Semax in the treatment of Stroke and TBI

Semax in stroke and TBI

Cerebral diseases are very common nowadays and they have a tendency to grow. The consequences are numerous and may include distortion of movement, speech, cognitive functions, mental state etc. Prevention and treatment of such cases often requires multidiscipline approach of neurosurgeons, neurologists, therapists, traumatologists, radiologists and other physical specialists. In this article you will find more information on how nootropics namely Semax nasal drops can help to prevent and treat stroke and TBI.

Semax in the treatment of Stroke

Semax in the stroke treatment

Stroke is a massive destruction of brain tissue because of the blood circulation disturbance or vessel bleeding. For many, stroke becomes the life sentence. Slightest hemorrhage in the brain tissue or a blockage of the cerebral vessel can lead to irreversible impairment of motor functions, sensitivity, weakening of reflexes, loss of speech, memory, hearing.

There are two types of strokes:

  1. Ischemic stroke is a cerebral infarction. Acute failure of blood flow to the brain area against the background of the blockage of a vessel by a clot. It is characterized by a sudden impairment of brain function, often leading to disability or death. Thrombosis may occur against the background of vascular atherosclerosis or hypertension. Atrial fibrillation can provoke thromboembolism too. 
  2. Hemorrhagic stroke is an acute failure in cerebral circulation with the rupture of blood vessels and cerebral bleeding, resulting in a hematoma. This type of stroke is often caused by aneurysms and hypertension. The damaging effect on neurons is more pronounced because of the pressure of the hematoma on the brain tissue, increased intracranial pressure and vasospasm, which causes additional ischemia. Consequences of this type of stroke are very severe, even after treatment.

More than 85% of all cases of vascular accidents happen because of ischemic stroke, the rest is hemorrhagic. In ischemic stroke, the prognosis is usually better due to a larger zone of ischemic penumbra, i.e. areas of living brain cells that can still be saved with the help of drug therapy, because they still retain the ability to absorb nutrients.

The causes and mechanisms of damage to the nervous tissue in ischemic and hemorrhagic strokes are different. However, in both cases, damage to nerve cells is based on the disruption of their nutrition and oxygen “starvation” of the brain tissues. This serves as a trigger for the ischemic cascade – a chain of pathological processes in the nervous tissue with impaired blood flow.

Consequences of Stroke

Manifestations of the disease depend on the location and size of the damaged vessel. The larger the vessel affected by hemorrhagic or ischemic stroke, the more severe the consequences. First signs of a vascular catastrophe are general symptoms of impaired brain function: confusion or loss of consciousness, movement disorders, changes and weakening of reflexes. Then the symptoms associated with damage to a specific area of the brain come to the fore: impaired limb movements, hearing, vision, speech, thinking, etc.

The treatment with drugs used in the hospital after stroke is aimed at:

  • Elimination or reduction of the causes of the development of a vascular catastrophe (surgical removal of hematoma in the brain, drug control of blood pressure, thrombosis treatment and its prevention);
  • Elimination or reduction of the consequences of stroke (restoration of nutrition, oxygen supply to neurons and neuroprotection, i.e. a set of therapeutic measures aimed at increasing the survival of nerve cells in adverse conditions).

In case of stroke, drugs and treatment methods in a hospital are selected individually, depending on the cause of the problem, the mechanism of its occurrence, concomitant diseases, etc. Neuroprotective therapy is usually provided to all patients.

Clinical studies have shown that the use of Semax 1% neuroprotector, begun at the pre-hospital stage, at home or by ambulance specialists, increases the effectiveness of further treatment in the hospital [6]. Semax 1% nasal drops help to significantly reduce mortality and the risk of disability in vascular accidents, minimizing the consequences of stroke [6].

What does Semax 1% do?

  • It’s known to activate metabolic processes aimed at protecting neurons from the consequences of the lack of oxygen;
  • Prevent the expansion of the area affected in stroke;
  • Increase the survival and recovery rate of neurons in the area of the ischemic penumbra;
  • Restore interneuronal connections, provide replacement of the functions of dead cells due to the active work of survivors;
  • Slow down the ischemic cascade, preventing the progressive death of neurons;
  • Contribute to the elimination of depression after stroke.

Dosage mode for Semax 1% in the Hospital

Суточная дозировкаДлительность приемаКоличество препарата на курс
Course duration: 10 days 3 drops into each nasal passage
6 times a day
6 bottles per course

One bottle contains 60 drops. Instillations must be carried out strictly on the nasal mucosa, preventing the leakage into the nasopharynx.


What do I do in a Stroke – First Aid? 

Prompt treatment at the onset of the first symptoms of a stroke can prevent extensive damage to brain cells and connections between them in brain tissue. Subsequently, this will contribute to more effective restoration of brain functions during the following treatment.

First signs of stroke:

  • F – face. Facial asymmetry or drooping of the mouth corner on one side. Especially noticeable when smiling.
  • A – arm. When a patient tries to raise both hands, one arm is located lower than the other. There might be a feeling of numbness and weakness in hands.
  • S – speech. Vague or altered speech, trouble repeating simple sentences.
  • Weakness or numbness on one side of the body;
  • Blurring or loss of vision, often in one eye, restricted field of view;
  • Severe headache;
  • Unexplained weakness, staggering, loss of consciousness;
  • Face redness, vomiting;
  • T – time. If you notice ANY of the above mentioned symptoms it might be the first sign of a stroke. Any suspicion of a vascular accident requires immediate call for the ambulance.

It is necessary to start early neuroprotection in any case, as it will help to significantly reduce the consequences of the problem and reduce the risk of disability in any type of stroke. Semax 1% in this case is convenient and effective for first aid, since it is easy to use (nasal drops) even by minor family members before the ambulance arrives.

First aid in Stroke is within Everyone’s powers

  1. Sit down or lay down the person who has supposedly had a stroke;
  2. Time the onset of symptoms of a vascular catastrophe;
  3. Make sure there are no obstacles to breathing (remove dentures from a person’s mouth, loosen tight clothing). 
  4. In case of loss of consciousness, lay the person on one side to avoid tongue retraction or aspiration of vomit;
  5. Start neuroprotective therapy with drugs approved by your doctor;
  6. Measure and record blood pressure if it’s possible;
  7. Do not give water or food to the person until the ambulance arrives.

In the ambulance, specialists will continue neuroprotection, and begin infusion therapy to normalize blood supply to brain cells, prevent intracranial hypertension, etc.

Dosage mode for Semax 1% at the Onset of stroke

Суточная дозировкаДлительность приемаКоличество препарата на курс
Instill every 20 minutes3 drops into each nasal passage1 bottle per course

One bottle contains 60 drops. Instillations must be carried out strictly on the nasal mucosa, preventing the leakage into the nasopharynx.


Recovery after Stroke

Recovery After Stroke

The competent use of various restorative techniques, not the least of which belongs to drug therapy, allows to return the patient who survived a stroke to an active life. Stroke rehabilitation is usually divided into two stages:

  1. Early – first 6 months;
  2. Late – the second half of the year after a stroke and later.

This is done for the convenience of drawing up the treatment plan, assessing the quality of results and predicting the completeness of recovery.

Early recovery after Stroke

Rehabilitation after stroke is a long and complex process, the early stage is aimed at restoring impaired brain functions. Treatment to restore speech, motor functions and memory includes physical therapy, classes with a speech therapist and taking a number of drugs that improve trophism and regeneration of nerve cells like Citicoline, Actovegin, Nimodipine, Cerebrolysin etc. Position of the American Stroke Association regarding the use of neuroprotective medications still remains unchanged. They state that currently there are no pharmacologically proven medications with presumably neuroprotective action which would be effective in the stroke treatment. However in Russia medical specialists have been paying close attention to neuroprotective therapy. Even though currently there is no generally approved program of neuroprotection, vast empirical experience of the use of neuroprotectors and nootropics allows their inclusion in stroke recovery process. 

Aims of early rehabilitation after a stroke:

  1. The maximum possible restoration of lost and impaired functions and minimization of the consequences of stroke.
  2. Prevention of recurrent stroke. Vascular accident makes the body more vulnerable and increases the risk of a second stroke, especially within a year after the first one. Therefore, a person who has suffered a stroke automatically falls into the risk group and needs an active recovery program as early as possible.

Where to start?

  • Drug therapy to improve nutrition and functions of nerve cells – taking neuroprotectors, neurometabolics, nootropics;
  • Drug therapy to eliminate factors predisposing to recurrent stroke – drugs against hypertension, atherosclerosis and other diseases;
  • Drug therapy to improve the psycho-emotional background – tranquilizers and antidepressants;
  • Physiotherapy and exercises – to establish the conduction of nerve impulses through the fibers of neurons, restore muscle strength, etc.;
  • Classes with a speech therapist to restore speech after a stroke;
  • Classes with a psychologist or psychotherapist, depending on the individual nature of post-stroke changes.

Post-stroke drug therapy

The drugs used after stroke are divided into two main types: 

  1. Neuroactive preparations – nootropics, neuroprotectors and neurometabolics, restoring the functionality of nerve cells; and
  2. Vasoactive preparations – working on blood circulation.

According to experts, the task of neuroprotective treatment is not only to protect the affected group of brain cells, but also to ensure further full functioning of the nervous tissue. Semax 1% plays a special role in rehabilitation after stroke. It simultaneously acts as a full-fledged neuroprotector, neurometabolic and nootropic, and can replace a number of drugs with mono-action. This avoids unnecessary drug burden on the patient and improves their psychological state.

Semax 1% is an effective link in rehabilitation in the early period after stroke and is involved not only in the recovery process, but also in the prevention of repeated vascular catastrophe. Thus it ensures the fulfillment of both main tasks at once. In the late recovery period, it is advisable to switch to a less potent version – Semax 0.1% [2].

How Long does it take to Recover after Stroke?

Much of the recovery process occurs during the first 3-6 months after a stroke. After the 6th month, the speed of these processes slows down. However, the restoration of functions can last up to 2 years or even longer. For example, there is a good chance of complete speech recovery after stroke if speech rehabilitation is started within the first weeks. Therefore, the early recovery period is crutial for the future of the patient: his\her ability to self-care, professional and social activity.

Dosage mode for Semax 1% at the Early stage of recovery after Stroke

Суточная дозировка Длительность приемаКоличество препарата на курс
Course duration: 15 days2 drops into each nasal passage
2x per day
2 bottles per course

One bottle contains 60 drops. Instillations must be carried out strictly on the nasal mucosa, preventing the leakage into the nasopharynx.


Late recovery after Stroke

Stroke recovery activities carried out after 6 months from the onset are called the late recovery period. If the treatment of stroke and recovery after it in the early period were started on time and carried out as fully as possible and then supplemented with measures in the late recovery period, the patient’s chances of returning to an active life will be very high.

This is a difficult task with a set of various measures which include: neuroprotection, physiotherapy and exercises, assistance of a speech therapist, psychologist and, of course, close people and family. All these measures combined will help a person get through this hard period of life easier, recover from stroke faster and return to a full-quality life.

Semax 0.1% neuropeptide is effective in the late period of recovery from a stroke due to its following properties:

  • It promotes the restoration of speech, memory, attention, and improvement of cognitive functions;
  • Increases the survival of neurons and the normalization of the functions of the nervous tissue;
  • Normalizes the work of vegetative centers;
  • Prevents the development of depression after stroke;
  • Provides restoration of the sleep / wake cycle.

Another advantage of Semax 0.1% is the convenience of its use. The dosage in the form of nasal drops is excellent for regular self-use by the patient or his/her relatives at home.

Dosage mode for Semax 0.1% at the Late stage of recovery after Stroke

Суточная дозировкаДлительность приемаКоличество препарата на курс
Course duration: 14 days4 drops into each nasal passage
3x per day
5 bottles per courserepeated course in 3-6 months.

One bottle contains 60 drops. Instillations must be carried out strictly on the nasal mucosa, preventing the leakage into the nasopharynx.

Recovery must be Consistent and Comprehensive

The better the restoration of functions was in the first 3-6 months, the greater the chances of their complete return to normal in the late rehabilitation period. Important brain functions such as speech recover gradually and at different rates. In the first 6 months, the activity of reparative processes in the nervous system is maximal. For example, recovery of speech after a stroke can occur after the 5-6th month of rehabilitation, provided that a drug therapy and classes with a speech therapist were carried out along the way in courses and with regularity of at least 2-3 times a week. After six months the recovery rate slows down but still continues. Total improvement in motor skills and other functions can take several years.

Rehabilitation measures after a stroke are carried out in courses, with breaks of 1-2 months. They necessarily include:

  • Drug therapy (neuroprotectors, antihypertensive drugs, antidepressants, and others);
  • Physical therapy and daily physical activity (walks in the fresh air);
  • Physiotherapy (water treatments, massage, myostimulation). 

To avoid a recurrent stroke, the late recovery period should include the following:

  • Control and correction of the levels of blood cholesterol derivatives (with atherosclerosis and lipid imbalance);
  • Control and correction of blood pressure;
  • Prevention of an increased risk of blood clots;
  • Protection of the nervous tissue from a new damage, improvement of the metabolism in neurons and their resistance to stress factors (neuroprotection).

This is done with the help and supervision of a medical specialist (therapist, cardiologist, neurologist), as well as with the help of prescribed medications, dietary and lifestyle changes.

Neuroprotective drugs after a stroke should be applied in courses several times a year.

Prevention of stroke as the most effective treatment

Stroke is a massive death of brain tissue because of impaired blood flow or hemorrhage. Stroke prevention is not only the treatment of major diseases, primarily hypertension and atherosclerosis, but also the preventive protection of brain cells from the effects of hypoxia and ischemia. 

How to prevent stroke?

Stroke prevention is the only way to protect yourself from severe and often irreversible consequences. Neurotrophic therapy is a reliable and affordable way to prevent the development of changes in the nervous tissue at the very initial stages.

Semax 0.1% has the properties for the prevention of stroke:

  • Optimize the metabolism in nerve cells;
  • Eliminate or reduce the incipient changes in the structure of the nervous tissue;
  • Weaken the destructive effect of concomitant diseases (atherosclerosis and others) as well as stress, and bad habits on the vascular system and nervous tissue of the brain;
  • Prevent primary disorders, as well as the aggravation of existing problems under the influence of neurotransmitters.

Clinical trials of Semax confirm that its use for the prevention of stroke in people suffering from chronic circulatory disorders in the brain reduces the risk of a vascular catastrophe by several times [5].

Dosage mode of Semax 0.1% for Prevention of stroke

Суточная дозировкаДлительность приемаКоличество препарата на курс
Course duration: 10 days3 drops into each nasal passage
2x per day
2 bottles per course2 courses per year

One bottle contains 60 drops. Instillations must be carried out strictly on the nasal mucosa, preventing the leakage into the nasopharynx.

Primary and secondary prevention of stroke

Primary prevention is the prevention of the first occurrence of a cerebrovascular accident. Secondary stroke prevention includes measures to prevent new vascular catastrophes after a previous case. Early initiation of the secondary prevention is vital, as the likelihood of a second stroke increases more than 10 times in the first year after the first stroke. Semax 0.1% can be effectively used for both primary and secondary prevention of stroke in men and women.

The common cause of strokes is our lifestyle: bad habits, low physical activity, poor diet, stress, lack of sleep and day regimen violations. Another predisposing factor is the presence of chronic diseases of the heart, blood vessels, endocrine organs, etc., which are not subject to timely drug control by a doctor [1].

Therefore, preventing vascular problems must necessarily include:

  • Early detection of chronic diseases (atherosclerosis, hypertension and others), regular medical examinations;
  • Medical treatment of concomitant diseases;
  • Healthy lifestyle.

Secondary prevention is complemented by medical methods: improving the trophism of the nervous tissue and controlling concomitant diseases and their complications. The combination of these methods can reduce the risk of recurrent vascular accidents by more than 80%. 


Semax in the treatment of TBI 

TBI treatment with Semax

Traumatic brain injury (TBI) is the result of damage to bones of the skull and brain tissue. It can be caused by bumps, falls, and accidents. TBI usually causes massive death of brain cells – neurons, and disrupts the connections between them. This type of neuronal damage is often aggravated by impaired cerebral blood flow, inflammatory reactions and edema of brain tissue.

Damage to neurons can be: 1) Primary or 2) Secondary (delayed).

Primary damage to nerve cells caused by a mechanical impulse proceeds as follows:

  • Damage to the brain tissue and bones of the skull occurs.
  • Mechanical impact causes displacement of layers of nerve cells, as well as direct damage to their membranes and processes.
  • This causes violation of the normal connections between nerve cells and an increase in intracranial pressure. 
  • Damage may be accompanied by the malnutrition of the surviving neurons.
  • Temporary dysfunction or death of nerve cells may follow.

Secondary damage to brain cells occurs because the death of neurons during the primary TBI damage triggers a complex biochemical process or a cascade of reactions that provoke the expansion of the affected area with the capture of healthy cells:

  • When the brain is compressed or bruised, an inflammatory reaction, tissue edema, local disturbance of blood flow and the lack of oxygen supply to neighboring neurons develop around the damaged nerve cells.
  • These changes lead to a decrease in the functional activity and metabolism in healthy cells and to their gradual death. 
  • In addition, the formation of colonies of cells inferior in function and prone to subsequent “programmed” death – apoptosis, takes place.
  • Against the background of these changes, there is a risk of a vascular damage and intracerebral hemorrhage after an injury.

The treatment of all types of TBI is aimed at prevention and elimination of the risk of such complications.

What are different types of head injuries?

The division of traumatic brain injury into types helps to choose the right treatment and to prevent consequences of the injury.

According to the type of injury, TBI is divided into open and closed.

  1. Closed TBIs are those without damage to the aponeurosis and meninges.
  2. Open type includes cases with damage to these structures and fractures of the base of the skull, accompanied by the outflow of cerebrospinal fluid from the nasal passage or an ear, and possible bleeding.

The severity of an injury is determined by the clinical manifestations of TBI and diagnostic examinations (head tomograms or X-rays of the skull bones). The success of the treatment and the risk of developing irreversible consequences of TBI depend on the severity of the injury.

  • The mildest clinical form of trauma is a concussion. Its symptoms include short-term loss of consciousness, headache, single vomiting and sleep disturbance etc. These and other symptoms usually disappear in 2-7 days.  Most consequences of concussion are reversible, and their treatment is based on observation, symptomatic therapy (analgesics, sedatives, etc.) and prevention of possible complications (neuroprotective agents). The treatment of concussion patients should also include bed rest for several days. The decision on hospitalization is made by the doctor after the examination of the patient.
  • Brain contusion is accompanied by more significant damage to the nervous tissue and is also divided in types according to the severity. It is determined by a set of signs: the duration of loss of consciousness, the severity of neurological symptoms (speech impairment, mental disorders, paresis, etc.), and diagnostic examinations. In case of a contusion, the treatment depends on the manifestations of the disease and on the presence of an intracerebral hematoma. If there is a hemorrhage in the brain tissue or under the lining of the brain, surgical treatment is often required. In a contusion, neuronal death can occur because of the direct destruction of brain tissue at the time of the injury, as well as under the influence of intracerebral hemorrhage and increased intracranial pressure (ICP).

Various combinations of TBI types can be observed simultaneously: contusion and compression by hematoma, contusion and subarachnoid hemorrhage, diffuse axonal injury and contusion, etc.

How to treat TBI and eliminate its consequences?

Modern science has proven that nerve tissue can be recovered. Therefore, treatment for traumatic brain injury should include the following tasks:

  1. Elimination of the causes of the death of nerve cells (elimination of intracranial hematomas, decrease in ICP, etc.);
  2. Suspension of the secondary damage to the brain tissue;
  3. Creation of conditions for active nutrition and oxygen supply to all areas of the brain;
  4. Stimulation of recovery processes and the formation of new neural connections.

Semax 0.1% is a neuroprotector and neurometabolic agent, the properties of which make it possible to effectively perform several of the listed tasks. Therefore, it is successfully used after different types of TBI, including concussion for the treatment and prevention of its consequences, along with other drugs prescribed by the attending physician. [9

Dosage mode for Semax 0.1% at TBI

Суточная дозировкаДлительность приемаКоличество препарата на курс
Course duration: 14 days3 drops into each nasal passage
3x per day
4 bottles per course

One bottle contains 60 drops. Instillations must be carried out strictly on the nasal mucosa, preventing the leakage into the nasopharynx.

The effects of Semax 0.1% include:

  • Acceleration of recovery from coma and amnesia;
  • Restoration of motor and sensory functions, due to the improvement of the creation of new connections between neurons instead of the lost ones;
  • Restoration of cognitive functions, improvement of attention, mental state;
  • Improvement and restoration of memory, due to the influence on all stages of the process (memorization, processing and reproduction of information);
  • Relief of post-traumatic depression;
  • Normalization of the work of vegetative centers;
  • Prevention of encephalopathy and loss of work skills.

It’s still important to note that there is no single universally effective neurometabolic agent for TBI survivors. In order to increase the effectiveness and reduce the likelihood of side effects after a TBI, the combination treatment with a wide choice of medicational options is needed depending on a particular case. The choice of the therapy is very difficult, and it depends on many clinical factors and characteristics of the drugs and should be made by the doctor.


Bibliography

  1. Sacco RL (1995). Risk factors and outcomes for ischemic stroke. https://pubmed.ncbi.nlm.nih.gov/7885584/
  2. Zaets TY et al (2001). The use of Semax in the early recovery period of ischemic stroke. https://semax.ru/upload/iblock/35d/35d2ea3b64759a3a1ebe812bbebf55fc.pdf
  3. Puchkova EI, Alishev NV (2001). Study of the medicinal properties of the “Semax” oligopeptide in the rehabilitation of veterans of special risk units. https://lana-riz.nethouse.ru/static/doc/0000/0000/0094/94855.dkch61cj7o.pdf
  4. Bogousslavsky L (2003). Stroke prevention by the practitioner. https://pubmed.ncbi.nlm.nih.gov/12774793/
  5. Gusev E.I., Skvortsova V.I., Chukanova E.I. (2005). Semax in prevention of disease progress and development of exacerbations in patients with cerebrovascular insufficiency. https://pubmed.ncbi.nlm.nih.gov/15792140/
  6. Skvortsova VI (2010). The use of the neuroprotector “Semax 1%” in the first hours and days of acute cerebral stroke: guidelines for practical health care. https://semax.ru/upload/iblock/7b5/7b52764d1034555f7a95cb746d7da1ec.pdf
  7. Ivanova N.E. (2012). The results of taking the drug Semax in cognitive disorders in the acute phase of ischemic stroke and in chronic brain ischemia. https://umedp.ru/articles/rezultaty_primeneniya_preparata_semaks_pri_kognitivnykh_narusheniyakh_v_ostrom_periode_ishemicheskog.html
  8. Kostenko EV et al (2018). The efficacy of semax in the treatment of patients at different stages of ischemic stroke. https://pubmed.ncbi.nlm.nih.gov/29798983/
  9. Zaitsev OS (2010). Selection of neuromethabolic drug in severe brain injury. https://www.researchgate.net/publication/49766788_Selection_of_neuromethabolic_drug_in_severe_brain_injury
  10. Shabanov PD, I.V. Zarubina IV (2019). Hypoxia and Antihypoxants, Focus on Brain Injury. https://journals.eco-vector.com/RCF/article/view/12961/10266
  11. Official web-page of Semax nasal drops: [Electronic source]. URL: https://semax.ru/

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