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Stroke is one of the most common lifestyle diseases and is currently a leading medical cause of adult disability and loss of quality-adjusted life years.  The prognosis for survival from the disease is worse than that of most forms of cancer. Stroke leaves many people disabled, with many undergoing long periods of rehabilitation (Hinkle & Guanci, 2007). Stroke is characterized by a sudden weakness on the face, the leg and arm on one side of the body; diminishing vision on one eye; trouble talking or loss of speech; severe headaches; dizziness, unsteadiness or sudden falls, especially accompanied by other symptoms.

Stroke is a medical emergency, whether temporary or a major stroke and quick treatment is necessary. The key to treatment and recovery is prompt medical treatment. Treatment of stroke has always been medications that are aimed at preventing platelet adhesion, thus preventing blood clot formation as well as decrease the amount of brain damage following a stroke. Other medications to avoid the risk factors of stroke should also be prescribed ((Hinkle & Guanci, 2007).

Stroke treatment is associated with an increase in direct expenses for both families and society, which eventually brings the expenditure to a very high level according to healthcare costs. In the United States stroke affects an estimated 700, 000 people each year and, hence is one of the most alarming health problems. This eventually leads to very high expenditures for stroke related conditions, accounting for about 5% of most developed countries’ health care costs.

The main therapy in the cure of stroke is the administration of medications called thrombolytics. Randomized clinical trials indicate that the administration of thrombolytic therapy within six hours of onset is beneficial to selected patients, despite the risk of intracranial haemorrhage (Lovera et. al., 2007)

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Ginkgo biloba treatment is an extract from dried leaves of the Ginkgo tree. Clinical trials reveal that this extract contains active substances which have demonstrated several haemorheological, vascular and metabolic actions that exert a platelet adhesion effect preferentially directed at the ischemic zone (Junhua et. al., 2009). Therefore, experimental studies have shown support for the use of ginkgo biloba in the treatment of stroke. It has been demonstrated that Ginkgo biloba increases cerebral blood flow significantly and glucose uptake to the brain cells. Experimental studies have also shown that it reduces the likelihood of dementia following an attack.

This study aims at analyzing systematically the effectiveness of ginkgo biloba in the management of stroke and provides the best available evidence for clinical practice, as well as the outcomes of treatment after the maintenance treatment of stroke using ginkgo.

Literature Review

Studies in patient responses on the type of medication provide crucial information on the evaluation of stroke symptoms as well as the effects of medication on the well-being of the patients and the levels of functional activities. These studies are necessary in evaluating the effectiveness of Ginkgo biloba in the treatment of stroke. Medical practitioners depend on this information in prescribing medications to patients.

A stepwise approach to disease management is necessary for the assessment and eventual treatment of stroke. One of the main goals of stroke treatment is to uphold the well-being of people as one of the main humanistic upshot measures (Birks, Grimley & Evans, 2009). Today clinicians use many other measures to manage diseases with a need to control the effects of stroke as well as the well-being of the patients. These measures include patient satisfaction as well as other health related measures that are centered on the quality of life. Studies have revealed that patients’ preferences have a great impact on medication side effects, as well as the patients’ quality of life. Patients’ compliance with the medication is also necessary for successful control of stroke (Birks, Grimley & Evans, 2009). Disease control measures are also very crucial in reinforcing the postive perceptions of the treatment of stroke.

Many investigators in their publications from studies have revealed that Ginkgo biloba ameliorates the electrolyte imbalance present in cerebral edema and has a positive effect on haemorheoloy. In China Ginkgo biloba is widely accepted and used by health care providers in the treatment of ischemic stroke. It has also been prescribed occasionally in Germany and France in the treatment of acute stroke. However, the review of scientific evidence regarding the extract has not been systematic and effective. Nevertheless, some randomized controlled trials of Ginkgo biloba in ischemic stroke have been reported.

Research has shown that Ginkgo biloba increases the body’s production of Adenosine Triphosphate (ATP), an activity that has been shown to boost the energy of the brain to metabolize glucose and increase electrical activity. Studies have also shown that Ginkgo biloba contains useful compounds including vitamin C and carotenoids that are important antioxidants. However, the most remarkable ones are the flavonoid compounds that act to dilate the micro-capillaries. This leads to an increased flow of blood and oxygen levels to the brain tissues. The antioxidants present in Ginkgo biloba prevent platelet aggregation inside the walls of the arteries, maintaining their flexibility and decreasing the likelihood of an arteriosclerositic plaque to develop (Chen et. al., 2009).

One review on the Cochrane Stroke Group Trials was carried out including 792 patients. The study evaluated the treatment of Ischemic stroke using Ginkgo biloba with outcome measure being considerable betterment in neurological function when finishing the trials (Birks, Grimley & Evans, 2009). The assessment revealed considerable growth of the amount of recovered patients. The trials indicated significant improvement in the neurological deficit, and no major adverse effects or deaths were reported. However, the authors did not draw convincing evidence, since the methodological quality from the trials was not sufficient enough to encourage the regular use of the herb in the treatment of stroke. Nevertheless, the trials involving controls showed that the neurological improvement of those treated with Ginkgo biloba was significantly higher than the controls. The extract was also superior to placebo in the treatment of ischemic stroke (Birks, Grimley & Evans, 2009).

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Numerous studies have also shown that extract of Ginkgo biloba improves blood circulation to the extremities relieving swelling in the limbs, cold hands and feet as well as chronic arterial blockage (Lovera et. al., 2007). This makes it possible for patients to walk further with less difficulty. Research shows that Ginkgo biloba is widely used in Europe to treat complications of stroke, including disturbed thought processes, vertigo and memory and balance problems. Many studies also show that this herb helps to reduce fragility of capillaries, which can help to prevent haemorrhagic stroke. According to Lovera (2007), the most remarkable quality of the herb is that it can be used not only in treating stroke, but also in preventing it. Moreover, the herb was shown to inhibit free-radical formation and, more importantly, it is nontoxic. This makes it to be a drug of choice in preventing and slowing down the effects of degenerative diseases like stroke.

Pharmacology

The physiological action of Ginkgo biloba is dependent on the level of flavonoid and terpenoid components. The extract of Ginkgo biloba increases the integrity of body cells by exerting protective action in several ways. Stable intracellular polarity is ensured by activating the sodium balance in the cell membrane. In addition, the flavonoids possess great antioxidant qualities that decrease free radical lipid peroxidation (Junhua et. al., 2009). The ginkgolides prevent the platelets from aggregation and degranulation decreasing the likelihood of clot formation. Extract of Ginkgo biloba stimulates the relaxing factor in the vascular system exerting a vasodilatory effect. In cases of ischemic stroke, it exerts a relaxant effect in cases of spasms and increases tone in cases of paralysis.

Experimental studies have also revealed that extract of Ginkgo biloba exerts a protective action on neuronal tissue and cerebral function, especially in cases of low oxygen levels. The herb improves neurotransmitter production and regrowth of damaged neurons in the central nervous system which aids in the recovery process after stroke. Numerous clinical trials have documented the effectiveness of the extract in increasing the cerebral function caused by vascular insufficiency in stroke cases (Junhua et. al., 2009).  

Clinical Implications

Extract of Ginkgo biloba represents alternative medicine that has been supported considerably by research evidence in the treatment of degenerative diseases. Many medical practitioners continue to prescribe the herbal medicine and this leads to the conclusion that their patients derive similar benefits to those observed in numerous published studies (Chen et. al., 2009). Ginkgo biloba, when taken in the right dosage and for a sufficient period is likely to improve memory and physical well-being in both healthy persons and individuals with cognitive pathology.

Side Effects. Counterindications and Warnings

The side effects associated with Gingko biloba include gastrointestinal distress, such as diarrhea and nausea; headaches; dizziness and allergic skin reactions. However, these side effects are relatively mild and infrequent. Extract of Ginkgo biloba should be avoided before and after surgery to avoid bleeding. Patients taking blood thinners should also avoid this herb because it can interfere with platelet aggregation (Birks, Grimley & Evans, 2009). The other group of persons who should avoid the extract is those taking medications to prevent seizures and those who have ever had a seizure. In addition, the safety of Ginkgo biloba in pregnant and breastfeeding women and young children is not established.

Dosage

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The optimal dose is necessary in order to achieve maximum benefits. The typical daily dose of Ginkgo biloba for cerebral dysfunction is from 120 mg. for mild and moderate cases to 240 mg. in serious cases of a standardized extract. The standardized level of modern Ginkgo biloba extract consists of 24 % of flavonoids and 6-7% of terpenoids. Other naturally occurring components of the leaf, such as sterols are present only in minimal levels.

Summary

Ginkgo biloba is extensively used in China and Europe in the treatment of ischemic stroke. Clinical trials support that extract of Ginkgo biloba improves blood flow and glucose uptake into brain tissues. This study reviewed trials of extract of Ginkgo biloba in patients with ischemic stroke and the results were encouraging. The findings of this study demonstrate that the use of Ginkgo biloba significantly increases neurological improvement and hence the quality of life in patients presenting with acute ischemic stroke. The study suggests that the extract of Ginkgo biloba has clinical benefits in critical care settings and these benefits are evident in both mild and more serious cases.

The above studies were conducted in geographically distinct settings, with varying patient populations, physicians and socioeconomic conditions demonstrating that the herb improves patients’ outcomes by reversing cognitive degeneration and also prevents the occurrence of the disease in healthy persons. A post-hoc analysis on the patients found that their recovery significantly improved after the treatment was commenced.

Stroke cases cannot be handled in all healthcare facilities and this leads to very high costs both in treatment and rehabilitation. The use of extract of Ginkgo biloba will reduce the cost burden of the disease both on the family and society level. The clinical and preclinical benefits of Ginkgo biloba observed in the literature cited in this investigation show that the therapy produces both clinical and economical advantages. However, more high quality and large scale randomized controlled trials are required to assess the efficacy of the herb in the treatment of stroke. This will go a long way in reducing the disease burden that comes with stroke.

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