COMMON-DRUGS MAY INFLUENCE MOTOR RECOVERY AFTER STROKE

Studies in laboratory animals indicate that certain centrally acting d rugs leg, the antihypertensives clonidine and prazosin, neuroleptics a nd other dopamine receptor antagonists, benzodiazepines, and the antic onvulsants phenytoin and phenobarbital) impair behavioral recovery aft er focal brain injury. Even single doses may have long-term harmful ef fects. To determine whether these medications have a similar negative impact in humans, we analyzed the recoveries of control patients who w ere enrolled in the Sygen in Acute Stroke Study, a multicenter study o f the effects of GM(1) ganglioside after ischemic stroke. Motor impair ments 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 th ese data, we compared motor recovery between patients with initial mot or deficits who received at least one of the drugs that interfere with recovery in laboratory studies (''detrimental'' drug group, n = 37) a nd 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 interacti on between drug group and time after stroke [F(6,528) = 2.38; p = 0.03 ], with a significant (p < 0.001) difference between the groups beginn ing 7 days after the stroke. A similar trend was present for the lower extremity, but the overall difference between the groups was not sign ificant [ANOVA. F(6,498) = 1.22; p = 0.29]. Drug group did influence t he degree of independence in activities of daily living as measured wi th the Barthel Index. Repeated-measures ANOVA showed a significant int eraction between drug group and time after stroke [F(5,420) = 3.35; p = 0.006], with a significant (p less than or equal to 0.002) differenc e between the groups 56 and 84 days after stroke. Stepwise regression analyses incorporating other potential prognostic factors indicated th at drug group independently influenced both the degree of upper-extrem ity motor impairment and independence in activities of daily living 84 days after stroke. These data are consistent with the detrimental eff ects of certain drugs on recovery in laboratory animals and suggest th at similar effects may occur in humans.