Pharmacotherapy and motor recovery after stroke

Abstract

Stroke is one of the most prevalent neurological diseases worldwide, especially among the elderly population. There are various mechanisms that enhance motor recovery after a stroke. In clinical practice, we have the opportunity to enhance plasticity by designing specific rehabilitation programs. Areas covered: There are a variety of drugs commonly administered to people after the acute phase of a stroke. These drugs may modify motor performance. Herein reviewed is the evidence concerning motor enhancement or decline in stroke patients, produced by drugs commonly used in rehabilitation settings. An extensive review of animal and human studies is performed. Expert commentary: Many of the clinical trials carried out were underpowered. Modest evidence supports the claim that there are agents that can affect motor rehabilitation after a stroke. Amphetamine-like agents, serotonin reuptake inhibitors, and levodopa might improve motor outcomes, while antipsychotics, some antiepileptic drugs, and GABAmimetic drugs could impair the recovery process. To draw definite recommendations, more comprehensive knowledge about the efficacy, long-term effects, and safety of these drugs is required. There are also other interesting molecules that open a promising field for basic and clinical research, in the search for new therapeutic options.

Neurotechnology-aided interventions for upper limb motor rehabilitation in severe chronic stroke

“…As a result, each intervention is highly variable, especially when it is a combination of multiple interventions. Remarkably, despite generally larger patient numbers and fewer parameters to control than in the case of neurotechnologies, pharmacological treatments also show heterogeneous, and in part, contradictory findings, similar to those found in neurotechnology-aided treatments, leading to insufficient evidence, not allowing one to draw strong and clear conclusions in regard of favourable treatment effects to enhance neuro-rehabilitation and stroke recovery (Scheidtmann et al , 2001; Sprigg et al , 2007; Berends et al , 2009; Clark, 2009; Chollet et al , 2011; Chen et al , 2013; Cramer, 2015; Tran et al , 2016; Graham et al , 2017; Kraglund et al , 2018; Viale et al , 2018). Heterogeneity is an irreducible feature of stroke patients and already many factors have been suggested to possibly influence treatment effectiveness or impact recovery, such as age, gender, type of stroke (ischaemic or haemorrhagic), side of lesion, cortical or subcortical lesion, time since stroke onset, presence of the BDNF Val/Val genotype (Chang et al , 2016), and the structural integrity of corticospinal motor fibres and intracortical connections (Lindenberg et al , 2010; Schulz et al , 2015).…”

[Retracted] Meta‐Analysis on Cognitive Benefit of Exercise after Stroke

“…Blood supply disorders associated with ischemic or hemorrhagic stroke can provoke hypoxic death of nerve cells, altering neuronal structures and causing partial or complete loss of neuronal function [4]. Accordingly, timely treatment during the critical period after stroke will greatly affect the neural plasticity and functional recovery of the brain.…”

The Intersection of Central Dopamine System and Stroke: Potential Avenues Aiming at Enhancement of Motor Recovery

“…One approach, pharmacotherapy, uses drugs and physical rehabilitation to boost recovery. Several classes of drugs have been investigated for this purpose, including selective serotonin reuptake inhibitors (SSRIs), cholinergic agents and dopamine (DA)-enhancing drugs (Rösser and Flöel, 2008 ; Viale et al, 2018 ). However, none of these therapies have been approved for routine clinical use in stroke recovery.…”