Cerebrolysin Combined with Rehabilitation Enhances Motor Recovery and Prevents Neural Network Degeneration in Ischemic Stroke Patients with Severe Motor Deficits

Abstract

The objective of this study was to evaluate whether Cerebrolysin combined with rehabilitation therapy supports additional motor recovery in stroke patients with severe motor impairment. This study analyzed the combined data from the two phase IV prospective, multicenter, randomized, double-blind, placebo-controlled trials. Stroke patients were included within seven days after stroke onset and were randomized to receive a 21-day treatment course of either Cerebrolysin or placebo with standardized rehabilitation therapy. Assessments were performed at baseline, immediately after the treatment course, and 90 days after stroke onset. The plasticity of the motor system was assessed by diffusion tensor imaging and resting state fMRI. In total, 110 stroke patients were included for the full analysis set (Cerebrolysin n = 59, placebo n = 51). Both groups showed significant motor recovery over time. Repeated-measures analysis of varianceshowed a significant interaction between time and type of intervention as measured by the Fugl–Meyer Assessment (p < 0.05). The Cerebrolysin group demonstrated less degenerative changes in the major motor-related white matter tracts over time than the placebo group. In conclusion, Cerebrolysin treatment as an add-on to a rehabilitation program is a promising pharmacologic approach that is worth considering in order to enhance motor recovery in ischemic stroke patients with severe motor impairment.

Role and Impact of Cerebrolysin for Ischemic Stroke Care

“…Cerebrolysin is already contributing to the pharmacological armamentarium that clinicians have at their disposal in many countries worldwide [ 9 , 10 , 13 ]. Despite the prolific literature that has been published on the efficacy and safety of the add-on intervention for post-stroke neurorehabilitation, some limitations of clinical studies (e.g., small sample sizes) warrant additional investigation via large, high-quality confirmatory trials, as well as clinical and cost-effectiveness studies [ 4 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Improving this body of evidence in the future will impact current clinical guideline recommendations for Cerebrolysin after ischemic stroke, likely clarifying divergent opinions on this topic [ 60 , 61 , 62 ].…”

“…Chang et al focused on the combination of Cerebrolysin with standardized rehabilitation therapy. The results showed that in individuals with severe motor impairment caused by acute ischemic stroke, conventional rehabilitation therapy combined with Cerebrolysin delivers extra benefits to conventional rehabilitation therapy alone in motor recovery [ 36 ]. An earlier study by Chang et al (which used for the first-time neuroimaging for motor network plasticity evaluation when administering Cerebrolysin) revealed a positive influence of Cerebrolysin on cerebral tissue related to motor function, but no significant difference was found between the two groups [ 37 ].…”

Personalized Approaches to Stroke: One Step Forward for Functional Recovery of Stroke Patients

“…In order to apply individual treatment, research on the mechanism of action of a new treatment method is also essential. Lee et al [ 18 ] reported the change of cortical activity by high-definition transcranial direct current stimulation (HD-tDCS) and Chang et al [ 19 ] showed the potential mechanisms of Cerebrolysin for improving motor function in stroke patients [ 19 ]. Recent studies suggested appropriate indications for stem cell therapy [ 20 ] and transcranial direct current stimulation (tDCS) [ 21 ].…”

“…This article is meaningful in that genetic factors might be considered in stroke treatment. These reports [ 18 , 19 , 20 , 21 ] might be used as references for personalized stroke therapy in the future.…”

“…Personalized medicine is a growing field in diagnosing, managing and predicting stroke and will enable clinicians to develop individually tailored care plans for stroke patients [ 3 , 6 , 7 , 22 ]. All papers published in this Special Issue will be able to contribute to the advance of personalized medicine in strokes [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. The objective of this editorial is to stimulate any research on personalized medicine for the evaluation and treatment of stroke patients.…”