BACKGROUND: Extensive data, primarily from animal studies, suggest that several classes of drugs may have antineuroplastic effects that could impede recovery from brain injury or reduce the efficacy of rehabilitation. AIMS: The Locomotor Experience Applied Post-Stroke trial, a randomized controlled study of 408 subjects that tested the relative efficacy of two rehabilitation techniques on functional walking level at one-year poststroke, provided us the opportunity to prospectively assess the potential antineuroplastic effects of several classes of drug. METHODS: Subjects were randomized to receive one of the two rehabilitation therapies at two-months poststroke. Drugs taken were recorded at time of randomization. Outcome was assessed at one-year poststroke. Regression models were used to determine the amount of variance in success in improving functional walking level, gains in walking speed, and declines in lower extremity, upper extremity, and cognitive impairment accounted for by α1 noradrenergic blockers + α2 noradrenergic agonists, benzodiazepines, voltage-sensitive sodium channel anticonvulsants, and α2δ voltage-sensitive calcium channel blockers. RESULTS: The maximum variance accounted for by any drug class was 1.66%. Drug effects were not statistically significant when using even our most lenient standard for correction for multiple comparisons. CONCLUSIONS: Drugs in the classes we were able to assess do not appear to exert a clinically important effect on outcome over the period between two- and 12 months poststroke. However, the potential antineuroplastic effects of certain drugs remain an incompletely settled scientific question.
RCT Entities:
BACKGROUND: Extensive data, primarily from animal studies, suggest that several classes of drugs may have antineuroplastic effects that could impede recovery from brain injury or reduce the efficacy of rehabilitation. AIMS: The Locomotor Experience Applied Post-Stroke trial, a randomized controlled study of 408 subjects that tested the relative efficacy of two rehabilitation techniques on functional walking level at one-year poststroke, provided us the opportunity to prospectively assess the potential antineuroplastic effects of several classes of drug. METHODS: Subjects were randomized to receive one of the two rehabilitation therapies at two-months poststroke. Drugs taken were recorded at time of randomization. Outcome was assessed at one-year poststroke. Regression models were used to determine the amount of variance in success in improving functional walking level, gains in walking speed, and declines in lower extremity, upper extremity, and cognitive impairment accounted for by α1 noradrenergic blockers + α2 noradrenergic agonists, benzodiazepines, voltage-sensitive sodium channel anticonvulsants, and α2δ voltage-sensitive calcium channel blockers. RESULTS: The maximum variance accounted for by any drug class was 1.66%. Drug effects were not statistically significant when using even our most lenient standard for correction for multiple comparisons. CONCLUSIONS: Drugs in the classes we were able to assess do not appear to exert a clinically important effect on outcome over the period between two- and 12 months poststroke. However, the potential antineuroplastic effects of certain drugs remain an incompletely settled scientific question.
Authors: Pamela W Duncan; Katherine J Sullivan; Andrea L Behrman; Stanley P Azen; Samuel S Wu; Stephen E Nadeau; Bruce H Dobkin; Dorian K Rose; Julie K Tilson; Steven Cen; Sarah K Hayden Journal: N Engl J Med Date: 2011-05-26 Impact factor: 91.245
Authors: Niteesh K Choudhry; Jerry Avorn; Robert J Glynn; Elliott M Antman; Sebastian Schneeweiss; Michele Toscano; Lonny Reisman; Joaquim Fernandes; Claire Spettell; Joy L Lee; Raisa Levin; Troyen Brennan; William H Shrank Journal: N Engl J Med Date: 2011-11-14 Impact factor: 91.245
Authors: Min Wang; Nao J Gamo; Yang Yang; Lu E Jin; Xiao-Jing Wang; Mark Laubach; James A Mazer; Daeyeol Lee; Amy F T Arnsten Journal: Nature Date: 2011-07-27 Impact factor: 49.962
Authors: Arlene Schmid; Pamela W Duncan; Stephanie Studenski; Sue Min Lai; Lorie Richards; Subashan Perera; Samuel S Wu Journal: Stroke Date: 2007-05-17 Impact factor: 7.914
Authors: Pamela W Duncan; Katherine J Sullivan; Andrea L Behrman; Stanley P Azen; Samuel S Wu; Stephen E Nadeau; Bruce H Dobkin; Dorian K Rose; Julie K Tilson Journal: BMC Neurol Date: 2007-11-08 Impact factor: 2.474
Authors: Rosane Brondani; Andrea Garcia de Almeida; Pedro Abrahim Cherubini; Suelen Mandelli Mota; Luiz Carlos de Alencastro; Apio Cláudio Martins Antunes; Marino Bianchin Muxfeldt Journal: Cerebrovasc Dis Extra Date: 2017-03-30