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Recovery in a Patient with Locked-In Syndrome

  • Brian Silver (a1) (a2), Kavita M. Grover (a1), Ximena Arcila (a1) (a2), Panayiotis D. Mitsias (a1) (a2), Susan M. Bowyer (a1) (a3) and Michael Chopp (a1) (a3)...

Abstract:

Background and Purpose:

Sildenafil citrate has been shown to enhance neurogenesis, angiogenesis, synaptogenesis, and neurological outcome by augmentation of cyclic guanosine monophosphate (cGMP) levels in animal models of ischemic stroke. Whether sildenafil citrate may be helpful for recovery in human stroke is unknown at this time.

Methods:

A 41-year-old woman with locked-in syndrome due to pontine infarction began receiving 150 mg of oral sildenafil citrate daily on a compassionate use basis in August 2003 and continues treatment at this time. Magnetoencephalography (MEG) was performed at 12 and 17 months after stroke.

Results:

No serious adverse events have occurred. Significant milestone recoveries including standing, use of both arms, talking, and full return of swallowing have occurred, particularly after nine months of treatment. The MEG showed a significantly increased amplitude in the somatosensory cortex.

Conclusion:

Daily use of high dose sildenafil citrate appears to be safe in this patient with stroke resulting in locked-in syndrome. Further studies will be required to establish safety and efficacy.

RÉSUMÉ: Contexte et objectif:

La neurogenèse, l’angiogenèse et la synaptogenèse sont stimulées par le citrate de sildenafil et l’issue neurologique est améliorée à cause de l’augmentation des niveaux de guanosine monophosphate cyclique (cGMP) chez des modèles animaux d’accident vasculaire cérébral ischémique. On ne sait pas si le citrate de sildenafil peut être utile dans la récupération d’un accident vasculaire cérébral chez l’humain.

Méthodes:

Une femme âgée de 41 ans, atteinte du locked-in syndrome dû à un infarctus du pont, a commencé à recevoir 150 mg de citrate de sildenafil per os quotidiennement en août 2003 (accès spécial). Elle prend toujours cette médication. Une magnéto-encéphalographie (MEG) a été effectuée 12 et 17 mois après l’infarctus.

Résultats:

Elle n’a présenté aucun incident thérapeutique. Des étapes importantes au point de vue récupération ont été franchies : la station debout, l’utilisation des deux bras, la parole et la déglutition. Ceci était plus évident après neuf mois de traitement. On a observé une augmentation significative de l’amplitude dans le cortex somesthésique à la MEG.

Conclusion:

La prise quotidienne d’une dose élevée de citrate de sildenafil semble sûre chez cette patiente atteinte du locked-in syndrome suite à un accident vasculaire cérébral. Sa sécurité et son efficacité devront toutefois faire l’objet d’études plus poussées

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Copyright

Corresponding author

Department of Neurology, Henry Ford Hospital, 2799 West Grand Boulevard, K-11, Detroit, Michigan, 48202, USA

References

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