Derek Kamper1, Alexander Barry2, Naveen Bansal3, Mary Ellen Stoykov4, Kristen Triandafilou5, Lynn Vidakovic6, NaJin Seo7, Elliot Roth7. 1. UNC/NC State Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina, USA, Closed-Loop Engineering for Advanced Rehabilitation Research Core, North Carolina State University, Raleigh, North Carolina, USA, Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 2. Shirley Ryan AbilityLab, Arms + Hands Lab, Chicago, IL, USA. Electronic address: abarry@sralab.org. 3. Marquette University, Department of Mathematical and Statistical Sciences, Milwaukee, WI, USA. 4. Shirley Ryan AbilityLab, Arms + Hands Lab, Chicago, IL, USA, Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 5. Shirley Ryan AbilityLab, Arms + Hands Lab, Chicago, IL, USA. 6. Shirley Ryan AbilityLab, Chicago, IL, USA, Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 7. Medical University of South Carolina, Rehabilitation Sciences, Charleston, SC, USA.
Abstract
OBJECTIVES: The goal of this study was to examine how the administration and dosing of the anti-serotonergic medication cyproheptadine hydrochloride (HCl) affects involuntary muscle hypertonicity of the spastic and paretic hands of stroke survivors. MATERIALS AND METHODS: A randomized, double-blinded, placebo-controlled longitudinal intervention study was performed as a component of a larger clinical trial. 94 stroke survivors with chronic, severe hand impairment, rated as levels 2 or 3 on the Chedoke-McMaster Stroke Assessment Stage of Hand (CMSA-H), were block randomized to groups receiving doses of cyproheptadine HCl or matched doses of placebo. Doses were increased from 4 mg BID to 8 mg TID over 3 weeks. Outcomes were assessed at baseline and after each of the three weeks of intervention. Primary outcome measure was grip termination time; other measures included muscle strength, spasticity, coactivation of the long finger flexors, and recording of potential adverse effects such as sleepiness and depression. RESULTS: 89 participants (receiving cyproheptadine HCl: 44, receiving placebo: 45) completed the study. The Cyproheptadine group displayed significant reduction in grip termination time, in comparison with the Placebo group (p<0.05). Significant change in the Cyproheptadine group (45% time reduction) was observed after only one week at the 4mg BID dosage. The effect was pronounced for those participants in the Cyproheptadine group with more severe hand impairment (CMSA-H level 2) at baseline. Conversely, no significant effect of Group * Session interaction was observed for spasticity (p=0.6) or coactivation (p=0.53). There were no significant changes in strength (p=0.234) or depression (p=0.441) during the trial. CONCLUSIONS: Use of cyproheptadine HCl was associated with a significant reduction in relaxation time of finger flexor muscles, without adversely affecting voluntary strength, although spasticity and coactivation were unchanged. Decreasing the duration of involuntary flexor activity can facilitate object release and repeated prehensile task performance. REGISTRATION: Clinical Trial number: NCT02418949.
OBJECTIVES: The goal of this study was to examine how the administration and dosing of the anti-serotonergic medication cyproheptadine hydrochloride (HCl) affects involuntary muscle hypertonicity of the spastic and paretic hands of stroke survivors. MATERIALS AND METHODS: A randomized, double-blinded, placebo-controlled longitudinal intervention study was performed as a component of a larger clinical trial. 94 stroke survivors with chronic, severe hand impairment, rated as levels 2 or 3 on the Chedoke-McMaster Stroke Assessment Stage of Hand (CMSA-H), were block randomized to groups receiving doses of cyproheptadine HCl or matched doses of placebo. Doses were increased from 4 mg BID to 8 mg TID over 3 weeks. Outcomes were assessed at baseline and after each of the three weeks of intervention. Primary outcome measure was grip termination time; other measures included muscle strength, spasticity, coactivation of the long finger flexors, and recording of potential adverse effects such as sleepiness and depression. RESULTS: 89 participants (receiving cyproheptadine HCl: 44, receiving placebo: 45) completed the study. The Cyproheptadine group displayed significant reduction in grip termination time, in comparison with the Placebo group (p<0.05). Significant change in the Cyproheptadine group (45% time reduction) was observed after only one week at the 4mg BID dosage. The effect was pronounced for those participants in the Cyproheptadine group with more severe hand impairment (CMSA-H level 2) at baseline. Conversely, no significant effect of Group * Session interaction was observed for spasticity (p=0.6) or coactivation (p=0.53). There were no significant changes in strength (p=0.234) or depression (p=0.441) during the trial. CONCLUSIONS: Use of cyproheptadine HCl was associated with a significant reduction in relaxation time of finger flexor muscles, without adversely affecting voluntary strength, although spasticity and coactivation were unchanged. Decreasing the duration of involuntary flexor activity can facilitate object release and repeated prehensile task performance. REGISTRATION: Clinical Trial number: NCT02418949.
Authors: C Gowland; P Stratford; M Ward; J Moreland; W Torresin; S Van Hullenaar; J Sanford; S Barreca; B Vanspall; N Plews Journal: Stroke Date: 1993-01 Impact factor: 7.914
Authors: Alexander J Barry; Derek G Kamper; Mary Ellen Stoykov; Kristen Triandafilou; Elliot Roth Journal: Top Stroke Rehabil Date: 2021-03-03 Impact factor: 2.119