AMPHETAMINE PAIRED WITH PHYSICAL THERAPY ACCELERATES MOTOR RECOVERY AFTER STROKE - FURTHER EVIDENCE

Background and Purpose In animal models of brain injury, administratio n of numerous pharmaceuticals is reported to facilitate functional rec overy. However, only drugs that in crease the release of norepinephrin e have been shown to promote recovery when administered late (days to weeks) after injury. To determine whether these findings were applicab le to humans, we administered the norepinephrine stimulant dextroamphe tamine, paired with physical therapy, to hemiplegic stroke patients. M ethods Ten hemiplegic patients who suffered an acute ischemic infarcti on were entered between days 16 and 30 after onset and randomly assign ed to receive either 10 mg of dextroamphetamine or a placebo orally ev ery fourth day for 10 sessions paired with physical therapy. The Fugl- Meyer Motor Scale was used at baseline, within each session, and for 1 2 months after onset as the dependent measure. Confounding medications such as alpha-adrenergic antagonists or agonists were excluded in all subjects. Results Although there were no differences between the grou ps at baseline (P=.599), there was a significant (P=.047) difference b etween the groups when the drug had been discontinued for 1 week and a t the 12-month follow-up visit (P=.047). Conclusions Administration of dextroamphetamine paired with physical therapy increased the rate and extent of motor recovery in a small group of hemiplegic stroke patien ts. These data support and extend previous findings of the facilitator y aspects of certain types of drugs on recovery from brain injury. The use of neuromodulation may allow the nervous system to adapt previous ly unused or alternative pathways to relevant external input.