Nicergoline increases serum substance P levels in patients with an ischaemic stroke.
BACKGROUND
Aspiration pneumonia is one of the most important complications following ischaemic stroke, and a leading cause of mortality in stroke patients. This is particularly prevalent in patients with involvement of the basal ganglia, which may be due to impaired neurotransmission through lack of production of substance P.


METHODS
Consecutive patients in the chronic stage, 1-3 months after cerebral ischaemic infarction, were assessed for basal ganglia involvement by magnetic resonance imaging. The patients were randomised to 4 weeks of treatment with (n = 25) or without (n = 25) nicergoline (15 mg t.i.d.). Serum concentration of substance P was measured by radioimmunoassay.


RESULTS
At entry to the study, mean concentration of substance P was significantly (p < 0.001) lower in patients with bilateral basal ganglia lesions than in patients with no or unilateral basal ganglia involvement. Nicergoline administration caused a significant (p = 0.021) increase from baseline in mean substance P concentration. No significant change was seen in the nicergoline-untreated patients (p = 0.626). Among the patients who received nicergoline, 11 patients had bilateral basal ganglia involvement and there was no significant mean change in substance P in these patients, whereas there was a significant increase (p = 0.032) in the 14 nicergoline-treated patients with no or unilateral basal ganglia involvement.


CONCLUSIONS
The present study suggests a possible effect of nicergoline to increase substance P level in ischaemic stroke patients with partial damage to basal ganglia, who have a decreased swallowing response and consequent risk of aspiration pneumonia. Further trials of nicergoline treatment in patients at risk for aspiration pneumonia are warranted.
Nishiyama
Yasuhiro
Y
Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan. nomo16 @ nms.ac.jp
Abe
Arata
A
Ueda
Masayuki
M
Katsura
Ken-ichiro
K
Katayama
Yasuo
Y
D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D002491:Central Nervous System Agents / Q000627:therapeutic use*; D003679:Deglutition / Q000187:drug effects; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009530:Nicergoline / Q000627:therapeutic use*; D011015:Pneumonia, Aspiration / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D011863:Radioimmunoassay; D020521:Stroke / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D013373:Substance P / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D002491:Central Nervous System Agents; D013373:Substance P; D009530:Nicergoline