Physiotherapy coupled with dextroamphetamine for rehabilitation after hemiparetic stroke: a randomized, double-blind, placebo-controlled trial.
OBJECTIVE
Hemiparesis is the commonest disabling deficit caused by stroke. In animals, dextroamphetamine (AMPH) paired with training enhances motor recovery, but its clinical efficacy is uncertain.


METHODS
In a randomized, double-blind, placebo-controlled trial, 71 stroke patients were stratified by hemiparesis severity and randomly assigned to 10 sessions of physiotherapy coupled with either 10 mg AMPH or placebo. Study treatments were administered by 1 physiotherapist, beginning 5 to 10 days after stroke and continuing twice per week for 5 weeks. Outcomes were assessed by 1 physiotherapist at baseline, after each treatment session, at 6 weeks, and at 3 months. The primary outcome was motor recovery (impairment level) on the Fugl-Meyer (FM) scale. Secondary outcomes assessed mobility, ambulation, arm/hand function, and independence in activities of daily living.


RESULTS
Baseline hemiparesis was severe overall (mean FM score 27.7+/-20.0). Motor scores improved during treatment in both groups (mean change, baseline to 3 months 29.5+/-16.6). Repeated-measures ANOVA revealed no significant differences in recovery between the treatment groups for the entire cohort (n=67) or for subgroups with a severe hemiparesis (n=43), moderate hemiparesis (n=24), or cortically based stroke (n=26). In the moderate subgroup, there was a significant drug x time interaction for upper extremity motor recovery (F=5.14; P<0.001), although there was a significant baseline imbalance in motor scores in this subgroup.


CONCLUSIONS
In stroke patients with a severe motor deficit, 10 mg AMPH coupled with physiotherapy twice per week for 5 weeks in the early poststroke period provided no additional benefit in motor or functional recovery compared with physiotherapy alone. Patients with moderate severity hemiparesis deserve further investigation. Increased intensity and longer duration drug/therapy dosing regimens should be explored, targeting the upper and lower limbs separately.
Gladstone
David J
DJ
Regional Stroke Centre, Division of Neurology, Department of Medicine, and Neurosciences Research, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada. david.gladstone@sw.ca
Danells
Cynthia J
CJ
Armesto
Armi
A
McIlroy
William E
WE
Staines
W Richard
WR
Graham
Simon J
SJ
Herrmann
Nathan
N
Szalai
John P
JP
Black
Sandra E
SE
D000368:Aged; D015331:Cohort Studies; D003913:Dextroamphetamine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010291:Paresis / Q000188:drug therapy* / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D010919:Placebos; D020127:Recovery of Function; D020521:Stroke / Q000188:drug therapy*; D000071939:Stroke Rehabilitation; D013566:Sympathomimetics / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D010919:Placebos; D013566:Sympathomimetics; D003913:Dextroamphetamine