Recovery in a patient with locked-in syndrome.
OBJECTIVE
Sildenafil citrate has been shown to enhance neurogenesis, angiogenesis, synaptogenesis, and neurological outcome by augmentation of cyclic guanosine monophosphate (cGMP) levels in animal models of ischemic stroke. Whether sildenafil citrate may be helpful for recovery in human stroke is unknown at this time.


METHODS
A 41-year-old woman with locked-in syndrome due to pontine infarction began receiving 150 mg of oral sildenafil citrate daily on a compassionate use basis in August 2003 and continues treatment at this time. Magneto-encephalography (MEG) was performed at 12 and 17 months after stroke.


RESULTS
No serious adverse events have occurred. Significant milestone recoveries including standing, use of both arms, talking, and full return of swallowing have occurred, particularly after nine months of treatment. The MEG showed a significantly increased amplitude in the somatosensory cortex.


CONCLUSIONS
Daily use of high dose sildenafil citrate appears to be safe in this patient with stroke resulting in locked-in syndrome. Further studies will be required to establish safety and efficacy.
Silver
Brian
B
Department of Neurology, Henry Ford Hospital, Detroit, Michigan 48202, USA.
Grover
Kavita M
KM
Arcila
Ximena
X
Mitsias
Panayiotis D
PD
Bowyer
Susan M
SM
Chopp
Michael
M
D000328:Adult; D001488:Basilar Artery / Q000473:pathology / Q000503:physiopathology; D020526:Brain Stem Infarctions / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002533:Cerebral Angiography; D006152:Cyclic GMP / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D015225:Magnetoencephalography; D026882:Manipulation, Chiropractic / Q000009:adverse effects; D018919:Neovascularization, Physiologic / Q000187:drug effects / Q000502:physiology; D009416:Nerve Regeneration / Q000187:drug effects / Q000502:physiology; D009473:Neuronal Plasticity / Q000187:drug effects / Q000502:physiology; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage; D010879:Piperazines / Q000008:administration & dosage*; D011149:Pons / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D011687:Purines; D011782:Quadriplegia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D000068677:Sildenafil Citrate; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013450:Sulfones; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000209:etiology / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D006152:Cyclic GMP