EFFECTIVENESS OF AMINOPHENYLBUTIRIC ACID IN THE TRATMENT OF POST-STROKE FATIGUE
DOI:
https://doi.org/10.21802/2304-7437-2019-5(57)-119-127Keywords:
stroke, fatigue, intensity, pharmacotherapy, аminophe-nylbutyric acid hydro-chloride.Abstract
Up to now, a few studies were devoted to pharmacological correction of post-stroke fatigue (PSF) with rather disappointing results. PSF etiopathogenetic features in some extent depend on the time of PSF occurrence after acute cerebrovascular event (ACE). On this basis, it can be assumed that PSF management should be based on the time of PSF onset. Aim: to assess effectiveness of psychostimulant and nootropic drug – aminophenylbutiric acid in the treatment of PSF. Material and methods. The study included 29 patients who had global fatigue according to global fatigue subscale of multidimensional fatigue inventory-20 scale. 14 patients had persistent PSF (when PSF was firstly diagnosed within 1 month after ACE and was still present at 3 months after ACE), 15 patients had late PSF (when PSF was firstly diagnosed at 3 months after ACE or later). Aminophenylbutiric acid was taken orally 250 mg three times a day for 6 weeks. Rates and intensities of global PSF as well as rates and intensities of certain PSF aspects (physical, mental, motivational, activity-related) were evaluated and compared before and after 6 weeks treatment period. Results and discussion. In the cases of persistent PSF there were no significant changes in rate and severity of global PSF as well as no significant changes in rate and severity of all PSF components. On the other hand, 6 weeks aminophenylbutiric acid intake was associated with some statistically significant changes in characteristics of late PSF: decreasing of global PSF rate (from 100% to 64%), reduction of global PSF intensity (from 13,0 (12,3-14,8) to 12,0 (12,0-12,0)), reduction of mental PSF intensity (from 14,0 (13,0-14,0) to 12,0 (12,0-12,0)) and reduction of motivational PSF intensity (from 14,0 (13,5-16,5) to 12,0 (12,0-12,0)). Conclusions. 1. In cases of PSF onset at 3 months after ACE or later, aminophenylbutiric acid use for 6 weeks was associated with significant decreasing of global PSF rate, significant reduction of global, mental and motivational PSF intensities. 2. In cases of PSF onset within the first month after ACE, aminophenylbutiric acid use for 6 weeks was not associated with any PSF characteristics.
References
Zakharov V., Voznesenskaya T. Nervno-psikhicheskiye narusheniya: diagnosticheskiye testy. M.:MEDpressinform; 2013. 315 s.
Bivard A., Lillicrap T., Krishnamurthy V., Holliday E., Attia J. at al. MIDAS (modafinil in debilitating fatigue after stroke): a randomized, double-blind, placebo-controlled, crossover trial. Stroke, STROKEAHA-116. doi:10.1186/s13063-016-1537-4.
Choi-Kwon S., Choi J., Kwon S.U., Kang D.W., Kim J.S. Fluoxetine is not effective in the treatment of post-stroke fatigue: a double-blind, placebo-controlled study. Cerebrovasc Dis. 2007;23:103–108. doi: 10.1159/000097045.
Delva M., Lytvynenko N., Delva I. Factors associated with the time-based phenomenology of post-stroke fatigue over the first year after stroke occurrence. Georgian medical news. 2018;6 (279):92–97.
Duncan F., Wu S., Mead G.E. Frequency and natural history of fatigue after stroke: a systematic review of longitudinal studies. J. Psychosom. Res. 2012;73:18–27.
Gerrard P., Malcolm R. Mechanisms of modafinil: A review of current research. Neuropsychiatr Dis Treat. 2007;3(3):349-364.
Hinkle J., Becker K., Kim J. Poststroke fatigue: emerging evidence and approaches to management: a scientific statement for healthcare professionals from the American Heart Association. Stroke. 2017;48(7):159-170. doi: 10.1161/ STR.0000000000000132.
Karaiskos D., Tzavellas E., Spengos K., Vassilopoulou S., Paparrigopoulos T. Duloxetine versus citalopram and sertraline in the treatment of poststroke depression, anxiety, and fatigue. J Neuropsychiatry Clin Neurosci. 2012;24:349–353. doi: 10.1176/appi.neuropsych.11110325.
Karen C., Marsh EB. Chronic post-stroke fatigue: It may no longer be about the stroke itself. Clinical neurology and neurosurgery. 2018;174:192-197.
Lapin I. Phenibut (beta-phenil-GABA): tranquilizer аnd nootropic drug. CNS Drug Rev. 2001;7(4):471-481.
Lillicrap T.P., Levi C., Holliday E., Parsons M.W., Bivard A. Short-and long-term efficacy of modafinil at improving quality of life in stroke survi-vors; A posthoc sub study of the MIDAS trial. Frontiers in Neurology. 2018;9:269. doi:org/10.3389/fneur.2018.00269.
Nasreddine S., Phillip N., Bedirian V. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment Journal of the American Geriatric Society. 2005;53:695–699.
Sagen U., Vik T., Moum T. Screening for anxiety and depression after stroke: comparison of the hospital anxiety and depression scale and the Montgomery and Asberg depression rating scale. Journal of Psychosomatic Research. 2009;67(4):325–332.
Starkstein S., Migliorelli R., Manes F. The prevalence and clinical correlates of apathy and irritability in Alzheimer's disease. European Journal of Neurology. 1995;2:540-546.
Wu S., Mead G., Macleod M. Model of understanding fatigue after stroke. Stroke. 2015;46(3):893–898. doi: 10.1161/STROKEAHA.114.006647.