title: Post-insult valproate treatment potentially improved functional recovery in patients with acute middle cerebral artery infarction.
abstract: Animal stroke models suggest that valproate has multiple neuroprotective mechanisms against ischemic brain damage. This study investigated whether valproate improves functional recovery in patients with acute middle cerebral artery (MCA) infarction. This was an open-label controlled trial. Three to 24 hours after acute MCA infarction, patients were assigned to either the valproate group (n = 17) or the non-valproate group (n = 17). The valproate group received intravenous valproate (400 mg) at enrollment, and then every 12 hours for three days, followed by oral valproate (500 mg) every 12 hours for three months. Neurological function, laboratory data, and brain magnetic resonance imaging were examined at stroke onset, and at two-week and three-month follow-up. No significant differences were observed between the groups with regard to demographics or baseline characteristics. All patients were elderly, had a high pretreatment score on the NIH stroke scale (NIHSS), and slow stroke lesion growth with a final large infarct volume at two-week follow-up. At the three-month follow-up, functional outcome between pre- and post-treatment had improved significantly in the valproate group (NIHSS, p = 0.004; modified Rankin scale (mRS), p = 0.007; Barthel index (BI), p = 0.001). No such improvement was noted in the NIHSS or mRS for the non-valproate group, though mild improvement was seen on the BI (p = 0.022). This open-label trial is the first to demonstrate that valproate treatment markedly improves functional outcome in patients with acute MCA infarction.
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
authors: Jiunn-Tay
authors: JT
authors: Lee
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
authors: Chung-Hsing
authors: CH
authors: Chou
authors: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
authors: Nai-Yu
authors: NY
authors: Cho
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
authors: Yueh-Feng
authors: YF
authors: Sung
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
authors: Fu-Chi
authors: FC
authors: Yang
authors: Department of Medical Imaging, Taipei Medical University Hospital, Taipei Medical University Taipei, Taiwan.
authors: Cheng-Yu
authors: CY
authors: Chen
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan ; Department of Internal Medicine, Tri-Service General Hospital Penghu Branch Penghu, Taiwan.
authors: Yu-Hua
authors: YH
authors: Lai
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan ; Department of Internal Medicine, Hualien Armed Forces General Hospital Hualien, Taiwan.
authors: Chun-I
authors: CI
authors: Chiang
authors: Department of Epidemiology, School of Public Health, National Defense Medical Center Taipei, Taiwan.
authors: Chi-Ming
authors: CM
authors: Chu
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
authors: Jiann-Chyun
authors: JC
authors: Lin
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
authors: Yaw-Don
authors: YD
authors: Hsu
authors: Laboratory of Pharmacology and Chemistry, NIEHS-NIH, Research Triangle Park NC 27709, USA.
authors: Jau-Shyong
authors: JS
authors: Hong
authors: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
authors: Giia-Sheun
authors: GS
authors: Peng
authors: Molecular Neurobiology Section, NIMH-NIH Bethesda, MD, 20892-1363, USA.
authors: De-Maw
authors: DM
authors: Chuang
keywords: Ischemic stroke; neuroprotection; stroke outcome; valproate
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