to normal. The number of discocytes reached normal, as well as all indicators of the red blood cell 2 weeks after the start of treatment. The index of spicularity decreased to 0.1. The local curvature of the membrane is up to 4 ± 0.7; erythrocyte surface index to the control level.

By the end of treatment, memory, working capacity was fully restored, the indicator of personal anxiety decreased to 31 points, and reactive anxiety to 27 points.

The patient continued to work successfully. Dynamic observation and examination after 6 months showed no deterioration. For prophylactic purposes, taking into account very high workloads and data on hypoplasia of the left vertebral artery on MR-angiography, the patient underwent a short course of 3 intravenous infusions of aplegin at the rate of 5 mg per kg of weight after 2 days.

The patient's condition in the following years remained stable, however, every 6 months she was given a prophylactic course of oral administration of aplegin in 5.0 ml, once a day (5 doses of the drug per course).

The patient felt well, worked successfully, completely coped with the load at work and at home. Significantly decreased weather dependence.

In the clinic of the Russian State Medical University, 130 patients of the first and 107 patients of the second stage of chronic brain ischemia were treated with aplegin. The examination of patients was carried out before treatment, immediately after its completion and after 6 months. The results were compared with the data of patients similar in age, sex, and features of the manifestation of the disease who received conventional complex therapy.

Statistical processing was carried out by the Student method with the calculation of the confidence coefficient, as well as using the Mann-Whitney method to evaluate nonparametric criteria.

The research results are given in table 1 for patients of the first stage, and in table 2 for patients of the second stage of chronic brain ischemia. The effectiveness of treatment with aplegin in comparison with conventional therapy for patients with the first and second stages of chronic cerebral ischemia 6 months after the end of treatment is presented in Table 3.

Table 1
Dynamics of indicators of patients of stage I of chronic cerebral ischemia during treatment with aplegin and conventional therapy The investigated parameters Aplegin group (n = 130) Control Group (n = 129) Norm (in points) Before treatment after a course of treatment (12-14 days) in 6 months Before treatment after a course of treatment (12-14 days) in 6 months Complaints 27.45 ± 0.68 ^x 13.11 ± 0.32 12.4 ± 0.24 ^Δ 25.89 ± 0.67 21.07 ± 0.75 ^x 24.54 ± 0.41 ^x 1.2 ± 0.1 Neurological status 8.25 ± 0.23 ^x 4.3 ± 0.2 3.2 ± 0.31 ^xΔ 8.13 ± 0.28 6.97 ± 0.3 ^x 7.88 ± 0.37 0 Platelet score 16.93 ± 0.48 ^x 11.08 ± 0.4 11.0 ± 0.5 ^Δ 16.61 ± 0.44 13.86 ± 0.52 ^x 16.28 ± 0.51 ^x 11.5 ± 0.5 Erythrocyte score 22.36 ± 0.47 ^x 13.28 ± 0.32 12.8 ± 0.3 ^Δ 21.53 ± 0.41 20.4 ± 0.53 20.9 ± 0.61 12.5 ± 0.5 Score for all survey methods 59.17 ± 1.73 ^x 38.8 ± 1.42 40.1 ± 1.57 ^Δ 56.13 ± 1.65 51.62 ± 1.71 54.08 ± 1.43 29.8 ± 0.3 The total score of the total diagnostic coefficient - SIDK 94.87 ± 2.64 ^x 56.21 ± 1.67 55.7 ± 1.32 ^Δ 90.15 ± 2.11 79.66 ± 1.56 ^x 87.50 ± 1.89 ^x 31.0 ± 0.7 X - reliability in relation to the previous study (p <0.001)
Δ - reliability in relation to the initial data (p <0.001)

table 2
Dynamics of indicators of patients of stage II of chronic cerebral ischemia during treatment with aplegin and conventional therapy The studied parameters (in points) Aplegin group (n = 107) Control Group (n = 108) Norm Before treatment after a course of treatment (12-14 days.) in 6 months Before treatment after treatment (12-14 days) in 6 months Complaints 38.8 ± 1.7 ^x 16.28 ± 0.55 14.8 ± 0.3 ^xΔ 35.12 ± 0.81 31.32 ± 0.74 ^x 33.2 ± 0.57 ^x 1.2 ± 0.1 Neurological status 13.8 + 0.42 ^x 7.81 ± 0.34 6.9 ± 0.31 ^Δ 11.77 ± 0.63 9.83 ± 0.51 ^x 11.58 ± 0.52 ^x 0 Platelet score 17.24 ± 0.51 ^x 12.2 ± 0.48 12.8 ± 0.36 ^Δ 16.56 ± 0.55 14.86 ± 0.62 ^x 16.48 ± 0.33 ^x 11.5 ± 0.5  Erythrocyte score 24.62 ± 0.63 ^x 13.94 ± 0.56 14.09 ± 0.47 ^Δ 23.51 ± 0.46 21.3 ± 0.68 ^x 22.9 ± 0.37 ^x 12.5 ± 0.5 Score for all survey methods 67.38 ± 2.2 ^x 56.03 ± 56.03 58.7 ± 1.48 ^Δ 64.58 ± 1.37 61.8 ± 1.55 ^x 64.21 ± 1.62 ^x 29.8 ± 0.3 The total score of the total diagnostic coefficient - SIDK 119.98 ± 2.61 ^x 80.12 ± 80.12 80.4 ± 1.98 ^Δ 111.57 ± 2.77 102.95 ± 1.44 ^X 108.99 ± 1.89 ^x 31.0 ± 0.7 x- confidence in relation to the previous study (p> 0.001)
Δ -reliability with respect to the source data (p <0.001)

Table 3
The effectiveness of treatment with aplegin and conventional therapy for patients with the first and second stages of chronic brain ischemia (6 months after the end of treatment) Degree of effectiveness (%) I stage II stage Aplegin basic therapy Aplegin basic therapy Significant improvement 67.8% 21.9% 59.6% 16.9% Moderate improvement 29.9% 47.3% 36.9% 47.8% Lack of effect 2.3% 30.8% 3.5% 35.3% Total one hundred% one hundred% one hundred% one hundred%

The claimed invention is not obvious to specialists working in this field.

Firstly, for the first time, reparative properties in relation to nervous tissue were revealed.

Secondly, as shown by numerous clinical practice, in the treatment of chronic cerebral ischemia, complex therapy is always used, each of which is aimed at various links in the pathogenesis of chronic ischemic hypoxia and the prevention of its complications.

Until now, specialists working in the field of the prevention and treatment of cerebral ischemia did not know of any one drug capable of affecting the pathological processes that appear to be very different in pathogenesis, severity and nature of clinical manifestations that occur during chronic circulatory disorders in the nervous system. tissue.

The possibility of using DL-carnitine chloride as the only drug in the treatment and prevention of various forms and degrees of chronic cerebral ischemia was unexpected for neuropathologists and was first established by us.

This allows us to make an extremely important conclusion from a clinical, theoretical, and economic point of view on the possibility of using DL-carnitine chloride as a means of monotherapy, stabilizing the process and preventing complications of chronic cerebral ischemia (crises, transient ischemic attacks, strokes, vascular dementia and etc.).

The claimed invention opens up new prospects in the treatment, prevention of progression and development of complications of chronic ischemic hypoxia of the brain.

The claimed invention can be implemented in a clinic directly according to this description.

Claims (1)

The use of aplegin (10% solution of D, L-carnitine chloride) as a monotherapy for the treatment and prevention of the progression of chronic cerebral ischemia.