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Chapter 25 - Using Pharmacotherapy to Enhance Stroke Recovery

from Part VI - Stroke Rehabilitation and Recovery

Published online by Cambridge University Press:  15 December 2020

By
Larry B. Goldstein
Edited by
Jeffrey L. Saver  and
Graeme J. Hankey
Jeffrey L. Saver
Affiliation:
David Geffen School of Medicine, University of Ca
Graeme J. Hankey
Affiliation:
University of Western Australia, Perth
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Summary

Pre-clinical studies provide clear and consistent evidence that a variety of centrally acting drugs affecting specific neurotransmitters can either facilitate or interfere with functional recovery after brain injury. Although at least some clinical trials suggest similar effects in humans, results have been inconsistent. The impact of important factors such as drug dose, duration, and intensity of physiotherapy, and timing between injury and treatment are difficult to translate from preclinical studies. Issues related to variability in stroke severity, location of injury, and comorbid conditions further complicate trial design and could obscure a true treatment effect. Because of these and other issues, the design of efficacy trials assessing putative neuro-restorative interventions is not trivial. Although a proven pharmacological approach resulting in a clinically meaningful improvement in post-stroke recovery remains elusive, it is reasonable to avoid medications that may have harmful effects in patients who have had a stroke. It is also important to control for these possible harmful effects in future clinical trials assessing the outcomes of stroke patients after the acute period.

Keywords

Rehabilitationneuroplasticityneural repairnoradrenergicserotonin reuptake inhibitorslong-term potentiationdextro-amphetamineischaemic strokeintracerebral haemorrhagesubarachnoid haemorrhagetreatment
Type
Chapter
Information
Stroke Prevention and Treatment
An Evidence-based Approach
 , pp. 517 - 531
Publisher: Cambridge University Press
Print publication year: 2020

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