Targeting the Brain: Neuroprotection and Neurorestoration in Ischemic Stroke

Jeffrey L. Saver, M.D., FAHA, FAAN


Pharmacotherapy. 2010;30(7):62S-69S. 

In This Article

Main Points

  • Brain-based therapies for acute ischemic stroke hold great promise. Neuroprotective therapies block the molecular elaboration of injury in hypoxic environments, and neurorestoration therapies enhance neuroplasticity and brain reorganization after stroke.

  • Laboratory studies have identified multiple neuronal and vascular effects of magnesium that likely contribute to the potent neuroprotective effects observed in stroke models. In clinical trials, magnesium sulfate has shown signals of benefit for averting brain ischemic injury.

  • Choline precursors and nerve growth factors, which promote cell repair and growth, may confer neuroprotection when administered acutely and neurorepair when given subacutely.

  • In animal stroke models, acute administration of citicoline reduced infarct size and improved behavioral outcomes. More recent studies have revealed substantial neuroplasticity-enhancing properties of citicoline.

  • Neuroprotective agents such as magnesium sulfate can be administered in the field, before hospital arrival; subacute neuroplasticityenhancing therapy with citicoline can facilitate brain repair and improve functional outcomes.