Common drugs may influence motor recovery after stroke

Abstract

Article abstract—Studies in laboratory animals indicate that certain centrally acting drugs (eg, the antihyperten-sives clonidine and prazosin, neuroleptics and other dopamine receptor antagonists, benzodiazepines, and the anticon-vulsants phenytoin and phenobarbital) impair behavioral recovery after focal brain injury. Even single doses may have long-term harmful effects. To determine whether these medications have a similar negative impact in humans, we analyzed the recoveries of control patients who were enrolled in the Sygen in Acute Stroke Study, a multicenter study of the effects of GM1 ganglioside after ischemic stroke. Motor impairments were measured by the motor subscores of the Toronto Stroke Scale at baseline and 7, 14, 21, 28, 56, and 84 days after stroke. Using these data, we compared motor recovery between patients with initial motor deficits who received at least one of the drugs that interfere with recovery in laboratory studies (“detrimental” drug group, n = 37) and patients who did not receive these drugs (“neutral” drug group, n = 59). The groups were well balanced with regard to the frequency of comorbid conditions and other prognostic factors. For upper-extremity motor function, repeated-measures ANOVA showed a significant interaction between drug group and time after stroke [F(6,528) = 2.38; p = 0.031, with a significant (p < 0.001) difference between the groups beginning 7 days after the stroke. A similar trend was present for the lower extremity, but the overall difference between the groups was not significant [ANOVA F(6,498) = 1.22; p = 0.29]. Drug group did influence the degree of independence in activities of daily living as measured with the Barthel Index. Repeated-measures ANOVA showed a significant interaction between drug group and time after stroke [F(5,420) = 3.35; p = 0.0061, with a significant (p 5 0.002) difference between the groups 56 and 84 days after stroke. Stepwise regression analyses incorporating other potential prognostic factors indicated that drug group independently influenced both the degree of upper-extremity motor impairment and independence in activities of daily living 84 days after stroke. These data are consistent with the detrimental effects of certain drugs on recovery in laboratory animals and suggest that similar effects may occur in humans.