The Effect of Ginkgo biloba on Functional Outcome of Patients with Acute Ischemic Stroke: A Double-blind, Placebo-controlled, Randomized Clinical Trial

Savadi-Oskouei, Daryoush; Rikhtegar, Reza; Hashemilar, Mazyar; Sadeghi‐Bazargani, Homayoun; Sharifi-Bonab, Mohsen; Sadeghi-Hokmabadi, Elyar; Zarrintan, Sina; Sharifipour, Ehsan

doi:10.1016/j.jstrokecerebrovasdis.2013.06.010

Cited by 54 publications

(21 citation statements)

References 38 publications

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“…In 22 studies safety was measured using outcome(s) specified in methods and reported in results (21, 29, 31, 33-36, 40, 44, 46, 49-52, 56-59, 61-64), while mortality and adverse events were observed and reported in another 22 studies (15, 17, 20, 22-28, 30, 37-39, 41, 43, 45, 47, 48, 53, 55, 60). In 6 studies, no safety considerations were reported (16,18,19,32,42,54). No authors reported higher mortality or adverse events in drug intervention groups compared with placebo (Table SIII).…”

Section: Study Selectionmentioning

confidence: 99%

“…and duration. In 15 studies, no adjuvant therapy was reported (15,17,18,21,34,35,48,49,51,52,54,55,61,62,64), while in another 13 studies dose of adjuvant therapy was not reported (25, 30-32, 40, 42, 44, 45, 50, 53, 56, 57, 63). In 3 studies, a total of ≤ 60 min of adjuvant therapy was provided over the duration of the trial (16,22,26).…”

Section: Study Selectionmentioning

confidence: 99%

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Safety and efficacy of recovery-promoting drugs for motor function after stroke: A systematic review of randomized controlled trials

Firth¹,

Barker²,

Hayward³

et al. 2019

J Rehabil Med

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LAY ABSTRACTSeveral drugs, administered in combination with rehabilitation, have been found to increase the amount of physical recovery achieved by a stroke survivor. This paper reviews the published literature to investigate which drugs have the best evidence of efficacy and safety to promote motor recovery after stroke. However, many studies investigating these drugs lack rigor and have little consistency between how trials were performed. Consequently, it is difficult to make a definitive judgement on how safe and effective these drugs are, or to compare drugs to determine superiority. To overcome this, a reporting standard must be developed for trials of these particular drugs. In addition, stricter adherence is necessary to already established reporting standards, including those that outline how parallel group randomized trials and physical interventions embedded within them are described (the Template for Intervention Description and Replication checklist and the Consolidated Standards of Reporting Trials statement, respectively).Objective: To investigate the efficacy and safety of drug interventions to promote motor recovery poststroke. Data sources: CENTRAL, CINAHL, Embase, MEDLINE, SCOPUS and Web of Science. Study selection: Published human randomized controlled trials in which the primary intervention was a drug administered to promote motor recovery poststroke, vs placebo. Data extraction: Standardized pro forma used to extract safety and efficacy data; Cochrane Collaboration risk of bias assessment tool performed to assess risk of bias.Data synthesis: Fifty randomized controlled trials from 4,779 citations were included. An overall trend of high risk of attrition (n = 27) and reporting bias (n = 36) was observed. Twenty-eight different drug interventions were investigated, 18 of which demonstrated statistically significant results favouring increased motor recovery compared with control intervention. Forty-four studies measured safety; no major safety concerns were reported. Conclusion: Candidate drug interventions promoting motor recovery post-stroke were identified, specifically selective serotonin reuptake inhibitors and levodopa; however, the high risk of bias in many trials is concerning. Drugs to improve motor function remain an important area of enquiry. Future research must focus on establishing the right drug intervention to be administered at an optimal dose and time, combined with the most effective adjuvant physical therapy to drive stroke recovery.

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Safety and efficacy of recovery-promoting drugs for motor function after stroke: A systematic review of randomized controlled trials

Firth¹,

Barker²,

Hayward³

et al. 2019

J Rehabil Med

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“…Thus, new insight from astrocytes may provide new therapeutic targets for the treatment of Ischemic stroke. Bilobalide (BB) is a sesquiterpene trilactone constituent that accounts for~2.9% of the standardized Ginkgo biloba extract EGb 761, which has been widely used to treat a variety of neurological disorders including cerebral ischemia and neurodegeneration (Attia et al, 2012;Deng, Wei, & Zhang, 2006;Oskouei et al, 2013;Sadowska-Krepa et al, 2017;Vellas et al, 2012;Yancheva et al, 2009). Substantial experiments indicate that BB is a neuroprotective agent with multiple mechanisms of action (Goldie & Dolan, 2013;Jiang et al, 2014;Lang et al, 2011;Mdzinarishvili, Kiewert, Kumar, Hillert, & Klein, 2007;Suzuki, Sato, Takezawa, Usuki, & Okada, 2011;Zhou et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Bilobalide protects astrocytes from oxygen and glucose deprivation‐induced oxidative injury by upregulating manganese superoxide dismutase

Xiang

Zhang

Cai

et al. 2019

Phytotherapy Research

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Bilobalide (BB), a constituent of the Ginkgo biloba extract, is a neuroprotective agent with multiple mechanisms of action. To further explore the potential therapeutic effects of BB in stroke, we investigated its effects on primary astrocytes using the oxygen and glucose deprivation‐reoxygenation (OGD‐R) model. Cell viability was measured by lactate dehydrogenase release assay and 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide assay. Cell death was measured by annexin 5 conjgated with fluorescein isothiocyanate (V‐FITC) assay, and reactive oxygen species (ROS) production was measured by 2′,7′‐Dichlorodihydrofluorescein Diacetate (DCFH‐DA) probe. Manganese superoxide dismutase (MnSOD) expression was measured by western blot and immunofluorescence. Mitochondrial membrane potential was monitored using JC‐1 staining. Our results show that OGD‐R downregulated MnSOD and impaired mitochondrial function, which further enhanced ROS production in primary astrocytes. As a result, cell viability was compromised, and cell death increased. BB treatment protected astrocytes from those injuries mainly by restoring MnSOD level as MnSOD inhibitor abolished the effects of BB. In conclusion, we demonstrated that OGD‐R induced astrocytic injury, but BB increased the expression of MnSOD, the ROS scavenger, to reverse the exacerbated astrocytic injury.

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“…To support our preclinical studies, a recent double-blind, placebo-controlled and randomized clinical study for the first time recommended the use of G. biloba in stroke recovery. G. biloba (120 mg daily) treatment for 4 months following an ischemic stroke significantly reduced NIHSS in stroke patients compared to the placebo group (Oskouei et al, 2013). In order to promote the wide and safe use of G. biloba, further high quality and large-scale randomized controlled trials are warranted to test its efficacy in acute ischemic stroke recovery.…”

mentioning

confidence: 99%

Repair and regeneration properties of Ginkgo biloba after ischemic brain injury

Raghavan

Shah

2014

Neural Regen Res

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The Effect of Ginkgo biloba on Functional Outcome of Patients with Acute Ischemic Stroke: A Double-blind, Placebo-controlled, Randomized Clinical Trial

Cited by 54 publications

References 38 publications

Safety and efficacy of recovery-promoting drugs for motor function after stroke: A systematic review of randomized controlled trials

Safety and efficacy of recovery-promoting drugs for motor function after stroke: A systematic review of randomized controlled trials

Bilobalide protects astrocytes from oxygen and glucose deprivation‐induced oxidative injury by upregulating manganese superoxide dismutase

Repair and regeneration properties of Ginkgo biloba after ischemic brain injury

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