Use of Succinates for Correction of Metabolic Impairments in the Ischemic Penumbra Zone in Stroke Patients

The aim of the present work was to use MR spectroscopy to assess the quantitative contents and ratios of different metabolites in the infarct nucleus, ischemic penumbra, and unaltered tissue in the opposite hemisphere in patients in the acute period of ischemic stroke. A total of 72 patients were studied, of whom 37 (the study group) received the antioxidant Mexidol (2-ethyl-6-methyl-3-hydroxypyridine succinate) in addition to basal treatment, while 35 patients received only standard treatment without use of antioxidants. Stroke severity was assessed on the NIHSS scale and functional outcomes on day 30 were evaluated using the Bartel index and modified Rankin scale. MR proton spectroscopy was performed twice: during the first 24 h of disease onset and on day 5. Use of the succinate-containing antioxidant Mexidol (500 mg i.v. for 14 days) during the acute period of ischemic stroke significantly decreased the intracellular lactate (p = 0.002) and inositol contents (p = 0.005) from the levels in the control group, which helped restore the balance between the aerobic and anaerobic mechanisms of oxidation and had favorable influences on the rehabilitation potentials of the patients. A positive correlation was found between the lactate content in the ischemic penumbra zone and values on the NIHSS (r = 0.5786, p = 0.049), along with a negative correlation between the lactate content in the ischemic penumbra zone and the level of functional recovery assessed on the Bartel index (r = –0.6305, p = 0.028), which supports the existence of an interaction between impaired glucose metabolism in hypoxic conditions and the level of injury to nervous tissue.