• L Candelise and A Ciccone.
• Istituto di Clinica Neurologica, Universita di Milano, Ospedale Maggiore, Via F. Sforza 35, 20122 Milano, Italy. pitagora@imiucca.csi.unimi.it
• Cochrane Db Syst Rev. 2000 Jan 1; 2001 (2): CD000094CD000094.

BackgroundGangliosides may have a protective effect on the central and peripheral nervous systems.ObjectivesThe objective of this review was to assess the effect of exogenous gangliosides in acute ischaemic stroke.Search StrategyWe searched the Cochrane Stroke Group trials register (last searched: March 1999) and contacted drug companies.Selection CriteriaRandomised trials of gangliosides compared with placebo or standard treatment in people with definite or presumed ischaemic stroke. Trials were included if people were randomised within 15 days of symptom onset and if mortality data were available.Data Collection And AnalysisOne reviewer applied the inclusion criteria. Two reviewers independently extracted the data. Trial quality was assessed.Main ResultsEleven trials involving 2257 people were included. All the trials tested purified monosialoganglioside GM1. Only three trials described the randomisation procedure. Follow-up was between 15 to 180 days. Death at the end of follow-up showed no significant difference (odds ratio 0.91, 95% confidence interval 0.73 to 1.14). There was no difference shown between early (within 48 hours) and delayed treatment. For disability, two trials showed an improved Barthel index score with gangliosides (weighted mean difference 8.6, 95% confidence interval 1.2 to 16.0). In two trials, eight patients experienced adverse effects that led to discontinuation of ganglioside treatment, seven had skin reactions and one developed Guillain-Barré syndrome.Reviewer's ConclusionsThere is not enough evidence to conclude that gangliosides are beneficial in acute stroke. Caution is warranted because of reports of sporadic cases of Guillain-Barré syndrome after ganglioside therapy.

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