Original article The effect of NeuroAiD™ (MLC601) on cerebral blood flow velocity in subjects' post brain infarct in the middle cerebral artery territory Reza Bavarsad Shahripour a, ⁎, Gholamreza Shamsaei a , Hosein Pakdaman b , Nastaran Majdinasab a , Ehsan Mohammadiani Nejad a , Seyed Aidin Sajedi a , Mehdi Norouzi a , Ahmad Hemmati a , Reza Haj Manouchehri a , Abolfazl Shiravi c a Neurology Department, Golestan Hospital, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran b Neurology Department, Shahid Beheshti University of Medical Science, Tehran, Iran c Students' Research Committee, Faculty of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran abstract article info Article history: Received 17 October 2010 Received in revised form 25 December 2010 Accepted 7 January 2011 Available online 4 February 2011 Keywords: Ischemic Stroke Brain infarct Middle cerebral artery Mean blood flow velocity Neuroplasticity Background: Stroke is the third common cause of mortality and the most common cause of morbidity in adults. MLC601 (NeuroAiD™) is a treatment indicated for post stroke recovery. An increase of impaired cerebral blood flow may be an important parameter for recovery processes. The aim of this study was to investigate the effect of MLC601 on cerebral blood flow velocity as an indirect evidence of cerebral blood flow increase in post stroke subjects. Methods: This is a double-blinded, placebo controlled, randomized study of 80 subjects included within a week of stroke onset. All subjects were given either MLC601 or placebo, 4 capsules, 3 times a day for 3 months. Cerebral blood flow within the middle cerebral artery, with blood flow velocity measured by transcranial Doppler (TCD), and Barthel index was assessed at baseline and at 3 months. Results: The mean change in cerebral blood flow velocity in the MLC601 treatment group (15.9) was significantly increased (p = 0.009) compared to the placebo group (9.6). Subjects in the treatment group also showed a significant difference in the mean rank of modified ranking scale (p b 0.001) and mean change of the Barthel Index: 36 vs. 29 in the placebo group (p b 0.001). Conclusion: This is the first study suggesting that treatment with MLC601 may increase cerebral blood flow in stroke subjects. This may be mediated by an effect on stimulating microcirculation, an important process contributing to neuroplasticity in the central nervous system. This effect on cerebral blood flow may be associated with improvement in measures of functional recovery. © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. 1. Introduction Stroke is the third common cause of mortality and is the most common cause of long-term disability in adults. Ischemic and hemorrhagic stroke account respectively for 82% and 18% of all strokes in Iran [1]. Cerebral infarct leads to a localized death of brain tissues. Emergency treatment for ischemic stroke is essentially limited to thrombolysis [2] and is only applicable to less than 1% of patients in Iran due to general limits in eligibility criteria, hurdles in patient care, high cost and lack of health insurance coverage for this intervention [3]. 75% of survivors are affected by serious disabilities, which depend on the size and the location of the injury in the brain and may affect all neurological functions: motor, sensory and cognitive. The sudden interruption or decrease of the blood supply results in oxygen and energy deprived neurons in the ischemic core zone to cease function and show rapid sign of structural damage within minutes resulting in neuronal death [4]. Typically the core fails to regain its fine dendritic structure after reperfusion. In the penumbral zone, the blood flow increases towards the midline as tissues are supplied by other artery system left unblocked during the stroke and some loss of dendrites will reverse when reperfusion occurs. The brain has a natural ability to recover function [5], as some loss reverses in the penumbra and later through neuroplasticity processes; the brain establishes new synaptic connections and modulates the strength of existing connections [6]. These processes which are supported by an efficient microcirculation in the brain tissues as well as cell proliferation and migration towards the periphery of the injured tissues and the formation of new neuronal circuits [7]. There is a need for new treatments for stroke rehabilitation to support these processes and help patients achieving a more complete recovery. MLC601 (NeuroAiD™, Moleac Pte.Ltd, Singapore) is a TCM (Traditional Chinese Medicine), which is used extensively in Asia to facilitate recovery after stroke [8]. It combines nine herbal compounds (including Radix astragali, Radix salviae miltiorrhizae, Radix paeoniae European Journal of Internal Medicine 22 (2011) 509–513 ⁎ Corresponding author. E-mail address: nbavar@yahoo.com (R. Bavarsad Shahripour). 0953-6205/$ – see front matter © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejim.2011.01.002 Contents lists available at ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim