Subject: A retrospective cross-sectional, observational survey study to analyse role of alpha GPC &
piracetam in treatment of post stroke management.
Stroke is the acute severe manifestation of cerebrovascular disease. According to WHO, stroke is
defined as acute neurological dysfunction of vascular origin with sudden or at least occurrences of
symptoms and signs corresponding to the involvement of local areas in the brain.1 Crude incidence of
stroke ranged from 108 to 172/100,000 people per year, crude prevalence from 26 to 757/100,000 people per
year, and one month case fatality rates from 18 % to 42 %.2
The progression of cerebral tissue to irreversible infarction, depends on the magnitude of the drop in
cerebral blood flow and the duration of this drop. With a fall of cerebral blood flow by approximately
50%, patients remain asymptomatic. With a further fall, reversible neuronal dysfunction occurs
leading to ischemic symptoms, typically deficits of function corresponding to the location of the
ischemia. If flow is restored rapidly enough, neuronal function returns without infarction and the
patient is said to have had a transient ischemic attack. If low flow causing ischemia lasts long enough,
irreversible tissue injury occurs, leading to the pathophysiologic events described above for cerebral
infarction or ischemic stroke. The time from onset of symptoms until the onset of irreversible tissue
injury depend on the magnitude and duration of the drop in cerebral blood flow. 3
Alpha glycerophosphocholine (alpha GPC) is a new class of choline donor has shown to exert an
integrated neuronal function and to facilitate learning and memory in dose dependent way. Once
GPC crosses the blood brain barrier, it directly increases synthesis and the release of acetylcholine,
and serve as precursor for membrane phospholipids improving functionality of neuronal
membranes.
4
Piracetam acts on the cell membrane to which piracetam binds at the level of polar heads of
phospholipids and enhances the decreased fluidity of neuronal cell membrane. Restoration of
decreased neuronal cell membrane fluidity explains improvements in various membrane bound
functions like secondary messenger activity, neurotransmission, ATP production. 5
A multi-centre study was conducted on 2044 patients with the aim to assess clinical efficacy and
tolerability of alpha GPC in the treatment of neuropsychiatric symptoms following acute stroke.
Study demonstrated good improvement at the end of first phase and this was maintained in time
during the second phase. Mini mental status examination (MMSE), Global deterioration scale (GDS)
and Crichton rating scale (CRS) showed statistically significant improvement. Tolerability was
favourable with alpha GPC. This study confirms the therapeutic role of alpha GPC on cognitive
enhancement of patients with acute cerebrovascular attacks (stroke/ TIA). The very low adverse
events confirm that alpha GPC can be safely administered for long period after the occurrence of
stroke.6
A 12 week, multicentre, double blind, placebo controlled, randomized, parallel design study which
explores the effects of piracetam in patients with stroke. Assessment was done on ADL (activities of
daily living) rating scale, Barthel Index, Aachen Aphasia Test (AAT). Testing was performed at baseline
(6-9 weeks post stroke), at 5 weeks and 12 weeks. Multivariate analysis of AAT subset scores showed
significant improvement relative to baseline in favor of piracetam at 12 weeks (p = 0.02) Piracetam
improves higher cerebral integrative functions including those involved in cognitive processes such
as learning and memory. Piracetam improves the microcirculation both peripherally and centrally
due to reduced platelet activity, increased red blood cell deformability, reduced adherence of
damaged cells to endothelial cells and antispasmodic effects.7
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