Effect of methylphenidate and/or levodopa coupled with physiotherapy on functional and motor recovery after stroke--a randomized, double-blind, placebo-controlled trial.
OBJECTIVE
Amphetamine-like drugs are reported to enhance motor recovery and activities of daily living (ADL) in stroke rehabilitation, but results from trials with humans are inconclusive. This study is aimed at investigating whether levodopa (LD) and/or methylphenidate (MPH) in combination with physiotherapy could improve functional motor recovery and ADL in patients with stroke.


METHODS
A randomized, double-blind, placebo-controlled trial with ischemic stroke patients randomly allocated to one of four treatment groups of either MPH, LD or MPH+LD or placebo combined with physiotherapy was performed. Motor function, ADL, and stroke severity were assessed by Fugl-Meyer (FM), Barthel index (BI), and National Institute of Health Stroke Scale (NIHSS) at baseline, 15, 90, and 180 days respectively.


RESULTS
All participants showed recovery of motor function and ADL during treatment and at 6-month follow-up. There were slightly but significant differences in BI and NIHSS compared to placebo at the 6-month follow-up.


CONCLUSIONS
Ischemic chronic stroke patients having MPH and/or LD in combination with physiotherapy showed a slight ADL and stroke severity improvement over time. Future studies should address the issue of the optimal therapeutic window and dosage of medications to identify those patients who would benefit most.
Lokk
J
J
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
Salman Roghani
R
R
Delbari
A
A
D000203:Activities of Daily Living; D000368:Aged; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D015259:Dopamine Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D008875:Middle Aged; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D020521:Stroke / Q000628:therapy*
D000697:Central Nervous System Stimulants; D015259:Dopamine Agents; D008774:Methylphenidate; D007980:Levodopa