title: The effects of the dopamine agonist rotigotine on hemispatial neglect following stroke.
abstract: Hemispatial neglect following right-hemisphere stroke is a common and disabling disorder, for which there is currently no effective pharmacological treatment. Dopamine agonists have been shown to play a role in selective attention and working memory, two core cognitive components of neglect. Here, we investigated whether the dopamine agonist rotigotine would have a beneficial effect on hemispatial neglect in stroke patients. A double-blind, randomized, placebo-controlled ABA design was used, in which each patient was assessed for 20 testing sessions, in three phases: pretreatment (Phase A1), on transdermal rotigotine for 7-11 days (Phase B) and post-treatment (Phase A2), with the exact duration of each phase randomized within limits. Outcome measures included performance on cancellation (visual search), line bisection, visual working memory, selective attention and sustained attention tasks, as well as measures of motor control. Sixteen right-hemisphere stroke patients were recruited, all of whom completed the trial. Performance on the Mesulam shape cancellation task improved significantly while on rotigotine, with the number of targets found on the left side increasing by 12.8% (P = 0.012) on treatment and spatial bias reducing by 8.1% (P = 0.016). This improvement in visual search was associated with an enhancement in selective attention but not on our measures of working memory or sustained attention. The positive effect of rotigotine on visual search was not associated with the degree of preservation of prefrontal cortex and occurred even in patients with significant prefrontal involvement. Rotigotine was not associated with any significant improvement in motor performance. This proof-of-concept study suggests a beneficial role of dopaminergic modulation on visual search and selective attention in patients with hemispatial neglect following stroke.
authors: UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors: Nikos
authors: N
authors: Gorgoraptis
authors: Yee-Haur
authors: YH
authors: Mah
authors: Bjoern
authors: B
authors: Machner
authors: Victoria
authors: V
authors: Singh-Curry
authors: Paresh
authors: P
authors: Malhotra
authors: Maria
authors: M
authors: Hadji-Michael
authors: David
authors: D
authors: Cohen
authors: Robert
authors: R
authors: Simister
authors: Ajoy
authors: A
authors: Nair
authors: Elena
authors: E
authors: Kulinskaya
authors: Nick
authors: N
authors: Ward
authors: Richard
authors: R
authors: Greenwood
authors: Masud
authors: M
authors: Husain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018491:Dopamine Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000188:drug therapy* / Q000209:etiology*; D011597:Psychomotor Performance / Q000187:drug effects / Q000502:physiology; D020521:Stroke / Q000150:complications* / Q000188:drug therapy*; D013764:Tetrahydronaphthalenes / Q000494:pharmacology / Q000627:therapeutic use*; D013876:Thiophenes / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists; D013764:Tetrahydronaphthalenes; D013876:Thiophenes; C047508:rotigotine