title: GABAergic drug use and global, cognitive, and motor functional outcomes after stroke.
abstract: BACKGROUND
  In animal models and healthy volunteers, the use of GABA A receptor agonists (GABA-AGs) seem deleterious for functional recovery. The agents are widely used for subacute stroke, but their effect on functional recovery remains unclear.
  
  
  OBJECTIVE
  We aimed to evaluate the association between GABA-AG use and functional recovery after stroke.
  
  
  METHODS
  We retrospectively recruited 434 survivors of subacute stroke admitted for inpatient rehabilitation between 2000 and 2013 in our institution (107 with and 327 without GABA-AG use). We used multivariate regression to assess the association of GABA-AG use and successful functional recovery, defined as reaching, between admission and discharge, the minimal clinically important difference (MCID) of 22 points on the global Functional Independence Measure (FIM). Secondary analyses were the associations of GABA-AG with cognitive and motor FIM MCID and constant GABA-AG exposure (24h/24 GABA-AG) with global, cognitive and motor FIM MCID. A new estimation of the MCID was performed with the standard error of measurement.
  
  
  RESULTS
  Reaching the global FIM MCID was associated with GABA-AG use (adjusted odds ratio [aOR] 0.54 [95% CI 0.31-0.91], P=0.02) as well as 24h/24 GABA-AG use (aOR 0.25 [0.08-0.83]; P=0.02). Furthermore, GABA-AG and 24h/24 GABA-AG use was inversely but not always significantly associated with reaching the cognitive FIM MCID (aOR 0.56, P=0.07; aOR 0.26, P=0.06, respectively) and motor FIM MCID (aOR 0.51, P=0.07; aOR 0.13, P=0.01, respectively). The estimated MCID was 19 for global FIM, 4 for cognitive FIM, and 16 for motor FIM.
  
  
  CONCLUSIONS
  GABA-AG use is associated with not reaching successful functional recovery during stroke rehabilitation. Randomised trials are needed to formally establish the potential deleterious effect of GABA-AG use on functional recovery.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Nestlé Hospital, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: adrien.schwitzguebel@gmail.com.
authors.forename: A J-P
authors.initials: AJ
authors.lastname: Schwitzguébel
authors.affiliation: Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Lausanne, Switzerland; Institute for Research in Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Benaïm
authors.affiliation: Department of Physical Medicine and Rehabilitation, Nestlé Hospital, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Carda
authors.affiliation: Service of Neurologic Rehabilitation, Institution de Lavigny, Lavigny, Switzerland.
authors.forename: A M
authors.initials: AM
authors.lastname: Torea Filgueira
authors.affiliation: Department of Physical Medicine and Rehabilitation, Nestlé Hospital, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Frischknecht
authors.affiliation: Service of Neurologic Rehabilitation, Institution de Lavigny, Lavigny, Switzerland.
authors.forename: P-A
authors.initials: PA
authors.lastname: Rapin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000187:drug effects; D004185:Disability Evaluation; D005260:Female; D058785:GABA-A Receptor Agonists / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D020127:Recovery of Function / Q000187:drug effects*; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000523:psychology; D000071939:Stroke Rehabilitation / Q000379:methods*; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D058785:GABA-A Receptor Agonists
keywords: Benzodiazepines; Functional independence measure; GABA-A receptor agonists; Minimal clinically important difference; Recovery; Rehabilitation; Stroke