Methylphenidate modulates cerebral post-stroke reorganization.
OBJECTIVE
We hypothesized that a single dose of methylphenidate (MP) would modulate cerebral motor activation and behavior in patients having suffered a subcortical stroke.


METHODS
Eight men with a single stroke on the corticospinal tract resulting in a pure motor hemiparesia were included in a randomized, cross-over, double-blind, placebo-controlled study. Patients were first evaluated 17 days after stroke onset by validated neurological scales, motor tests and fMRI (flexion/extension of the digits) after 20 mg MP or placebo. Seven days later, the patients underwent the same protocol and received the drug they had not taken at the first evaluation. Each patient was his own control.


RESULTS
Placebo intake did not change performance. MP compared to placebo elicited a significant improvement in motor performance of the affected hand at the finger tapping test. MP induced: (1) a hyperactivation of the ipsilesional primary sensorimotor cortex including the motor hand and face areas and of the contralesional premotor cortex; (2) a hypoactivation of the ipsilesional anterior cingulum. Hyperactivation in the face motor area correlated positively with the improvement in performance.


CONCLUSIONS
We demonstrated that the reorganized network may efficiently be targeted by the drug and that the effect of MP might partly rely on an improvement in attention/effort through cingulum modulation.
Tardy
Jean
J
INSERM U455, Pavillon Riser, Purpan Hospital, Toulouse, France. tardyjean@yahoo.fr
Pariente
Jérémie
J
Leger
Anne
A
Dechaumont-Palacin
Sophie
S
Gerdelat
Angélique
A
Guiraud
Vincent
V
Conchou
Fabrice
F
Albucher
Jean-François
JF
Marque
Philippe
P
Franceries
Xavier
X
Cognard
Christophe
C
Rascol
Olivier
O
Chollet
François
F
Loubinoux
Isabelle
I
D000368:Aged; D000375:Aging / Q000502:physiology; D001288:Attention / Q000187:drug effects; D001519:Behavior / Q000187:drug effects / Q000502:physiology; D001921:Brain / Q000473:pathology*; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009044:Motor Cortex / Q000187:drug effects; D009473:Neuronal Plasticity / Q000187:drug effects; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects / Q000502:physiology; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology* / Q000523:psychology
D000697:Central Nervous System Stimulants; D008774:Methylphenidate