Citicoline After Stroke: Does It Help Recovery?

randomized-controlled-trial PMID: 35639720

Citicoline After Stroke: Does It Help Recovery?

Quick Summary: This study tested if citicoline, a form of choline, could boost recovery after a common type of stroke called acute ischemic stroke (AIS). Patients got it right after artery-opening treatment, but it didn't lead to better outcomes than a placebo. While brain damage seemed to shrink a bit more with citicoline, the difference wasn't big enough to matter statistically.

What The Research Found

Researchers wanted to see if citicoline could protect brain cells and improve recovery when given soon after stroke treatment. They measured brain damage on MRI scans and checked how well patients could function after three months.

Key results showed no real edge for citicoline:
- Brain damage (infarct volume) shrank by 4.2 cubic centimeters with citicoline, compared to 2.6 with placebo over six weeks. But this gap wasn't statistically significant (p=0.483), meaning it could be due to chance.
- At three months, chances of good recovery were similar in both groups:
- Low stroke severity score (NIHSS 0-2): Odds ratio 0.96 (95% CI 0.39-2.40)
- Low disability level (mRS 0-2): Odds ratio 0.92 (95% CI 0.40-2.05)
- High daily function score (Barthel index ≥95): Odds ratio 0.87 (95% CI 0.22-2.98)
These numbers mean citicoline didn't clearly help patients move better, think sharper, or handle daily tasks more easily.

Study Details

Who was studied: 60 adults with acute ischemic stroke who had just undergone recanalization therapy (a procedure to reopen blocked brain arteries). Half got citicoline, half got placebo, split evenly.
How long: Treatment lasted 42 days total, with check-ins at six weeks (for brain scans) and three months (for function tests).
What they took: Citicoline group got 1 gram twice daily by IV for three days, then oral pills for 39 days. Placebo group got IV saline for three days, then multivitamin pills for 39 days. Everyone also got standard stroke care like blood thinners and rehab.

The trial was run at one hospital in India, randomized, and checked by unbiased experts.

What This Means For You

If you've had a stroke or know someone who has, this study suggests citicoline right after artery-opening treatment won't likely speed up your recovery or shrink brain damage more than usual care. Choline supplements like citicoline are sometimes used for brain health, but here they didn't make a noticeable difference in walking, self-care, or stroke symptoms.

Focus on proven steps instead:
- Follow your doctor's rehab plan, including physical therapy.
- Manage risks like high blood pressure to prevent future strokes.
- Talk to your doctor before trying citicoline—it's not a magic fix based on this, but it might help in other ways, like for memory, in different situations.

Study Limitations

This research has some hurdles that mean it's not the final word:
- Small group: Only 60 people, so it might miss small benefits that bigger studies could spot.
- One hospital only: Results might not apply everywhere, as patient care varies.
- Placebo had multivitamins: These could have helped recovery a bit, muddying the comparison.
- Short follow-up: Three months might not show long-term effects on the brain.
- No details on ages or stroke severity: We don't know if it worked better for certain people, like younger patients.

Larger studies are needed to double-check if citicoline has any role in stroke care. Always rely on your healthcare team for personal advice.

Key Findings

The study concluded that Citicoline administration immediately after recanalization therapy for acute ischemic stroke (AIS) did not significantly improve clinical or radiological outcomes compared to placebo. While Citicoline showed a greater reduction in infarct volume (4.2 cm³ vs. 2.6 cm³ with placebo), this difference was not statistically significant (p = 0.483). Secondary outcomes at three months—NIH Stroke Scale (NIHSS) scores ≤2, modified Rankin Scale (mRS) scores ≤2, and Barthel Index ≥95—also lacked meaningful differences, with odds ratios (ORs) close to 1 and wide confidence intervals (CIs) crossing unity.

Study Design

The CAISR trial was a single-center, randomized, placebo-controlled, parallel-group trial conducted at All India Institute of Medical Sciences. It enrolled 60 participants (30 in each arm) with AIS undergoing recanalization therapy. Randomization was 1:1, and outcomes were assessed by blinded evaluators. Follow-ups occurred at six weeks (MRI for infarct volume) and three months (clinical scales). The trial was registered (CTRI/2018/011900) and ethically approved.

Dosage & Administration

Citicoline was administered intravenously (1g twice daily for three days), followed by oral tablets (1g twice daily for 39 days). The placebo group received intravenous normal saline (100ml twice daily for three days) and multivitamin tablets twice daily for 39 days. Both groups received standard post-stroke care.

Results & Efficacy

Primary Outcome: Infarct volume reduction from baseline to six weeks was 4.2 cm³ in the Citicoline group vs. 2.6 cm³ in the placebo group (p = 0.483), indicating no statistically significant benefit.
Secondary Outcomes (3-month follow-up):
NIHSS ≤2: OR = 0.96 (95% CI 0.39–2.40)
mRS ≤2: OR = 0.92 (95% CI 0.40–2.05)
Barthel Index ≥95: OR = 0.87 (95% CI 0.22–2.98)
All CIs included 1, and p-values were non-significant, suggesting no clear efficacy of Citicoline.

Limitations

Small Sample Size: Only 60 participants (30 per arm) may have limited statistical power to detect modest effects.
Single-Center Design: Findings may lack generalizability to broader populations or healthcare settings.
Placebo Composition: Multivitamins in the placebo arm could confound results if they influenced recovery independently.
Short Duration: Three-month follow-up might be insufficient to capture long-term neuroprotective effects.
Demographics Not Specified: Age, gender, or baseline stroke severity data were not detailed in the summary, limiting subgroup analysis.

Clinical Relevance

For AIS patients undergoing recanalization, adding Citicoline to standard care does not demonstrably improve functional recovery or reduce brain injury based on this trial. While Citicoline is theorized to support neuroprotection by stabilizing cell membranes and reducing inflammation, this study challenges its utility in acute post-stroke settings. Supplement users should note that these results apply specifically to Citicoline use after recanalization therapy; other populations (e.g., cognitive support, prevention) may require separate evaluation. Larger, multi-center trials with longer follow-ups are needed to confirm these findings.

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