Cerebrolysin in Early Stroke Rehabilitation - Tertiary Study

Cerebrolysin is a neuropeptide preparation from porcine brain in an aqueous solution. The composition of 1 ml of the solution contains 215.2 mg of a low molecular weight fraction of polypeptides extracted from porcine brain (Cerebrolysin concentrate), which corresponds to at least 5.8 mg of peptide nitrogen (15%) and free amino acids (85%).

Cerebrolysin has been registered for many years for the treatment of cerebrovascular and neurodegenerative diseases, as well as traumatic brain injuries worldwide. Since the first approval, the treatment of ischemic stroke (IS) has progressed and new treatment concepts have been developed. In addition, the treatment of IS with Cerebrolysin has developed with different time windows, doses and duration of treatment. The main objective of this study is to determine the effectiveness of Cerebrolysin in early rehabilitation as an adjunct to standard treatment in a group of patients with moderate to severe neurological impairment after acute IS in specific KOVNINT conditions.

All patients will receive acute IS care according to local standards of care, which will not be changed or influenced by the study in any way. To assess the safety and efficacy of Cerebrolysin in practice at KOVNINT, the outcome of patients treated with Cerebrolysin will be compared to patients in the control group who will not receive Cerebrolysin.

The reason for conducting the study is to determine the effectiveness of Cerebrolysin treatment in patients with moderate to severe neurological deficits after acute IS at KOVNINT and to assess the impact of these parameters on the outcome of treatment, especially the effect on neurological impairment at discharge and 90 days after IS.

The aim of this study is to observe the safety and efficacy of Cerebrolysin in patients with moderate to severe neurological impairment after acute IS in the specific KOVNINT conditions. We will conduct an analysis of the use of Cerebrolysin as an adjunct to standard treatment and evaluate its efficacy in the early phase of IS, defined by neurological impairment at discharge and 90 days after IS.

Consecutive patients will be enrolled in the study over a specified period, with the investigator independently deciding to treat with Cerebrolysin within 7 days after IS after obtaining informed consent. Patients will be included whose clinical diagnosis of acute IS will be confirmed by imaging, with patients having moderate to severe neurological impairment, defined by an initial NIHSS score of 6-12. All patients will receive standard care for IS according to local treatment. Treatment standards will not be changed and they will not be affected by the study.

Cerebrolysin group: (15 patients) Patients who will be treated with Cerebrolysin will receive the drug according to the SmPC. Dosage 30 ml/day, 10 days. Administration by intravenous infusion (IV infusion). Administration procedure: The drug is diluted to a volume of 100 ml with 0.9% saline. The infusion time will be 15 min.

Patients will receive the drug in accordance with the regulations on sterility of the application. To ensure sterility, single-use infusion sets and cannulas are always used. The infusion is started as soon as possible after dilution.

Control group: (15 patients) Patients receiving all standard care for ICU and not receiving Cerebrolysin.

• National Institute of Health Stroke Scale (NIHSS) at discharge and 90 days [Срок оценки: 90 days]
• Modified Rankin Score (mRS) at day 90 [Срок оценки: 90 days]
• Extended Barthel index (EBI) 90 days post-stroke [Срок оценки: 90 days]
• The De Morton Mobility Index (DEMMI) Score 90 days [Срок оценки: 90 days]
• Montreal Cognitive Assessment (MoCA) 90 days [Срок оценки: 90 days]