Comparative effectiveness study of vinpocetine vs. nimodipine on functional recovery in patients of head injury
Keywords:Vinpocetine, Nimodipine, Head injury
Background: Head injuries are increasing cause of overall disability which needs aggressive researches on neuroprotective agents to prevent or rectify the sequelae of brain damage. The outcomes on functional recovery following add on therapies either nimodipine or vinpocetine was done to compare merits of either therapies.
Methods: 90 head injury cases admitted to S.S. hospital were divided into standard treatment group given neither vinpocetine nor nimodipine & other two groups given either nimodipine or vinpocetine dependent entirely on clinician’s discretion. The patients data on initial severity on GCS scale and functional recovery on Barthel Index, head injury watch scale, Disability rating score were collected at discharge & at one month follow up thereafter to compare the recovery profiles.
Results: Vinpocetine treatment proved superior to nimodipine or standard treatment on examining the outcomes. Significance of time since injury was emphasized for improved outcome to nimodipine but not so necessary for vinpocetine.
Conclusions: Nimodipine delayed administration had no consequence while vinpocetine is useful treatment at any stage to enhance functional recovery in cases of head injury.
Rink A, Fung KM, Trojanowski JQ, Lee VM, Neugebauer E, McIntosh TK. Evidence of apoptotic cell death after experimental traumatic brain injury in the rat. Am J Pathol 1995;147:1575-83.
Faden AI, Salzmen S. Pharmacological strategies in CNS trauma. Trends Pharmacol Sci 1992;13:29-35.
Bullock M, Lyeth B, Muizelaar J. Current status of neuroprotection trials for traumatic brain injury: lessons from animal models and clinical studies. Neurosurgery 1999;45:207-17.
Krieglstein J, Rischke R. Vinpocetine increases the neuroprotective effect of adenosine in vitro. Eur J Pharmacol 1991;205:7-10.
Rischke R, Krieglstein J. Effects of vinpocetine on local cerebral blood flow and glucose utilization seven days after forebrain ischaemia in the rat. Pharmacology 1990;41:153-60.
Jucker M, Meier-Ruge W, Baettig K. Relative regional changes in 2- deoxyglucose uptake reflect cognitive performances in aged and adult rats. Effects of brovincamine and vinpocetine. Psychopharmacology 1988;96:29.
Kuzuya F. Effects of vinpocetine on platelet aggregability and erythrocyte deformability. Ther Hung 1958;33:22-34.
Szobor A, Klein M. Examinations of the relative fluidity in cerebrovascular disease patients. Ther Hung 1991;40:8-11.
Hayakawa M. Effect of vinpocetine on red blood cell deformability in stroke patients. Arzneimittelforschung 1992;42:425-7.
Rappaport M, Hall KM et al. Disability Rating Scale for Severe head trauma: Coma to Community. Arch Phys Med Rehabil 1982;63:118-23.
Ratcliff JJ, Greenspan AJ, Goldstein FC, et al. Gender and traumatic brain injury: do the sexes face differently? Brain Inj 2007;21:1023-30.
Levin H. Neurobehavioral outcome of mild to moderate head injury. Boston: Blackwell Scientific, pp 153-85.
Kazner E, Sprung C, Adelt D, Ammerer HP, Karnick R, Baumann H, et al. Clinical experience with nimodipine in the prophylaxis of neurological deficits after subarachnoid hemorrhage. Neurochirurgia (Stuttg) 1985;28 Suppl 1:110-3.
Mabe H, Takaji T, Umemera S, et al. Effect of Calcium entry blocker Nimodipine on cerebral function and metabolism. No To Shinkei 1985;37:1067-72.
Jakala P, Riekkinen M, Bjorklund M et al. Efficacy of combined Nimodipine and Metrifonate on rat cognition and cortical Electroencephalograph. Eu J. of Pharmacology 1996;318:239-50.
Mourice T, Su TP, Parish DW, Privat A. Prevention of nimodipine-induced impairment of learning by selective sigma ligand PRE-084. J Neural Transm Gen Sect 1995;102:1-18.
Wang W, Wang LN, Zhang XH, Ma L, Li DJ. A nimodipine Interventional study of Patients with mild cognitive impairment. Zhonghua Nei Ke Za Zhi 2006;45:274-6.
Levy A, Kong RM, Stillman MJ, et al. Nimodipine Improves Spatial Working Memory and Elevates Hippocampal Acetylcholine in Young Rats. Pharmacol Biochem Behav 1991;39:781-6.
Bönöczk P, Gulyás B, Adam-Vizi V, et al. Role of sodium channel inhibition in neuroprotection: effect of vinpocetine. Brain Res Bull 2000;53:245-54.
Lamar JC, Poignet H, Beaughard M. Calcium antagonist activity of vinpocetine and vincamine in several models of cerebral ischemia. Drug Dev Res 1988;14:297-304. doi: 10.1002/ddr.430140322.
Medina AE. Vinpocetine as a potent antiinflammatory agent. Proc Natl Acad Sci U S A. 2010;107:9921-2.
Truss MC, Stief CG, Uckert S, et al. Phosphodiesterase 1 inhibition in the treatment of lower urinary tract dysfunction: from bench to bedside. World J Urol 2001;19:344-50.
Majumder P, Trujillo CA, Lopes CG, et al. New insights into purinergic receptor signaling in neuronal differentiation, neuroprotection, and brain disorders. Purinergic Signal 2007;3:317-31.
Gaál L, Molnár P. Effect of vinpocetine on noradrenergic neurons in rat locus coeruleus. Eur J Pharmacol 1990;187:537-9.
Deshmukh R, Sharma V, Mehan S, Sharma N, Bedi KL. Amelioration of intracerebroventricular streptozotocin induced cognitive dysfunction and oxidative stress by vinpocetine — a PDE1 inhibitor. Eur J Pharmacol 2009;620:49-56.
Rosdy B, Balazs M, Szporny L. Biochemical effects of ethyl apovincaminate. Arzneimittelforschung 1976;26(10a):1923-6.
Trejo F, Nekrassov V, Sitges M. Characterization of vinpocetine effects on DA and DOPAC release in striatal isolated nerve endings. Brain Res 2001;909:59-67.
Clark JD, Raggatt PR, Edwards OM. Abnormalities of the hypothalamo-pituitary-gonadal axis after head injury. Clin Endocrinol (Oxf) 1992;36:481-5.