Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study

Background Functional disability is generally caused by hemiplegia after st roke. Physiotherapy used to be the only way of improving motor function in such patients. However, administration of amphetamines in addition to exerc ise improves motor recovery in animals, probably by increasing the concentr ation of norepinephrine in the central nervous system. Our aim was to ascer tain whether levodopa could enhance the efficacy of physiotherapy after hem iplegia. Methods We did a prospective, randomised, placebo-controlled, double-blind study in which we enrolled 53 primary stroke patients. For the first 3 week s patients received single doses of levodopa 100 mg or placebo daily in com bination with physiotherapy. For the second 3 weeks patients had only physi otherapy. We quantitatively assessed motor function every week with Riverme ad motor assessment (IRMA). Findings Six patients were excluded from analyses because of non-neurologic al complications. Motor recovery was significantly improved after 3 weeks o f drug intervention in those on levodopa (RMA improved by 6.4 points) compa red with placebo (4.1), and the result was independent of initial degree of impairment (p<0.004). The advantage of the levodopa group was maintained a t study endpoint 3 weeks after levodopa was stopped. At the end of the stud y the total RMA score gain for the levodopa group was 8.2 points compared w ith 5.7 in the placebo group (p=0.020). Interpretation A single dose of levodopa is well tolerated and, when given in combination with physiotherapy, enhances motor recovery in patients with hemiplegia. In view of its minimal side-effects, levodopa will be a possib le add-on during stroke rehabilitation.