Effect of methylphenidate and/or levodopa coupled with physiotherapy on functional and motor recovery after stroke - a randomized, double-blind, placebo-controlled trial

Lökk, Johan; Roghani, Reza Salman; Delbari, Ahmad

doi:10.1111/j.1600-0404.2010.01395.x

Cited by 52 publications

(51 citation statements)

References 41 publications

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“…Our finding that mood recovery is improved by a combined treatment (MPH + LD) accords with the result of a previous investigation in which there was a significant difference in the Barthel Index compared to placebo [29]. It seems that combination therapy may have a widespread effect on ADL and mood recovery by the presence of L -dopa, thereby causing increased dopamine levels.…”

Section: Discussionsupporting

confidence: 81%

Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial

Delbari¹,

Roghani

Lökk

2011

Eur Neurol

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Background/Aim: Stimulant medications can enhance mood and cognition in stroke rehabilitation, but human clinical trial results are inconclusive. We sought to prospectively study the effects of levodopa (LD) and/or methylphenidate (MPH) in combination with physiotherapy on mood and cognition following stroke in human subjects. Methods: Ischemic stroke patients were enrolled in our study 15 to 180 days after stroke onset. The patients were randomized into four medication groups (MPH, LD, MPH + LD, or placebo) and received a 15-day course of medication therapy (1 dose daily) and 45-min standard physiotherapy treatment daily. Mood and cognitive function were assessed at the study onset and 15, 90 and 180 days after study enrollment. Results: The strongest improvement of mood and cognition was found between baseline and the first follow-up immediately after the intervention. A significant improvement in mood was also found in the combined treatment group (MPH + LD) at 90 and 180 days, compared to the placebo group. Conclusions: A 15-day course of daily MPH + LD combined with physiotherapy over a 3-week period was safe and significantly improved mood status in ischemic stroke patients. Future studies are needed which determine the optimal therapeutic window for and dosage of psychostimulants as well as identify those stroke patients who might benefit the most from treatment.

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Section: Discussionsupporting

confidence: 81%

Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial

Delbari¹,

Roghani

Lökk

2011

Eur Neurol

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“…6 Likewise, clinical studies have shown that the use of pharmacological therapies that increase brain concentrations of brain amines such as dopamine and serotonin promotes a positive impact on stroke outcomes. 7 Moreover, the modulation of serotoninergic neurotransmission by using selective serotonin reuptake inhibitors such as fluoxetine and citalopram improved motor and cognitive recovery in both the clinic 8,9 and the laboratory. 10 Positron emission tomography (PET) with [ 11 C]DASB and [ 18 F]altanserin has widely been used to investigate the availability of serotonin transporter (SERT) and serotonin receptor 5-HT 2A in both humans and animals.…”

Section: Introductionmentioning

confidence: 99%

PET Imaging of Serotoninergic Neurotransmission with [¹¹C]DASB and [¹⁸F]altanserin after Focal Cerebral Ischemia in Rats

Martín

Szczupak

Gómez‐Vallejo

et al. 2013

J Cereb Blood Flow Metab

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The use of selective serotonin reuptake inhibitors has shown functional improvement after stroke. Despite this, the role of serotoninergic neurotransmission after cerebral ischemia evolution and its involvement in functional recovery processes are still largely unknown. For this purpose, we performed in parallel in vivo magnetic resonance imaging and positron emission tomography (PET) with [ 11 C]DASB and [ 18 F]altanserin at 1, 3, 7, 14, 21, and 28 days after middle cerebral artery occlusion (MCAO) in rats. In the ischemic territory, PET with [ 11 C]DASB and [ 18 F]altanserin showed a dramatic decline in serotonin transporter (SERT) and 5-HT 2A binding potential in the cortex and striatum after cerebral ischemia. Interestingly, a slight increase in [ 11 C]DASB binding was observed from days 7 to 21 followed by the uppermost binding at day 28 in the ipsilateral midbrain. In contrast, no changes were observed in the contralateral hemisphere by using both radiotracers. Likewise, both functional and behavior testing showed major impaired outcome at day 1 after ischemia onset followed by a recovery of the sensorimotor function and dexterity from day 21 to day 28 after cerebral ischemia. Taken together, these results might evidence that SERT changes in the midbrain could have a key role in the functional recovery process after cerebral ischemia.

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“…Patients receiving levodopa had significant improvement in motor recovery and independent ambulation. Subsequent small studies using levodopa with or without methylphenidate [36] or levodopa with or without amphetamine [37] could not show a difference in motor recovery or improvement in functional outcomes with treatment. An ongoing study which commenced in 2010, has enrolled 572 patients are to receive 100 mg of levodopa and 25 mg of carbidopa, or placebo, 1 hour before physiotherapy.…”

Section: Enhancing Recovery With Special Reference To Walking and Aphmentioning

confidence: 94%

Pharmacological Agents in Post Stroke Recovery

Moonis¹

2014

JNSK

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Pathophysiology of ischemic stroke [7]The degree and duration of impaired blood flow determines the extent and pattern of cerebrovascular damage. Ischemia causes loss of membrane potentials leading to anoxic depolarization and kills uniquely vulnerable neurons such as pyramidal neurons in the CA1 and CA4 zones of the hippocampus while sparing other neurons and glial cells. Deprivation of oxygen supply to the brain AbstractStroke is the second commonest cause of death and disability in the world. In spite of the Amazonian advances in understanding of the pathophysiology and pathogenesis of stroke, there is unfortunately limited number of agents available in the armamentarium to fight stroke. There is therefore a compelling need to develop novel therapies to target restoration of the damaged brain and not merely protect or treat in the acute phase of the disease. By developing interventions which can be administered several days or weeks after the onset of stroke, which can essentially remodel the intact brain so as to compensate for the infarction, many more patients can be treated and brought back to their previous level of integration into the society as useful members. A variety of therapeutic approaches that could be considered Neuroprotective and Neurorestorative are currently in preclinical and clinical trials after stroke. There are essentially two varieties of restorative approaches. One is cellbased and includes stem cell transplantation with and without augmentation with growth factor and other variety is the pharmacological approach. Since the current review deals only with the later, we will deliberate on the several strategies currently being explored under this banner which include statins, erythropoietin and analogs, human chorionic gonadotropin, growth factors, and agents that increase cyclic GMP. Recent published literature was searched using PubMed and Google for the article reporting on Pharmacological approaches in Post stroke recovery.

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Effect of methylphenidate and/or levodopa coupled with physiotherapy on functional and motor recovery after stroke - a randomized, double-blind, placebo-controlled trial

Cited by 52 publications

References 41 publications

Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial

Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial

PET Imaging of Serotoninergic Neurotransmission with [¹¹C]DASB and [¹⁸F]altanserin after Focal Cerebral Ischemia in Rats

Pharmacological Agents in Post Stroke Recovery

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Effect of methylphenidate and/or levodopa coupled with physiotherapy on functional and motor recovery after stroke - a randomized, double-blind, placebo-controlled trial

Cited by 52 publications

References 41 publications

Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial

Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial

PET Imaging of Serotoninergic Neurotransmission with [11C]DASB and [18F]altanserin after Focal Cerebral Ischemia in Rats

Pharmacological Agents in Post Stroke Recovery

Contact Info

Product

Resources

About

PET Imaging of Serotoninergic Neurotransmission with [¹¹C]DASB and [¹⁸F]altanserin after Focal Cerebral Ischemia in Rats