Stroke rehabilitation and dopamine

BACKGROUND: To explore whether a polymorphism in dopamine metabolism influences the effectiveness of neurological rehabilitation and the outcome after ischemic stroke. METHODS: The Barthel Index (BI) and the Rivermead Motor Assessment (RMA) were assessed in 78 moderately affected stroke patients (1) after they had entered a neurological inpatient rehabilitation, (2) after 4 weeks of rehabilitation therapy, and (3) 6 months later. Polymorphisms of the gene encoding catechol-O-methyltransferase (COMT) were determined...

Identification of functional molecules in the brain related to improvement of motor dysfunction after stroke will contribute to establish a new treatment strategy for stroke rehabilitation. Hence, monoamine changes in basal ganglion related to motor control were examined in groups with/without voluntary exercise after cerebral infarction. Cerebral infarction was produced by photothrombosis in rats. Voluntary exercise using a running wheel was initiated from 2 days after surgery. Motor performance was measured by the accelerated rotarod test...

Previous studies have demonstrated that newborn striatal neurons can functionally integrate with local neural networks in adult rat brain after injury. In the present study, we determined whether these newly generated striatal neurons can develop projections to the substantia nigra, a target of striatal projection neurons. We used 5'-bromodeoxyuridine (BrdU) and a retroviral vector expressing green fluorescent protein (GFP) combined with multiple immunostaining labels of newborn striatal neurons, and nigral microinjection of fluorogold (FG) to trace the striatonigral projection in adult rat brain at different weeks following a transient middle cerebral artery occlusion (MCAO)...

BACKGROUND: Based on experimental studies, pharmacological augmentation (PA) of stroke rehabilitation might be reasonable. Whether PA is beneficial in clinical practice is unclear. METHODS: We performed an observational study on the use of PA in addition to regular rehabilitative therapies in a stroke rehabilitation unit. Over 20 months, we systematically observed (1) the utilization rate of PA, (2) possible adverse events, and (3) the functional outcome of patients with versus without PA (non-PA)...

OBJECTIVE: Amphetamine-like drugs are reported to enhance motor recovery and activities of daily living (ADL) in stroke rehabilitation, but results from trials with humans are inconclusive. This study is aimed at investigating whether levodopa (LD) and/or methylphenidate (MPH) in combination with physiotherapy could improve functional motor recovery and ADL in patients with stroke. MATERIAL AND METHODS: A randomized, double-blind, placebo-controlled trial with ischemic stroke patients randomly allocated to one of four treatment groups of either MPH, LD or MPH+LD or placebo combined with physiotherapy was performed...

PURPOSE: Promising new rehabilitative approaches to improve the substantial motor disability associated with chronic stroke include pharmacotherapy to enhance motor recovery. We conducted a single-blind placebo-controlled crossover pilot study to investigate the effects of prolonged treatment with L-DOPA in stroke patients. METHODS: Ten chronic (10-48 months) stroke patients received placebo or L-DOPA 100 mg daily for 5 weeks. During drug's treatment patients suspended physiotherapy...

Therapeutic strategies to promote recovery from stroke are now beginning to utilize current knowledge of neural plasticity and the neuromodulatory role of physical rehabilitation. Current interests are also focused on adjuvant therapies that may enhance plasticity associated with recovery and rehabilitation. Amphetamine was one of the earliest pharmacological interventions and continues to show promising results as an adjuvant treatment for recovery of function in pre-clinical animal studies. This drug is a potent modulator of neurological function and cortical excitation, acting primarily through norepinephrine and dopamine mechanisms to enhance arousal and attention, and thus, to facilitate learning of motor skills...

In this contribution, we first provide an overview of general principles of reorganisation in the human brain, and point out possible biomarkers of recovery. Subsequently, we expand on possibilities of adjuvant therapy in human rehabilitation using cortical stimulation and pharmacological treatments. Finally, we suggest future directions for research in this field.

OBJECTIVE: Few studies confirm that pharmacological treatments support post-stroke recovery. The purpose of this study was to determine whether the combination of levodopa with language therapy improves aphasia rehabilitation. METHODS: We did a prospective, randomized, placebo-controlled, double-blind study in which twenty patients received levodopa before each language therapy session, and an additional 19 received a placebo. Language training was provided during a 3-week period...

OBJECTIVE: To test the hypothesis that administration of dopamine precursor levodopa improves procedural motor learning (defined as the ability to acquire novel movement patterns gradually through practice) in patients with residual motor deficits in the chronic phase after stroke (> or =1 y after stroke). DESIGN: A double-blind, placebo-controlled, randomized crossover design. SETTING: Neurology department in a German university. PARTICIPANTS: Eighteen patients with chronic motor dysfunction because of stroke (13 men, 5 women; age range, 53-78 y; mean time poststroke +/- SD, 3...

Psychopharmacology is rapidly becoming an adjuvant treatment to traditional rehabilitation strategies for patients with stroke or brain injury because it helps to facilitate recovery in a time-efficient manner. Norepinephrine, dopamine, acetylcholine, and serotonin appear to play important roles in recovery from stroke or brain injury. Animal models have shown that blockade of these neurotransmitters inhibits recovery, whereas recovery is promoted by drugs that promote norepinephrine, dopamine, acetylcholine, and serotonin activity...

Previous studies have suggested that increased norepinephrine plays an important role in recovery of function after brain injury; however, the majority of these studies used drugs that are known to also affect other monoamines to increase or decrease norepinephrine. The purpose of the present study was to determine if norepinephrine is required to promote recovery after ischemia. A form of enriched rehabilitation was used to rehabilitate animals after ischemia and the neurotoxin N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine was used to selectively destroy norepinephrine projections from the locus coeruleus...

OBJECTIVE: Dopaminergic agents may stimulate behavior and verbal expression after frontal lobe dysfunction. Although amantadine is used in neurorehabilitation of motivational disorders and head injury, it is not commonly prescribed to improve aphasia. This pilot study examined verbal fluency on and off amantadine for nonfluent speech. DESIGN: Four participants undergoing inpatient rehabilitation, meeting criteria for transcortical motor aphasia had stroke (2), stroke postaneurysm surgery (1), or brain tumor resection (1)...

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Amphetamine (AMPH) has been proposed as a treatment for post-stroke motor deficits when coupled with symptom-relevant physical rehabilitation. Whereas a number of experimental studies report improvements in endpoint measures of skilled reaching for food by rats, there has been no assessment of whether beneficial effects extend to overcoming learned non-use of the limb in the acute post-stroke period or to the qualitative deficits in movement in the chronic post-stroke period. In addition to evaluating the effects of AMPH on success, these were the objectives of the present study...

OBJECTIVES: Major therapeutic advances in the rehabilitation of subacute stroke are lacking. A promising approach is treatment with facilitating drugs like amphetamine or levodopa in combination with physiotherapy. METHODS: In a randomized, double-blind, placebo-controlled clinical trail, the effect of 10 sessions with either 20 mg of D-amphetamine, 100 mg of L-dopa or 10 mg of D-amphetamine + 50 mg of L-dopa combined with physiotherapy during a 2-week period was investigated in 25 patients admitted to a stroke rehabilitation unit...

Increasing interest has been directed to role of pharmaceuticals in the recovery of cerebrovascular events. However, only few scientific studies are available to date, and further research is needed. Amphetamine is the most extensively studied drug shown to promote recovery of function, although clinical data have lead to conflicting results. Other psychostimulants drugs have been proposed, as levodopa or methylphenidate, even if published data are still few. Recently, two studies have been published about the positive role of cholinesterase inhibitor donepezil on stroke recovery...

The effects of a single oral dose of levodopa administered in a randomized, double-blind, placebo-controlled cross-over design on formation of a motor memory were studied by a training protocol in patients with chronic stroke. Levodopa enhanced the ability of motor training to encode an elementary motor memory relative to placebo. Up-regulation of dopaminergic function may enhance motor memory formation, crucial for successful rehabilitative treatments in patients with chronic stroke.

This article describes the state of the science in stroke rehabilitation dealing with three main topics: (1) General approach to stroke rehabilitation (stroke services and stroke units), (2) Neurophysiological and pharmacological interventions (facilitation of brain repair mechanisms) and (3) Experimental approaches (neuronal transplantation). Stroke rehabilitation is an active process beginning during acute hospitalisation, progressing to a systematic program of rehabilitation services and continuing after the individual returns to the community...

This review discusses the physiology and pharmacological treatment of vertigo and related disorders. Classes of medications useful in the treatment of vertigo include anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists and dopamine receptor antagonists. These medications often have multiple actions. They may modify the intensity of symptoms (e.g. vestibular suppressants) or they may affect the underlying disease process (e.g. calcium channel antagonists in the case of vestibular migraine)...