An Open Study of Clomethiazole in Patients with Acute Cerebral Infarction

Wester, Per; Strand, T; Wahlgren, Nils-Gunnar; Ashwood, Tim; Osswald, Gunilla

doi:10.1159/000015846

Cited by 27 publications

(10 citation statements)

References 7 publications

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“…539,540 Larger clinical trials failed to demonstrate efficacy of clomethiazole in improving outcomes after ischemic stroke. [541][542][543][544][545] Diazepam is being tested, but the results of the trials are not available. 546 Although a dose-escalation study of naloxone found the medication to be safe, no hint of efficacy was noted.…”

Section: Neuroprotective Agentsmentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

Stroke

2,123

483

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Purpose-Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Methods-Members of the panel were appointed

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Section: Neuroprotective Agentsmentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

Stroke

2,123

483

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“…759,760 Larger clinical trials failed to demonstrate the efficacy of clomethiazole in improving outcomes after ischemic stroke. 758,[761][762][763] A randomized trial of diazepam, another γ-aminobutyric acid agonist, demonstrated no improvement in outcome at 3 months. 764 Although a dose-escalation study of naloxone found the medication to be safe, no signal of efficacy was noted.…”

Section: Pharmacological Agentsmentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,374

1,801

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Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

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“…86,87 A dose-escalation trial demonstrated an acceptable safety profile in acute stroke patients with dose-related sedation observed. 88 In this study, 75 mg/kg administered as a continuous infusion over 24 h achieved plasma concentrations comparable to those producing experimental neuroprotection. 89 Therefore this dose was chosen for phase 3 trials.…”

Section: Other Neurotransmitter Modulatorsmentioning

confidence: 56%

Clinical trials for cytoprotection in stroke

Labiche

Grotta

2004

Neurotherapeutics

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Summary:To date, many cytoprotective drugs have reached the stage of pivotal phase 3 efficacy trials in acute stroke patients. (Table 1) Unfortunately, throughout the neuroprotective literature, the phrase "failure to demonstrate efficacy" prevails as a common thread among the many neutral or negative trials, despite the largely encouraging results encountered in preclinical studies. The reasons for this discrepancy are multiple, and have been discussed by Dr. Zivin in his review. Many of the recent trials have addressed deficiencies of the previous ones with more rigorous trial design, including more specific patient selection criteria (ensure homogeneity of stroke location and severity), stratified randomization algorithms (time-totreat), narrowed therapeutic time-window and pharmacokinetic monitoring. Current trials have also incorporated biologic surrogate markers of toxicity and outcome such as drug levels and neuroimaging. Lastly, multi-modal therapies and coupled cytoprotection/reperfusion strategies are being investigated to optimize tissue salvage. This review will focus on individual therapeutic strategies and we will emphasize what we have learned from these trials both in terms of trial design and the biologic effect (or lack thereof) of these agents.

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An Open Study of Clomethiazole in Patients with Acute Cerebral Infarction

Cited by 27 publications

References 7 publications

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Clinical trials for cytoprotection in stroke

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