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Administration of Cilostazol, an Antiplatelet, to Patients with Acute-stage Cerebral Infarction and Its Effects on Plasma Substance P Level and Latent Time of Swallowing Reflex

Arata Abe, Yasuhiro Nishiyama, Hiroshi Hagiwara, Seiji Okubo, Masayuki Ueda, Ken-ichiro Katsura and Yasuro Katayama

Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School

Background and Objective: It has been reported that medical treatment with cilostazol (cilo) as an antiplatelet may increase a substance P level in the striatum to shorten the latent time of swallowing reflex (LTSR). We undertook a pilot study to confirm whether cilo administration to patients with cerebral infarction is effective in increasing their plasma substance P level and then in ameliorating the status of LTSR.
Methods and Subjects: Eligible subjects were recruited, after informed consents, from 20 hospitalized patients with acute-phase cerebral infarction within 72 hours from the onset. At the start of treatment, the subjects were assigned at random to those given aspirin alone (non-cilo group) and those given aspirin plus cilo (cilo group). Plasma substance P levels and LTSR values were measured at the starting point (baseline), 28 days after, and 180 days after.
Results and Discussion: No significant time-dependent change in plasma substance P level was found probably because of large individual differences but, 28 days after the start of treatment, this value tended to become higher in cilo group than in non-cilo group (P<0.10). Whereas, in terms of fold changes of LTSR in cilo group, there was a significant between-term difference at P<0.05, indicating that this medication is effective in ameliorating the swallowing function is improved in the long run.
Conclusion: The LTSR values was significantly shortened within 180 days after the start of cilo treatment, but the result was not well explained by substance P levels as far as these were measured using the plasma, probably because this substance had diluted during blood circulation. However, it will become clinically usable as a single swallowing index, if in the future some ingeneus method of its measurement is developed. A larger-scale study would also be needed to confirm our conclusion from this pilot study.

J Nippon Med Sch 2013; 80: 50-56

Keywords
substance P, Cilostazol Stroke Prevention Study (CSPS), simple swallowing provocation test, acute cerebral infarction, latent time of swallowing reflex

Correspondence to
Arata Abe, MD, PhD, Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
abe@nms.ac.jp

Received, March 14, 2012
Accepted, September 11, 2012