Speeding stroke recovery?

Sprigg, Nikola; Bath, Philip M.W.

doi:10.1016/j.jns.2009.04.040

Cited by 29 publications

(15 citation statements)

References 32 publications

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“…Thus, the agents used for PA seem relatively safe. None of our patients had piracetam or amphetamines, about the safety of which there is doubt [16,17,18]. …”

Section: Discussionmentioning

confidence: 99%

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Safety of Pharmacological Augmentation of Stroke Rehabilitation

Engelter

Frank²,

Lyrer³

et al. 2010

Eur Neurol

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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.

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“…Thus, the agents used for PA seem relatively safe. None of our patients had piracetam or amphetamines, about the safety of which there is doubt [16,17,18]. …”

Section: Discussionmentioning

confidence: 99%

“…In addition, according to meta-analyses across several studies, there were some concerns about safety of some agents (i.e. piracetam [16] and amphetamines [17,18]). More research is necessary [16].…”

Section: Introductionmentioning

confidence: 99%

Safety of Pharmacological Augmentation of Stroke Rehabilitation

Engelter

Frank²,

Lyrer³

et al. 2010

Eur Neurol

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“…This list was based on reviews covering several drugs [11,13,23] and on reported studies about specific agents: levodopa [4,5,15], dopamine agonists [6], selective serotonin reuptake inhibitors (SSRI) [24,25], serotonin-noradrenaline reuptake inhibitors (SNRI) [26], acetylcholinesterase inhibitors [7,8], modafinil [27], methylphenidate [10,28], and memantine [29]. D -Amphetamines [20,21] were not considered because of their unavailability.…”

Section: Methodsmentioning

confidence: 99%

“…Nevertheless, the clinical evidence regarding benefits of this treatment approach is still considered weak [11] and future research is recommended [12,13] for the following reasons: (1) the beneficial findings of some studies [4,5,6,7,8,9,10] were not confirmed by others [14,15,16,17,18,19], (2) several studies were limited by small patient populations and narrow inclusion criteria, and (3) there were some concerns regarding safety of some agents (i.e. piracetam [13] and amphetamines [20,21]). It is not well known how often agents potentially enhancing post-stroke recovery have been used in practice outside clinical trials.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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Background: Pharmacological enhancement in stroke rehabilitation (PESR) is promising. Data about its use in clinical practice are missing. Methods: In a prospective, explorative study of four rehabilitation centers, we systematically observed the frequency and determinants of using PESR in consecutive patients. PESR was defined as using agents potentially enhancing post-stroke recovery exclusively to aid rehabilitation without an established indication. Results: 257 (55.4%) of 464 patients had agents potentially enhancing recovery. Selective serotonin reuptake inhibitors (SSRI) (n = 125, 26.9%), levodopa (n = 114, 24.6%), serotonin-noradrenaline reuptake inhibitors (SNRI) (n = 52, 11.2%), and acetylcholinesterase inhibitors (n = 48, 10.3%) were used most often. SSRI in 102/125 patients and SNRI in 46/52 patients were mostly used for accompanying depressive symptoms. 159 (34.3%) patients had PESR (without an otherwise established indication). In PESR patients, levodopa (n = 102, 64.1%) was used most commonly. PESR was primarily used for aphasia (36.5%) and paresis (25.2%). PESR patients did not differ from non-PESR patients in age, gender and stroke type. However, the utilization rates of PESR differed significantly across centers (2, 4, 38 and 55%). Conclusion: SSRI and SNRI were predominately used for accompanying depression, while levodopa was nearly exclusively used to aid stroke rehabilitation in the absence of an otherwise established indication. The differences in utilization rates for PESR between centers suggest therapeutic uncertainty and indicate the need for additional studies.

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“…Although amphetamine was associated with a trend to improved motor function after IS in a systematic review, there was a non-significant increase in death, raising doubts over its safety. 82 Other potential agents including norepinephrine (noradrenaline), epinephrine (adrenaline) and dopamine have no significant evidence base. 79 …”

Section: Nitric Oxide Donorsmentioning

confidence: 99%

Blood Pressure Management in Acute Stroke

SpringerReference

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Blood pressure (BP) is elevated in 75% or more of patients with acute stroke and is associated with poor outcomes. Whether to modulate BP in acute stroke has long been debated. With the loss of normal cerebral autoregulation, theoretical concerns are twofold: high BP can lead to cerebral oedema, haematoma expansion or haemorrhagic transformation; and low BP can lead to increased cerebral infarction or perihaematomal ischaemia. Published evidence from multiple large, high-quality, randomised trials is increasing our understanding of this challenging area, such that BP lowering is recommended in acute intracerebral haemorrhage and is safe in ischaemic stroke. Here we review the evidence for BP modulation in acute stroke, discuss the issues raised and look to on-going and future research to identify patient subgroups who are most likely to benefit.

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Speeding stroke recovery?

Abstract: Introduction: The use of drugs to enhance recovery ('rehabilitation pharmacology') has been

Cited by 29 publications

References 32 publications

Safety of Pharmacological Augmentation of Stroke Rehabilitation

Safety of Pharmacological Augmentation of Stroke Rehabilitation

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

Blood Pressure Management in Acute Stroke

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