Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

The role of the new coronavirus infection (COVID-19) in the progression and development of cerebrovascular diseases. A competent choice of pathogenic treatment is the key to success in treatment and prevention. An expert’s view from the ‘red zone’

https://doi.org/10.14412/2074-2711-2021-1-57-66

Full Text:

Abstract

COVID-19 worsens the course of cerebrovascular diseases (CVD), including chronic cerebral ischaemia (CCI). The Actovegin drug, which has long been widely used in CCI treatment, has an antioxidant and endothelium protective effect. It makes sense to study the effect of Actovegin therapy on the clinical manifestations of CCI in patients with a recent experience of COVID-19.

Objective: to evaluate Actovegin efficacy in the treatment of CCI in patients with a recent experience of COVID-19.

Patients and methods. The study included 440 patients (234 female; 206 male) with a recent experience of COVID-19, suffering from CCI, their average age being 67.8 years (from 54 to 85 years). All patients were broken down into two groups of 220 people (the patients in Group 1 were administrated Actovegin, the ones in Group 2 – were not). All patients were followed up for 90 days; their condition was assessed by the severity of clinical manifestations of CCI, using special scales and questionnaires.

Results and discussion. After 90 days of follow-up, the frequency of complaints of cognitive impairment, sleep disorder, dizziness, fatigue, emotional disorders, and headache in Group 1 was significantly lower than in Group 2 (p<0.05). According to Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), Multidimensional Fatigue Inventory (MFI-20), and Spiegel Sleep Questionnaire (SSQ), the average indicators improved significantly more in Group 1 than in Group 2 (p<0.05). The absence of quality of life impairment and their minimal severity were observed in Group 1 in 77.9%; in Group 2 – in 33.7% (p<0.001). Statistically significant differences between the groups of patients were also observed in relation to emotional state recovery according to the Wakefield Questionnaire and the Spielberger State Trait Anxiety inventory.

Conclusion. The observational study demonstrated the efficacy of Actovegin in the treatment of main clinical manifestations of CCI in patients with recent COVID-19 experience.

About the Author

V. V. Kovalchuk
Saint Petersburg Centre of Medical Rehabilitation, N.A. Semashko City Hospital Thirty Eight
Russian Federation

Vitaly Vladimirovich Kovalchuk

7/2, Gospitalnaya St., liter A, Town of Pushkin, Saint Petersburg 196602


Competing Interests: The investigation has not been sponsored. There are no conflicts of interest. The author is solely responsible for submitting the final version of the manuscript for publication. The author has participated in developing the concept of the article and in writing the manuscript. The final version of the manuscript has been approved by the author.


References

1. Shchelkanov MYu, Popova AYu, Dedkov VG, et al. History of investigation and current classification of coronaviruses (Nidovirales: Coronaviridae). Infektsiya i immunitet. 2020;10(2):221-46. doi: 10.15789/2220-7619HOI-1412 (In Russ.).

2. Poyiadji N, Shahin G, Noujaim D, et al. COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: Imaging Features. Radiology. 2020;296:E119-E120. doi: 10.1148/radiol.2020201187

3. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020 May;94:55-8. doi: 10.1016/j.ijid.2020.03.062. Epub 2020 Apr 3.

4. Valikova TA, Pugachenko NV, Golikova NB, et al. Clinical manifestations in Bickerstaff encephalitis. Byulleten' sibirskoy meditsiny. 2011;(2):68-73 (In Russ.).

5. Yel'chaninov AP, Zhuravlev PV, Amosova NV, et al. Bickerstaff encephalitis. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2018;(7):84-8. doi: 10.17116/jnevro20181187184 (In Russ.).

6. Gutierrez C, Mendez A, Rodrigo-Rey S, et al. Miller Fisher syndrome and polyneuritis cranialis in COVID-19. Neurology. 2020. doi: 10.1212/WNL.0000000000009619. Epub 2020 April 17.

7. Dinkin M, Gao V, Kahan J, et al. COVID19 presenting with ophthalmoparesis from cranial nerve palsy. Neurology. 2020 Aug 4;95(5):221-3. doi: 10.1212/WNL.0000000000009700. Epub 2020 May 1.

8. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 28;395(10229):1033-4. doi: 10.1016/S01406736(20)30628-0. Epub 2020 Mar 16.

9. Kollias A, Kyriakoulis KG, Dimakakos E, et al. Thromboembolic Risk and Anticoagulant Therapy in COVID-19 Patients: Emerging Evidence and Call for Action. Brit J Haematol. 2020 Jun;189(5):846-7. doi: 10.1111/bjh.16727. Epub 2020 May 4.

10. Ciceri F, Beretta L, Scandroglio A-M, et al. Microvascular COVID-19 Lung Vessels Obstructive Thromboinflammatory Syndrome (MicroCLOTS): An Atypical Acute Respiratory Distress Syndrome Working Hypothesis. Crit Care Resusc. 2020;22(2):95-7.

11. Voznyuk IA, Il'ina OM, Kolomentsev SV. COVID-19: New Techniques, Relevant Recommendations. Vestnik vosstanovitel'noy meditsiny. 2020;4(98):90-8. doi: 10.38025/2078-1962-2020-98-4-90-98 (In Russ.).

12. Oxley TJ, Mocco J, Majidi S, et al. Largevessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med. 2020;382(20):e60. doi: 10.1056/NEJMc2009787

13. Liu W, Li H. COVID-19: Attacks the 1-beta chain of hemoglobin and captures the porphyrin to inhibit human heme metabolism. СhemRxiv. 2020. April 27. Available from: https://chemrxiv.org/articles/COVID19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolismby_Binding_to_Porphyrin/11938173 (accessed 12.05.2020).

14. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-20. doi: 10.1056/NEJMoa2002032. Epub 2020 Feb 28.

15. Teplova NV, Grishin DV. Correction of endothelial dysfunction in COVID-19. Meditsinskiy alfavit. 2020;(22):56-9. doi: 10.33667/2078-5631-2020-22-56-59 (In Russ.).

16. Lee M-H, Perl DP, Nair G, et al. Microvascular Injury in the Brains of Patients with Covid-19. N Engl J Med. 2020 Dec 30;NEJMc2033369. doi: 10.1056/NEJMc2033369. Online ahead of print.

17. Yaghi S, Ishida K, Torres J, et al. SARSCoV-2 and Stroke in a New York Healthcare System. Stroke. 2020 Jul;51(7):2002-11. doi: 10.1161/STROKEAHA.120.030335. Epub 2020 May 20.

18. Buchmayer F, Pleiner J, Elmlinger MW, et al. Actovegin: Biological Substance With Semicentennial History. Farmateka. 2012;6:20-7.

19. Gustov AV, Shmyrev VI, Smirnov AA, et al. Aktovegin i instenon v nevrologicheskoy praktike: Metodicheskiye rekomendatsii [Actovegin and instenon in neurological practice: Methodological recommendations]. Nizhniy Novgorod: NGMA; 2002. 68 p. (In Russ.).

20. Reichel H, Weiss C, Leichtweiss HP. [The effects of a blood extract on the oxygen uptake of isolated artificially perfused kidneys and skeletal muscles in rats]. Arzneimittelforschung. 1965;15:756-7 (In Germ).

21. Elmlinger MW, Kriebel M, Ziegler D. Neuroprotective and Anti-Oxidative Effects of the Hemodialysate Actovegin on Primary Rat Neurons in Vitro. Neuromolecular Med. 2011 Dec;13(4):266-74. doi: 10.1007/s12017-0118157-7. Epub 2011 Oct 9.

22. Tanashyan MM, Shabalina AA, Lagoda OV, et al. Multimodal approach to treatment of neurological complications of chronic brain ischemia. Terapevticheskiy arkhiv. 2018;90(12):61-7. doi: 10.26442/00403660.2018.12.000010 (In Russ.).

23. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. Psychosom Res. 1995 Apr;39(3):315-25. doi: 10.1016/00223999(94)00125-o

24. Poluektov MG. Insomnia. In: Somnologiya i meditsina sna: Natsional'noye rukovodstvo [Somnology and Sleep Medicine: National Guide]. Moscow: Medforum; 2016. P. 298-318 (In Russ.).

25. Hickie I, Lloyd A, Wakefield D, Parker G. The psychiatric status of patients with the chronic fatigue syndrome. Brit J Psychiatry. 1990 Apr;156:534-40. doi: 10.1192/bjp.156.4.534

26. Karelin A. Bol'shaya entsiklopediya psikhologicheskikh testov [Big encyclopedia of psychological tests]. Moscow: Eksmo; 2007. 416 p. (In Russ.).

27. Folstein M, Folstein S, McHugh P. «Minimental state». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. doi: 10.1016/0022-3956(75)90026-6

28. Nasreddine Z, Phillips N, Bacdirian V, et al. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.15325415.2005.53221.x

29. Bergner M, Bobbitt R, Carter W, Gilson B. The Sickness Impact Profile: Development and Final Revision of a Health Status Measure. Med Care. 1981 Aug;19(8):787-805. doi: 10.1097/00005650-198108000-00001

30. Koval'chuk VV, Khafizova TL, Galkin AS. The use of neurometabolic therapy in the complex rehabilitation of patients after stroke. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2014;(11):61-6 (In Russ.).

31. Boriskina LM. Actovegin in the treatment of patients with cognitive impairment in chronic cerebral ischemia. Nervno-myshechnyye bolezni. 2015;5(4):25-31. doi: 10.17650/22228721-2015-5-4-25-31 (In Russ.).

32. Mikhaylova NM, Selezneva ND, Kalyn YaB, et al. The effectiveness of Actovegin treatment in elderly patients with a syndrome of mild cognitive decline in vascular genesis. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. Spetsvypuski. 2013;113(7-2):69-76. Available from: https://www.mediasphera.ru/issues/zhurnal-nevrologii-i-psikhiatrii-im-s-s-korsakova2/2013/7/031997-72982013728 (In Russ.).

33. Zakharov VV, Sosina VB. Possibilities of antihypoxants in the treatment of moderate cognitive impairments in patients with diabetes mellitus. Lechashchiy vrach. 2010;(3):87-91. Available from: https://www.elibrary.ru/item.asp?id=21546938 (In Russ.).

34. Ostroumova OD, Galeyeva NYu, Pervichko EI. Correction of cognitive impairment with Actovegin in patients with essential hypertension. Meditsinskiy alfavit. 2012;(4):3-6. Available from: https://www.elibrary.ru/item.asp?id=18883322 (In Russ.).

35. Kol'tsova EA. The use of Actovegin for the prevention of cognitive impairment after a stroke. Farmateka. 2018;5(358):66-70. Available from: https://www.elibrary.ru/item.asp?id=34998854 (In Russ.).

36. Yansen V, Brukner GV. Treatment of chronic cerebrovascular insufficiency using Actovegin forte pills (double-blind, placebo-controlled study). RMZh. 2002;(12-13):543-6. Available from: https://www.rmj.ru/articles/obshchiestati/lechenie_hronicheskoy_cerebrovaskulyarnoy_nedostatochnosti_s_ispolyzovaniem_draghe_aktovegin_forte_dvoynoe_slepoe_placebo-kontroliruemoe_issledovanie/ (In Russ.).

37. Guekht A, Skoog I, Edmundson S, et al. ARTEMIDA Trial (A Randomized Trial of Efficacy, 12 Months International DoubleBlind Actovegin): A Randomized Controlled Trial to Assess the Efficacy of Actovegin in Poststroke Cognitive Impairment. Stroke. 2017 May;48(5):1262-70. doi: 10.1161/STROKEAHA.116.014321

38. Kanowski S, Kinzler E, Lehmann E, et al. Confirmed clinical efficacy of Actovegin in elderly patients with organic brain syndrome. Pharmacopsychiatry. 1995 Jul;28(4):125-33. doi: 10.1055/s-2007-979604

39. Bubnova MG, Aronov DM. COVID-19 and cardiovascular disease: from epidemiology to rehabilitation. Pul'monologiya. 2020;30(5):688-99. doi: 10.18093/0869-01892020-30-5-688-699 (In Russ.).

40. Belopasov VV, Yashu Ya, Samoylova EM, Baklaushev VP. Damage to the nervous system in COVID-19. Klinicheskaya praktika. 2020;11(2):60-80. doi: 10.17816/clinpract34851 (In Russ.).

41. Hernandez-Fernandez F, Sandoval Valencia H, Barbella-Aponte RA, et al. Cerebrovascular disease in patients with COVID-19: neuroimaging, histological and clinical description. Brain. 2020 Oct 1;143(10):3089-103. doi: 10.1093/brain/awaa239

42. Bridwell R, Long B, Gottlieb M. Neurologic complications of COVID-19. Am J Emerg Med. 2020 Jul;38(7):1549.e3-1549.e7. doi: 10.1016/j.ajem.2020.05.024. Epub 2020 May 16.

43. Varatharaj A, Thomas N, Ellul MA, et al; CoroNerve Study Group. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020 Oct;7(10):875-82. doi: 10.1016/S2215-0366(20)30287-X. Epub 2020 Jun 25.

44. Stasi C, Fallani S, Voller F, Silvestri C. Treatment for COVID-19: An overview. Eur J Pharmacol. 2020 Dec 15;889:173644. doi: 10.1016/j.ejphar.2020.173644

45. Wade DT. Rehabilitation after COVID-19: an evidence-based approach. Clin Med (Lond). 2020 Jul;20(4):359-65. doi: 10.7861/clinmed.2020-0353


For citation:


Kovalchuk V.V. The role of the new coronavirus infection (COVID-19) in the progression and development of cerebrovascular diseases. A competent choice of pathogenic treatment is the key to success in treatment and prevention. An expert’s view from the ‘red zone’. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(1):57-66. (In Russ.) https://doi.org/10.14412/2074-2711-2021-1-57-66

Views: 87


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)