Ettore Beghi1, Heinrich Binder2, Codruta Birle3, Natan Bornstein4, Karin Diserens5, Stanislav Groppa6, Volker Homberg7, Vitalie Lisnic8, Maura Pugliatti9, Gary Randall10, Leopold Saltuari11, Stefan Strilciuc12, Johannes Vester13, Dafin Muresanu3,11. 1. Laboratorio di Malattie Neurologiche, Dipartimento di Neuroscienze, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy. 2. Department of Neurology, Otto Wagner Hospital, Vienna, Austria. 3. RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania. 4. Shaare Zedek Medical Center, Jerusalem, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel. 5. Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. 6. Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova. 7. Department of Neurology, SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany. 8. Department of Neurology, State University of Medicine and Pharmacy 'Nicolae Testemitanu', Chisinau, Republic of Moldova. 9. Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy. 10. Stroke Alliance for Europe (SAFE), Brussels, Belgium. 11. Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy. 12. Department of Neurosciences, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Cluj-Napoca, Romania. 13. Department of Biometry and Clinical Research, idv Data Analysis and Study Planning, Gauting, Germany.
Abstract
BACKGROUND AND PURPOSE: Early pharmacological support for post-stroke neurorehabilitation has seen an abundance of mixed results from clinical trials, leaving practitioners at a loss regarding the best options to improve patient outcomes. The objective of this evidence-based guideline is to support clinical decision-making of healthcare professionals involved in the recovery of stroke survivors. METHODS: This guideline was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. PubMed, Cochrane Library and Embase were searched (from database inception to June 2018, inclusive) to identify studies on pharmacological interventions for stroke rehabilitation initiated in the first 7 days (inclusive) after stroke, which were delivered together with neurorehabilitation. A sensitivity analysis was conducted on identified interventions to address results from breaking studies (from end of search to February 2020). RESULTS: Upon manually screening 17,969 unique database entries (of 57,001 original query results), interventions underwent meta-analysis. Cerebrolysin (30 ml/day, intravenous, minimum 10 days) and citalopram (20 mg/day, oral) are recommended for clinical use for early neurorehabilitation after acute ischaemic stroke. The remaining interventions identified by our systematic search are not recommended for clinical use: amphetamine (5, 10 mg/day, oral), citalopram (10 mg/day, oral), dextroamphetamine (10 mg/day, oral), Di-Huang-Yi-Zhi (2 × 18 g/day, oral), fluoxetine (20 mg/day, oral), lithium (2 × 300 mg/day, oral), MLC601(3 × 400 mg/day, oral), phosphodiesterase-5 inhibitor PF-03049423 (6 mg/day, oral). No recommendation 'for' or 'against' is provided for selegiline (5 mg/day, oral). Issues with safety and tolerability were identified for amphetamine, dextroamphetamine, fluoxetine and lithium. CONCLUSIONS: This guideline provides information for clinicians regarding existing pharmacological support in interventions for neurorecovery after acute ischaemic stroke. Updates to this material will potentially elucidate existing conundrums, improve current recommendations, and hopefully expand therapeutic options for stroke survivors.
BACKGROUND AND PURPOSE: Early pharmacological support for post-stroke neurorehabilitation has seen an abundance of mixed results from clinical trials, leaving practitioners at a loss regarding the best options to improve patient outcomes. The objective of this evidence-based guideline is to support clinical decision-making of healthcare professionals involved in the recovery of stroke survivors. METHODS: This guideline was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. PubMed, Cochrane Library and Embase were searched (from database inception to June 2018, inclusive) to identify studies on pharmacological interventions for stroke rehabilitation initiated in the first 7 days (inclusive) after stroke, which were delivered together with neurorehabilitation. A sensitivity analysis was conducted on identified interventions to address results from breaking studies (from end of search to February 2020). RESULTS: Upon manually screening 17,969 unique database entries (of 57,001 original query results), interventions underwent meta-analysis. Cerebrolysin (30 ml/day, intravenous, minimum 10 days) and citalopram (20 mg/day, oral) are recommended for clinical use for early neurorehabilitation after acute ischaemic stroke. The remaining interventions identified by our systematic search are not recommended for clinical use: amphetamine (5, 10 mg/day, oral), citalopram (10 mg/day, oral), dextroamphetamine (10 mg/day, oral), Di-Huang-Yi-Zhi (2 × 18 g/day, oral), fluoxetine (20 mg/day, oral), lithium (2 × 300 mg/day, oral), MLC601(3 × 400 mg/day, oral), phosphodiesterase-5 inhibitor PF-03049423 (6 mg/day, oral). No recommendation 'for' or 'against' is provided for selegiline (5 mg/day, oral). Issues with safety and tolerability were identified for amphetamine, dextroamphetamine, fluoxetine and lithium. CONCLUSIONS: This guideline provides information for clinicians regarding existing pharmacological support in interventions for neurorecovery after acute ischaemic stroke. Updates to this material will potentially elucidate existing conundrums, improve current recommendations, and hopefully expand therapeutic options for stroke survivors.
Authors: Johannes Vester; Natan Bornstein; Wolf-Dieter Heiss; Milan Vosko; Herbert Moessler; Marion Jech; Stefan Winter; Michael Brainin Journal: J Med Life Date: 2021 Sep-Oct
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Authors: Stefan Strilciuc; László Vécsei; Dana Boering; Aleš Pražnikar; Oliver Kaut; Peter Riederer; Leontino Battistin Journal: Pharmaceuticals (Basel) Date: 2021-12-13