The Evaluation of the Neuroprotective Effect of a Single High-Dose Vitamin D3 in Patients with Moderate Ischemic Stroke

Abstract

Introduction. Vitamin D insufficiency is highly prevalent and is a negative predictor for survival in ischemic stroke patients. We evaluated the effect of a high dose of vitamin D3 on the Neuron-Specific Enolase (NSE) level, National Institute of Health Stroke Scale (NIHSS), and Barthel Index (BI) scoring system in moderate ischemic stroke patients. Methods. This prospective, double-blind, randomized clinical trial (RCT) study was conducted from April 2020 to March 2021. Patients with moderate ischemic stroke (NIHSS 5 to 15) who had vitamin D deficiency (serum 25-OH vitamin D ≤30 ng/mL) were recruited and randomized into intervention and control groups. Subjects in the intervention group received a single dose, intramuscular (IM) injection of 600000 international unit (IU) vitamin D3, in addition to the standard treatment. NSE level and NIHSS were evaluated at baseline and 48 hours after the intervention. The BI was monitored three months after discharge. Results. During the study period, 570 patients were assessed; finally, forty-one patients completed the study. Except for the age which was higher in the control group ( p = 0.04 ), there were no statistically significant differences in other baseline characteristics between the two groups. After 48 hours, the NIHSS score was significantly lower in the intervention group (median 8 vs. 6.5, p = 0.008 in the control and intervention groups, respectively), but there was no significant difference in the NSE level ( p = 0.80 ). Three months after discharge, the BI was significantly higher in the intervention group (median 8 vs. 9, p = 0.03 in the control and intervention groups, respectively). Conclusions. Administration of a single 600000 IU of vitamin D3 could have neuroprotective effects in patients with moderate ischemic stroke, according to its significantly positive effects on functional clinical outcomes (NIHSS and BI), but this effect on the biomarker related to neural damage (NSE) was not significant.

Effects of early adjunctive pharmacotherapy on serum levels of brain injury biomarkers in patients with traumatic brain injury: a systematic review of randomized controlled studies

“…• High-dose vitamin D offered neuroprotective effects in patients with moderate ischemic stroke (Hesami et al, 2022). Similar action might be expected in patients with TBI.…”

A systematic review examining the effect of vitamin D supplementation on functional outcomes post-stroke

“…A total of 43 articles underwent full text review of which 33 studies were subsequently excluded (Figure 1 and Appendix B for list of excluded studies at full text stage). Ten studies were included in this systematic review, including eight randomized controlled trials 7,[18][19][20][21][22][23][24] and two non-randomized studies of intervention, 3,25 examining a total of 691 patients (Table 1).…”

“…The effect of vitamin D supplementation on activities of daily living was examined in four randomized controlled trials 19 , 21 , 22 : three 19 , 21 , 24 used the Barthel Index and one 22 used the Functional Independence Measure. Sari et al 21 and Hesami et al 24 both assessed the Barthel Index and found a significant improvement in the vitamin D supplementation group compared to placebo and usual care, respectively.…”

“…The effect of vitamin D supplementation on activities of daily living was examined in four randomized controlled trials 19 , 21 , 22 : three 19 , 21 , 24 used the Barthel Index and one 22 used the Functional Independence Measure. Sari et al 21 and Hesami et al 24 both assessed the Barthel Index and found a significant improvement in the vitamin D supplementation group compared to placebo and usual care, respectively. However, two other randomized controlled trials by Momosaki et al 19 and Torrisi et al, 22 found no significant between group difference on ability to perform activities of daily living after vitamin D supplementation.…”

Vitamin D: The silent rescuer from ischemic stroke

“…This is evident that a single dose of 600000 IU of vitamin D 3 exerts neuronal protection by preventing reactive oxygen species damage and vasodilatation in moderate ischemia. The synergistic effect of vitamin A with vitamin D reduces serum IL-1β levels, resulting in a better outcome for ischemic stroke patients [ [3] , [4] , [5] , [6] ].…”