title: Increased Lower Limb Spasticity but Not Strength or Function Following a Single-Dose Serotonin Reuptake Inhibitor in Chronic Stroke.
abstract: OBJECTIVE
  To investigate the effects of single doses of a selective serotonin reuptake inhibitor (SSRI) on lower limb voluntary and reflex function in individuals with chronic stroke.
  
  
  METHODS
  Double-blind, randomized, placebo-controlled crossover trial.
  
  
  METHODS
  Outpatient research setting.
  
  
  METHODS
  Individuals (N=10; 7 men; mean age ± SD, 57±10y) with poststroke hemiplegia of >1 year duration who completed all assessments.
  
  
  METHODS
  Patients were assessed before and 5 hours after single-dose, overencapsulated 10-mg doses of escitalopram (SSRI) or placebo, with 1 week between conditions.
  
  
  METHODS
  Primary assessments included maximal ankle and knee isometric strength, and velocity-dependent (30°/s-120°/s) plantarflexor stretch reflexes under passive conditions, and separately during and after 3 superimposed maximal volitional drive to simulate conditions of increased serotonin release. Secondary measures included clinical measures of lower limb coordination and locomotion.
  
  
  RESULTS
  SSRI administration significantly increased stretch reflex torques at higher stretch velocities (eg, 90°/s; P=.03), with reflexes at lower velocities enhanced by superimposed voluntary drive (P=.02). No significant improvements were seen in volitional peak torques or in clinical measures of lower limb function (lowest P=.10).
  
  
  CONCLUSIONS
  Increases in spasticity but not strength or lower limb function were observed with single-dose SSRI administration in individuals with chronic stroke. Further studies should evaluate whether repeated dosing of SSRIs, or as combined with specific interventions, is required to elicit significant benefit of these agents on lower limb function poststroke.
authors.affiliation: Department of Biomedical Engineering, Marquette University, Milwaukee, WI.
authors.forename: Krishnaj
authors.initials: K
authors.lastname: Gourab
authors.affiliation: Department of Biomedical Engineering, Marquette University, Milwaukee, WI; Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Schmit
authors.affiliation: Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL. Electronic address: tgh@uic.edu.
authors.forename: T George
authors.initials: TG
authors.lastname: Hornby
mesh_terms: D000368:Aged; D000842:Ankle / Q000503:physiopathology; D002908:Chronic Disease; D015283:Citalopram / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006429:Hemiplegia / Q000534:rehabilitation*; D006801:Humans; D007717:Knee / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000534:rehabilitation*; D053580:Muscle Strength; D016059:Range of Motion, Articular; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D000071939:Stroke Rehabilitation
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Muscle spasticity; Muscle strength; Rehabilitation; Serotonin; Stroke