Safety of Pharmacological Augmentation of Stroke Rehabilitation

Abstract

Background: Based on experimental studies, pharmacological augmentation (PA) of stroke rehabilitation might be reasonable. Whether PA is beneficial in clinical practice is unclear. Methods: We performed an observational study on the use of PA in addition to regular rehabilitative therapies in a stroke rehabilitation unit. Over 20 months, we systematically observed (1) the utilization rate of PA, (2) possible adverse events, and (3) the functional outcome of patients with versus without PA (non-PA). The primary outcome variable was the increase in abilities in activities of daily living during in-hospital rehabilitation as quantified by the delta ‘functional independence measure’ (FIM). Results: Ninety-seven of 249 (39%) patients had PA. L-Dopa was used in 63 (65%), acetylcholinesterase inhibitors in 33 (34%), and selective serotonin reuptake inhibitors in 31 (32%) PA patients. In 11 (11%) patients, PA was associated with delirium (n = 4), gastrointestinal symptoms (n = 4), electrolyte disorders (n = 2), or incontinence (n = 1). All adverse events were temporary. PA patients did not differ from non-PA patients in age (74 vs. 73 years; p = 0.62), gender ratio, and stroke type (ischemia 85 vs. 82%; p = 0.49). However, compared with non-PA patients, PA patients were more severely affected (median NIH Stroke Scale Score 7 vs. 4; p < 0.001; median FIM 58 vs. 85; p = 0.01). At discharge, the PA group had a higher median ΔFIM compared with non-PA patients (16 vs. 9; p = 0.01). None of the PA patients but 5 (3.3%) of the non-PA patients had died. Conclusion: PA of stroke rehabilitation was used frequently. The absence of safety concerns suggests that there is scope for benefit from PA in stroke rehabilitation. A large randomized controlled trial seems feasible and ethically justified.

Frequency and Determinants of Using Pharmacological Enhancement in the Clinical Practice of In-Hospital Stroke Rehabilitation

“…First, we defined PESR – in line with previous research [22] – in prescription of agents potentially enhancing post-stroke recovery exclusively with the idea of augmenting rehabilitation and in the absence of an established indication for their use. Second, we agreed upon the following list of agents potentially useful for PESR.…”

“…Age, gender, type of stroke (ischemic vs. hemorrhagic [22]), use or non-use of any of the aforementioned agents, presence or absence of an established indication in case such agents were used, PESR use vs. PESR non-use, and symptoms for which PESR were primarily used. These data were collected with a standardized form (online suppl.…”

“…Data were given as means ± SD and median including range. One of the centers also ascertained safety data, which however were not available for the entire multicenter cohort [22]. …”

Nach Schlaganfall profitieren alle Patienten von SSRI-Gabe

“…Hinsichtlich der Post-Stroke-Depression räumt die Studie von Engelter et al relevante Sicherheitsbedenken gegen eine pharmakologische Augmentation aus [5]. Die Autoren dieser Studie, in der innerhalb von 20 Monaten 97 (39 %) von 249 Schlaganfallpatienten mit pharmakologischer Augmentation behandelt wurden (32 % erhielten SSRI, die übrigen L-Dopa oder Acetylcholinesterase-Hemmer) empfehlen nach Die Plasmapherese wird nicht nur als eskalierende Schubtherapie bei der Multiplen Sklerose oder der Neuromyelitis optica eingesetzt, sondern auch in der Akuttherapie neuroimmunologischer Erkrankungen wie des Guillain-Barré-Strohl-Syndroms und der myasthenen…”

Combining levodopa and virtual reality-based therapy for rehabilitation of the upper limb after acute stroke: pilot study Part II

“…(7,8) Pharmacological modulation, through the use of dopaminergic agents, has been shown to be safe and potentially beneficial in modulating neuroplasticity, although the efficacy of dopaminergic agents as a monotherapy has not been established. (9) On the other hand, VR-based therapy offers high-intensity, repetitive, goaloriented tasks in a stimulating and enjoyable environment. (10) In some trials, VR-based therapy has been shown to be more effective than conventional therapeutic interventions for improving arm function.…”