The effect of lithium in post-stroke motor recovery: a double-blind, placebo-controlled, randomized clinical trial.
OBJECTIVE
Evidences from cultured cells and animal models of ischemia suggest that lithium has neuroprotective and neurotrophic effects and may play a desirable role in reducing infarct volume and even improving the brain insults from stroke. The aim of this study was to evaluate the efficacy of lithium in early motor recovery of patients after ischemic stroke.


METHODS
Eighty patients with first ever stroke, allocated randomly in lithium, 300 mg twice daily, or placebo. Treatment was initiated 48 hours after stroke and continued for 30 days. Modified National Institute of Health Stroke Scale (mNIHSS) and hand subsection of Fugl-Meyer Assessment (hFMA) were used to evaluate impairment on the fifth and 30th day of treatment.


RESULTS
Sixty-six subjects (32 subjects in the lithium group and 34 subjects in the placebo group) completed the study. There were no significant differences in the improvement in mNIHSS (P=0.40) and hFMA (P=0.07) after 30 days. However, a subgroup analysis showed that patients with cortical strokes in the lithium group had significantly better improvement in both mNIHSS and hFMA in comparison to the placebo group (P=0.003). Approximately 44% (n=14) of patients in the lithium group, mainly from the cortical stroke subgroup, regained more than 25% of full function based on hFMA, whereas this rate in the placebo group was 14.7% (n=5; P=0.009).


CONCLUSIONS
The observed discrete difference between the lithium group and the placebo group in the cortical stroke subgroup may suggest an enhanced motor recovery after stroke by using an early treatment with a low dose of lithium carbonate. However, a larger trial with more patients with cortical stroke is needed to investigate this effect better.
Departments of *Neurology and †Internal Medicine, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Seyed Ehsan
SE
Mohammadianinejad
Nastaran
N
Majdinasab
Seyed Aidin
SA
Sajedi
Fahimeh
F
Abdollahi
Mehdi Masoudi
MM
Moqaddam
Fatemeh
F
Sadr
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000187:drug effects*; D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D002540:Cerebral Cortex / Q000098:blood supply / Q000187:drug effects; D003131:Combined Modality Therapy / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use*; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000187:drug effects; D009474:Neurons / Q000187:drug effects*; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D011597:Psychomotor Performance / Q000187:drug effects*; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D000071939:Stroke Rehabilitation
D018696:Neuroprotective Agents; D016651:Lithium Carbonate