A preliminary study published in this week’s issue of THE LANCET suggests that the neurotransmitter precursor levodopa used in combination with physiotherapy could improve motor recovery for patients after stroke.
Hemiplegia (paralysis to one side of the body) causes functional disability after stroke. Physiotherapy used to be the only way of improving motor function in such patients. However, administration of amphetamines in addition to exercise has been found to improve motor recovery in animals, probably by increasing the concentration of the neurotransmitter norepinephrine in the central nervous system. Klaus Scheidtmann and colleagues from Bad Aibling Neurological Hospital, Germany, investigated whether levodopa could enhance the efficacy of physiotherapy after hemiplegia.
53 primary stroke patients were assessed in a prospective, randomised study. For the first 3 weeks patients received single doses of 100 mg levodopa or placebo daily in combination with physiotherapy. For the second 3 weeks patients had only physiotherapy. Motor function was assessed every week by Rivermead motor assessment (RMA).
Motor recovery was substantially improved after 3 weeks of drug intervention in patients given levodopa (RMA improved by 6.4 points) compared with placebo (4.1), and the result was independent of initial degree of impairment. The advantage of the levodopa group was maintained 3 weeks after levodopa was stopped. At the end of the study the total RMA score gain for the levodopa group was 8.2 points compared with 5.7 in the placebo group.
Friedemann Müller (one of the investigators) comments: "A single dose of levodopa was well tolerated and, when given in combination with physiotherapy, was found to enhance motor recovery in patients with hemiplegia. This trend should be confirmed, and we need to establish long-term ceiling effects, which our short observation period did not allow us to judge. We should also ascertain to what extent the lesion size and amount of levodopa affect enhanced functional recovery. In view of its minimal side-effects, levodopa will be a possible add- on during stroke rehabilitation."
Contact: Dr Friedemann Müller, Neurological Hospital Bad Aibling, Kolbermoorerstr 72, D-83043 Bad Aibling, Germany; T) 49-8061-9030 F) 49-8061-903502; E) FMueller@Schoen-Kliniken.de
Journal
The Lancet