EFFECT OF PIRACETAM ON RECOVERY AND REHABILITATION AFTER STROKE - A DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY

The nootropic agent piracetam has been shown to improve learning and m emory, and it may, by this means, facilitate recovery and rehabilitati on after a stroke. We report the results of a pilot study exploring it s effects in patients undergoing rehabilitation after acute cerebral i nfarction in the carotid artery territory. We compared piracetam and p lacebo, each given for 12 weeks, in a multicenter, double-blind, rando mized trial of parallel-group design; testing was performed at baselin e (6-9 weeks poststroke), weeks 5 and 12, and, in fewer patients, 12 w eeks after termination of treatment. Standardized tests of activities of daily living (Barthel Index, Kuriansky Test), aphasia (Aachen Aphas ia Test), and perception (Rivermead Perception Assessment Battery) wer e the primary efficacy variables. Of 158 patients, 137 (81 males, 56 f emales) were studied after treatment and 88 at 24-week follow-up. Thir ty patients on piracetam (45%) and 37 on placebo (53%) were aphasic on entry. Both groups, including the subgroups with aphasia, were well m atched at baseline for demographic data, stroke sequelae, type and sev erity of aphasia, and prognostic parameters. Multivariate analysis of Aachen Aphasia subtest scores showed a significant overall improvement relative to baseline in favor of piracetam (p = 0.02) at 12 weeks. Th is was not seen at 24 weeks when, however, fewer patients were availab le for evaluation so that we could neither confirm nor deny whether im provement was maintained after cessation of piracetam. We were unable to demonstrate an effect on tests of activities of daily living and co uld neither confirm nor exclude an effect on perceptual deficit. We ha ve shown an improvement in aphasia in patients undergoing rehabilitati on after a stroke after 12 weeks' treatment with piracetam that requir es confirmation in further studies.