Intravenous Minocycline in Acute Stroke

Kohler, E.; Prentice, David; Bates, Timothy R.; Hankey, Graeme J.; Claxton, Anne; Heerden, Jolandi van; Blacker, David

doi:10.1161/strokeaha.113.000780

Cited by 119 publications

(76 citation statements)

References 24 publications

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“…In a recent pilot study the use of intravenous-administered minocycline in a small sample of acute ischemic and hemorrhagic stroke patients has proven to be safe but not efficacious [85], although scalability and a relative delay in administration (within 24 h after onset) could account for this.…”

Section: New Developments and Future Conceptsmentioning

confidence: 99%

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

et al. 2014

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Background: The global burden of stroke is immense, both in medical and economic terms. With the aging population and the ongoing industrialization of the third world, stroke prevalence is expected to increase and will have a major effect on national health expenditures. Currently, the medical treatment for acute ischemic stroke is limited to intravenous recombinant tissue plasminogen activator (IV r-tPA), but its time dependency leads to low utilization rates in routine clinical practice. Prehospital delay contributes significantly to delayed or missed treatment opportunities in acute stroke. State-of-the-art acute stroke care, starting in the prehospital phase, could thereby reduce the disease burden and its enormous financial costs. Summary: The first part of this review focuses on current education measures for the general public, the emergency medical services (EMS) dispatchers and paramedics. Although much has been expected of these measures to improve stroke care, no major effects on prehospital delay or missed treatment opportunities have been demonstrated over the years. Most interventional studies showed little or no effect on the onset-to-door time, IV r-tPA utilization rates or outcome, except for prenotification of the receiving hospital by the EMS. No data are currently available on the cost-effectiveness of these commonly used measures. In the second part, we discuss new developments for the improvement of prehospital stroke diagnosis and treatment which could open new perspectives in the nearby future. These include the implementation of prehospital telestroke and the deployment of mobile stroke units. These approaches may improve patient care and could serve as a platform for prehospital clinical trials. Other opportunities include the implementation of noninvasive diagnostics (like transcranial ultrasound and blood-borne biomarkers) and the reevaluation of neuroprotective strategies in the prehospital phase. Key Messages: Timely initiation of treatment can effectively reduce the medical and economic burden of stroke and should begin with optimal prehospital stroke care. For this, prehospital telemedicine is a particularly attractive approach because it is a scalable solution that has the potential to rapidly optimize acute stroke care at limited cost.

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Section: New Developments and Future Conceptsmentioning

confidence: 99%

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

et al. 2014

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“…They showed that patients taking minocycline showed a significant decrease in NIHSS (10). This is despite the fact that in a pilot study, Kohler et al studied the effect of an intravenous dose of minocycline 100 mg over 24 hours after stroke and every 12 hours, consecutively in the stroke patients, and showed that minocycline was a safe drug but not effective (11). It seems that because the dose used and route of administration in this study was different with the current study, this difference is justified.…”

Section: Discussionmentioning

confidence: 99%

“…Lamp et al showed that minocycline caused a significant de-crease in NIHSS (10). Kohler et al showed that minocycline in stroke is a drug safe but not effective treatment option (11). Therefore, the purpose of this clinical trial was to evaluate the efficacy of minocycline in the recovery of patients with acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Effect of Oral Minocycline on Clinical Recovery Process in Patients with Acute Ischemic Stroke: A Randomized Clinical Trial

Shamsaei

Mohammadi

2017

Jundishapur J Nat Pharm Prod

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Background: Acute ischemic stroke is one of the most common causes of death worldwide with one new case being diagnosed every five seconds. The mortality rate and permanent disability are very high and the current treatment still needs to improve to a large extent. Minocycline drug, a derivative of tetracycline, is an anti-inflammatory and anti-apoptotic protection of neurons, the role of which has been studied recently in recovery from nerve degenerative diseases, especially stroke. This study aimed at evaluating the effect of minocycline in the recovery of patients with a history of stroke. Methods: In this randomized clinical trial, 42 patients with ischemic stroke were divided to 2 groups: receiving minocycline 200 mg for 5 days and receiving the placebo. Aspirin was prescribed to all patients. Clinical assessment before and 90 days after the intervention was performed by the National institutes of health stroke scale score (NIHSS). Results: A total of 36 patients completed the study. The number of females in the case and control groups was 55.5% and 51.1%, respectively. In the case group, NIHSS decreased from 9.55 to 6.1 and in the control group, it decreased from 10.2 to 7.33, which was statistically significant. Although the NIHSS decreased in patients taking minocycline more than the control group, this difference was not statistically significant. Conclusions: According to the findings of this study, it seems that minocycline could be used as a complementary therapy in patients with ischemic stroke. However, these results need to be confirmed by further studies in this field.

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“…The same treatment paradigm was also utilized by Amiri-Nikpour et al who reported improved NIHSS scores at 30, 60 and 90 days post-AIS in male patients receiving minocycline [233]. Kohler et al utilized lower doses of minocycline (ive 100 mg doses) and saw no improvement in NIHSS at 7 days nor in the mRS or BI at 90 days post-AIS [234].…”

Section: The Antibiotic Minocycline In Ais and Tbimentioning

confidence: 91%

Roles of Pro- and Anti-inflammatory Cytokines in Traumatic Brain Injury and Acute Ischemic Stroke

Dugue¹,

Nath²,

Dugue³

et al. 2017

Mechanisms of Neuroinflammation

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This chapter will introduce the reader to the pathophysiology of two devastating neurologic events, traumatic brain injury (TBI) and acute ischemic stroke (AIS). Here we focus on the role of key pro-inlammatory and anti-inlammatory cytokines. Several experimental interventions have been found to modulate cytokine production and brain injury after AIS or TBI. Here minocycline, biological response modiiers, hormonal therapies, omega-3 faty acids, N-acetylcysteine, and cannabinoids will be discussed. In addition, the role of cytokine-induced inlammasomes in both TBI and AIS will be addressed and followed by discussion of pro-inlammatory cytokines (e.g., TNF-α, IL-1β, IL-18, and IFN-γ). Finally, the main anti-inlammatory cytokines, IL-33, IL-10, IL-6, and IL-4, will be discussed in the context of both TBI and AIS. It should be noted that the role of these cytokines is diverse and the dichotomization of classically pro-versus anti-inlammatory cytokines is being re-examined, as many of these cytokines have been found to play dual roles in TBI and AIS brain injury.Keywords: traumatic brain injury, ischemic stroke, cytokines, interleukins, inlammasome Pathophysiology of traumatic brain injuryTraumatic brain injury (TBI) is a major cause of death and disability worldwide [1,2]. It is one of the most commonly diagnosed neurological disorders in the United States, impacting people of a variety of ages and segments of society [3]. In Europe, the economic cost of © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.TBI is over 33 billion euros per year [4]. Continued surveillance and research is being done to reduce primary and secondary TBI [as well as acute ischemic stroke(AIS)]-induced brain injury [1].The pathophysiology of TBI begins with the initial brain trauma (i.e., the primary injury). This primary injury results from mechanical damage that disrupts the blood-brain barrier (BBB), alters the vasculature and damages brain tissue. The resulting injured glia and neurons release their intracellular contents (i.e., damage-associated molecular paterns; (DAMPs)) into the extracellular space and activate neighboring glia and neurons. Activated glia and neurons then produce molecular signals that can both exacerbate and mend the acute injury and contribute to long-term recovery [5][6][7][8][9]. These downstream molecular and cellular processes (i.e., the secondary injury in TBI) are the focus of many pre-clinical and clinical therapeutic studies. Secondary injury in TBI involves a host of molecular and cellular responses to the The pathophysiology of AIS and TBI share common mechanisms. The initial insult in AIS, an occlusion of blood low resulting in a core infarct zone surrounded by a poorly perfused penumbra, versus the initial primary physical impact in TBI both result in pe...

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Intravenous Minocycline in Acute Stroke

Cited by 119 publications

References 24 publications

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

Effect of Oral Minocycline on Clinical Recovery Process in Patients with Acute Ischemic Stroke: A Randomized Clinical Trial

Roles of Pro- and Anti-inflammatory Cytokines in Traumatic Brain Injury and Acute Ischemic Stroke

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