Functional recovery

Ereret T, Valable S, Chazalviel L, Saulnier R, Mackenzie ET, Petit E, Bemaudin M, Boulouard M, Schumann-Bard P. Delayed administration of deferoxamine reduces brain damage and promotes functional recovery after transient focal cerebral iscbemia in tbe rat. Eur J Neurosci 2006 23 1757-1765. 

The abciximab in Acute Ischemic Stroke trial was a randomized, placebo-controlled dose-escalation study to examine the safety of abciximab in acute stroke. It randomized 74 patients within 24 hours of stroke onset to receive one of four doses of abciximab (by bolus with or without additional infusion, 54 patients) or placebo (20 patients). The median baseline National Institute of Health Stroke Scale (NIHSS) score was 15. The rates of asymptomatic ICH were 19% in the intervention group compared to 5% in the placebo group p = 0.07). Most (9 of 11) of the asymptomatic ICH patients had more severe stroke (NIHSS >14). No cases of symptomatic ICH or major systemic bleeding occurred. There was a trend toward a lower rate of stroke recurrence (2% vs. 5%) and a higher rate of functional recovery at 3 months in the group treated with abciximab than with placebo. 

The Safety of Tirofiban in Acute Ischemic Stroke (SaTIS) trial examined 250 patients 6-22 hours after stroke onset treated with tirohban infusion or placebo for 48 hours. No increase in ICH was reported in the active group. Although no beneht in early functional recovery was observed, 5-6-month mortality was lower in the tirohban-treated group (relative risk reduction (RRR) 27%, 95% Cl 0.08-0.95, p = 0.03). 

Corticosteroids hasten functional recovery after relapses.27 Intravenous adrenocorticotropic hormone, intravenous methylprednisolone, or oral prednisone are used for treatment of relapses. Generally, intravenous methylprednisolone is considered the drug of choice for acute relapses.28... 

Compensatory plasticity and functional recovery can be enhanced in the injured adult central nervous system through blockade of Nogo-A 525... 

Nogo-A neutralizing antibodies lead to axonal growth and functional recovery in vivo. After cell culture experiments, the next step was to show the ability to block myelin inhibitors and achieve axonal regrowth after spinal cord injury. The monoclonal antibody IN-1 was initially raised against myelin fractions enriched for... 

Even in the case of spinal cord injury where application of anti-Nogo antibodies results in regeneration of the cut axons, an additional important element for functional recovery is enhanced fiber growth from the unlesioned fibers, i.e. compensatory plasticity, as discussed above. After high corticospinal tract injury in the rat at the level of the medullary pyramid and treatment with anti-Nogo antibodies, rubrospinal pathways were shown to sprout into deafferented areas of the spinal cord, resulting in high levels of functional recovery, i.e. a functional switch in the remodeled pathway [42]. 

Bradbury, E. J., Moon, L. D., Popat, R. J. etal. Chondroitinase ABC promotes functional recovery after spinal cord injury. Nature 416 636-640, 2002. 

Papadopoulos, C. M., Tsai, S-Y., Alsbiei, T., O Brien, T. E., Schwab, M. E. and Kartje, G. L. Functional recovery and neuroanatomical plasticity following middle cerebral artery occlusion and IN-1 antibody treatment in the adult rat. Ann. Neurol. 51 433-441, 2002. 

Gash, D. M., Zhang, Z., Ovadia, A. et al. Functional recovery in parkinsonian monkeys treated with gdnf. Nature 380 252-255, 1996. 

Tighilet B, Lacour M. (1995). Pharmacological activity of the Ginkgo biloba extract (EGb 761) on equilibrium function recovery in the unilateral vestibular neurectomized cat. J Vestib Res. 5(3) 187-200. 

Comparison of their rate of onset and recovery of a treated mucosa has been made [37]. Fatty acids have strong and fast reactivity and allow for a fast recovery of the barrier function. Bile salts and salicylates are moderate, fast-acting agents with fast barrier-function recovery. Strong surfactants and chelators have strong or moderate reactivity and a slow recovery of barrier function. Solvents like dimethylsulfoxide and ethanol have moderate reactivity and act primarily as agents to improve drug miscibility in an aqueous environment. The enhancers listed above are also effective in the small intestine [22]. Enhancers that are more colon specific include ethylaceto-acetate, which must be first metabolically transformed to enamine [38]. 

Akhter, S. A., D Souza, K. M., Petrashevskaya, N. N., Mialet-Perez, J., and Liggett, S. B. (2006) Myocardial beta 1-adrenergic receptor polymorphisms affect functional recovery after ischemic injury. Am. J. Physiol. Heart. Circ. Physiol. 290, H1427-H1432. 

The full spectrum of depressive symptoms including depressed mood, anhedonia, lack of energy, and even suicidal thoughts may strike as many as 25% of patients who experience a TBL Depression in these patients not only exacts a tremendous psychosocial toll but also interferes with their participation in physical and occupational rehabilitation. As a result, long-term functional recovery from TBl can be sorely compromised by depression. Potential treatments for post-TBl depression include conventional antidepressants and stimulants (see Table 12.1). 

Dual isotope SPECT protocols obtain resting images with t1 and stress images with MIBI followed by 24 h xi late redistribution imaging [39, 40]. These protocols have demonstrated good prediction of contractile function recovery after revascularization comparable to simpler single tracer protocols [41]. 

Size and severity of ischemic areas correlate well with mortality in both stable CAD populations [70] and after myocardial infarction [71]. Moreover, the presence of ischemia in a dysfunctional segment of myocardium is a powerful predictor of functional recovery. Up to 83% of regions with reversible defects (ischemia) will improve with revascularization compared to only 33% for regions where no reversibility was demonstrated [72]. In patients with heart failure, viable poorly contracting myocardium correlates with recovery... 

The value of SPECT viability imaging with is well established clinically with overall 70-75% accuracy for predicting recovery of LV function compared to PET [28, 29, 61, 89]. For MIBI, predictive accuracy decreases to 64% compared to PET [106, 107]. Some of these discrepancies are explained by frequent inferior wall attenuation artifacts encountered with SPECT [4, 108]. The randomized trial CHRISTMAS (Carvedilol Hibernating Reversible Ischemia) demonstrated that SPECT MIBI predicted LV functional recovery in patients receiving carvedilol [109] with LVEF improving by 3.8%, more in those patients with... 

Gropler RJ, Geltman EM, Sampathkumaran K, Perez JE, Moerlein SM, Sobel BE et al. Functional recovery after coronary revascularization for chronic coronary artery disease is dependent on maintenance of oxidative metabolism. J Am Coll Cardiol 1992 20 569-577... 

Bax JJ, Wijns W, Cornel JH, Visser FC, Boersma E, Fioretti PM. Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease comparison of pooled data. J Am Coll Cardiol 1997 30 1451-1460... 

Schmidt M, Voth E, Schneider CA, Theissen P, Wagner R, Baer FM et al. F-18-FDG uptake is a reliable pre-dictory of functional recovery of akinetic but viable infarct regions as defined by magnetic resonance imaging before and after revascularization. Magn Reson Imaging 2004 22 229-236... 

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