الفهرس 
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Abstract
Our finding is that Citicoline useful in the management of severe head injury
IS known to hasten neurological recovery, reduce duration of mechanical
ventilation and hospital stay but does not affect mortality or disability.
In 1967, Moriyama et al. (175) published their study on the effects of
citicoline in 25 patients with head trauma and depressed consciousness. The drug
was shown to be effective, leading to recovery from neurological clinical
symptoms and return to a conscious state, in 70% of cases, and was very well
tolerated, causing no side effects.
De la Hemin et al. (l76) compared the effects of Citicoline administration
in a series of 50 patients with an impaired level of consciousness, of a traumatic
origin in 32 cases, to another series of patients with similar characteristics who
were receiving standard treatment. Thirty-four percent of patients recovered
consciousness within 48 hours. After a few days, ~6% of patients had recovered
consciousness. These results were better than those achieved in the control
group. With these. results, authors showed that citicoline reactivates and
accelerates normalization of the consciousness stated in patients with head
trauma.
Espagno et al. (177) compared the effects of Citicoline versus placebo in a
series of 46 patients who had sustained a head trauma. For this, authors conducted
a double-blind study in which 22 patients received citicoline 250 mg/d by the
parenteral route for 20 days, while 24 patients were given placebo. The results obtained showed that, in mild coma, citicoline significantly accelerated (p < 0.05)
recovery of consciousness, while in more severe coma and at the administered
dose, that is currently considered to be highly inadequate, citicoline improved
prognosis, so that 75.2% of patients in the placebo group showed a late recovery (>
15 days) of consciousness and/or progressed to death. By contrast, in the group
treated with the active product, recovery from coma beyond the is” day occurred
in 31 % of cases, and incidence of prolonged coma and/or death was 12.5%. In
conclusion, citicoline resulted in an earlier recovery of consciousness and an
increased number of clinical and electroencephalographic improvements, and was
also very well tolerated.
Richer and Cohadon (178) conducted a double-blind study in a group of 60
patients with coma of a traumatic origin who were distributed into two
homogeneous groups, one of which was given the active drug, and the other
placebo. As regards coma duration, the number of patients who had recovered
consciousness at 60 days was significantly greater (p < 0.01) in the group treated
with citicoline. After 90 days, a greater recovery (p < 0.04) from the motor deficit
was found in the citicoline-treated group. Gait recovery was also shown to be
significantly accelerated in the active drug group. As a result, a greater social and
occupational reinsertion was found at 60 days in the group treated with citicoline
(p < 0.06). This demonstrated the limiting effect of duration ofposttraumatic coma
of citicoline, as well as its participation in restoration of deficits related to the brain
lesions associated to such coma. However, there were no changes in mortality
associated to the treatments.
Cohadon et al. (179) showed the clinical efficacy of citicoline in a double-
blind study conducted on a series of 60 patients with severe head trauma. A
standard treatment was used in both groups, and surgery was performed when
required. A group of patients was given citicoline 750 mg/d by the intravenous
route for the first 6 days, and subsequently by the intramuscular route for an
additional 20 days. The other group was administered placebo. Clinical evaluation
was continued up to 6 months. At 15 days, response to painful stimuli was already
superior in the group of citicoline-treated patients (p < 0.01), in which an earlier
recovery of consciousness was also seen. Authors also noted a greater recovery
from neurological deficits in the active group. After 120 days, autonomous
ambulation was seen in 84% of patients in the citicoline group, as compared to
62.5% of patients in the placebo group. This difference was statistically significant
from day 60 (p < 0.01). The mortality rate was similar in both groups. Data
reported in this study show that citicoline shortens the time elapsed to recovery of
consciousness and accelerates recovery from neurological deficits in patients with
severe head trauma.
At the Department of Neurosurgery of the ”Ramon y Cajal” Special Center
in Madrid, a series of 100 patients with HT treated with citicoline until discharge
were studied, and their results were compared to those of another series of 100
patients with similar characteristics, but who did not receive citicoline. (180)
Treatment with citicoline was started at doses of 600-1200 mg/d by the parenteral
route, switched to 300-900 mg/d by the oral route in the rehabilitation phase. The
course was monitored by assessing mean coma duration, persistence of
neurological and psychic symptoms.. Results achieved suggested that citicoline
addition to the treatment regimen caused a decrease in duration of posttraumatic
coma and rate of both neurological and psychological sequelae and achieved a
better response in recover; from intellecgjal disorders and motor deficits.
Raggueneau ani Jarrige (181) in a national survey conducted in France,
recorded 921 cases of severe Head Truma with an initial score in the Glasgow
Coma Scale (GCS) of 8 or less. Of these, 219 patients had been treated with
citicoline, which allowed for distribution into two groups to compare the results
obtained. No significant differences were found in mortality, but differences were
seen in the number of dependent states, and the greatest effect was found in
patients with an initial GCS score of 6-7. Citicoline improved quality of survival,
allowing for more frequent social and familiar reinsertion, as well as return to work
or school.
Lozano (182) reported the impact of citicoline therapy on the course of
posttraumatic cerebral edema in a study conducted in 78 cases of Head Truma with
an initial GCS score ranging from 5 and 7. In all cases, a computerized
tomography of the head was performed at the start and end of the study to assess
changes in the tomographic image of cerebral edema. Other parameters
investigated included duration of hospital stay and the extent of autonomy at
hospital discharge. Citicoline was administered to 39 patients for the first 2 weeks
at a dose ranging from 3 and 6 g/d by intravenous infusion. After 14 days of
treatment with citicoline, image of cerebral edema evolved. Cerebral edema had
been reduced or normalized in a higher number of patients treated with citicoline
as compared to control patients, with differences being highly significant (p <
0.005). No significant differences were seen between both groups in therapeutic
requirements or treatments received. Mean hospital stay was 28.718 ± 21.6 days
for the group receiving active treatment and 37.323 ± 35.22 days for the control
group, with statistically significant differences (p < 0.001). Differences in final
outcomes assessed according to the Glasgow Outcome Scale (GaS) did not reach
statistical significance.